Pre-Op and Post-Op Care Flashcards
Ejection fraction under __% poses prohibitive cardiac risk for noncardiac operations.
35% (normal is 55%)
What is the worst single finding predicting high cardiac risk in surgery?
Goldman’s index of cardiac risk attributes the highest amount of points to:
jugular venous distention (evidence of CHF; 11 points)
If possible, treat with ACEI, BB, digitalis, and diuretics before surgery
What factors play into Goldman’s index of cardiac risk:
jugular venous distention (CHF=worst predictor), recent MI (within 6 months=next worse predictor), PVCs (5 or more per minute), non-sinus rhythm, age over 70, emergency surgery, aortic valvular stenosis/poor medical condition/surgery within chest or abdomen
What is the most common cause of increased pulmonary risk for surgery?
smoking
Cessation of smoking for ___ weeks and intensive respiratory therapy (physical therapy, expectorants, incentive spirometry, humidified air) should precede surgery
8 weeks
About 40% mortality is predictable with either bilirubin above ___, albumin below ___, prothrombin time above ___, or encephalopathy. 80-85% mortality if three or more exist, or with bilirubin alone above ___, albumin alone below ___, or blood ammonia above ____
40%:
bilirubin >2, albumin 16
80-85%:
bilirubin >4, albumin 150 mg/dL
Severe nutritional depletion is identified by loss of 20% body weight over a couple of months, serum albumin below ___, anergy to skin antigens, or serum transferrin less than ___.
Requires >5 days of preoperative nutritional support
albumin
Malignant hyperthermia develops shortly after onset of an anesthetic like
halothane or succinylcholine
Chills and temperature spike exceeding 104F 30-45 minutes into invasive procedure (such as instrumentation of the urinary tract) =
bacteremia. Blood cx x3 and empiric antibiotics
What are causes of postoperative fever (101-103F)?
1) wind (atelectasis, pneumonia)
2) water (UTI)
3) walking/weins (PE, deep venous thrombophlebitis)
4) wound infection, deep abcesses
5) wonder drugs (drug fever)
What is the treatment of atelectasis?
Improve ventilation! (deep breathing, postural drainage, incentive spirometry)
Which cause of post-op fever occurs on: POD 1? POD 3? POD 5? POD 7?
POD 1: atelectasis POD 3: PNA, UTI POD 5: deep vein thrombophlebitis POD 7: wound infection, PE POD 10-15: deep abscesses
Treatment of deep venous thrombophlebitis?
Anticoagulate with heparin with antibiotics
How can you distinguish between whether there is cellulitis or an abscess in a wound infection?
sonogram
What is the treatment of perioperative MI?
Emergency angioplasty and coronary stent; not clot busters!!!!
What is prevention of aspiration in intubations?
NPO and antacids before induction
What is the treatment of aspiration?
Lavage and removal of acid and particulate matter with help of bronchoscopy, followed by bronchodilators and respiratory support (steroids don’t help)
Patients withdrawing from alcohol get confused, have hallucinations, and become combatative around which POD?
2-3. Treat with IV benzo
In the case of zero urinary output, what do you do?
Usually a mechanical problem! Look for plugged or kinked catheter
Paralytic ileus is prolonged by which electrolyte abnormality?
Hypokalemia
What was probably assumed to be paralytic ileus not resolving after 5-7 days is most likely actually due to
early mechanical bowel obstruction because of adhesions
Diagnosis of mechanical bowel obstruction with adhesions is confirmed with an abdominal CT scan showing:
What is the treatment?
a transition point between proximal dilated bowel and distal collapsed bowel at the site of the obstruction; surgical intervention is needed to correct the problem
T/F: Ogilivie syndrome does not follow abdominal surgery.
True! Instead, it is classically seen in sedentary patients (Alzheimer, nursing home) who have become further immobilized owing to surgery elsewhere (broken hip, prostatic surgery).
T/F: Patients with Ogilivie syndrome have a tense, but not tender, abdomen.
True
