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Extra > surgery 2 > Flashcards

surgery 2 Flashcards

1
Q

when not to close a wound

A

superficial wounds
wounds open longer then 8 hours (exception is face, scalp, and neck)
grossly contaminated wounds

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2
Q

absorbable sutures

A

surgical gut
vicryl

mucosal areas and subcutaneous tissue (deep sutures)

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3
Q

non absorbable

A 
nylon
stainless steel
polyprolene
monofilament
braided

skin, ligament and tendon repairs

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4
Q

size of suture

A

larger the number the smaller the suture

4-0 foot, trunk, extremities
5-0 hand, scalp
6-0 face, ear, nose
7-0 eyelid

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5
Q

most common suture

A

simple interrupted

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6
Q

other options to close wounds

A

steri strips
glue
staples
butterfly bandages

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7
Q

scalp

A

6-8 days

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8
Q

face

A

4-5 days

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9
Q

chest/abdomen

A

8-10 days

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10
Q

back

A

10-14 days

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11
Q

arm/leg

A

8-10 days

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12
Q

hand

A

8-10 days

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13
Q

fingertip

A

8-12 days

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14
Q

foot

A

12-14 days

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15
Q

scip (surgical care improvement project) national goal

A

reduce preventable surgical morbidity and mortality 25% by 2010

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16
Q

surgical infxn prevention

A

glucose control in cardiac surgery pts (<200)
prophylactic abx (begin 1 hr before surgery and stop w/in 24 hrs of end of surgery)
proper hair removal
normothermia in colorectal surgical pts

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17
Q

prevention of ventilator associated pneumonia

A

ppl on ventilators need head of bed at 30 degrees

give these pts peptic ulcer prophylaxis

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18
Q

pulmonary risks

A

pneumonia
atelectasis
hypoventilation

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19
Q

physiology of respiratory during surgery

A

effects of surgery and opiods depress respiratory
vital capacity decresead 50-60%
functional residual capacity decreased 30%
chest and abdomen surgeries put you at higher risk of pulmonary complications

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20
Q

pulmonology risk factors

A 
copd
>50
asthma (if NOT controlled)
smoking >20 pack year history
CHF
URI
albumin 30
21
Q

when to get pft

A

Obtain for pts w/ COPD or asthma if clinically cannot determine if pt at their best baseline
Obtain for pts w/ dyspnea or exercise intolerance that remains unexplained

22
Q

how to reduce post op pulmonary comp

A

copd:
bronchodilators, abx, systemic steroids
pts should receive daily ipratorium bromide (anticholinergic)
beta agonsit as needed

asthma:
well controlled w/ beta agonist and steroids if needed

uri:
delay elective surgery in presence of viral uri

23
Q

post op strategies to decreased pulmonary complications

A

incentive spirometry
deep breathing strategies
adequate pain control so pt can ambulate early and makes it easier for pt to take deep breaths
use of NG tube has increased risk of pulmonary comp

24
Q

cardiac risks

A

MI
CHF
HTN
increased mortality post op day 3

25
Q

who is at risk for cardiac comp (major factors)

A 
recent mi
vascular heart disease
decompensated heart failure
unstable angina
strongly positive stress test
significant arrithmias (high grade av block, symptomatic ventricular arrhythmia, supra ventricular arrhythmia w/ uncontrolled rate
26
Q

intermediate risk factors for cardiac

A 
Mild Angina
Previous MI by history or by Q-waves
Compensated or prior CHF
Diabetes
Renal Insufficiency (Creat>2.0)
27
Q

endocrine risk

A

thyroid storm
adrenal insufficiency
diabetic complication

28
Q

dvt medical prophylaxis

A

low dose unfractioned heparin:
5000 Units SQ q8 or q12 hrs
First dose pre-op or post-op

low molecular weight heparin(lovenox)

29
Q

post op fever immediate diff (during operation to a few hours after)

A

fever due to surgery (release of cytokines stimulate fever; fever >38 degrees common in first couple days after surgery)
rxn to blood products or med
malignant hyperthermia

30
Q

post op fever acute (within 1st week0

A 
Nosocomial infections
Community acquired infections
Surgical site infection
Intravascular catheters
Pneumonia
UTI
31
Q

post op fever sub acute 1st week to 4th week

A 
Surgical site infection
Central venous catheter related infections
Thrombophlebitis
Antibiotic associated diarrhea
Drug Fever
Deep Vein Thrombophlebitis
Pulmonary Embolism
32
Q

post op fever delayed (>1month)

A

wound infection

infection from blood products

33
Q

orthopedic procedures post op fever diff

A

DVT/thrombophlebitis
surgical site infxn
hematoma

34
Q

5 w’s

A 
wind
water 
wound
walking
wonder drugs/whopper
35
Q

wind

A

usually the cause of fever in first 24-48 hrs post op
atelectasis
pneumonia
embolism (pe)
Physical exam: bronchial breathing, deviated trachea, sob, etc

36
Q

water

A

usually in 48-72 hours post op
UTI
usually due to indwelling urinary catheters or GU instruments
physical exam: cloudy urine, positive urine cultures, dysuria, frequency, or urgency

37
Q

wound

A

usually after 72 hrs (most common cause of fever after 72 hrs)
Staph Aureua is most common cause
physical exam: mild change in vital signs is seen early, and pain may or may not be present at site of infxn, look for drainage and erythema, swelling, and warmth

38
Q

walking

A

after 72 hrs
thrombophlebitis (usually associated w/ intravascular catheters.
physical exam:
superficial- purulent drainage around catheter w/ induration of the vein
deep- can be associated w/ indwelling central lines or dot
exam could show humans sign, unilateral edema is more specific of dvt

39
Q

wonder drugs

A

anesthetics, sulfa containing abc, and others
usually a diagnosis of exclusion
persistent fever w/ negative cultures should raise suspicion of this

40
Q

whopper

A

presence of postoperative abscess

intra abdominal abscesses may present w/ blood cultures that are polymicrobial

41
Q

what to tx fever w/

A

tylenol

42
Q

prevention of wound infxn

A

cefazolin 1-2 mg IV 60 min before surgery
for bowl procedures cefoxitin or ampicilin/sulbactam
vanco if pcn allergic

43
Q

wound healing

A

initial inflammatory response (days)
epithelialization (days)
fibroplasia (weeks)
maturation (weeks - months)

44
Q

dehisence

A

wound bursting open

45
Q

evisceration

A

a total separation of all wound layers and protrusion of internal organs through the open wound

46
Q

hematoma

A

collection of blood in the wound

47
Q

seroma

A

collection of fluid in the wound other then pus or blood

48
Q

gangrene

A

complication of necrosis (cell death) characterized by decay of body tissues
rick factors smoking, diabetes, decrease blood supply

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