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GK General Surgery > Pre/Post Op > Flashcards

Pre/Post Op Flashcards

1
Q

What are possible tx options for DVT?

A

Anticoag w/Heparin (LMWH or unfractionated) w/ bridge to —> Warfarin​

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2
Q

Which anticoagulation agent is safe in pregnancy?

A

LMWH

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3
Q

What are rescue antiemetics and when are they used?

A

if N//V occurs in PACU (post-anesthesia care unit):

Prochlorperazine

Droperidol

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4
Q

What are the Ca+, PTH and phosphate levels in hypocalcemia?

A

Labs: ↓ Ca+ ↓ PTH ↑ phosphate

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5
Q

s/s of hypercalcemia

A

“Stones, bones, abdominal groans, psychiatric moans”

EKG: shortened QT interval.

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6
Q

Adults with ______ risk factors are considered high risk for developing postoperative N/V

A

4

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7
Q

Tx for severe hyponatremia

A

hypertonic 3% saline

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8
Q

What are possible interventions for postoperative N/V?

A

antiemetics

acupuncture

anesthesia modification

non-opioid pain management

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9
Q

What are the Ca+, PTH and phosphate levels in hypocalcemia?

A

Blood: ↑ PTH, ↑ Calcium, ↓ phosphorus

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10
Q

What reduces the incidence of post-op N/V?

A

pre-operative fasting 2-6 hrs prior to operation

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11
Q

S/S of hypernatremia

A

Poor skin turgor, dry mucous membranes, flat neck veins, hypotension, increased BUN/CR ratio > 20:1

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12
Q

What is the biggest risk factor for DVT?

A

virchow’s triad:

  1. venous stasis
  2. hypercoagulability
  3. endothelial damage
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13
Q

What is the antidote for warfarin (coumadin) toxicity?

A

Vitamin K

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14
Q

What are some antiemetic choices for postoperative N/V tx?

A

transdermal scopolamine

dexamethasone

ondansetron

prochlorperazine

droperidol

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15
Q

S/s of hyperkalemia

A
  • peaked T waves
  • muslce fatigue
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16
Q
A
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17
Q

What are the 8 positive wells criteria?

A
  1. active CA or tx w/in 6 mos
  2. paralysis or immobilization of lower extremity
  3. bedridden for more than 3 days due to surgery within 1 mo
  4. localized tenderness along distribution of deep veins
  5. swelling of entire leg
  6. unilateral calf swelling of greater than 3 cm
  7. unilateral pitting edema
  8. collateral SF veins
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18
Q

MOA of unfractionated heparin

A

potentiates anti-T III

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19
Q

What is the MOA of warfarin?

A
  • inhibits vit K-dependent coag factors of EXTRINSIC pathway: 2,7,9, 10.
  • inhibits protein C & S
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20
Q

What is the least emetogenic general anesthetic?

A

Propofol

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21
Q

What is the duration of action of the anticoag drugs?

A
  1. LMWH: 12 h
  2. UFH: 1h p IV drip is discontinued
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22
Q

What is the minimum time a pt should be on anticoagulation for following a DVT?

A

at least 3 months

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23
Q

What is the best test to rule OUT DVT?

A

a negative D-dimer test can rule out DVT in a LOW risk patient

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24
Q

When does postoperative N/V usually take place?

A

within 24 hrs after surgery

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25
Q

s/s of Hypocalcemia

A
  • QT prolongation
  • +Trousseau’s sign (placing a blood pressure cuff on the patient’s arm and inflating to 20 mm Hg above systolic blood pressure for 3-5 minutes will ilicit a flexion of the wrist and carpal joints that cannot be controlled)
  • +Chvostek’s sign (twitching of lip at corner of mouth to spasm of all facial muscles due to nerv hyperexcitability)
26
Q

Why do many pts prefer LMWH?

A

no need to monitor PT INR

27
Q

What can rapid overcorrection of hypernatremia cause?

A

cerebral edema and pontine herniation

28
Q

What are risk factors for postoperative N/V?

A

female gender

history of previous postoperative nausea and vomiting or motion sickness

nonsmoking status

opioid administration

29
Q

Emetogenic drugs commonly used in anesthesia include what?

A

Nitrous Oxide

Physostigmine

Opioids

(Nausea Post Op)

30
Q

What is a CI of LMWH?

