Surgery PA (Exam #4) Flashcards
What two groups of meds should always be considered pre-op?
- NSAIDs
- Anticoagulants
What group of disorders can indicate increased risk for infection post-op? What are two examples?
Metabolic disorders
- DM
- Adrenal insufficiency
What is the #1 goal when positioning the patient for surgery?
PROTECT THE PATIENT
When would Trendelenburg vs. Reverse Trendelenburg positioning be used?
- Trendelenburg = increase exposure to pelvis
- Reverse Trendelenburg = increase exposure to upper abdomen
Describe Laparotomy vs. Laparoscopy?
- Laparotomy = open, large incision
- Laparoscopy = small incisions with camera aid
If infection presents post-op, what pathogen is most common?
GAS
What constitutes a Post-Op Fever? What labs should be ordered (4)?
102+ F within 48 hours post-op
- CBC with diff
- UA
- Cultures
- CXR
What is the prophylaxis abx goal with Post-Op Infection?
Which class of abx does this typically involve?
Choose abx that will cover MOST probable intraoperative contaminants
- Often Cephalosporins (1st and 2nd Gen)
What is the MOST common cause of fever in first 48 hours after surgery?
Atelectasis (pulm)
What post-op condition presents with fever, chills, tachycardia, leukocytosis, hypotension?
What is the recommended tx (2)?
Bacteremia
- Tx = change IV lines every 3 days; abx
What post-op condition presents with decreased mental status, often a/w NG tube feedings?
Aspiration
What two pathogens are most often associated with Post-Op Wound Infections?
- Staph
- Strep
What type of wound debridement involves use body’s own enzymes to liquify necrotic debris?
Autolytic Debridement
What type of wound debridement involves use chemical enzymes to turn necrotic tissue → slough?
Enzymatic Debridement
What type of wound debridement involves wet-to-dry dressing; cheap but non-selective, traumatic and painful?
Mechanical Debridement
What type of wound debridement involves remove necrotic tissue in OR or bedside?
Sharp Surgical Debridement
Under what five conditions would use of Negative Pressure Wound Therapy (NPWT/VAC) be CI?
- Necrotic tissue
- Untx osteomyelitis
- Fistula
- CA in wound
- Exposed artery/vein
What three signs/sxs should have you suspecting wound infection?
- Wound isn’t healing/worsens
- Exudate or pain increases
- Odor develops
How long should an elective surgery be postponed if post-MI?
6+ months post-MI
What are four possible etiologies of Post-Op Fever WITHIN 0-48 HOURS?
- Atelectasis
- Wound infection (GAS)
- Leakage of bowel anastomosis
- Aspiration PNA
What are five possible etiologies of Post-Op Fever AFTER POD #3?
- UTI
- Wound infection
- IV catheter infection
- Intra-abdominal abscess
- DVT
When is the best time to administer parenteral abx pre-surgery?
30-60 minutes before incision
