Pre-Op/Nutrition Flashcards
What is the purpose of pre-surgical clearance?
to make recommendations concerning the evaluation, mgmt, and risk of cardiac and medical problems
what is considered high risk sx?
intermediate risk?
low?
reported risk of adverse cardiac effect >5%
<5%
<1%
most important part of perioperative risk assessment
HP
metabolic equivalent
exercise capacity of a pt
<4 increased risk for cardiopulm rxns
when to use a CXR?
for pts over 60 or suspected cardiopulm problems
when to order an EKG?
if you think pt may have ischemic issues class I-definite indication
when to order an echo?
Current or poorly-controlled CHF unless prior studies have documented severe ventricular dysfunction.
should pts continue beta blockers?
yes, they can throughout the sx
also CCBs and clonidine
how to titrate beta blockers?
titrate to pulse <65 bpm
when should you stop taking ASA for general concerns? ASA for CVA/TIA/MIA plavix? ACE/ARB Oral diabetics?
14 days 7 days 4-7 days 1 day cut in half day before
what if pt is on diuretics?
hold off on day of sx
strongest predictor of surgical outcome
albumin, <2 we are concerned
prealbumin
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
how do we determine energy requirements?
current weight unless they are 20% > ideal body weight
Cr deficiency
Se
glucose intolerance
cardiomyopathy
scar tissue strength
80% of original
clean contaminated wound
Wounds that are open for drainage or reopened for surgical reasons
contaminated wound
F/B passing through wound (knife, bullet)
dirty infected wound
Traumatic wounds from a dirty source or delayed treatment
sacral decub ulcer
wet to dry dressing (dirty wound)
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
wet-wet dressing (clean wound)
gauze isn’t allowed to dry before removal, keeping tissues moist
Doesn’t debride healthy tissues upon removal
tissue tensile strength
At 20 days, 20% of normal
At 40 days, 40% of normal
At 90 days, 60% of normal
At 1 year, 70% of normal
suture sizes
From smallest to largest:
7-0, 3-0, 0, 1, 3, 7, etc
monofilament sutures are good for…
percutaneous
