PreOp Eval/PostOp Comps Flashcards
Common post operative problems and complications
- Inadequate pain control
Fever - Pulm, CV, GI, renal/urinary, neuro, and bleeding complications
- Infection
Post operative fever may indicate what?
Atelectasis UTI Wound infection Pneumonia Sepsis
low grade fever may be normal tissue trauma of surgery
Physiological cause of most post-op CV and pulmonary complications
acidosis, hypoxemia, and/or hypercarbia
volume disorders
Common GI complications post surgery
N/V - narcotics
Gastroparesis
GI bleed or stress ulcers
C. diff
How is MET’S significant in pre-operative eval?
Measure of energy expenditure
1 MET = sitting watching tv
4 MET = going up 1 flight of stairs
anything less than 4 increases post-op risk; asses CV and pulm more closely
What to ask for in history in pre-operative eval?
angina, prior MI CHF HTN valvular d/o rhythm d/o Recent URI Asthma/COPD Renal impairment prolonged bleeding, coagulopathies h/o TIA or stroke h/o anesthesia problems smoke? obese?
effects of over-sedation during surgery
atelectasis
Indications for antibiotic prophylaxis pre-surgery?
Valvular heart disease
Prosthetics (ex. total hip)
Certain procedures (ex. colon resection, knee arthroscopy)
Prophylaxis for pulmonary embolism post-surgery?
Get patients out of bed and moving
Mini-heparin; Lovenox
Pneumatic sequential stockings; ted hose for those at risk (hip surgery, Virchow’s triad)
Ulcer prophylaxis for ICU patients
PPI’s
H2 blockers/ antacid
Why do a preoperative eval?
decrease incidence of operative or post complications
Post-operative N/V (PONV) risk factors
female young motion sickness nonsmoker prior PONV
Prophylaxis for post-operative N/V
5HT-3 inhibitors
Scopalamine
Dexatmethosone
Metoclopromide
American Society of Anesthesiologists (ASA) classification of surgery patients
I: Normally healthy pt
II: Mild/controlled systemic dz
III: Non-incapacitating severe systemic dz
IV: incapacitating / threat to life systemic dz
V: Moribund pt not expected to survive 24 hrs w/ or w/o operation (basically dead)
- most facilities do not do class 3 or above due to high risk of complications
Why listen for carotid bruit in pre-op eval?
assess stroke risk
