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Surgery EOR > PreOp/PostOp Care (Alice) > Flashcards

PreOp/PostOp Care (Alice) Flashcards

1
Q

6 predictors of surgical cardiac complications

what level of serum creatinine?

A

ischemic heart dz
CHF
cerebrovascular dz
high risk operation
pre op tx w. insulin
pre op SCr > 2.0

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2
Q

5 other rf for surgical cardiac complications

A

age
smoking
abnl cardiac stress test
long term bb therapy
COPD

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3
Q

pre op management of pt w. rheumatic heart dz

A

prophylactic abx

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4
Q

who should get a pre op EKG

A

all pt’s >/= 40 yo

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5
Q

2 indications for noninvasive stress testing prior to noncardiac operations

A

active cardiac conditions: unstable angina, recent MI, significant arrhythmias, severe valvular dz
high risk vascular ops

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6
Q

6 indications for coronary revascularization prior to noncardiac ops

A

-significant left main coronary artery stenosis
-stable angina w. 3 vessel coronary dz
-stable angina w. 2 vessel dz
-significant proximal LAD coronary artery stenosis w. EF < 50% OR ischemia on noninvasive testing
-high-risk unstable angina or NSTEMI
-acute STEMI

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7
Q

why may it be dangerous to give a COPD pt supplemental O2 during surgery

A

pt relies on relative hypoxia for respiratory drive -> supplemental O2 may remove this drive

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8
Q

when should smokers stop smoking prior to surgery

A

at least 8 weeks prior

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9
Q

mc perioperative complications involve which system

A

pulmonary

pcc: post op pulmonary complications

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10
Q

2 determinants of pulmonary perioperative risk

A

lung dz
operative site

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11
Q

pre op management of COPD pt

A

minimum of one week of aggressive treatment:
-smoking cessation
-abx if purulent sputum
-bronchodilators

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12
Q

t/f: pt w. well controlled asthma is not at higher risk for perioperative complications

A

t!

but poorly controlled asthma is high risk

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13
Q

pre op management of poorly controlled asthma

A

-step up therapy
-systemic steroids if FEV < predicted value or personal best
-pre elective surgery goals: wheezing free, peak flows > 80% predicted or personal vest

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14
Q

intubation consideration for pt’s w. poorly controlled asthma

A

-SABA 2-4 puffs vs nebulizer w.in 30 mins before intubation

+/- systemic steroids

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15
Q

preop management of pulmonary fibrosis pt (3)

A

treat infxns
remove sputum
smoking cessation

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16
Q

pre op management of acute lower respiratory tract infxns (tracheitis, bronchitis, pna)

A

-elective surgeries are contraindicated!
-emergent surgeries: humidification, removal of secretions, bronchodilators, abx

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17
Q

location of operation for operative pulmonary risk

A

high to low:
torachotomy
upper abdomen
lower abdomen
periphery

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18
Q

what test is used for pre op pulmonary function eval

A
  1. spirometry to measure FEV
  2. if low FEV: measure response to bronchodilators, obtain ABGs
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19
Q

spirometry indications for increased risk for pulmonary complications (2)

A

FEV1 < 50% of normal
PaCO2 > 45 mm

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20
Q

surgeries lasting > _ are associated w. higher risk of pulmonary complications

A

3-4 hr

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21
Q

greatest risk ops for pulmonary complications (3)

A

upper abd
open aortic aneurysm repair
head/neck

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22
Q

lung protective ventilation should be used for _ ops, and involves _

A

abdominal ops

low tidal volume ventilation

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23
Q

post op management of pulmonary complications (3)

A

lung expansion
incentive spirometry
early mobilization

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24
Q

what is atelectasis

A

collapse of alveoli

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25
Q

7 rf for atelectasis

A

intubation
high flow O2
COPD
smoking
abd/thoracic surgery
oversedation
poor pain control

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26
Q

5 sx of atelectasis

PE and CXR findings

A

fever
decreased breath sounds
rales
tachypnea/tachycardia
increased densities on CXR

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27
Q

mc cause of fever POD 1-2

A

atelectasis

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28
Q

prevention for atelectasis (7)

A

pre op smoking cessation
incentive spirometry
good pain control
coughing
early ambulation
NT suctioning
chest physiotherapy

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29
Q

what is post op pulmonary failure

A

respiratory impairment w.:
increased RR
SOB
dyspnea

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30
Q

indications for intubation/ventilation (3)

A

-unconscious
-excessive wob
-progressive hypoxemia despite supplemental O2: PaO2 < 55, pH < 7.3, RR > 35

