Pre/post op Flashcards
The earliest clinical indication of hypermagnesemia is
loss of deep tendon reflexes
States of magnesium excess are characterized by
generalized neuromuscular depression
neuromuscular effects resemble those of calcium deficiency
Symptomatic hyponatremia levels
NA less than 120 mEq/L
–> HA, SZ, coma, and signs of ↑ICP
may require infusion of hypertonic saline
Pts w/ loss of much of the ileum is at high risk of developing ?
enteric hyperoxaluria
Normally, fatty acids are absorbed by the terminal ileum, and calcium and oxalate combine to form an insoluble compound that is not absorbed.
with no ileum, unabsorbed fatty acids reach the colon, where they combine with calcium
* leaving free oxalate to be absorbed–> kidney stone
elevated arterial pH and PCO2
met alk with resp comp
The PCO2 would be normal if the metabolic alkalosis was uncompensated
decreased pH, increased PCO2, and increased bicarbonate levels
resp acidosis
pH is normal, but the PCO2 and bicarbonate levels are abnormal
mixed process
*or if the compensatory responses appear to be
excessive or inadequate
Volume depletion acid/ base state
metabolic alkalosis
volume depletion –> excessive salt / water retention–> ↑ bicarbonate reabsorption –> alkalosis
Correction of volume depletion alone is usually sufficient to correct the alkalosis
lepirudin is?
an anti-coag.
In the postoperative period, transfusion reactions usually present as
fever, apprehension, and headache
von Willebrand factor (vWF) is?
an important stimulus for platelet aggregation at the site of tissue injury
major carrier protein for circulating factor VIII.
Systemic inflammatory response syndrome (SIRS)
*2 OR MORE* >38°C (100°F) or <36°C (97°F) HR >90 RR >20 or PaCO2 <32 mm Hg WBC count >12,000 or <4000/mm/ >10%pmns
Sepsis
= SIRS + documented infection
SIRS: *2 OR MORE* >38°C (100°F) or <36°C (97°F) HR >90 RR >20 or PaCO2 <32 mm Hg WBC count >12,000 or <4000/mm/ >10%pmns
Severe sepsis
sepsis + organ dysfunction or hypoperfusion
(lactic acidosis, oliguria, or AMS).
Septic shock
sepsis + organ dysfunction + hypotension
(systolic blood pressure <90 mm Hg or >90 mm Hg with vasopressors).
class IV hemorrhagic shock
loss of more than 40% of circulating blood volume
requires massive blood transfusion
The term massive blood transfusion is defined as
transfusion > 10 units of PRBCs over 24 hours
. The _________ remains uncoordinated in its muscular activity and does not empty efficiently for about 24 hours after abdominal procedures
stomach
The small bowel functions normally within _______ of surgery
- hours
- able to accept nutrients promptly, either by nasoduodenal or percutaneous jejunal feeding catheters
- or after 24 hours, by gastric emptying
The colon is stimulated by the gastrocolic reflex but ordinarily is relatively inactive for ___________ after surgery
3 to 4 days.
Well-nourished patients who undergo uncomplicated surgical procedures can tolerate ___________ before significant problems with protein breakdown begin to occur
up to 10 days without full nutritional support
___________ is a specific antidote to heparin
Protamine sulfate
protamine is also an anticoagulant
The indications for inferior vena cava (IVC) filter placement fall into three categories:
failure or complication of anticoagulation
a known free-floating venous clot
prior history of PE.
Adrenal insufficiency s/s
classically manifested as AMS, ↑ temperature, cardiovascular collapse, hypoglycemia, and hyperkalemia
Dexamethasone should be used as steroid replacement
Transfusions with FFP to replenishes?
vitamin K–dependent clotting factors
The half-life of the most stable factor, (VII) is 4 - 6 hours
consider this timing if using prophylactically before surgery
The most common nosocomial infection is ?
a urinary tract infection
Causes of Fistulas
foreign body radiation inflammation, epithelialization of the tract neoplasm distal obstruction steroids
“FRIENDS.”
Hemolytic transfusion reactions are caused by ____________ of transfused red blood cells by the recipient’s pre existing antibodies
complement-mediated destruction
ε-aminocaproic acid is a?
Clotting promoter- an inhibitor of fibrinolysis
sometimes given before an operation to prevent serious bleeding for patients with ↑ chance of bleeding.
aspirin permanently acetylates cyclooxygenase and leaves affected platelets dysfunctional throughout their ________ lifespan
7-day
nsaids: 3-4 days
