Preop/Postop

Question 1

If the patient has a prior history of myocardial infarction, there is what percent of risk of postoperative MI

Answer 1

5% to 10% risk

Question 2

Which patients get a preop EKG

Answer 2

• Preoperative EKG on patients 40 years of age and older

Question 3

Should pts take antihtn meds day of surgery

Answer 3

• Patient should take antihypertensive medication on the day of the procedure

Question 4

How long should smokers stop smoking before surgery?

Answer 4

Optimally, patients who smoke should stop smoking at least 8 weeks before the scheduled surgery

Question 5

If a pt has COPD what precautions need to be taken prior to surgery?

Answer 5

• A minimum of one week of therapy including cessation of smoking administration of antibiotics for purulent sputum and bronchodilators when indicated

Question 6

What should pts with poorly controlled asthma be treated with?

Answer 6

• Patients whose asthma is not well-controlled should receive a step-up in asthma therapy; this may include a brief course of systemic glucocorticoids in patients whose forced expiratory volume in one second (FEV₁) or peak expiratory flow rate (PEFR) are below their predicted values or personal best

Question 7

For patients who require endotracheal intubation and have asthma when should a rapid beta agonist be given?

Answer 7

• For patients who require endotracheal intubation, administer an inhaled rapid-acting beta agonist two to four puffs or a nebulizer treatment within 30 minutes before intubation

Question 8

What type of pulmonary disease is contraindicated for surgery?

Answer 8

Acute lower respiratory tract infections (tracheitis, bronchitis, and pneumonia)

• For emergency surgery, therapy includes humidification of inhaled gas is, removal of lung secretions, and continued administration of bronchodilators and antibiotics

Question 9

What is the normal range for postop insulin ranges?

Answer 9

• Normal: 90 to 100 mg/dL, preferred; control with IV insulin
  
  • Moderate control: 120 to 200 mg/dL

Question 10

Best tx option for DVT prophy?

Answer 10

• Subcutaneous heparin and low-molecular-weight heparin are equivalent in reducing both deep venous thrombosis and pulmonary embolism

Question 11

5 Ws of postop fever

Answer 11

1. Wind—atelectasis - First 24 to 48 hours UTI
2. Water—urinary tract infection (UTI) - Anytime after POD #3
3. Wound—wound infection - Usually after POD #5 (but it can be anytime!)
4. Walking—DVT/thrombophlebitis - PODs #7 to #1
5. Wonder drugs—drug fever - Anytime

Question 12

When do wound infections usually appear postop?

Answer 12

Wound infections usually appear between the fifth and tenth days after surgery

Question 13

MC bug in postop wounds

Answer 13

Staph

Question 14

Tx of postop wound infection

Answer 14

Treatment includes removal of skin sutures/staples, rule out fascial dehiscence, pack wound open, send wound culture, administer antibiotics

• Delayed closure — Traditionally, wounds that have been opened due to infection are left to heal by secondary intention

Question 15

Virchow’s triad:

Answer 15

• Virchow’s triad: stasis, vascular injury, hypercoagulable state (OCP, cancer, surgery, factor V Leiden)

Question 16

discomfort behind the knee on forced dorsiflexion of the foot

Answer 16

Homan sign = DVT

Question 17

What is daily maintenance fluids for average adult

Answer 17

• Daily maintenance for sensible and insensible loss in adult = 1500 to 2500 mL depending on age, gender, weight, BSA

Question 18

What qualifies as increased requirements for fluids

Answer 18

• Increased requirements for fever, hyperventilation, and increased catabolism IV fluid replacement for a short period (most)

Question 19

What is the general rule for maintenance fluids daily

Answer 19

2000 to 2500 mL of 5% dextrose in normal saline or lactated Ringer’s solution delivered daily

Question 20

Why do you not add potassium to fluids in the first 24hrs

Answer 20

• Do not add potassium during the first 24 hours because K+ is already increased during surgery (stress)

Question 21

Indications of foley

Answer 21

• Indications for urinary catheter placement: (1) anticipating long procedure, (2) performing urologic or low pelvic surgery, (3) need to monitor fluid balance

Question 22

What electrolyte disorder causes the following?

• Peaked T waves -
• Flattened T waves U waves -
• Long QT -
• Short QT -
• Tall T waves -
• Prolonged PR interval widened QRS -

Answer 22

• Peaked T waves - Hyperkalemia
• Flattened T waves U waves - Hypokalemia
• Long QT - Hypocalcemia
• Short QT - Hypercalcemia
• Tall T waves - Hypomagnesemia
• Prolonged PR interval widened QRS - Hypermagnesemia

Question 23

Causes of Deficient secretion of vasopressin

Answer 23

(ADH - anti-piss-hormone) from the posterior pituitary - Neurogenic (central) Diabetes insipidus

Question 24

Average values of acid/base

HCO3, pH, CO2

Answer 24

• 24 (HCO3, base) / 7.40 (pH) / 40 (CO2, acid)

“24/7 40/40”

Question 25

Causes of resp acidosis

Answer 25

**Lungs fail to excrete CO2** (Breathing too slow (holding onto CO2), pulmonary disease, neuromuscular disease, drug-induced hypoventilation - opiates, barbiturates)

Question 26

Causes of resp alkalosis

Answer 26

**Excessive elimination of CO2** (Breathing too fast (blowing of CO2), pulmonary embolism, fever, hyperthyroid, anxiety, salicylate intoxication, septicemia )

Question 27

Causes of metabolic acidosis

Answer 27

* **MUDPILES:** * Methanol * Uremia * Diabetic Ketoacidosis * Paraldehyde * Infection * Lactic Acidosis * Ethylene Glycol * Salicylates

Question 28

Causes of metabolic alkalosis

Answer 28

Loss of hydrogen **(vomiting)**, bulimia, overdose of antacids, the addition of bicarbonate (hyperalimentation therapy)