Pre-Op/Nutrition

Question 1

What is the purpose of pre-surgical clearance?

Answer 1

to make recommendations concerning the evaluation, mgmt, and risk of cardiac and medical problems

Question 2

what is considered high risk sx?
intermediate risk?
low?

Answer 2

reported risk of adverse cardiac effect >5%
<5%
<1%

Question 3

most important part of perioperative risk assessment

Answer 3

HP

Question 4

metabolic equivalent

Answer 4

exercise capacity of a pt

<4 increased risk for cardiopulm rxns

Question 5

when to use a CXR?

Answer 5

for pts over 60 or suspected cardiopulm problems

Question 6

when to order an EKG?

Answer 6

if you think pt may have ischemic issues
class I-definite indication

Question 7

when to order an echo?

Answer 7

Current or poorly-controlled CHF unless prior studies have documented severe ventricular dysfunction.

Question 8

should pts continue beta blockers?

Answer 8

yes, they can throughout the sx

also CCBs and clonidine

Question 9

how to titrate beta blockers?

Answer 9

titrate to pulse <65 bpm

Question 10

when should you stop taking ASA for general concerns?
ASA for CVA/TIA/MIA
plavix?
ACE/ARB
Oral diabetics?

Answer 10

14 days
7 days
4-7 days
1 day
cut in half day before

Question 11

what if pt is on diuretics?

Answer 11

hold off on day of sx

Question 12

strongest predictor of surgical outcome

Answer 12

albumin, <2 we are concerned

Question 13

prealbumin

Answer 13

shorter half life making it a more favorable marker of acute change in nutritional status. Increase prealbumin by 3-5 mg/dl/week
C-reactive protein >10 indicates acute phase stress

Question 14

how do we determine energy requirements?

Answer 14

current weight unless they are 20% > ideal body weight

Question 15

Cr deficiency

Se

Answer 15

glucose intolerance

cardiomyopathy

Question 16

scar tissue strength

Answer 16

80% of original

Question 17

clean contaminated wound

Answer 17

Wounds that are open for drainage or reopened for surgical reasons

Question 18

contaminated wound

Answer 18

F/B passing through wound (knife, bullet)

Question 19

dirty infected wound

Answer 19

Traumatic wounds from a dirty source or delayed treatment

sacral decub ulcer

Question 20

wet to dry dressing (dirty wound)

Answer 20

gauze is moistened and placed into wound followed by a dry dressing to cover
Allowed to dry before removal thereby taking necrotic tissue away
Often removes healthy tissue inadvertently

Question 21

wet-wet dressing (clean wound)

Answer 21

gauze isn’t allowed to dry before removal, keeping tissues moist
Doesn’t debride healthy tissues upon removal

Question 22

tissue tensile strength

Answer 22

At 20 days, 20% of normal

At 40 days, 40% of normal

At 90 days, 60% of normal

At 1 year, 70% of normal

Question 23

suture sizes

Answer 23

From smallest to largest:

7-0, 3-0, 0, 1, 3, 7, etc

Question 24

monofilament sutures are good for…

Answer 24

percutaneous

Question 25

multifilament sutures

Answer 25

Affords greater tensile strength, pliability, flexibility, and knot security
May harbor micro-organisms and “wick” them down the suture
Should not be used for percutaneous sutures

Question 26

non-absorptive sutures are used for

Answer 26

device fixation, areas of extreme tension, slow healing areas, or percutaneous skin sutures

Question 27

conventional cutting needle is used for

Answer 27

skin closure

Question 28

reverse cutting needle is used for

Answer 28

tough, difficult to penetrate tissues

Question 29

taper point needle is used for

Answer 29

soft, easy to penetrate tissues (colon)

Question 30

blunt point needle is used for

Answer 30

blunt dissection and suturing friable tissues (fat, omentum)

Question 31

spatula needle is used for

Answer 31

eye surgery

Question 32

negative wound pressure VAC

Answer 32

This allows for granulation tissue to grow till you can close primarily