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Pre/Post Operative Flashcards

1
Q

When can a patient eat prior to major surgery

A

Should be NPO after midnight the night before surgery or at least 8 hours before surgery

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2
Q

What risks should be discussed with all patients and documented on the consent form for a surgical procedure

A

Bleeding, Infection, Anesthesia, Scar

Other risks specific to patient such as MI, CVA, Death

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3
Q

If the patient is on antihypertensive meds should the patient take them on the day of the procedure

A

Yes

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4
Q

If a patient is on oral hypoglycemic agent should the patient take it the day of surgery

A

Not if they are to NPO before surgery

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5
Q

If the patient is taking insulin should the patient take it on the day of surgery

A

No
Only half of a long lasting insulin and start D5 NS IV
Check glucose levels often before, during, and after surgery

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6
Q

Should a patient who smokes cigarettes stop before an operation

A

Yes, Improvements are seen in just 2-4 weeks after smoking cessation

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7
Q

What laboratory test must all women of childbearing age have before enter an OR

A

Beta-HCG and CBC (pregnancy and anemia)

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8
Q

What preoperative procedure should be performed before colon surgery

A

Bowel prep with colon cathartic (goLYTELY), Oral antibiotics (Neomycin and Erythromycin base), IV antibiotic before incision

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9
Q

What preoperative meds can decrease postoperative cardiac events and death

A

Beta-Blockers

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10
Q

What must you always order preoperatively for your patient undergoing a major operation

A

NPO/IVF
Preoperative Antibiotics
Type and Cross Blood

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11
Q

What electrolyte must you check preoperatively if a patient is on hemodialysis

A

Potassium

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12
Q

What gets a preoperative EKG

A

Patients older than 40 years of age

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13
Q

What are the surgical causes of Metabolic Alkalosis

A

Vomiting, NG suction, diuretics, alkali ingestion, mineralocorticoid excess

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14
Q

What are the surgical causes of Respiratory Acidosis

A

Hypoventilation, PTX, Pleural effusions, Airway Obstruction

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15
Q

What are the surgical causes of Respiratory Alkalosis

A

Hyperventilation

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16
Q

What are surgical causes for Hypokalemia

A

Diuretics, antibiotics, steroids, NG aspiration, Vomiting

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17
Q

Sx of Hypokalemia

A

Weakness, tetany, N/V, Ileus, Paraesthesia

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18
Q

What are EKG findings for Hypokalemia

A

Flattening of T waves

U waves

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19
Q

Tx of Hypokalemia

A

KCL IV

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20
Q

What electrolyte must you replace first before replacing Potassium

A

Magnesium

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21
Q

What are surgical causes for Hypernatremia

A

Inadequate hydration Diabetes Insipidus, Diuresis, Vomiting, Diarrhea

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22
Q

Sx of Hypernatremia

A

Seizures, Confusion, Stupor, Pulmonary or Peripheral Edema, Tremors, Resp. Paralysis

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23
Q

Tx for Hypernatremia

A

D5W, 1/4 NS or 1/2 NS

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24
Q

What is a major complication of lowering sodium level too fast

A

Seizures

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25
Q

What are the surgical causes for Hypovolemia

A

Diuretic excess, hypoaldosteronism, Vomiting, NG suction, burns, pancreatitis, Diaphoresis

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26
Q

What are the surgical causes for Euvolemia

A

SIADH, CNS abnormalities, Drugs

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27
Q

What are the surgical causes for Hypervolemia

A

Renal Failure, CHF, liver failure (cirrhosis), iatrogenic fluid overload

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28
Q

Sx of Volume imbalance

A

Seizures, coma, N/V, ileus, lethargy, confusion, weakness

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29
Q

Tx for Hypovolemia

A

IV NS, correct underlying cause

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30
Q

Tx for Euvolemia

A

SIADH: Furosemide and NS

Fluid restriction

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31
Q

Tx for Hyervolemia

A

Dilution: Fluid restriction and diuretics

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32
Q

What results if you correct hyponatremia too quickly

A

Central pontine myelionolysis

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33
Q

What are sx of Central Pontine Myelinolysis

A

Confusion
Spastic Quadriplegia
Horizontal gaze paralysis

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34
Q

What are causes of Hypercalcemia

A 
Calcium Supplements
Hyperparathyroidism
Hyperthyroidism
Immobility
Milk Alkali Syndrome
Paget's Disease (of bone)
Addison's Disease
Neoplasm
Zollinger-Ellison Synddrome
Excess Viatmin D, Vitamin A
Sarcoid
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35
Q

