Pre-op And Post-op Care Flashcards
An EF that is a contraindication to surgery is?
EF<35%
What is the single clinical finding that indicates high cardiac risk?
JVD
What is the worst predictor of cardiac complications?
Recent transmural or subendocardial MI
What action should be taken by smokers prior to surgery to reduce pulmonary risk?
Cessation of smoking 8 weeks prior to surgery
What lab values must be considered before operating on a patient with liver disease?
Encephalopathy, ascites, serum albumin, INR, bilirubin
Severe nutritional depletion is characterized by?
Loss of 20% body weight, albumin <3, anergy to skin antigens, transferrin <200
What should be done prior to operating on a patient with severe nutritional depletion?
4-5 days of nutritional support
Bacteremia generally shows a temperature to this level and requires this follow up?
Fever >104
Blood cultures X 3 and emperic antibiotic coverage
Standard diagnostic testing for PE is?
Spiral CT
Prevention of aspiration pneumonia in intubated patients is best accomplished by?
NPO and antacids before induction
The standard therapy for an adult with bilaterally pulmonary infiltrates, hypoxia, and a complicated post-op course is?
PEEP for his ARDS
A trauma patient with severe hyponatremia should be treated with? What caused their low sodium level?
Prevention with sodium in IV’s. Treatment with hypertonic saline aliquots and osmotic diuretics.
Trauma can trigger ADH release
How can you quickly determine if a patient with low urinary output post-op is dehydrated or in renal failure?
Fluid challenge: give 500 mL IV fluid over 10 minutes and check urinary output response.
What electrolyte abnormality will prolong paralytic ileus post-op?
Hypokalemia
Wound dihiscence is characterized by this clinical finding?
Large amounts of copious salmon colored fluid
What characteristics of GI tract fistula’s indicate surgery will be needed for repair?
FETID: foreign body, epithelization, irradiated tissue, IBD distal obstruction
MRI is first choice for what areas of the body?
Spinal cord, brain tumors, knee, herniated discs, soft tissue sarcomas
PET scans are used primarily in identifying what cancer?
Lung
What lab value assesses nutritional status for the past few weeks? The last 72 hours?
Albumin
Pre-albumin
What is the typical protein requirement for an average adult? Where does protein absorption take place?
0.8 g/kg/day
Duodenum and proximal ileum
Carbohydrates provide how much energy? Where are they absorbed?
1 g- 4 kcal
Absorbed in small intestine
What is the energy production from lipid breakdown? What part of the body is needed for absorption?
1 g- 9 kcal
Ileum
What would happen if >12% dextrose was given with PPN nutrition?
Phlebitis
Why is TPN preferred over PPN?
PPN requires more volume for the same nutritional supply
What lab values must be monitored on a patient on TPN?
Mg, Phos, Calcium daily
LFT’s, TG’s Chol, pre-albumin daily