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OSCE > Pre-op Management > Flashcards

Pre-op Management Flashcards

1
Q

What acronym can be used for management of any patient?

A

RAPRIOP

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2
Q

What does the first R stand for in RAPRIOP?

A

Reassurance

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3
Q

What does A stand for in RAPRIOP?

A

Advice

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4
Q

What does the first P stand for in RAPRIOP?

A

Prescription

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5
Q

What does the second R stand for in RAPRIOP?

A

Referral

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6
Q

What does I stand for in RAPRIOP?

A

Investigations

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7
Q

What does O stand for in RAPRIOP?

A

Observations

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8
Q

What does the second P stand for in RAPRIOP?

A

Patient understanding and follow up

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9
Q

Why is reassurance important?

A

A few kind words can help settle patient anxiety

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10
Q

What advice should be given regarding eating food before an operation?

A

Stop 6 hours before the operation

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11
Q

What advice should be given regarding drinking dairy products (INCLUDING tea and coffee)?

A

Stop 6 hours before

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12
Q

What advice should be given with regards to drinking clear fluids e.g. water before surgery?

A

Stop 2 hours before

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13
Q

Can patients use water to take medications before operation?

A

Only small sips if <2 hours before

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14
Q

Why is it important to fast before surgery?

A

To reduce the risk of aspiration pneumonitis and aspiration and pneumonia

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15
Q

What mnemonic can be used to remember medications to stop before surgery?

A

CHOW

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16
Q

What does CHOW stand for?

A

Clopidogrel
Hypoglycaemics
Oral contraceptive pill and HRT
Warfarin

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17
Q

When should clopidogrel be stopped?

A

7 days before surgery

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18
Q

Why should clopidogrel be stopped?

A

Increases bleeding risk

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19
Q

Should normal does aspirin be stopped?

A

No - only higher treatment doses

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20
Q

When should metformin be stopped?

A

Morning of surgery

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21
Q

When should all other oral hypoglycaemics (not metformin) be stopped?

A

24 hours before surgery

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22
Q

What happens to Type 2 diabetics once they stop their medications?

A

They will likely need to be put on VRIII and 5% dextrose

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23
Q

When should the OCP and HRT be stopped?

A

4 weeks before surgery

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24
Q

Why must OCP and HRT be stopped?

A

Due to risk of DVT

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25
Q

What advise should be given when telling a patient to stop OCP?

A

Use other means of contraception

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26
Q

When should warfarin be stopped?

A

5 days before surgery

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27
Q

What INR should be aimed for before undertaking surgery?

A

<1.5

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28
Q

When a patient stops their warfarin what should they be given?

A

Cover with SC LMWH

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29
Q

If the INR is high the evening before what should the patient be given?

A

PO vitamin K to reverse the warfarin

30
Q

What drugs should be altered before surgery?

A

SC insulin

Long-term steroids

31
Q

What happens to SC insulin before surgery?

A

Should be switched to VRIII

32
Q

Where should all Type 1 DM patients be placed on the surgical list?

A

First in the morning

33
Q

When might T1DM patients need admitting?

A

Night before surgery

34
Q

What should happen on the night before surgery in T1DM patients?

A

Reduce basal insulin dose by 1/3

35
Q

What should happen to morning insulin dose on day of surgery in T1DM patient?

A

Omit it

36
Q

What happens to a T1DM patient on the morning of surgery?

A

They are put on a VRIII (sliding scale)

37
Q

What is a VRIII?

A

A syringe driver with 49.5ml saline with 50 units of actrapid

38
Q

What is usually given alongside VRIII?

A

5% dextrose at 125ml/hour

39
Q

How often should CBG be checked when on a VRIII?

A

Every 2 hours

40
Q

What should be done based on 2 hourly CBG measurements?

A

Adjust infusion rate

41
Q

When should a VRIII be continued until?

A

Until the patient can eat and drink

42
Q

How should a VRIII be stopped?

A

Give SC rapid acting 30 mins before meal then stop VRIII 30-60 mins after eating

43
Q

Why must long-term steroids be continued?

A

To avoid an Addisonian crisis

44
Q

Why might continuing oral steroids be difficult?

A

If a patient cannot take them orally

45
Q

If a patient cannot take long-term steroids orally what should be done?

A

Switch to IV

46
Q

How can oral steroids be converted to IV?

A

5mg PO prednisolone = 20mg IV hydrocortisone

47
Q

Which drugs should be started (if necessary) before surgery?

A

LMWH
TED stockings
Anitbiotic prophylaxis

48
Q

What decides if a patient needs LMWH?

A

VTE risk assessment

49
Q

Who will not receive LMWH?

A

Those with contraindications/having neck or endocrine surgery

50
Q

Which patients should receive post-op LMWH and TED stockings?

A

Major GI surgery for cancer/lower limb joint replacement/fracture repair

51
Q

How long should post-op VTE prophylaxis be given if needed?

A

28 days

52
Q

Who should be given TED stockings?

A

Everyone*

53
Q

*Who is the exception to ‘everyone should have TED stockings’?

A

Vascular surgery patients

54
Q

Can you just give a patient TED stockings?

A

No - they need to be prescribed

55
Q

What are the contraindications for TED stockings?

A

Severe PVD
Peripheral neuropathy
Recent skin graft
Severe eczema

56
Q

Who needs antibiotic prophylaxis?

A

Patients having orthopaedic, vascular, or GI surgery

57
Q

What are the forms of bowel preparation?

A

Laxatives

Enemas

58
Q

Are bowel preparations always used?

A

No

59
Q

Why are bowel preparations being used less and less?

A

Because they’ve been shown to prolong recovery time and cause fluid shifts

60
Q

What broad class of surgery may require bowel preparation?

A

Colorectal

61
Q

Is bowel prep needed in upper GI, HPB or small bowel surgery?

A

No

62
Q

Is bowel prep needed in right hemi-colectomy or extended right hemi-colectomy?

A

No

63
Q

Is bowel prep needed in left hemi-colectomy, sigmoid colectomy, or abdo-peroneal resection?

A

Yes

64
Q

What bowel prep is needed in left hemi-colectomy, sigmoid colectomy, or abdo-peroneal resection?

A

Phosphate enema

65
Q

When is a phosphate enema given for left hemi-colectomy, sigmoid colectomy, or abdo-peroneal resection?

A

Morning of surgery

66
Q

Is bowel prep needed in anterior resection?

A

Yes

67
Q

What bowel prep is needed in anterior resection?

A

2 sachets of picolax or phosphate enema

68
Q

What should all patients receiving major GI, HPB, vascular, gynae or orthopaedic surgery have as a minimum?

A

G&S

69
Q

What colour blood bottle is used for G&S (vacutainer)?

A

Pink

70
Q

What may some patients require before major GI, HPB, vascular, gynae or orthopaedic surgery?

A

Cross matching

71
Q

When might a patient need a referral before surgery?

A

When they may require a HDU or ITU bed

72
Q

What investigations may a patient need before surgery?

A 
FBC
Kidney function testing
ECG
Haemostasis
Lung function/ABG
Pregnancy testing
Sickle cell testing
HbA1c
MSU for MCS
Echo

OSCE (19 decks)

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