Sx of Hypercalcemia

A

Stones, Bones, Groans and psychiatric overtones

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36
Q

Tx for Hypercalcemia

A

Volume expansion with S

Diuresis with furosemide

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37
Q

What are surgical causes for Hypocalcemia

A 
Short bowel syndrome
Intestinal bypass
Vitamin D deficiency
Sepsis
Acute Pancreatitis
Osteoblastic Mets
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38
Q

What is Chvostek’s Sign

A

Facial muscle spasm with tapping of facial nrve

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39
Q

What is Trousseau’s Sign

A

Carpal spasm after occluding blood flow in forearm with blood pressure cuff

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40
Q

Sx of Hypocalcemia

A

Chvostek’s and Trousseau’s Sign, Increased DTR, Confusion, Abdominal Cramps

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41
Q

What are EKG findings for Hypocalcemia

A

Prolonged QT and ST intervals

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42
Q

Tx for Hypocalcemia

A

Calcium Gluconate IV

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43
Q

What is a complication of infused calcium if th IV infiltrates

A

Tissue necrosis

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44
Q

What are surgical causes for Hypermagnesemia

A

TPN, Renal Failure

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45
Q

Sx of Hypermagnesemia

A

Respiratory Failure, CNS Depression, Reduced DTR

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46
Q

Tx of Hypermagnesemia

A

Calcium gluconate IV, Insulin plus Glucose, Dialysis

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47
Q

What are surgical causes for Hypomagnesemia

A

TPN, Hypocalcemia, Gastric Suctioning, Aminoglycosides, Renal Failure, Diarrhea, Vomiting

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48
Q

What are sx of Hypomagnesemia

A

Increased DTR, Tetany, Asterixis, Tremor, Chvostk’s Sign

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49
Q

Tx for Hypomagnesemia

A

MgSO IV

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50
Q

What are surgical causes for Hyperglycemia

A

DM, Infection, Stress, TPN, Drugs

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51
Q

Sx of Hyperglycemia

A

Polyuria, Hypovolemia, Confusion/coma

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52
Q

Tx of Hyperglycemia

A

Insulin

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53
Q

What are surgical causes for Hypoglycemia

A

Excess insulin, decreased caloric intake, drugs, liver failure

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54
Q

Sx of Hypoglycemia

A

Diaphoresis, Tachycardia, Palpitations, Confusion, Coma, Headache, Diplopia, Neurologic deficits, seizures

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55
Q

Tx for Hypoglycemia

A

Glucose (IV or PO)

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56
Q

What are sx of a transfusion reaction

A

Fever, Chills, Nausea, Hypotension, lumbar pain, chest pain, abnormal bleeding

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57
Q

Tx for transfusion hemolysis

A

Stop transfusion, provide fluds, perform diuresis (Lasix) to protect kidenys, give pressors if needd

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58
Q

What factor is deficient in Hemophilia A

A

Factor 8

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59
Q

What is the preoprative treatment for Hemophilia A

A

Factor 8 infusion to more than 100% normal preoperative levels

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60
Q

What coagulation study is elevated with Hemophilia A

A

PTT

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61
Q

What factor is deficient in Hemophilia B

A

Factor 9

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62
Q

What is Von Willebrand’s Disease

A

Deficiency of vWF and Factor 8:C

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63
Q

What is used to correct Von Willebran’d Disease

A

DDAVP or Cryoprecipitate

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64
Q

What coagulation is abnormal with
Hemophilia A
Hemophilia B
vWF

A 
Hem.A = PTT is elevated
Hem.B = PTT is elevated
vWF = Bleeding Time
65
Q

What is the effect on the coagulation of a patient with deficiency in Protein C, Protein S, or Antithrombin III

