Surgery

Question 1

indications for arterial catheritization

Answer 1

need for continuous blood pressure monitoring (shock states, hypertensive crisis, surgery in high risk pts, ppl getting inotropic agents or vasoactive, controlled hypotensive anastesia, procedures that can lead to rapid changes in cardiac fund)
need for frequent arterial blood sampling

Question 2

relative contraindications to arterial cath

Answer 2

local infxn
bleeding problems
presence of vascular prosthesis
anticoagulant thearpy

Question 3

most common site for arterial cath

Answer 3

radial artery

Question 4

complicatino that can arise from using brachial artery

Answer 4

median artery contracture (volkman contracture)

Question 5

indications for central venous cath

Answer 5

access for fluid therapy
access for drug infusion
parenteral nutrition
cvp monitoring
aspirate air embolism
placement of cardiac pacemaker/ ivc filter
hemodialysis access

Question 6

normal cvp

Answer 6

4-7 mmH2O
(0-3- needs more fluid)
8-20- high; more fluid then heart can handle

Question 7

what does cvp do

Answer 7

give info about relationship between fluid status and right ventricular function
useful w/ hypotensive pts
can detect arrithmias

Question 8

great way to determine amount of needed fluids and blood products

Answer 8

CVP

Question 9

indications for cvp

Answer 9

acute blood loss where you’re giving a lot of fluids
in cases of shock in post op
in old ppl who have limited cardiac reserve undergoing surgery
in pts w/ anuria due to possible kidney shutdown

Question 10

respiratory monitoring indications

Answer 10

deciding if to use mechanical ventilation
assessment response to therapy
optimize ventilator mngmt
decision to wean of ventilator

Question 11

things that affect BUN

Answer 11

increased in gi bleed, tpn, trauma, sepsis, steroid use

decreased in starvation and liver disease

Question 12

intracranial pressure monitoring

Answer 12

normal cerebral perfusion pressure >70mmHg

glascow coma scale

Question 13

how many days before surgery are pts required to have a workup

Answer 13

30 days

Question 14

indication for cbc (H&H)

Answer 14

> 65 years old w/ major surgery

surgery w/ major blood loss expected

Question 15

indication for serum creatinine

Answer 15

> 50 w/ intermediate or high risk surgery

younger w/ anticipated hypotension or use of nephrotoxic drugs

Question 16

electrolytes

Answer 16

if on diuretics, arb, acei, or known renal disease

Question 17

pt/ptt/platelets indications

Answer 17

pts on anticoagulants

neurosurgery

Question 18

what is recommended in all women of reproductive age

Answer 18

pregnancy test

Question 19

ekg

Answer 19

routinely recommended in pts > 50

required in pts w:
ischemic heart disease, chf, arrhythmia
peripheral artery disease or cerebrovascular disease
diabetes or renal insufficiency

Question 20

cxr

Answer 20

recomneded in pt > 50 undergoing AAA or upper abdomina/thorac surgery

Question 21

sleep study

Answer 21

for pts who have persistent sxs and NOT adherent w/ tx, and have had changes in weight

tx w/ cpap before surgery

Question 22

scip program for preventing surgical infxn

Answer 22

meticulous sterile tech
perioperative abx (depends on surgery)
glucose control <200
normothermia room temp
supplemental o2 therapy
surveillance and infxn control programs

Question 23

effects of Anesthesia

Answer 23

peripheral vasodilatoin leading to hypotension
reduced myocardial contractility

so much find out ejection fraction prior to surgery

Question 24

what can the decrease in tidal volume caused by spinal epidural cause

Answer 24

atelectasis, so we do incentive spirometry and deep breathing exercises

Question 25

tool to assess functional status before surgery

Answer 25

duke criteria

The ability to perform greater than 4 metabolic equivalents has been associated with a lower cardiovascular risk

Question 26

lee index

Answer 26

risk factors for major cardiac complications

one point each for:
High-risk surgery 
History of ischemic heart disease
History of congestive heart failure
History of stroke or transient ischemic attack
Insulin-dependent diabetes mellitus
Serum Cr > 2mg/dL

0 points, 0.4% complication rate
1 point, 1% complication rate
2 points, 7% complication rate
> or = to 3 points, 11% complication rate

Question 27

when to perform an echo

Answer 27

if hear a murmur

Question 28

what type of heart murmur is at greatest risk for complications

Answer 28

aortic stenosis

Question 29

what level of htn is associated w/ higher compl

Answer 29

> 180/110

Question 30

3 pt specific factors associated w/ increased risk of post operative pulmonary complications

Answer 30

chronic lung disease
tobacco use
morbidly obese

Question 31

when to quit smoking before cabg

Answer 31

at least 8 weeks before

Question 32

2 most common serious side effects of neuro

Answer 32

acute delirium and stroke

Question 33

what meds have been associated w/ delirium

Answer 33

anticholinergics
meperidine
benzodiazepines

Question 34

when to do steroid replacement

Answer 34

when on 7.5 mg prednisone for 3 weeks or 20 mg for 1 week
if evidence of adrenal insufficiency then give pts 100 mg of hydrocortisone every 8 hours beginning the morning of surgery and contenting for 48-72 hours; do not need to taper

Question 35

meds to discontinue before surgery

Answer 35

acei, diuretics, metfomrin, hypoglycemics
herbal supplements 2 weeks before surgery
pts whose risk of bleeding exceeds thrombosis:
asa 7-10 days
nsaids 3-5 days
plavix 2 weeks

Question 36

if taking warfarin where should inr be

Answer 36

<1.5

Question 37

what med should all pts w/ cardiovascular risk factors take

Answer 37

beta blocker