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31
Q

4 causes of post op pleural effusion

A

fluid overload
pna
diaphragmatic inflammation
subphrenic abscess

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32
Q

tx for absorption atelectasis

A

nitrogen

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33
Q

what is a non rebreather mask

O2 concentration + bag type

A

100% O2 w. reservoir bag

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34
Q

max FiO2 delivered by nonrebreather mask

A

80-90%

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35
Q

PaO2 to O2 sat equivalents

A

PaO2 40, 50, 60 = O2 sat 70, 80, 90

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36
Q

each liter of increased NC O2 increases FiO2 by _

A

3%-4%

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37
Q

max flow for NC O2

A

6 L

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38
Q

BG levels > _ are a predictor for surgical site infxn

A

140

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39
Q

best management of post op hyerglycemia

A

IV insulin

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40
Q

DM pt’s are at higher risk for _ post oc complications

A

cardiac

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41
Q

management of periop hyperglycemia (2)

A

IV short acting insulin
SQ SSI (sliding scale insulin)

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42
Q

patient-related conditions associated w. higher risk for surgical infxns (11)

A

advanced age
DM
malnutrition
smoking
obesity
immunosuppressive therapy
systemic steroids
PVD
malignancy/anti neoplastic tx
HIV/AIDS
liver failure
renal failure

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43
Q

what is virchow’s triad

A

stasis
hypercoagulable states
trauma

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44
Q

4 hypercoagulable states that Smarty PANCE stresses

hint, one is a blood disorder

A

factor V leiden
cancer
OCP + smoking
pregnancy

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45
Q

imaging for DVT: first line vs gs

A

first line: duplex US
gs: venography

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46
Q

tx for DVT

post-op I am thinking?

A

IV heparin bridge to warfarin

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47
Q

is DVT mc in left or right iliac vein

A

left

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48
Q

what surgery is especially high risk for post op DVT

A

colorectal

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49
Q

what 2 scoring systems are used to assess probability of developing post op DVT

A

caprini score
american college of chest physicians

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50
Q

heparin prophylaxis for DVT reduces risk for what 3 complications

A

wound hematomas
mucosal bleeding
reoperation

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51
Q

smoking w.in _ of surgery increases risk of complications

Basically if you had not quit smoking w/in this amount of time

A

1 year

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52
Q

best pharm for perio-op smoking cessation

A

bupropion

when op, use bupropion

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53
Q

screening rec for lung ca

A

low dose CT annually for adults 50-80 yo w. a 20 pack/year smoking hx and currently smoke or have quit in the last 15 yr

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54
Q

when can lung ca screening stop

Hint: x years w/out smoking is one of them

A

no smoking x 15 years
contraindication lung surgery

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55
Q

3 types of NRT

A

patch
gum
lozenges

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56
Q

NRT recommended for people who smoke 25 or more cigs/day

A

gum

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57
Q

NRT recommended for pt’s who smoke w.in 30 min of waking up

A

lozenges

helps your breath smell better?

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58
Q

what should be avoided w. NRT gum

A

acidig beverages

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59
Q

s.e of nicotine patches

and what you should do as a result

A

vivid dreams/insomnia
-> remove at bedtime

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60
Q

2 meds for smoking cessation

A

varenicline (chantix)
bupropion (zyban, wellbutrin)

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61
Q

moa for bupropion

A

enhances noradrenergic and dopaminergic release

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62
Q

how does varenicline work (3)

A

reduces withdrawal sx
reduces reward aspects

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63
Q

surgical problems associated w. SUD (7)

substance abuse disorder

A

venous access
arterial injury
DVT
abscess formation
gas gangrene
compartment syndrome
neuropraxia

64
Q

who should be screened pre op for SUD

A

all pt’s

65
Q

NIAAA definition of AUD

A

> 2 drinks/day for men
1 drink/day for women or >/= 65

66
Q

CAGE questionnaire

A

cut down?
annoyed?
guilt?
eye opener?

67
Q

how many drinks may cause BAC >/= 0.08

A

2

68
Q

complications of stimulant use

A

greater pressor/intubation response
need for more anesthetic

69
Q

complications fo volatile solvent abuse (4)

A

cardiomyopathy
dysrhythmia
sensitivity to sympathomimetics
myocardial dpn

70
Q

PCA usually involves what analgesic

A

morphine

71
Q

pharm for SUD (7)

A

naltrexone
acamprosate
disulfiram
topiramate
methadone
buprenorphine
naltrexone

72
Q

what are the 6 w’s of post op infxn

A

wind: atelectasis
water: UTI
wound: infxn
walking: thrombophlebitis
wonder drugs: anesthetic/sulfas causing fever
whopper: abscesses -> ileus, anastomotic leaking

