Pre-Op and Post-Op Care Flashcards

1
Q

Pulmonary Risk

A

Smoking- Compromise ventilation, but not oxygenation.

  • Assess FEV1, then if abnormal, blood gases.
  • Cessation of smoking for 8 weeks and intensive respiratory therapy (PT, expectorants, incentive spirometry, humidified air) should precede surgery.
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2
Q

Pre-Op: Hepatic Risk

A

Operative Mortality:

  • Encephalopathy, ascites, serum albumin, prothrombin time (INR) and bilirubin.
  • Mortality risk based on Child Risk.
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3
Q

Pre-Op: Nutritional Risk

A

Severe nutritional depletion is identified by:

  • Loss of 20% of body weight over 2 months.
  • Serum albumin below 3.
  • Anergy to skin antigens
  • Serum transferrin level of less than 200 mg/dL
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4
Q

Pre-Op: Metabolic Risk

A

Diabetic coma is absolute contraindication to surgery.

  • Rehydration, return of UO, and partial correction of acidosis and hyperglycemia have to be achieved before surgery.
  • Septic process will not resolve this.
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5
Q

Post Op: Malignant Hyperthermia

A

Malignant Hyperthermia: Halothane or succinylcholine. >104 degrees, metabolic acidosis, hypercalcemia.
- Tx: IV dantrolene, 100% oxygen, correction of acidosis, and cooling blankets.

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6
Q

Post Op: Bacteremia

A

Seen within 30-45 minutes of procedure. Chills and temperature spike to 104 degrees F.
- Blood culture x3 and start empiric ABX.

If severe wound pain and high fever within hours of surgery, gas gangrene in surgical wound.

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7
Q

PO in 101-103F Causes

A

Atelectasis- 1 day
- Listen to lungs, chest xray, improve ventilation (deep breathing, coughing, postural drainage, incentive spirometry).

Pneumonia- 3 days if atelectasis does not resolve
- Fever will persist, chest xray will show infiltrates, do sputum culture and tx with ABX

UTI- 3rd day
- Urinalysis and urinary cultures. Tx with ABX.

Deep Thrombophlebitis- Day 5
- Doppler studies of deep leg and pelvic veins is best diagnostic modality. Anticoagulate with heparin.

Wound Infection- Day 7

  • Erythema, warmth, and tenderness.
  • Tx w/ ABX if only cellulitis. If abcess, drain. Can’t tell? Sonogram.

Deep Abscess- 10-15 days
- Ct scan is dx. Tx via percutaneous radiologically guided drainage.

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8
Q

Perioperative Myocardial Infarction

A

Triggered most commonly by hypotension.
Detected by EKG (ST depression and t wave flattening).
Post-Op 2-3 days. Chest pain only in one third.
Troponin. Cannot use clot busters perioperatively, but can use emergency angiplasty and coronary stent.

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9
Q

Pulmonary Embolism

A

Day 7- pleuritic pain, sudden onset, SOB, anxious, diaphoretic, and tachycardic with prominent distended veins.

Hypoxemia and hypocapnia. Spiral CT or CT angio is standard diagnosis test.

Tx: heparinization. Add greenfield if PEs recur while anticoagulated.

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10
Q

Aspiration

A

Hazard in awake intubations in combative patients with full stomach. Lethal immediately or chemical injury of tracheobronchial tree and subsequent pulmonary failure.

Prevention: NPO and antacids before induction

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11
Q

Intraoperative Tension Pneumothorax

A

Traumatized lungs once subjected to positive pressure breathing.

Decompression through diaphragm. If not needle, followed by chest tube.

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12
Q

PO Pt is Confused and Disoriented

A

Hypoxia- check blood gases and provide respiratory support.

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13
Q

ARDS- Adult Respiratory Distress Syndrome

A

Sepsis is precipitating event. Bilateral infiltrates and hypoxia with no evidence of CHF.

Tx: PEEP (Positive end expiratory pressure) taking care not to use excessive volume, otherwise barotrauma. Sepsis must be sought and corrected.

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14
Q

Delirium Tremens

A

Drinking is interrupted by surgery. Confused, hallucinations, combative.