A

Hypercoaguable state

66
Q

What is the most common inherited Hypercoaguable state

A

Factor V Leiden

67
Q

What is the most common cause of fever during post-op day 1 or 2

A

Atelectasis = Collapse of Alveoli

68
Q

Tx of Atelectasis

A

Incentive Spirometry, deep breathing, coughing, early ambulation, NT suctioning and chest PT

69
Q

What are causes of postoperative pleural effusions

A

Fluid overload, pneumonia, diaphragmatic inflammation with possible subphrenic abscess formation

70
Q

Tx for posoperative wheezing

A

Alubetrol Nebulizer

71
Q

What is a PE

A

DVT that embolizes to pulmonary arterial system

72
Q

Sx of DVT

A

Lower extremity pain, swelling, tenderness, Homan’s Sign, PE

73
Q

Dx of DVT

A

Duplex Ultrasound

74
Q

What is Virchow’s Triad

A

Stasis, Endothelial Injury, Hyprcoaguable state

75
Q

Sx of PE

A

SOB, Tachypnea, Hypotension, CP, Fever, Hemoptysis

76
Q

Dx for PE

A

CT Angiogram, V/Q Scan

77
Q

What are Chest Xray signs of PE

A

Westermark’s Sign (Wedge shaped area of decreased pulmonary vasculature)
Opacity with base at pleural edge from pulmonary infarct

78
Q

Tx for PE if patient is stable

A

Anticoagulation (Heparin followed by Coumadin)

79
Q

Tx for PE if patient is unstable

A

Thrombolytic Therapy

80
Q

What are risk factors for aspiration pneumonia

A

Intubation/Extubation, drugs, alcohol, dysphagia, nonfunctioning NGT

81
Q

Sx of Aspiration Pneumonia

A

Respiratory failure, CP, Increased Sputum, Fever, Cough, Mental Status Changes

82
Q

What organisms are involved in Aspiration Pneumonia

A

CAP: Gram Positive

Hospital/ICU: Gram Negative Rods

83
Q

Dx of Aspiration Pneumonia

A

CXR, Sputum Culture

84
Q

Tx for Aspiration Pneumonia

A

Bronchoscopy, Abx

85
Q

What are possible NGT complications

A

Aspiration-Pneumonia/Atelectasis
Sinusitis
Minor UGI bleeds

86
Q

Sx of Gastric Dilatation

A

Abdominal Distension, Hiccups, Electrolyte Abnormalities, Nausea

87
Q

Tx for Gastric Dilatation

A

NGT Decompression

88
Q

What is Postoperative Pancreatitis

A

Pancreatitis resulting from manipulation of pancreas during surgery or low blood flow during procedure, gallstones, hypercalcemia, meds

89
Q

What lab tests are performed for pancreatitis

A

Lipase and Amylase

90
Q

Tx for Pancreatitis

A

NPO, Aggressive fluid resuscitation, NGT PRN

91
Q

What are postoperative causes for Constipation

A

Narcotics, Immobility

92
Q

Tx for Constipation

A

Ortho Bowel Routine: Docusate sodium, Dicacoyl suppository if no bowel movement occurs, Fleet enema if suppository is ineffctive

93
Q

What is Short Bowel Syndrome

A

Malabsorption and diarrhea resulting from extensive bowel resection

94
Q

Tx for Short Bowel Syndrome

A

TPN early, followed by many small meals chronically

95
Q

What causes SBO

A

Adhesions, Incarcerated hrnia

96
Q

What causes Ileus

A

Laparotomy, Hypokalemia or Narcotics, Intraperitoneal Infection

97
Q

What are the signs of resolving ileus/SBO

A

Flatus, Stool

98
Q

What is the order of recovery of bowel function after abdominal surgery

A

First small intestine
Second stomach
Third Colon

99
Q

What is Blind Loop Syndrome

A

Bacterial Overgrowth in the small intestine

100
Q

What are causes of Blind Loop Syndrome

A

Anything that disrupts the normal flow of intestinal contents

101
Q

What are surgical causes of B12 Deficiency

A

Gastrectomy (decreased secretion of intrinsic factor) and excision of ileum (site of B12 absorption)

