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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
What advise should be given when telling a patient to stop OCP?
Use other means of contraception
26
When should warfarin be stopped?
5 days before surgery
27
What INR should be aimed for before undertaking surgery?
<1.5
28
When a patient stops their warfarin what should they be given?
Cover with SC LMWH
29
If the INR is high the evening before what should the patient be given?
PO vitamin K to reverse the warfarin
30
What drugs should be altered before surgery?
SC insulin | Long-term steroids
31
What happens to SC insulin before surgery?
Should be switched to VRIII
32
Where should all Type 1 DM patients be placed on the surgical list?
First in the morning
33
When might T1DM patients need admitting?
Night before surgery
34
What should happen on the night before surgery in T1DM patients?
Reduce basal insulin dose by 1/3
35
What should happen to morning insulin dose on day of surgery in T1DM patient?
Omit it
36
What happens to a T1DM patient on the morning of surgery?
They are put on a VRIII (sliding scale)
37
What is a VRIII?
A syringe driver with 49.5ml saline with 50 units of actrapid
38
What is usually given alongside VRIII?
5% dextrose at 125ml/hour
39
How often should CBG be checked when on a VRIII?
Every 2 hours
40
What should be done based on 2 hourly CBG measurements?
Adjust infusion rate
41
When should a VRIII be continued until?
Until the patient can eat and drink
42
How should a VRIII be stopped?
Give SC rapid acting 30 mins before meal then stop VRIII 30-60 mins after eating
43
Why must long-term steroids be continued?
To avoid an Addisonian crisis
44
Why might continuing oral steroids be difficult?
If a patient cannot take them orally
45
If a patient cannot take long-term steroids orally what should be done?
Switch to IV
46
How can oral steroids be converted to IV?
5mg PO prednisolone = 20mg IV hydrocortisone
47
Which drugs should be started (if necessary) before surgery?
LMWH TED stockings Anitbiotic prophylaxis
48
What decides if a patient needs LMWH?
VTE risk assessment
49
Who will not receive LMWH?
Those with contraindications/having neck or endocrine surgery
50
Which patients should receive post-op LMWH and TED stockings?
Major GI surgery for cancer/lower limb joint replacement/fracture repair
51
How long should post-op VTE prophylaxis be given if needed?
28 days
52
Who should be given TED stockings?
Everyone*
53
*Who is the exception to 'everyone should have TED stockings'?
Vascular surgery patients
54
Can you just give a patient TED stockings?
No - they need to be prescribed
55
What are the contraindications for TED stockings?
Severe PVD Peripheral neuropathy Recent skin graft Severe eczema
56
Who needs antibiotic prophylaxis?
Patients having orthopaedic, vascular, or GI surgery
57
What are the forms of bowel preparation?
Laxatives | Enemas
58
Are bowel preparations always used?
No
59
Why are bowel preparations being used less and less?
Because they've been shown to prolong recovery time and cause fluid shifts
60
What broad class of surgery may require bowel preparation?
Colorectal
61
Is bowel prep needed in upper GI, HPB or small bowel surgery?
No
62
Is bowel prep needed in right hemi-colectomy or extended right hemi-colectomy?
No
63
Is bowel prep needed in left hemi-colectomy, sigmoid colectomy, or abdo-peroneal resection?
Yes
64
What bowel prep is needed in left hemi-colectomy, sigmoid colectomy, or abdo-peroneal resection?
Phosphate enema
65
When is a phosphate enema given for left hemi-colectomy, sigmoid colectomy, or abdo-peroneal resection?
Morning of surgery
66
Is bowel prep needed in anterior resection?
Yes
67
What bowel prep is needed in anterior resection?
2 sachets of picolax or phosphate enema
68
What should all patients receiving major GI, HPB, vascular, gynae or orthopaedic surgery have as a minimum?
G&S
69
What colour blood bottle is used for G&S (vacutainer)?
Pink
70
What may some patients require before major GI, HPB, vascular, gynae or orthopaedic surgery?
Cross matching
71
When might a patient need a referral before surgery?
When they may require a HDU or ITU bed
72
What investigations may a patient need before surgery?
``` FBC Kidney function testing ECG Haemostasis Lung function/ABG Pregnancy testing Sickle cell testing HbA1c MSU for MCS Echo ```

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