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Med Procedures > Pre & post op management > Flashcards

Pre & post op management Flashcards

1
Q

The factors involved for pre op evaluation

A

The nature of the surgical procedure

The overall health of the patient

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2
Q

Pre- Op Evaluation consists of what?

A 
Critical to obtain complete medical hx
Allergies
Meds
Prior surgeries/ ?problems w/anesthesia
Family hx of problems w/anesthesia
ROS
Physical Exam
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3
Q

Pre-op Evaluation – Red Flag Disorders

A 
Cardiac Dz
Lung Dz
Diabetes
Bleeding disorders (Coumadin/ASA)
Liver Dz
Renal Dz
Seizure disorders
Infections
Pregnancy
Drug or ETOH abuse
HIV/AIDS/Immunocompromised
Endocrine Dz
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4
Q

Pre- op work up

A 
CBC/BMP (lytes/BUN/Creat/glucose)
Clotting studies only if indicated
LFT’s in older pts or when indicated
EKG if pt is > 40 or has cardiac hx
CXR only if indicated
T & C PRN
Surgical Consent
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5
Q

What are risks with general anesthesia?

A

Decreases systemic vascular resistance
Decreases myocardial contractility
Decreases stroke volume
Increases cardiac irritability

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6
Q

Major Cardiac Risk includes (4)

A

Unstable coronary syndrome
Decompensated CHF
Significant arrhythmia
Severe valvular disease

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7
Q

Intermediate cardiac risk (6)

A 
Mild angina
Previous MI
Compensated CHF
Prior CHF
Diabetes mellitus
Renal insufficiency
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8
Q

minor cardiac risk

A 
Advanced age
Abnormal findings on echocardiography
Rhythm other than sinus 
Prior hx of stroke
Uncontrolled HTN
Low cardiac functional capacity
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9
Q

Pre-operative testing for cardiac risk pts include?

A 
EKG
Dobutamine stress echocardiography
Dipyridamole thallium imaging
Coronary angiography
Exercise stress testing not always used
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10
Q

epidemiology of risk of ischemia with surgery

A

Pre-op risk of ischemia = 20%
Intra-op risk of ischemia = 25%
Post-op risk of ischemia = 55%

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11
Q

4 Pulmonary Complications

A

Age
Obesity
Smoking
COPD

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12
Q

Preventative Measures for reducing pulmonary risks

A

Stop smoking >8 weeks prior to surgery
Delay elective surgery for COPD pts who are poorly controlled – and change meds PRN
Prevention of most common pulmonary complication (atelectasis)

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13
Q

DVT Risk

A

The bane of surgeons existence
May be related to heightened clotting associated with blood loss during surgery
Combined with decreased activity
DVT can lead to PE and death

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14
Q

Anemia

A

Oxygen delivery diminishes w/HCT < 30
Blood loss unpredictable but various procedures have increased risk
Even without significant blood loss IV hydration intraoperatively can lower HCT
HCT<28 will increase MI risk

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15
Q

What are 4 surgeries that carry a greater risk

A

Oral
Trauma
Bowel
Vaginal

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16
Q

Diabetes increases the risk for what during surgery?

A 
Stroke
MI
Infection (wound and systemic)
Wound dehiscence
DKA
17
Q

Malnutrition/Drug Dependency

A 
Vitamin K deficiency
Hepatic dysfunction
Poor wound healing
Electrolyte abnormalities
Poor social/family support often the case
Pain relief in light of drug dependency
Drug withdrawal
18
Q

Steroids

A

Chronic steroid use will suppress endogenous steroid production
Doses as small as 7.5mg Prednisone per day (or Hydrocortisone 30 mg/day) can be a suppressive dose
Partial adrenal insufficiency may be present for these pts as long as 9 mos after d/cing

19
Q

The 5 P’s for post op pts

A

Pain control – PCA/Epidural/IM/IV/PO PRN
Prevent Pus – Post op antibiotic prophylaxis
“Pillow” – sleeper PRN
“Poop” – narcotics + inactivity = constipation
Previous Meds

20
Q

Fever with surgery

A

Common post op complication
Often resolves spontaneously
Fevers in first 24 hrs are rarely wound infections – but wound should be checked
Can be caused by atelectasis

21
Q

If patient has a foley with a fever what do you need to check for?

A

check for UTI and Rx PRN

22
Q

Oversedation and confusion after surgery

A

More common in elderly pts
Sensitivity to narcotics
Multi factorial – polypharmacy, sundowning, unfamiliar surroundings, etc.
Scale back or d/c narcotic analgesics PRN
Try to avoid narcotic antagonis

23
Q

Infection associated with surgery

A

Use of antibiotic prophylaxis to reduce risk of wound infection.
D/C drains/tubes as soon as feasible
Higher risk w/implants or immuno-compromised pts
W/U fevers as needed

24
Q

Wound healing after surgery

A

Compromised in the elderly, chronically ill, diabetics, immunocompromised.
Check wound QD or QOD at least
Remove stitches/staples when ready and steri strip wound PRN
Watch for signs of infection; redness, calor, drainage esp purulent, dehiscence.

25
Q

Fluid/ electrolytes after surgery

A

Check lytes, BUN, Creat PRN
Older pts tend to be dehydrated when they come in
Pts can lose fluid/blood intra-op
Pts can get a lot of fluids IV intra op
Daily wts/I & O PRN – QD weights can help Dx CHF / fluid retention

Med Procedures (5 decks)

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