PreTest Surgery: Pre- and Postoperative Care Flashcards
<p>Review the symptoms of hypermagnesemia as levels rise. </p>
<p>•Loss of DTRs
•Flaccid paralysis
•Hypotension
•AMS </p>
<p>What are the two most common causes of hypermagnesemia? </p>
<p>•Iatrogenic (giving MgSO4 to treat preeclampsia)
| •Advanced renal failure with magnesium supplementation</p>
<p>Urine sodium less than \_\_\_\_\_\_\_\_ mEq/L is indicative of prerenal azotemia. </p>
<p>20 </p>
<p>Early signs of hypomagnesemia include \_\_\_\_\_\_\_\_\_\_\_\_\_\_.</p>
<p>tetany, hyperreflexia, prolonged QT, and paresthesias </p>
<p>Describe the standard prophylactic antibiotic regimen. </p>
<p>A single dose of parenteral antibiotics no greater than 1 hour prior to the incision
Colon surgeries warrant an additional oral dose against anaerobes and aerobes as part of the bowel prep. </p>
<p>What does "uncompensated metabolic alkalosis" mean? </p>
<p>The pCO2 is normal (i.e., around 40). If the pCO2 were elevated to compensate, then it would be metabolic alkalosis with respiratory acidosis. </p>
<p>How do you treat heparin-induced thrombocytopenia? </p>
<p>Cease the heparin and switch to a non-heparin agent: bivalirudin, lepirudin, or dabigatran </p>
<p>A patient develops bleeding three hours post-op from the wound. Coagulation labs are normal with the exception of decreased fibrinogen. What is the likely cause? </p>
<p>Incomplete control of bleeding in the surgical incision </p>
<p>Any signs of \_\_\_\_\_\_\_ (a cardiac condition) warrant further workup before elective surgery. </p>
CHF
<p>How are DVTs in pregnant women treated? </p>
Heparin or enoxaparin
Remember that warfarin is a teratogen.
<p>List the four SIRS criteria. </p>
- T: > 38ºor < 36º
- HR: > 90
- RR: > 20 or PaCO2 < 32
- WBC: > 12,000 or < 4,000
<p>Patients receiving massive transfusions for hemorrhagic shock require what two additional things? </p>
Platelets and FFP
Research shows that patients arriving in hemorrhagic shock are generally coagulopathic and need FFP. Additionally, transfusions lead to dilutional thrombocytopenia.
<p>In patients who've had bowel surgery and are expected to have prolonged recoveries, it's best to start J-tube feeds \_\_\_\_\_\_\_\_\_\_\_\_\_\_.</p>
within 24 hours
It used to be thought that the bowel was paralyzed after bowel surgery and needed days to recover, but new research shows that the bowel can start absorbing within 24 hours afterward. Those who are well nourished can go up to ten days without feeds, so only those with prolonged recoveries should do so.
What lab values and vital signs suggest adrenal insufficiency?
- Hypoglycemia
- Hyperkalemia
- Hyponatremia
- Fever
- Hypotension
A patient has a clotting factor disorder and requires surgery. When should you administer FFP?
On call to surgery
The half-life of clotting factors is as little as 4 hours for some of the proteins.
Review the mnemonic for fistula formation.
Two lumens become FRIENDS through a fistula: •Foreign bodies •Radiation •Inflammation •Epithelialization of the tract •Neoplasm •Distal obstruction • Steroids
True or false: give FFP to hemophiliacs prior to surgery to treat bleeding.
False
FFP has factors VIII and IX, but the quantities are too small to adequately treat bleeding. You need to give DDAVP and aminocaproic acid (an inhibitor of tPA) to treat the bleeding.
When do you need to stop aspirin and the other NSAIDs prior to elective surgery?
- Aspirin: 1 week
- Other NSAIDs: 3-4 days
ASA is irreversible and thus inhibits them for longer.
A patient presents after sigmoid resection with new-onset hydronephrosis. What diagnostic should they get?
Intravenous pyelogram (for suspected ureteral injury)
What are the two tiers of calcium replacement?
- Mild: oral calcium gluconate
* Severe: IV calcium gluconate
List ways to reduce the likelihood of postoperative wound infection.
- Treat any underlying infections prior to surgery
- Maximize host immune status: reduce steroid/immunosuppressants if possible; optimize nutritional status; minimize hospital stay
- Minimize tissue damage and incision length
- Use closed drainage systems
What ratio of fluid replacement to blood loss is standard for NS, LR, and colloid?
- NS: 3:1
- LR: 3:1
- Colloid: 1:1
If you need to replace a lot of volume in a Jehovah’s Witness, you should use ____________.
LR
NS can cause non-AG metabolic acidosis in those receiving liters of fluid, whereas LR doesn’t.
They give you a question that says “long-term hospitalized patient is losing lots of fluid through his NG” and then ask about fluid replacement. What’s the correct answer?
Replace the NG fluid with LR and then do maintenance rate.
Why do you give bicarb in those with hyperkalemia?
The mild alkalosis causes a shift of potassium into cells.
True or false: hypoglycemia is an early sign of sepsis.
False
Sepsis causes a surge of stress hormones: epinephrine, cortisol, and glucagon. This leads to an early hyperglycemia in both diabetic and nondiabetic patients with sepsis.
List three features of early sepsis.
- Tachypnea
- Flushing / peripheral vasodilation
- AMS
Hemolytic transfusion reactions lead to ________________.
hypotension and oliguria
How do you treat hemolytic transfusion reactions?
Aggressive fluid resuscitation and mannitol
The main worry is that hemolyzed RBC membranes will lead to glomerular damage. Thus, you need administer fluid and mannitol to stimulate diuresis which will clear the nephrons.
How do calorie replacements vary in starvation, after surgery, during organ failure, and after a massive burn?
- Starvation: decrease by 10% (due to decreased metabolic rate)
- After surgery: increase by 10%
- Organ failure: increase by 50%
- Massive burn: increase by 100%