102
Q

What is Dumping Syndrome

A

Delivery of hyperosmotic chyme to the small intestine causing massive fluid shifts into the bowel
Normally the stomach will decrease the osmolality of the chyme prior to its emptying

103
Q

With what condition is Dumping Syndrome associated with

A

Any procedure that bypasses the pylorus or compromises its function (Gastroeterostomies or pyloroplasty)

104
Q

Sx of Dumping Syndrome

A

Postprandial Diaphoresis, Tachycardia, Abdominal Pain/Distention, Emesis, Increased Flatus, Dizziness, Weakness

105
Q

Dx of Dumping Syndrome

106
Q

Tx of Dumping Syndrome

A

Small, multiple, low fat/carb meals that are high in protein

Avoid liquids with meals to slow gastric emptying

107
Q

Surgical tx of Dumping Syndrome

A

Converstion to Roux-en-Y

108
Q

What is DKA

A

Deficiency of body insulin, resulting in hyperglycemia, formation of ketoacids, osmotic diuresis and metabolic acidosis

109
Q

Sx of DKA

A

Polyuria, tachypnea, dehydration, confusion, abdominal pain

110
Q

Lab values seen with DKA

A

Elevated glucose, increased anion gap, hypokalemia, urine ketones, acidosis

111
Q

Tx of DKA

A

Insulin drip, IVF rehydration, Potassium Supplement

112
Q

What is Addisonian Crisis

A

Acute Adrenal Insufficiency in the face of a stressor (surgery, trauma, infection)

113
Q

Cause of Addison Crisis

A

Postoperative, inadequate cortisol release usually results from steroid administration in the past year

114
Q

Sx of Addison Crisis

A

Tachycardia, N/V, diarrhea, abdominal pain, hypotension, eventual hypovolemic shock

115
Q

What are typical lab values seen with Addison Crisis

A

Decreased Sodium

Increased Potassium

116
Q

Tx of Addison Crisis

A

IVF, hydrocortisone IV, Fludrocortisone PO

117
Q

What is SIADH

A

Inappropriate ADH Secretion

118
Q

What does ADH do

A

ADH increases sodium and water resportion in the kidney

Increases intravascular volume

119
Q

What causes SIADH

A

Mainly lungs/CNS

CNS trauma, oat-cell lung cancer, pancreatic cancer, duodenal cancer, pneumonia/lung abscess

120
Q

Tx of SIADH

A

Restrict fluid intake

Tx underlying cause

121
Q

What is Diabetes Insipidus

A

Failure of ADH renal fluid conservation resulting in dilute urine in large amounts

122
Q

What is the source of ADH

A

Posterior Pituitary

123
Q

What are the 2 types of Diabetes Insipidus

A

Central: Decreased production of ADH
Nephrogenic: Deceased ADH effect on kidney

124
Q

What are causes of Central Diabetes Insipidus

A

Brain injury, tumor, surgery and infection

125
Q

What are causes of nephrogenic Diabetes Inspidus

A

Amphoterecin B, Hypercalcemia and Chronic Kidney Infection

126
Q

Tx for Diabetes Insipidus

A

Fluid replacement
Central: Pressin
Nephrogenic: Thiazide

127
Q

What are the common causes of dyspnea following central line placement

A

Pneumothorax
Pericardial Tamponade
Carotid puncture, air embolism

128
Q

What is the most dangerous period for postoperative MI following a previous MI

A

6 months after an MI

129
Q

What are risk factors for postoperative MI

A

History of MI
Angina
Q waves
JVD, CHF, Aortic Stenosis, Advanced Age, MI within 6 months, EKG changes

