Pre-op And Post-op Care

Question 1

An EF that is a contraindication to surgery is?

Answer 1

EF<35%

Question 2

What is the single clinical finding that indicates high cardiac risk?

Answer 2

JVD

Question 3

What is the worst predictor of cardiac complications?

Answer 3

Recent transmural or subendocardial MI

Question 4

What action should be taken by smokers prior to surgery to reduce pulmonary risk?

Answer 4

Cessation of smoking 8 weeks prior to surgery

Question 5

What lab values must be considered before operating on a patient with liver disease?

Answer 5

Encephalopathy, ascites, serum albumin, INR, bilirubin

Question 6

Severe nutritional depletion is characterized by?

Answer 6

Loss of 20% body weight, albumin <3, anergy to skin antigens, transferrin <200

Question 7

What should be done prior to operating on a patient with severe nutritional depletion?

Answer 7

4-5 days of nutritional support

Question 8

Bacteremia generally shows a temperature to this level and requires this follow up?

Answer 8

Fever >104

Blood cultures X 3 and emperic antibiotic coverage

Question 9

Standard diagnostic testing for PE is?

Answer 9

Spiral CT

Question 10

Prevention of aspiration pneumonia in intubated patients is best accomplished by?

Answer 10

NPO and antacids before induction

Question 11

The standard therapy for an adult with bilaterally pulmonary infiltrates, hypoxia, and a complicated post-op course is?

Answer 11

PEEP for his ARDS

Question 12

A trauma patient with severe hyponatremia should be treated with? What caused their low sodium level?

Answer 12

Prevention with sodium in IV’s. Treatment with hypertonic saline aliquots and osmotic diuretics.

Trauma can trigger ADH release

Question 13

How can you quickly determine if a patient with low urinary output post-op is dehydrated or in renal failure?

Answer 13

Fluid challenge: give 500 mL IV fluid over 10 minutes and check urinary output response.

Question 14

What electrolyte abnormality will prolong paralytic ileus post-op?

Answer 14

Hypokalemia

Question 15

Wound dihiscence is characterized by this clinical finding?

Answer 15

Large amounts of copious salmon colored fluid

Question 16

What characteristics of GI tract fistula’s indicate surgery will be needed for repair?

Answer 16

FETID: foreign body, epithelization, irradiated tissue, IBD distal obstruction

Question 17

MRI is first choice for what areas of the body?

Answer 17

Spinal cord, brain tumors, knee, herniated discs, soft tissue sarcomas

Question 18

PET scans are used primarily in identifying what cancer?

Answer 18

Lung

Question 19

What lab value assesses nutritional status for the past few weeks? The last 72 hours?

Answer 19

Albumin

Pre-albumin

Question 20

What is the typical protein requirement for an average adult? Where does protein absorption take place?

Answer 20

0.8 g/kg/day

Duodenum and proximal ileum

Question 21

Carbohydrates provide how much energy? Where are they absorbed?

Answer 21

1 g- 4 kcal

Absorbed in small intestine

Question 22

What is the energy production from lipid breakdown? What part of the body is needed for absorption?

Answer 22

1 g- 9 kcal

Ileum

Question 23

What would happen if >12% dextrose was given with PPN nutrition?

Answer 23

Phlebitis

Question 24

Why is TPN preferred over PPN?

Answer 24

PPN requires more volume for the same nutritional supply

Question 25

What lab values must be monitored on a patient on TPN?

Answer 25

Mg, Phos, Calcium daily

LFT’s, TG’s Chol, pre-albumin daily