Preoperative and Postoperative Care Flashcards
What is cardiac disease?
history of myocardial infarction, unstable angina, valvular disease, hypertension, arrhythmias, heart failure
-If the patient has a prior history of myocardial infarction, there is a 5 to 10% risk of postoperative MI
What are the characteristics of cardiac disease pre and post surgery?
- preoperative EKG on patients 40 years of age and older
- If current unstable angina - avoid elective surgeries
- If stage two HTN - control prior to surgery
- patient should take antihypertensive medication on day of the procedure
- If a history of rheumatic heart disease - provide prophylactic antibiotic therapy
- send the patient to a cardiologist for clearance to have a stress test or echo if any concerns
What are some pulmonary diseases?
history of asthma, chronic obstructive pulmonary disease
-optimally, patients who smoke should stop smoking at least 8 weeks before the scheduled surgery
What are the characteristics of chronic obstructive lung disease pre and post surgery?
- patients with COPD should be aggressively treated in order to achieve their best possible baseline level of function
- a minimum of one week of therapy including cessation of smoking administration of antibiotics for purulent sputum and bronchodilators when indicated
What are the characteristics of asthma pre and post surgery?
poorly controlled asthma is a risk factor for the development of postoperative pulmonary complications, but well-controlled asthma appears to confer little additional risk
- patient 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 (PERF) are below their predicted values or personal best
- for elective surgery, patients should be free of wheezing and have a peak expiratory flow rate greater than 80 percent of predicted or of their personal best prior to surgery
- for patients who require endotracheal intubation, administer an inhaled rapid-acting beta agonist two or four puffs or a nebulizer treatment within 30 minutes before intubation
- one to two days of systemic glucocorticoid therapy has sometimes been advised as a method to prevent acute bronchooconstriction at the time of intubation
What are the characteristics of pulmonary fibrosis and restrictive lung disease pre and post surgery?
preoperative preparation is similar to that for any other lung disease and consists of treatment of infection, removal of sputum, and discontinuance of smoking
What are the characteristics of acute lower respiratory infection (tracheitis, bronchitis, and pneumonia) pre and post surgery?
- these infections are absolute contraindications to elective surgery
- for emergency surgery, therapy includes humidification of inhaled gas is, removal of lung secretions, and continued administration of bronchodilators and antibiotics
What are some metabolic diseases that affect surgery?
history of diabetes, adrenal insufficiency
-Intravenous insulin is best for preoperative glucose control due to its rapid onset of action, short half-life, and immediate availability (as opposed to subcutaneous injection)
What is the postoperative glycemic control?
- normal: 90 to 100 mg/dL, preferred; control with IV insulin
- moderate control: 120 to 22 mg/dL
What do you need to monitor for postoperative?
hyperglycemia or hypoglycemia, infection, poor healing and wound issues, CVD: double risk for men, quadruple the risk for women
What are the hematologic diseases that can effect surgery?
history of clotting disorders, anticoagulant use
- deep venous thrombosis was diagnosed in 20% of general surgery patients and 30% of colorectal patients without prophylaxis
- subcutaneous heparin and low-molecular-weight heparin are equivalent in reducing both deep venous thrombosis and pulmonary embolism
- scoring systems stratify patients by their probability of developing a postoperative VTE to guide preventative measures
- caprini score for venous thromboembolism
- american college of chest physicians recommendations
What are the characteristics of tobacco use/dependence?
cigarette smoking is the leading preventable cause of death in the United States
- cigarette smoking causes more than 480,000 deaths each year in the United States, this is nearly one in five deaths
- smoking causes more deaths each year than the following causes combined:
- human immunodeficiency virus (HIV)
- Illegal drug use
- alcohol use
- motor vechile injuries
- firearm-related incidents
What are the symptoms of tobacco intoxication?
restlessness, insomnia, anxiety, arrhythmias
What are the symptoms fo tobacco withdrawal?
irritability, headache, anxiety, weight gain, craving
What is the tx for tobacco cessation?
- bupropion
- varenicline (chantix): partial nicotine receptor agonist, mediates partial reward of nicotine yet blocks reward of nicotine
- the highest success rate of all anti-smoking drugs, particularly when stacked with nicotine patches
- nicotine administration via other routes
What is alcohol use disorder?
a problematic pattern of alcohol use leading to clinically significant impairment or distress
What is cannabis-related disorder?
a problematic pattern of cannabis use leading to clinically significant impairment or distress, occurring within a 12-month period
What is hallucinogen-related disorders?
- PCP: patient that is extremely aggressive and becomes enraged when sudden movements or loud sounds are made
- LSD: patients wants to hurt himself, they say that he has “been freaking out” and seeing things that are not there
What are inhalant-related disorders?
inhalation of certain gases found in pain, petroleum, toluene, glues, and nail polish produce the sam effects of a volatile anesthetic
-mechanism of action unknown
What are opioid-related disorders?
mu receptor agonist - examples: morphine, heroin, methadone
What are sedative-, hypnotic-, or anxiolytic-related disorders?
- benzodiazepines used for the treatment of anxiety disorders, they have additive effects with alcohol and tend to have a cumulative effect if doses are repeated indiscriminately
- Barbiturates GABA channel - increased the duration of opening
What are stimulant-related disorders?
- cocaine: block biogenic amine (dopamine (DA), norepinephrine (NE) and serotonin (5-hydroxytryptamine; 5-HT)) reuptake
- amphetamines: methamphetamine, dextroamphetamine (dexedrine), methylphenidate (concerta), stimulates biogenic amine (dopamine (DA), norepinephrine (NE), and serotonin (5-hydroxytryptamine; 5=HT) release + decreases reuptake (high dose)
- MDMA (ecstasy): similar to amphetamines, effects 5-HT more than dopamine, may damage seotonergic neurons
What are tobacco-related disorders?
cigarette smoking is the leading preventable cause of death in the United States
What are the classic 5 W’s of postoperative 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 #7-10
- Wonder drugs - drug fever - anytime