A

renal failure

31
Q

s/s of diabetes insipidus

A

Low urine sodium (but high serum sodium) and polyuria

32
Q

What are the possible causes of hypernatremia?

A

Diarrhea, burns, diuretics, hyperglycemia, diabetes insipidus, a deficit of thirst

33
Q

What is the antidote for heparin toxicity?

A

protamine sulfate

34
Q

What causes neurogenic (central) Diabete Insipidus?

A

deficient secretion of vasopressin (ADH - anti-piss-hormone) from the posterior pituitary

35
Q

What is 1st line dx for DVT?

A

venous suplex US: thrombus will show noncompressible echogenecity

36
Q

S/S of hyponatremia

A
  • Peripheral and presacral edema, pulmonary edema, JVD, hypertension, decreased hematocrit, decreased serum protein, decreased BUN/CR
  • muscle cramps and seizures
37
Q

Where do most DVTs originate?

A

the calf

38
Q

How long should coumadin (warfarin) be overlapped with heparin for atleast?

A

5 days

39
Q

What is recommended therapy for pt with CI to or who failed anticoag tx for DVT?

A

IVC filter

40
Q

Which tx for DVT do you NEED to check PT INR for?

A

unfractionated heparin

41
Q

What are the 3 types of hyponatremia?

A
  1. Hypervolemic(think hypervolume states): CHF, nephrotic syndrome, renal failure, cirrhosis
  2. Euvolemic: SIADH, steroids, hypothyroid
  3. Hypovolemic: Na loss (renal, non-renal)
42
Q

Tx for asymptomatic hyponatremia

A

free water restriction

43
Q

What do you need to keep in mind when correct hyponatremia?

A

Serum Na should be corrected slowly—by ≤ 10 mEq/L over 24 h to avoid osmotic demyelination syndrome

44
Q

Tx for hyperkalemia

A

insulin, sodium bicarb, glucose

calcium gluconate (antagonizes effect of K on heart)

45
Q

What causes nephrogenic Diabetes Insipidus?

A

kidneys that are unresponsive to normal vasopressin levels - usually inherited X-linked or from lithium or renal disease

46
Q

What do you want to avoid when you are on warfarin (coumadin)?

A

avoid cruciferous vegetables with increased Vit K

47
Q

Tx for hypercalcemia

A

IV normal saline + furosemide

48
Q

s/s of hypokalemia

A
  • EKG: flattened/inverted T waves, U waves
  • muscle cramps
  • constipation
49
Q

What is the negative wells criteria category?

A

alt dx as likely or more likely than DVT (-2)

50
Q

Tx for hypocalcemia

A

IV Calcium gluconate

51
Q

What are the main s/s of DVT?

A
  1. unilateral swelling/edema of lower extremity >3cm (most specific sign of DVT)
  2. calf pain/tenderness
    1. Homan’s sign: pain in calf w/dorsiflexion of affected foot and knee.
    2. Phlebitis: warmth, erythema, palpable cord.
52
Q

Tx for hypokalemia

A
  • potassium repletion
  • _**DO NOT USE DEXTROSE CONTAINING FLUIDS*_*
    • this will stimulate insulin release and shift potassium within the cell which worsens the hypokalemia
  • Replace Mg if Mg is low
53
Q

Tx fo hypernatremia

A

IV 5% dextrose in water (D5W)

54
Q

tx for moderate hyponatremia

A

IV normal saline +/- loop diuretics ( decrease H2O volume)

55
Q

What is gold standard for DVT dx?

A

venography: filling defect ir ninfilling of the deep veins

56
Q

major causes of metabolic alkalosis

A

GI hydrogen loss: vomiting, NG suction

Any type of hydrogen loss or shift of hydrogen

57
Q

What is the MCC of metabolic alkalosis

A

volume loss and gastric fluid loss seen in small bowel tx with NG tube

58
Q

During this type of surgery, aggressive third-spacing of fluid into the peritoneal cavity, as well as the intestinal lumen, is the cause of volume contraction.

What surgery?

A

small bowel surgery

59
Q

What causes metabolic acidosis post op?

A

large blood loss or resuscitation causing lactic acidosis

60
Q

What causes post-op respiratory acidosis?

A

secondary to hypoventilation from resp depression (narcotics or sedation)

61
Q

What causes post-op respiratory alkalosis?

A

pts who undergo upper abdominal or thoracic surgery and take shallow breaths to avoid incisional pain.

62
Q
A

GK General Surgery (11 decks)

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