73
Q

mc nocosomial infxn in hospital setting

A

UTI

74
Q

mc pathogen associated w. post op infxn

A

staph

75
Q

mcc of infxn > 72 hr post op

A

staph infxn

76
Q

mcc of superficial vs deep thrombophlebitis

A

superficial: intravascular catheter
deep: indwelling catheter

77
Q

tx for post op atelectasis

A

incentive spirometry
mucolytics
expectorants
SABA/LABA

best tx is prevention: smoking cessation

78
Q

tx for post op DVT

A

LMWH
heparin contraindication: greenfield filter

79
Q

definition of post op fever

A

> 38.5/101.5

80
Q

timeline of 5 w’s

A

wind: 24-48 hr
water: anytime after POD 3
wound: mc after pod 5
walking: pod 7-10
wonder drugs: anytime

81
Q

mcc of post op atelectasis

A

cytokine release from tissue damage

82
Q

4 causes of post op fever < 24 hr post op

A

atelectasis
cytokine release
strep vs clostridial infxn
anastomotic leak

83
Q

4 causes of fever POD 3-5

A

UTI
PNA
IV site infxn
wound infxn

84
Q

cause and tx of fever intraoperatively

A

malignant hyperthermia
dantrolene

85
Q

cause of fever POD 5-10 (lots!)

A

wound infxn
pna
abscess
infected hematoma
cdiff
anastomotic leak
DVT
peritoneal abscess
drug fever
PE
abscess
parotitis

86
Q

causes of wound infxn POD 1-2

A

strep clostridia

painful bronze-brown wound weeping

87
Q

3 anytime causes of post op fever

A

IV site infxn
central line infxn
meds

88
Q

surgical site infxns mc occur POD

A

5-7

89
Q

common bacteria associated w. surgical site infxns

A

staph - mc
e.coli
enterococcus

90
Q

what makes you think of clostridium infxn

A

bronze-brown weeping tender wound

91
Q

management of surgical site infxn (5)

A

remove sutures/staples
rule out fascial dehiscence
pack wound open
cultures
abx

92
Q

wounds that have been opened due to infxn usually heal by

A

secondary intention

93
Q

what is a clean contaminated wound

A

operation on GI or respiratory tract w.o unusual contamination or entr into biliary or urinary tract

94
Q

what is a contaminated wound (4)

A

acute inflammation
traumatic wound
GIT spillage
major break in sterile technique

95
Q

what is a dirty wound (3)

A

pus present
perforated viscus
dirty traumatic wound

96
Q

what factors influence the development of infxns (8)

A

foreign body
decreased blood flow
excessively tight sutures
excessive bovie (tissue destruction)
ops > 2 hr
hypothermia in OR
hematoma/seroma
dead space

97
Q

pt factors that increase rate of infxn

A

uremia
hypovolemic shock
vascular occlusive states
advanced age
distant area of infxn

98
Q

4 indications for abx after drainage of subcutaneous abscess

A

DM
surrounding cellulitis
prosthetic heart valve
immunocompromised

99
Q

what type of operation increases risk for AKI

A

cardiac

100
Q

how to reduce risk of AKI (2)

A

push fluids
avoid NSAIDs/IV contrast

101
Q

what should you avoid adding to fluids in the first 24 hr post op

A

K+

it is already high from stress

102
Q

3 indications for urinary catheter placement

A

long procedure
urologic/pelvic surgery
need to monitor fluid balance

103
Q

what electrolyte d.o causes prolonged QT

A

hypocalcemia

104
Q

what electrolyte d.o causes short QT

A

hypercalcemia

105
Q

what electrolyte d.o causes tall T waves

A

hypomagnesemia

106
Q

what electrolyte d.o causes prolonged PR interval and wide QRS

A

hypermagnesemia

107
Q

sx of hyponatremia (6)

A

peripheral/presacral edema
pulmonary edema
JVD
htn
decreased Hct
decreased BUN/Cr

108
Q

2 high risk pt pops for hyponatremia

A

etoh
malnourished

109
Q

3 types of hyponatremia

A

hypervolemic
hypovolemic
euvolemic

110
Q

4 causes of hypervolemic hypoNa

A

CHF
nephrotic syndrome
renal failure
cirrhosis

111
Q

causes of hypovolemic hypoNa

A

renal vs non renal sodium loss

112
Q

3 causes of euvolemic hypoNa

A

SIADH
steroids
hypothyroid

113
Q

consequences of acute hypoNa (3)

A

brainstem herniation
coma
sz

114
Q

sx of chronic hypoNa

A

motor/gait dysfxn
falls

115
Q

consequence of correcting chronic hypoNa too quickly

A

osmotic demyelination syndrome

116
Q

tx for hypoNa:

asymptomatic:
moderate:
severe:

