Surgical - medical complications Flashcards

1
Q

What are the 4 pre-operative assessment types?

A

Type 1 - easy patient easy case
Type 2 - easy patient difficult case
Type 3 - difficult patient easy case
Type 4 - difficult patient difficult case

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2
Q

List 4 aspects of infection control in surgical setting:

A
  1. Scrubbing
  2. Gloving
  3. Gowning
  4. Draping
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3
Q

After experiencing a MI, how long should patients not undertake elective treatment?

A

6 months after MI

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4
Q

Liver Disease:

What pre-op. precautions must be taken?

What post-op. precautions must be taken?

A

Pre-op.:
-liaise with physician
-check BNF for drugs
-caution with LA and sedation administration

Post-op.:
-Haemostatic agent in socket
-Hep. B immunity

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5
Q

Kidney disease:

What pre-op. precautions must be taken?

What post-op. precautions must be taken?

A

Pre op,:
-Liaise with physician
-Renal profile
-May require antibiotic cover

Post-op.:
-Haemostatic measures

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6
Q

Diabetes:

What pre-op. precautions must be taken?

What post-op. precautions must be taken?

A

Pre-op.:
-Measure blood glucose level - pt safe to treat if blood sugar 5-15 mmol/L
-Morning appointment

Post-op.:
-Antibiotics if poorly controlled or difficult procedure

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7
Q

What approach is most suitable when treating patients with epilepsy and what is a potential way to treat?

A

Check to frequency and presentation of seizures

IV sedation can be recommended due to anticonvulsant effects

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8
Q

What levels must Factor VIII be between prior to treatment of Haemophiliac A, B and Von Willebrand’s patients be?

A

Between 50-75%

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9
Q

What should platelet levels be for Thrombocytopenia patients be for treatment?

A

> 50 x 10(9)/L

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10
Q

What is the recommend INR level for treatment of patients receiving anticoagulant therapy (e.g., Warfarin, Heparin, Aspirin)

A

INR of less than 4
-cannot treat if more than 4 and recording must be within 24 hours, ideally the same day

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11
Q

What is neutropenia?

What may be required for neutropenic patients?

A

A lower than normal number of neutrophils

May require antibiotics to prevent infection

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12
Q

What is the suitable level of CD4 count for treatment in HIV patients?

A

CD4 count of more than 200 cells/mm of blood

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13
Q

What is thrombocytopenia?

A

Decreased level of platelets

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14
Q

At what level of platelets is a platelet transfusion required?

A

< (less than) 50 x 10(9)/L

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15
Q

Give 3 reasons when patients receiving radiotherapy are particularly at risk of osteonecrosis:

A
  1. When the total radiation dose exceeds 60 Gy
  2. There is local trauma from a tooth extraction, perio or ill-fitting prosthesis
  3. The patients is immunodeficient or malnourished
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16
Q

Give 3 post-op. instructions for radiotherapy-receiving patients:

A
  1. Post-op. antibiotics - metronidazole/amoxicillin for 7 days
  2. 0.2% chlorhexidine gluconate until healing has healed
  3. Avoid wearing dentures
17
Q

What are bisphosphonates used to treat?

What bisphosphonate agents are more potent for causing ARONJ (Anti-Resorptive agent induced OsteoNecrosis of the Jaw)?

What is the development of ARNOJ dependent on?

A

Bisphosphonates are used to treat osteoporosis

IV agents are more potent than oral

The development of ARNOJ is dependent on the length of time and dose of the drug prescribed

18
Q

Give 2 post-op. instructions for ARNOJ patients who require extraction:

A
  1. Post-op. antibiotics - metronidazole/amoxicillin for 7 days
  2. 0.2% chlorhexidine gluconate until healing has healed
19
Q

Give 2 potential risks of patients using steroids:

A
  1. Risk of Addisonian crisis
  2. May cause delayed healing
20
Q

Give 2 pre-op. recommendations for patients taking steroids:

A
  1. > 15mg prednisolone
  2. 25-50mg hydrocortisone IV
21
Q

Give 2 post-op. instructions for patients taking steroids:

A
  1. 25-50mg hydrocortisone IM every 6 hours for 24 hours
  2. May consider antibiotics
22
Q

Give 3 contra-indications of using sedations:

A
  1. Allergy to benzodiazepines
  2. Pregnancy
  3. Severe COPD
23
Q

In elderly patients, how should the sedation be administrated?

In sickle cells disease patients, what should be accompanied with the sedation?

A

Elderly - administer sedation slowly

Sickle Cell - administer 30 minutes of oxygen pre and post-operatively