Pre, peri, post-op care and Complications

Question 1

What are the 4 initiatives under the SCIP project?

Answer 1

prevention of surgical infection, CV complications, VTE, respiratory complications

Question 2

Abx recommendations according to SCIP

Answer 2

give one hr prior to sx, every 4 hrs during surgery, and discontinue within 24 hrs post-op

Question 3

Induces small skin lacerations and disturbs hair follicles which are colonized by S. aureus. Risk of infection is greatest when done the night before

Answer 3

shaving hair with a razor

Question 4

third most common cause of hospital-related deaths in the United States

Answer 4

pulmonary embolism

Question 5

What elevation should the head of the bed be for patients on a ventilator to reduce risk of pneumonia?

Answer 5

30 degrees

Question 6

Potential pulmonary complications due to surgery

Answer 6

hypoventilation, pneumonia, atelectasis

Question 7

Why do abdominal and thoracic surgeries have a high risk for pulmonary complications?

Answer 7

vital capacity and functional residual capacity are reduced

Question 8

What should you do if a patient is scheduled for an elective surgery and they develop a URI?

Answer 8

delay in the presence of a viral URI

Question 9

Post-op strategies to reduce pulmonary complications

Answer 9

deep breathing excercises, incentive spirometry, pain control

Question 10

How does pain control reduce pulmonary complications?

Answer 10

allows for early ambulation improving patients ability to take deep breaths

Question 11

Potential cardiac complications of surgery

Answer 11

MI, CHF, HTN

Question 12

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

Answer 12

nothing further

Question 13

Presentation includes fever, tachycardia, diaphoresis, increased CNS activity and emotional lability. Often caused by withdrawal of antithyroid drugs

Answer 13

thyroid storm

Question 14

Treatment for adrenal insufficiency with surgery

Answer 14

more steroids

Question 15

decreases need for ventilator support, renal replacement therapy, and septic episodes

Answer 15

intensive insulin control

Question 16

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

Answer 16

factor V leiden

Question 17

Type of surgery with the highest incidence of symptomatic PE

Answer 17

hip

Question 18

Well documented non-pharmacologic prophylaxis of VTE esp with lower extremity surgery

Answer 18

early ambulation

Question 19

Improve venous flow/ reduce vessel wall damage caused by passive dilation during surgery. Apply pre-operatively

Answer 19

elastic stocking (TED hose)

Question 20

Pharmacologic prophylaxis of VTE as surgical complication

Answer 20

low dose unfractionated heparin or low MW heparin (Lovenox)

Question 21

What is the etiology of most early post-op fevers during the first few days after surgery?

Answer 21

inflammatory stimulus of surgery (cytokines)

Question 22

Describe the different timelines of fever after surgery

Answer 22

immediate- occurs in OR or within hrs post-op. Acute-occurs within 1st week. Subacute- occurs week 1-4. Delayed- occurs after one month

Question 23

Common causes of immediate post-op fever

Answer 23

medications, blood products, malignant hyperthermia

Question 24

Common causes of delayed post-op fever

Answer 24

viral infections from blood products or SSI

Question 25

How long should a wound be kept from getting wet and patients only allowed to shower (no bathtub or hot tub)?

Answer 25

2-10 days depending on wound site

Question 26

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

Answer 26

wound healing by secondary intention

Question 27

Among surgical patients, most common nosocomial infection

Answer 27

surgical site

Question 28

When are most SSIs acquired?

Answer 28

at the time of surgery

Question 29

What is the most common source of SSIs?

Answer 29

direct inoculation of pt flora—S. aureus and coag neg staph

Question 30

Preferred abx for most surgeries

Answer 30

cefazolin (Ancef) 1-2g IV

Question 31

Abx of choice for surgical procedures is patient has a PCN allergy

Answer 31

vanco

Question 32

Abx of choice for bowel procedures

Answer 32

cefoxitin or ampicillin/sulbactam (unasyn)

Question 33

Protocol for ventilator patients that involves daily sedation vacations and assessments of readiness to extubate in order to decrease incidence of VAP

Answer 33

rapid weaning

Question 34

a total separation of all wound layers and protrusion of internal organs through the open wound

Answer 34

evisceration

Question 35

Collection of blood in the wound usually due to poor hemostasis. Slightly higher risk in those on Heparin, Aspirin or coumadin.

Answer 35

hematoma

Question 36

Treatment for large hematomas

Answer 36

surgically evacuated, the vessels ligated, and the wound reclosed

Question 37

Collection of fluid other than pus or blood usually under skin flaps or in dead spaces

Answer 37

seroma

Question 38

Prevention and treatments of seromas

Answer 38

avoid leaving dead spaces. Treat with aspiration and drains

Question 39

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

Answer 39

malignant hyperthermia

Question 40

Operative triggers of malignant hyperthermia

Answer 40

inhaled halogenated anestheitic agents and succinylcholine

Question 41

Increase in body temperature of patient experiencing malignant hyperthermia

Answer 41

1-2 degrees every 5 minutes (but may take 36 hours to rise)

Question 42

Treatment of malignant hyperthermia

Answer 42

dantrolene rapid IV push