IV benzodiazepines, or intravenous alcohol (5% in 5% dextrose).

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15
Q

Hyponatremia

A

Quickly induced by liberal administration of sodium free IV fluids with high levels of ADH (triggered by the response to trauma). Central Pontine Myelinolysis.

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16
Q

PreOperative Assessment- Cardiac Risk

A

Ejection Fraction-

17
Q

Hypernatremia

A

Rapidly induced by large, unreplaced water loss.

Surgical damage to posterior pituitary with unrecognized diabetes insipidus. Use less saline like D51/2 or D51/3.

18
Q

Ammonium Intoxication

A

Common source of coma in cirrhotic patient with bleeding esophageal varices who undergoes portocaval shunt.

19
Q

Postoperative Urinary Retention

A

Feels need to void but can’t.

In and out bladder catherization should be done at 6 hours post-op if no spontaneous voiding has occurred.

20
Q

Zero Urinary Output

A

Typically mechanical; look for plugged or kinked catheter.

21
Q

Low Urinary Output

A

Less than 0.5 mL/kg/h in presence of normal perfusing pressure.

Fluid deficit or acute renal failure? Fluid challenge of 500 mL of IV fluid infused over 10 min. Can also measure urinary sodium, 10-20 mEq/L vs 40 in kidney disease (FeNa > 1 in renal failure)

22
Q

Paralytic Ileus

A

Bowel sounds absent, no passage of gas, mild distention, no pain.
Will be prolonged by hypokalemia.

23
Q

Early mechanical bowel obstruction

A

Adhesions can happen during the PO period. Paralytic ileus will resolve 5, 6, 7 days. If not, obstruction.

Surgical Intervention

24
Q

Ogilvie Syndrome

A

Paralytic ileus of colon that does not follow abdominal surgery.

Old and AD from surgery due to broken hip or something.
Massive, dilated colon. Fluid and electrolyte correction, follwed by colonoscopy to get air out and place long rectal tube.

25
Q

Wound Dehiscence

A

5th PO following open laparoscopy.
Salmon colored fluid.
Prompt reoperation

26
Q

Evisceration

A

Catastrophic complication of wound dehiscence, where skin opens and abdominal contents rush out.
Emergency closure.

27
Q

Wound Infections

A

7th Post Op day

28
Q

Fistulas of GI Tract

A

Bowel contents will leak through wound or drain site. Sepsis, fluid electrolyte loss, nutritional depletion, erosion and digestion of belly wall.

Suction tubes of ostomy bags to protect abdominal wall until fistula heals. Will heal if no foreign body, epithelialization, tumor, infection, irradiated tissue, IBD, or distal obstruction. FETID.

29
Q

Hypernatremia

A

Every 3 mEq/L that the serum sodium concentration is above 140 = 1 L of water loss.
D51/5.
If more rapid development of hypernatremia, CNS symptoms and correction should be done with more dilute fluid.

30
Q

Hyponatremia

A

ADH or not receiving appropriate replacement of isotonic fluids.

Ns for alkalosis or Ringer Lactate for acidotic pts and whose pH is normal.

31
Q

Hypokalemia

A

Happens when potassium is lost from GI tract or urine and not replaaced.
Speed limit of IV potassium id 10eEq/h.

32
Q

Hyperkalemia

A

Occurs slowly when kidney cannot excrete, or rapidly if K is being dumped from cells into blood.

Tx: hemodialysis, or can help by pushing potassium into the cells. (50% dextrose and insulin).
Or neutralize its effect with IV calcium (quickest protection).

33
Q

Metabolic Acidosis

A

Production of acids, loss of buffers, inability for kidney to secrete fixed acids.

If abnormal acids are piling up, anion gap. Serum sodium exceeds more than 10 to 15 the sum of cholirde and bicarbonate.
Administration of bicarbonate would temporarily help correct the pH.

34
Q

Metabolic Alkalosis

A

Loss of acid gastric juice, or excessive bicarb.

KCL intake to correct

35
Q

Respiratory Acidosis or Alkalosis

A

Impaired ventilation or abnormal hyperventilation.