130
Q

How do postoperative MI’s present

A

Without chest pain
New onset CHF, new onset dysrhythmia
Hypotension, Tachypnea, Tachycardia, N/V

131
Q

What lab tests are indicated for suspected MI

A

Troponin

CK (Cardiac Isoenzymes)

132
Q

Tx for postoperative MI

A 
MONA-BASH (for CHF), for MI it's MONA-BH
Morphine
Oxygen
Nitrates
ASA
Beta Blockers
Ace-I
Statins
Heparin
133
Q

What is a CVA

A

Cerebrovascular Accident

134
Q

Sx of CVA

A

Aphasia, Motor/Sensory Deficits

135
Q

Dx of CVA

A

CT (rule out hemorrhage)

Carotid Doppler Ultrasound

136
Q

Tx for CVA

A

ASA, Heparin

Thrombolytic therapy not usually post-op option

137
Q

Perioperative prevention for CVA

A

Avoid Hypotension

ASA

138
Q

What is Postoperative Renal Failure

A

Increase in serum creatinine and decreas in creatinine clearance, usually associated with decreased urine output

139
Q

What are reasons for prerenal Renal Failure

A

Inadequate blood perfusion to kidney

Inadequate fluids, Hypotension, CHF

140
Q

What are reasons for intrarenal Renal Failure

A

Kidney Parechymal Dysfunction

Acute Tubular Necrosis, Nephrotoxic Contrast, Drugs

141
Q

What are reasons for Postrenal Rena Failure

A 
Obstruction to outflow of urine from Kidney
Foley catheter obstruction
stone
Ureteral/urethral injury
BPH
Bladder dysfuntion
142
Q

What is Abdominal Compartment Syndrome

A

Increased intra-abdominal pressure usually seen after laparotomy or after massive IVF resuscitation (burn patients)

143
Q

Sx of Abdominal Compartment Syndrome

A

Tight distended abdomen, decreased urine output, increased airway pressure, increased intra-abdominal pressure

144
Q

Tx for Abdominal Compartment Syndrome

A

Release the pressure by placing a drain or by opening the abdomen and place a sheet of synthetic material to the skin to allow for more intra-abdominal volume

145
Q

Sx of Wound Infection

A

Erythema, Swelling, Pain, Heat

146
Q

Tx of Wound Infection

A

Open wound, leave open with wet to dry dressing changes, abx if cellulitis

147
Q

What is fascial dehiscence

A

Acute separation of fascia that has been sutured closed

148
Q

Tx for Fascial Dehiscence

A

Bring back to OR for reclosure of fascia

149
Q

What is a wound infection

A

Infection in an operative wound

150
Q

When do wound infections typically arise

A

5-7 days postoperatively

151
Q

Sx of Wound Infection

A

Pain at incision site, erythema, drainage, induration, warm skin, fever

152
Q

Tx of Wound Infection

A

Remove skin sutures/staples, perform digital exam to rule out fascial dehiscence, pack wound open, snd wound cultures, give abx

153
Q

What are common bacteria found in Wound Infections

A

Staph Aureus
E.Coli
Enterococcus

154
Q

What bacteria cause fever in wound infections in the first 24 hours after surgery

A

Streptococcus

C.Diff

155
Q

What is post-operative Fever

A

Temperature >101.5

156
Q

What are the classic W’s (causes) of postoperative Fever

A 
Wind: Atelectasis
Water: UTI
Wound: Infection
Walking: DVT/Thrombophlebitis
Wonder Drugs: Drug Fever
157
Q

What is the most common cause of fever on postoperative day 1 and 2

A

Atelectasis

158
Q

What causes fever from postoperative day 3-5

A

UTI, Pneuonia, IV site infection, wound infection

159
Q

What causes fever from postoperative day 5-10

A

Wound infection, pneumonia, abscess, infected hematoma, C.Diff Colitis, DVT, Peritoneal Abscess, Drug Fever

Surgery (12 decks)

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