Surgery: Block 1 Flashcards
What is one of the most important features of a SurgHx?
What is the first part when investigating this feature?
What is the most important aspect of this feature?
Pain
How it began
PTs reaction to it
PT shrieking/thrashing is either ? or could have ?
PT in true pain due to infection, inflammation or vascular dz may present what type of movement?
Gross over reaction
Renal/biliary colic
Extremely restricted movement
What is a common complaint found during a pre-op Hx that is not of much significance?
When does this become an issue?
Change in bowel habits
Constant/regular becomes cyclic diarrhea/constipation= suspect colon Ca
What is the MC error when providers are presented with bleeding from the rectum?
A complete exam of a surgical PT includes what five steps?
Hemorrhoid Dx
PE Special Labs X-rays F/u exams
What is the first and second thing immediately assessed when conducting an elective surgery PE?
What are the objectives of doing Labs during a pre-op work up?
Why is a Neg GI study not truly negative?
Physique/habitus and then, hands
Screening for ASx Dz (anemia, DM)
Dz c/i elective/req Tx prior to surgery (DM, HF)
D/o requiring surgery (HyperThyroid, Pheo)
Metabolic/septic complications
Ulcers/Neoplasms not excluded, especially in R colon
Ordering INR/PTT would be warranted during a Pre-Op prior to ? procedures?
What is the relation w/ the blood bank prior to a surgery?
Little post-op bleeds threshold (brain, spine, neck)
INR- bile obstruction, malnutrition, absent terminal ileum= dec Vit K absorption
Blood typing alone
Pre-op labs include ?
What is a True Liver function test?
What is MC acquired nosocomial infection and RFs
CBC CMP PT/INR
PT/INR + Total Bili, Albumin
Lower UTI- Retention Instrumentation Contamination
Dx by exam, confirm w/ culture
Who signs a pre-op consent form?
When can consent form signing be waived?
Who can sign for the PT if they’re unavailable or physically able to sign
Surgery team member, PT, Witness NOT on team
Emergencies, two Drs sign
Medical power of attorney
If emergency surgery is needed and signed consent may be affected, who needs to be notified?
What is the universal protocol for pre-op precautions
When/how is hair removed from a surgical site?
Hospital administrator
Site/sign location
Time out prior to first cut
Electric clippers immediately prior
What meds may be taken on the day of surgery w/ sip of water
HN
Hormones Neuro
BARHOPS
BB Alpha ant/agonist Reflux HTN OCP Psych
CCC
CBC Cardiac rhythm COPD
HNP
Hormone Nitrate Peptic diatheses
Why may PTs be advised to NOT take their ACEI prior to surgery
When are ABX given prior to surgery
If additional ABX are needed during surgery, when are they given?
General anesthesia refractory HOTN
W/in 1hr of incision
Every 2 t1/2 (q4hrs for Cefazolin*, Augmenten)
Operations that involve bacteroides should have ? ABX added to the regime
Surgical ABX are chosen by ?
Multiple doses or prolong ABX use post-op are more likely during ? procedures?
Metronidazole
Hospital antibiogram
GI Tract
Implantation
Contaminated wounds
ImmComp PTs
ABX given to PTs for prophylaxis are not continued after surgery except for ? procedures?
What is the ASA Classification system for?
Vascular grafts
Cardiac surgery
Joint replacement
Degree of perioperative risk for PTs
1: health PT, no systemic d/o
5: moribund, won’t survive 24hrs w/out operation
What are examples of Cat 5 ASA PT
What is the APACHE II System for?
How is the Mallampati classification scoring done?
Trauma w/ shock
Ruptured AAA w/ shock
Cerebral trauma w/ inc ICP
Massive PE
Severity of illness in ICU PTs to predict mortality
Open mouth, tongue out w/out saying ‘ah’
What are the 6 things evaluated when conducting a Mallampati
NTC PST
TMJ C-spine Dentition Short neck Tracheal deviation Neck mass
Respiratory complications are bad because of what 4 increased things
Pulmonary complications can be as minor as ? and extend in severity up to ?
Most costly
Inc re/admission, 30 day mortality
Atelectasis
Pneumonia/Resp Failure
What are the risk factors for a PT to develop post-op pulmonary complications?
What PE findings may indicate an underlying pulmonary Dz
Functional dependence AMS Malnutrition
CHF Alcohol COPD Inc age ASA
Dec breath sounds
Wheeze
Rhonchi
Prolonged expiratory phases
If PT has mitigating pulmonary complications during pre-op, what two tests may be done prior to surgery, especially ? procedure
How are PTs w/ very low, low, mod or high risk of VTEs managed post-op?
PFT ABG
Lung resection
Very Low= early ambulation Low= mechanical prophylaxis and ICPs
Mod= LMWH, UFH, IPC
High= IPC and LMWH/UFH
What are the 6 independent factors in a RCRI
If PT has findings indicative of ischemic heart dz, cardiac Sxs or abnormal EKG on pre-op have what f/u test ordered?
Deck 1, Slide 24
Hx ischemic Heart Dz CHF- JVD/S3 CerebroVDz High risk operation Pre-op Tx w/ insulin Pre-op SrCr >2.0mg
Stress test: Treadmill,
Dipyridamole/Adenosine-thallium
Dobutamine echo
What is the most widely used Dx test to evaluate for CADz
If there is a risk of a peri-operative re-infarct after an MI, try to postpone surgery by ? mon
Exercise electrocardiography until Sxs or ST segment shifts, enhanced w/ T-201
> 6mon
What are the two goals of pre-op fasting?
Avoid drinking/eating how far in advance to surgery?
Min volume, max pH
No drinking 2hrs prior
No light/heavy meals 6-8hrs
Infant- 4hrs breast milk, 6hrs formula
What would be signs that liver failure is occurring post-op and what labs would be ordered?
Pre-op eval of the hepatic system includes ? two measurements used for calculating ?
Spider telangiectasis
Jaundice
PT INR PTT
Total bili and INR
CTP or MELD
What are PTs given who are identified to have bleeding risks and when are they given?
If PT w/ hepatic issues develops worsening encephalopathy, ? is accumulating and it’s Tx w/ ?
Vit K/FFP- on call to OR
Ammonia tx w/ Lactulose
PTs w/ liver dz risk ? outcome w/ surgery
What are the decompensation risk %s per CTP scoring
Decompensation
Class A: 2-10%
Class B: 12-30%
Class C: 12-82% w/ 63% mortality rate