A

asymptomatic: fluid restriction
moderate: IVNS, +/- diuretics
severe: 50 mL bolus 3% NS

117
Q

goal for chronic hypoNa correction

A

</= 10 mEq/L over 24 hr

118
Q

6 causes of hyperNa

A

diarrhea
burns
diuretics
hyperglycemia
dm insipidus
deficit of thirst (elderly)

119
Q

5 sx of hyperNa

A

poor skin turgor
dry mm
flat neck veins
hypotn
BUN:Cr > 20:1

120
Q

tx for hyperNA

A

D5W

121
Q

2 consequences of correcting hyperNa too quickly

A

cerbral edema
pontine herniation

122
Q

presentation of diabetes insipidus

A

low urine Na
high serum Na
polyuria

123
Q

2 types of diabetes insipidus

A

neurogenic (central)
nephrogenic

124
Q

what causes neurogenic diabetes insipidus

A

deficient secretion of vasopresin (ADH) from posterior pituitary

125
Q

what causes nephrogenic diabetes insipidus

A

kidneys are unresponsive to vasopressin (ADH)

think lithium vs renal dz

126
Q

3 causes of hyperK

A

AKI
late CKD
meds

127
Q

tx for hyperK (4)

A

insulin
sodium bicarb
glucose
calcium gluconate

128
Q

why must hyperK w. EKG changes must be treated asap

A

sine waves -> v-tach -> v-fib

129
Q

2 causes of hypoK

A

diuretics
cushing’s

130
Q

tx for hypoK

A

replace Mg first
oral vs IV K+

131
Q

what fluid should you not use when correcting hypoK

A

dex containing fluids

this will stimulate insulin release and shift K+ into the cell -> worse hypoK

132
Q

mcc of hypoCa

A

hypoparathyroidism

other: thyroid surgery, renal dz

133
Q

involuntary contraction of the muscles in the hand and wrist after compression of the upper arm

A

trosseau’s sign -> hypoCa

134
Q

tapping the cheeck ellicits twitching of the facial muscles

A

chvostek sign -> hypoCa

135
Q

tx for hypoCa

A

IV calcium gluconate
vs
calcium chloride

136
Q

lab findings of hypoCa

A

low: Ca, PTH
elevated: phosphate

137
Q

mcc of hyperCa

A

hyperparathyroidism

also:
sarcoidosis
TB
paget dz
metastatic ca
multiple myeloma

138
Q

presentation of hyperCa

A

stones
bones
abdominal groans
psychiatric moans

139
Q

labs of hyperCa

A

elevated: Ca, PTH
low: phos

140
Q

tx for hyperCa

A

IV NS
furosemide

141
Q

hyperCa in elderly is _ until proven otherwise

A

cancer

142
Q

presentation of hypoMg

A

muscle weakness
hyperreflexia
tachycardia

143
Q

EKG finding of hypoMg

A

torsades
prolonged QT
wide QRS

144
Q

tx for hypoMg

A

acute: IV Mg
chronic: oral Mg

145
Q

tx for hyperMg

A

IV isotonic saline
+/- diuretics

146
Q

cause of hyperphos

A

CKD

147
Q

tx for hyperphos

A

replace Ca
restrict K+

148
Q

4 sx of hyphoPhos

A

weakness
muscle/bone pain
osteomalacia
rickets

149
Q

norma range:
pH
PCO2
HCO3

A

pH: 7.34-7.45
PCO2: 35-45
HCO3: 20-26

150
Q

5 causes of respiratory acidosis

A

lungs fail to excrete CO2:
pulmonary dz
neuromuscular dz
drug induced hypoventilation
opiates
barbituates

151
Q

7 causes of respiratory alkalosis

A

excessive ellimination of CO2:
tachypnea
PE
fever
hyperthyroid
anxiety
salicylate intoxication
septicemia

152
Q

causes of metabolic acidosis w. increased anion gap

A

mudpiles:
methanol
uremia
dka
paraldehyde
infxn
lactic acidosis
ethylene glycol
salicylates overdose

153
Q

2 types of metabolic acidosis

A

increased anion gap >16
low anion gap < 16

154
Q

3 causes of metabolic acidosis w. low anion gap

A

diarrhea
pancreatic/biliary drainage
renal tubular acidosis

155
Q

3 causes of metabolic alkalosis

A

vomiting
bulimia
overdose of antacids

156
Q

what 2 organs play a major role in maintaining pH in the body

A

lungs
kidneys

Surgery EOR (17 decks)

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