Pre, peri, post-op care and Complications Flashcards
What are the 4 initiatives under the SCIP project?
prevention of surgical infection, CV complications, VTE, respiratory complications
Abx recommendations according to SCIP
give one hr prior to sx, every 4 hrs during surgery, and discontinue within 24 hrs post-op
Induces small skin lacerations and disturbs hair follicles which are colonized by S. aureus. Risk of infection is greatest when done the night before
shaving hair with a razor
third most common cause of hospital-related deaths in the United States
pulmonary embolism
What elevation should the head of the bed be for patients on a ventilator to reduce risk of pneumonia?
30 degrees
Potential pulmonary complications due to surgery
hypoventilation, pneumonia, atelectasis
Why do abdominal and thoracic surgeries have a high risk for pulmonary complications?
vital capacity and functional residual capacity are reduced
What should you do if a patient is scheduled for an elective surgery and they develop a URI?
delay in the presence of a viral URI
Post-op strategies to reduce pulmonary complications
deep breathing excercises, incentive spirometry, pain control
How does pain control reduce pulmonary complications?
allows for early ambulation improving patients ability to take deep breaths
Potential cardiac complications of surgery
MI, CHF, HTN
Do you need to do further pre-op testing on a patient who had coronary revascularization w/in 5yrs or a coronary evaluation w/in 2yrs? Neither are symptomatic
nothing further
Presentation includes fever, tachycardia, diaphoresis, increased CNS activity and emotional lability. Often caused by withdrawal of antithyroid drugs
thyroid storm
Treatment for adrenal insufficiency with surgery
more steroids
decreases need for ventilator support, renal replacement therapy, and septic episodes
intensive insulin control
mutation of one of the clotting factors in the blood that can increase your chance of developing abnormal blood clots (thrombophilia), usually in your veins
factor V leiden
Type of surgery with the highest incidence of symptomatic PE
hip
Well documented non-pharmacologic prophylaxis of VTE esp with lower extremity surgery
early ambulation
Improve venous flow/ reduce vessel wall damage caused by passive dilation during surgery. Apply pre-operatively
elastic stocking (TED hose)
Pharmacologic prophylaxis of VTE as surgical complication
low dose unfractionated heparin or low MW heparin (Lovenox)
What is the etiology of most early post-op fevers during the first few days after surgery?
inflammatory stimulus of surgery (cytokines)
Describe the different timelines of fever after surgery
immediate- occurs in OR or within hrs post-op. Acute-occurs within 1st week. Subacute- occurs week 1-4. Delayed- occurs after one month
Common causes of immediate post-op fever
medications, blood products, malignant hyperthermia
Common causes of delayed post-op fever
viral infections from blood products or SSI
How long should a wound be kept from getting wet and patients only allowed to shower (no bathtub or hot tub)?
2-10 days depending on wound site
Epidermas and dermis not closed, sometimes other layers not closed, and allowed to granulate in. packed daily to every other day with saline gauze and covered with sterile dressing
wound healing by secondary intention
Among surgical patients, most common nosocomial infection
surgical site
When are most SSIs acquired?
at the time of surgery
What is the most common source of SSIs?
direct inoculation of pt flora—S. aureus and coag neg staph
Preferred abx for most surgeries
cefazolin (Ancef) 1-2g IV
Abx of choice for surgical procedures is patient has a PCN allergy
vanco
Abx of choice for bowel procedures
cefoxitin or ampicillin/sulbactam (unasyn)
Protocol for ventilator patients that involves daily sedation vacations and assessments of readiness to extubate in order to decrease incidence of VAP
rapid weaning
a total separation of all wound layers and protrusion of internal organs through the open wound
evisceration
Collection of blood in the wound usually due to poor hemostasis. Slightly higher risk in those on Heparin, Aspirin or coumadin.
hematoma
Treatment for large hematomas
surgically evacuated, the vessels ligated, and the wound reclosed
Collection of fluid other than pus or blood usually under skin flaps or in dead spaces
seroma
Prevention and treatments of seromas
avoid leaving dead spaces. Treat with aspiration and drains
Autosomal dominant condition of skeletal muscle. Build up of calcium causes violent sustained muscle contraction and rigidity, heat production and acidosis, muscle necrosis and rhabdomyolysis
malignant hyperthermia
Operative triggers of malignant hyperthermia
inhaled halogenated anestheitic agents and succinylcholine
Increase in body temperature of patient experiencing malignant hyperthermia
1-2 degrees every 5 minutes (but may take 36 hours to rise)
Treatment of malignant hyperthermia
dantrolene rapid IV push
