Surgery 1 COPY Flashcards
1
Q
What is pre-medication
A
- Medication given before surgery
- e.g. sedatives, antiemetics
2
Q
What is elective surgery
A
- Surgeries that are planned in advance
- Not emergency, life-threatening surgeries
- May be for serious conditions however, such as cancer
3
Q
What is the pre-operative assessment
A
- Ensures pt fit for surgry
- Consent
4
Q
What is the peri-operative assessment
A
- Comprehensive review of the patient to determine their stability for surgery
- How to optimise existing medical conditions
Period between where patient is admitted –> pre meds –> surgery
5
Q
What is anastomosis
A
- Artificial connection made between two ends of the same organ during surgery
- Often between tubular structures e.g. blood vessels, loops of intestine
6
Q
What is wound dehiscence
A
- Breaking open of a wound/incision site
7
Q
What are adhesions
A
- Fibrous bands that form between tissues and organs as a result of injury during surgery
- It is scar tissue that attaches to organs
8
Q
Angio-
A
Relates to blood vessels
9
Q
Arthr-
A
Related to joints
10
Q
Colono- or col-
A
Related to large intestine
11
Q
Cysto-
think cystitis
A
Related to bladder
12
Q
Gastr-
A
Related to stomach
13
Q
Lapar-
A
Related to adbominal cavity
14
Q
Mammo and masto-
think ma to remember
A
Related to breasts
15
Q
Nephro-
A
Related to kidney
16
Q
-ectomy
A
To remove e.g. colectomy is removal of the whole colon
17
Q
-otomy
A
To open up
18
Q
-ostomy or -stomy
A
Artificial opening or hole
19
Q
-oscopic
A
- Use a scope - keyhole surgery, minimally invasive
20
Q
-plasty
think plastering
A
To modify or reshape
21
Q
8 Common surgical complications
A
- n+v
- infection
- pain
- wound dehiscence
- VTE
- haemorrhage
- fluid overload or dehydration
- paralytic ileus
22
Q
Why is VTE a risk after surgical
A
- VTE = blood clot forms in vein
- Immobility post op
- use of plaster casts
- disrupted vascular bed-thrombogenic surface
23
Q
8 patient related risks of VTE
A
- High BMI
- OCP (pill)
- HRT
- Diabetes
- Malignancy
- History of thrombosis
- Thrombophilia
- Pregnancy
24
Q
Haemorrhage
A
- Acute loss of blood from a damaged blood vessel
- Bleeding post op
- Causes: blood clotting disorders, complications from surgery, damage to internal organs
25
Why is fluid overload or dehydration a common surgical complication
* Under and over hydration
* Fluid and blood loss during procedure
26
What is paralytic ileus
* Intestinal blockage in the absence of an actual physical obsturction
* Caused by malfunction in the muscles and nerves of the intestine that impairs digestive movement
27
Pre-op assessment in elective surgeries - what does it involve
1. **Inform** patient of procedure + if they need to do anything e.g. food/drinks
2. **Conduct** relevant blood tests, X-rays etc
3. Determine **anaesthetic risk**
4. Consider if any meds should be **stopped**
5. Provide **alternatives** if necessary
6. Plan and predict for any post-op **complications**
7. Highlight if patient will be at risk of **malnutrition** post op (e.g. likely prolonged NBM periods, refer to dieticians)
28
# read over don't memorise
Roles of pre-op pharmacists (10)
* Taking DHx
* Writing inpatient medication chart
* Administration of medicines during pero-operative period
* Counselling
* Prescribing regular meds
* Advising on appropriate medicaiton management during peri-operative period
* Forsee post-op complications and recommend appropriate treatment
* Smoking cessation
* Producing guidelines for pre-op team
* Preparing for discharge
29
Anaesthesia clasification: ASA
## Footnote
6 classes ASA1-6
1. Healthy patients
2. Mild-moderate systemic disease
3. Severe systemic disease which limits activity but **not** incapacitating
4. Severe disease process that is a constant threat to life
5. Moribund (at death) patient not expected to surivive 24h w/o op
6. Declared brain-dead patient, organs being removed for donor purposes
30
You see Mr Jones in a pre-op assessment clinic 2 weeks before his elective total knee replacement. He is 76 years old and has hypertension as well as RA and osteoporosis.
Why is he at higher risk of post-op complications? What considerations do you need to make?
* Impaired wound healing - RA patients often on immunosuppressants e.g. steroids, MABs, MTX
* Elderly - anaesthetic risk, sedation, drug clearance, respiratory impact, risk of VTE as elderly and non-mobilising surgery
31
You see Mr Jones in a pre-op assessment clinic 2 weeks before his elective total knee replacement. He is 76 years old and has hypertension as well as RA and osteoporosis. Which class of anaesthesia risk is he likely to be in?
ASA 3: severe disease process which limits activity but is not incapacitating
32
7 areas for pharmaceutical intervention in surgical pharmacy
1. Pain
2. Post operative nausea and vomiting (PONV)
3. Nil by mouth (NBM) period
4. VTE prophylaxis
5. Fluid management
6. Anticoagulation in the perioperative period
7. Abx prophylaxis
33
What is the WHO analgesic ladder
34
What is the MHRA advice on NSAID selection
○ Assess CV risk vs gastro risk
○ Ibuprofen 2.4g is lowest
○ Diclofenac has high cardio risk
○ Naproxen has higher GI risk
35
5 methods of pain management in surgery
* WHO pain ladder
* Patient controlled analgesia (PCA)
* Spinal
* Regional/peripheral nerve LA blocks
* Epidural
36
What is patient controlled analgesia (PCA)
* Strong opioid based
* Gives pt control of pain so they aren't waiting potentially long times for the nurse for PRN doses of analgesia
* Pt must be alert to use and have some understanding of process and how to use
* Some pt can become very drowsy with morphine PCA - counter productive, as they will not be able to operate PCA effectively
37
What is spinal pain management
* Diamorphine administered spinally during surgery
38
What is regional/peripheral nerve LA blocks
* Nerve blocks are good for fracture
* Hip fracture (neck of femur NOF) - insert LA to nerve = good results for pain relief
39
What is an epidural
* Form of anaesthetic injected into epidural space
* Numbs limb post-op
* Alleviates pain
* Consists of LA + opioid, synergic action of drugs acting on different sites
1. LA acts on nerve blocks
2. Opioids act on opioid receptors near spinal cord
* Less n+v with epidural and less risk of DVT due to mobility
40
Advantages of PCA
* Patient in control of analgesia
* Lockout period protects against OD
* Number of requests for drug can be monitored
* Fast acting
* Rduced patient anxiety on pain
* Improved patient experience
* Suitable if patient NBM
* Useful for incident pain e.g. physio, dressing changes
* Patient's don't need multiple injections
41
Disadvantages of PCA
* not suitable for all patients
* renal impairment - accumulation of morphine metbaolites
* SE: n+v, pruritis, constipation, sedation
* not to be used with any other opoids
* if patients sleeps without PCA, may wake up in pain
