Surgical - medical complications Flashcards
What are the 4 pre-operative assessment types?
Type 1 - easy patient easy case
Type 2 - easy patient difficult case
Type 3 - difficult patient easy case
Type 4 - difficult patient difficult case
List 4 aspects of infection control in surgical setting:
- Scrubbing
- Gloving
- Gowning
- Draping
After experiencing a MI, how long should patients not undertake elective treatment?
6 months after MI
Liver Disease:
What pre-op. precautions must be taken?
What post-op. precautions must be taken?
Pre-op.:
-liaise with physician
-check BNF for drugs
-caution with LA and sedation administration
Post-op.:
-Haemostatic agent in socket
-Hep. B immunity
Kidney disease:
What pre-op. precautions must be taken?
What post-op. precautions must be taken?
Pre op,:
-Liaise with physician
-Renal profile
-May require antibiotic cover
Post-op.:
-Haemostatic measures
Diabetes:
What pre-op. precautions must be taken?
What post-op. precautions must be taken?
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
What approach is most suitable when treating patients with epilepsy and what is a potential way to treat?
Check to frequency and presentation of seizures
IV sedation can be recommended due to anticonvulsant effects
What levels must Factor VIII be between prior to treatment of Haemophiliac A, B and Von Willebrand’s patients be?
Between 50-75%
What should platelet levels be for Thrombocytopenia patients be for treatment?
> 50 x 10(9)/L
What is the recommend INR level for treatment of patients receiving anticoagulant therapy (e.g., Warfarin, Heparin, Aspirin)
INR of less than 4
-cannot treat if more than 4 and recording must be within 24 hours, ideally the same day
What is neutropenia?
What may be required for neutropenic patients?
A lower than normal number of neutrophils
May require antibiotics to prevent infection
What is the suitable level of CD4 count for treatment in HIV patients?
CD4 count of more than 200 cells/mm of blood
What is thrombocytopenia?
Decreased level of platelets
At what level of platelets is a platelet transfusion required?
< (less than) 50 x 10(9)/L
Give 3 reasons when patients receiving radiotherapy are particularly at risk of osteonecrosis:
- When the total radiation dose exceeds 60 Gy
- There is local trauma from a tooth extraction, perio or ill-fitting prosthesis
- The patients is immunodeficient or malnourished
Give 3 post-op. instructions for radiotherapy-receiving patients:
- Post-op. antibiotics - metronidazole/amoxicillin for 7 days
- 0.2% chlorhexidine gluconate until healing has healed
- Avoid wearing dentures
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?
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
Give 2 post-op. instructions for ARNOJ patients who require extraction:
- Post-op. antibiotics - metronidazole/amoxicillin for 7 days
- 0.2% chlorhexidine gluconate until healing has healed
Give 2 potential risks of patients using steroids:
- Risk of Addisonian crisis
- May cause delayed healing
Give 2 pre-op. recommendations for patients taking steroids:
- > 15mg prednisolone
- 25-50mg hydrocortisone IV
Give 2 post-op. instructions for patients taking steroids:
- 25-50mg hydrocortisone IM every 6 hours for 24 hours
- May consider antibiotics
Give 3 contra-indications of using sedations:
- Allergy to benzodiazepines
- Pregnancy
- Severe COPD
In elderly patients, how should the sedation be administrated?
In sickle cells disease patients, what should be accompanied with the sedation?
Elderly - administer sedation slowly
Sickle Cell - administer 30 minutes of oxygen pre and post-operatively
