Preop/Postop Flashcards
If the patient has a prior history of myocardial infarction, there is what percent of risk of postoperative MI
5% to 10% risk
Which patients get a preop EKG
- Preoperative EKG on patients 40 years of age and older
Should pts take antihtn meds day of surgery
- Patient should take antihypertensive medication on the day of the procedure
How long should smokers stop smoking before surgery?
Optimally, patients who smoke should stop smoking at least 8 weeks before the scheduled surgery
If a pt has COPD what precautions need to be taken prior to surgery?
- A minimum of one week of therapy including cessation of smoking administration of antibiotics for purulent sputum and bronchodilators when indicated
What should pts with poorly controlled asthma be treated with?
- 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
For patients who require endotracheal intubation and have asthma when should a rapid beta agonist be given?
- 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
What type of pulmonary disease is contraindicated for surgery?
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
What is the normal range for postop insulin ranges?
- Normal: 90 to 100 mg/dL, preferred; control with IV insulin
- Moderate control: 120 to 200 mg/dL
Best tx option for DVT prophy?
- Subcutaneous heparin and low-molecular-weight heparin are equivalent in reducing both deep venous thrombosis and pulmonary embolism
5 Ws of postop fever
- Wind—atelectasis - First 24 to 48 hours UTI
- Water—urinary tract infection (UTI) - Anytime after POD #3
- Wound—wound infection - Usually after POD #5 (but it can be anytime!)
- Walking—DVT/thrombophlebitis - PODs #7 to #1
- Wonder drugs—drug fever - Anytime
When do wound infections usually appear postop?
Wound infections usually appear between the fifth and tenth days after surgery
MC bug in postop wounds
Staph
Tx of postop wound infection
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
Virchow’s triad:
- Virchow’s triad: stasis, vascular injury, hypercoagulable state (OCP, cancer, surgery, factor V Leiden)
discomfort behind the knee on forced dorsiflexion of the foot
Homan sign = DVT
What is daily maintenance fluids for average adult
- Daily maintenance for sensible and insensible loss in adult = 1500 to 2500 mL depending on age, gender, weight, BSA
What qualifies as increased requirements for fluids
- Increased requirements for fever, hyperventilation, and increased catabolism IV fluid replacement for a short period (most)
What is the general rule for maintenance fluids daily
2000 to 2500 mL of 5% dextrose in normal saline or lactated Ringer’s solution delivered daily
Why do you not add potassium to fluids in the first 24hrs
- Do not add potassium during the first 24 hours because K+ is already increased during surgery (stress)
Indications of foley
- Indications for urinary catheter placement: (1) anticipating long procedure, (2) performing urologic or low pelvic surgery, (3) need to monitor fluid balance
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 -
- 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
Causes of Deficient secretion of vasopressin
(ADH - anti-piss-hormone) from the posterior pituitary - Neurogenic (central) Diabetes insipidus
Average values of acid/base
HCO3, pH, CO2
- 24 (HCO3, base) / 7.40 (pH) / 40 (CO2, acid)
“24/7 40/40”
Causes of resp acidosis
Lungs fail to excrete CO2 (Breathing too slow (holding onto CO2), pulmonary disease, neuromuscular disease, drug-induced hypoventilation - opiates, barbiturates)
Causes of resp alkalosis
Excessive elimination of CO2 (Breathing too fast (blowing of CO2), pulmonary embolism, fever, hyperthyroid, anxiety, salicylate intoxication, septicemia )
Causes of metabolic acidosis
-
MUDPILES:
- Methanol
- Uremia
- Diabetic Ketoacidosis
- Paraldehyde
- Infection
- Lactic Acidosis
- Ethylene Glycol
- Salicylates
Causes of metabolic alkalosis
Loss of hydrogen (vomiting), bulimia, overdose of antacids, the addition of bicarbonate (hyperalimentation therapy)
