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clinical skills JM > the surgical patient > Flashcards

the surgical patient Flashcards

1
Q

approach

A

establish a rapport of trust

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2
Q

COMMON SYMPTOMS OF SURGICAL PROBLEMS

A
  • pain (OPQRST)
  • vomiting
  • hematemesis
  • trauma
  • emotional background
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3
Q

PHYSICAL EXAM/LAB/IMAGING/SPECIAL EXAMS

A
  • elective
  • emergent
  • screening for asymptomatic disease
  • appraisal of disease
  • diagnosis requiring surgery
  • metabolic or septic complications
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4
Q

H and P for surgery

A
  • complete H&P
  • include risks of DVT, PE, VTE
  • frailty (ADLs)
  • walking up a set of stairs
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5
Q

pre operative testing

A
  • tailored to the patients condition but some are routine for everyone
  • CBC
    -CMP
    -INR, PT, PTT (Brian spine neck heart)
  • Hga1c, glucose
  • pregnancy test
  • type and screen (make sure there is enough blood)
  • nasal swab for staph areas upon admission
  • EKG
  • CXR
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6
Q

risk assesment

A
  • benefit vs risk
  • ASA 1-6
  • 4: severe systemic disease, possible risk of death, unstable angina, copd, chf
  • 6: brain dead whose organs are removed for donor purposes
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7
Q

NSQIP

A
  • collect and validate a set of defined patient variable, comorbidities, and outcomes for 30 days after hospital discharge
  • risk adjusted 30 mortality and morbidity
  • provides opportunities for improvement
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8
Q

clinical databases

A

society of thoracic surgeons (STS)

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9
Q

cardiovascular assesment

A
  • revised cardiac risk index (RCRI)
  • IHD
  • CHF
  • CVA
  • high risk operation
  • preoperative treatment with insulin
  • preoperative serum Cr > 2.0
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10
Q

medications

A
  • continue beta blockers
  • ASA
  • clopidogrel
  • drug eluding stent x12 months
  • bare metal stents x4 months
  • balloon angioplasty x4 weeks
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11
Q
  • PPC postoperative pulmonary complications
  • risk factors include:
  • advanced age, elevated ASA, CHF, functional dependence, COPD, malnutrition, alcohol disease, altered mental status
  • stop smoking
  • stop bang - snoring, tired during day, HTN, BMI > 50 years, neck, male, sleep apnea
A

pulmonary

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12
Q
  • major complications
  • use of heparin products even after discharge
  • malignancy surgeries
  • efficacy of stocking for VTE prevention
A

VTE

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12
Q
  • increased SSI - surgical site infections
  • prolonged hospitalization
  • linear increase with SSI with blood glucose >140. 30% increase with every 20mg increase
  • desirable range in critically ill patients 120-140
  • may require inpatient admission, oral/insulin regimen
A

diabetes

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13
Q

antibiotics:
- 1 hour before incision for clean, clean-contaminated, contaminated, and dirty operations

normothermia:
- affects wound oxygen levels and reduce SSI
- warming blankets

MRSA:
- mupirocin nasal ointment
- choloerexidine soap shower before surgery

A

SSI surgical site infections

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13
Q
  • loss can be overestimated and lead to pulmonary edema, ilieus and wound infection
  • virtual signs and CVP- little correlation with fluid volume and carry procedural risks
  • dialysis: should occur 12-24 hours before surgery
  • blood transfusions
A

fluid and volume status

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14
Q

malnourished: albumin <3.0
unfavorable outcomes associated with:
- BMI >50
- male
- HTN
-IVC
- RHF

15
Q
  • post operative withdrawl
  • meth
  • cocaine
A

drug and ETOH use

16
Q
  • multiple comorbidities
  • frailty scales
A

geriatric patients

16
Q

addition of supplemental steroids:
- primary adrenal insufficiency
- chronic renal suppression from chronic steroid use
- inadequate amounts of steroid can result in addisonian crisis
- administered to patients on a regimen of >20 mg of prednisone
- 5-20mg of prednisone for 3 weeks or greater

thyrotoxicosis
- must be corrected

17
Q

preoperative instructions

A
  • screening
  • fasting
  • medications: ASA, platelets, ACE inhibitors, -flozins
  • Narcotics: most continue to limit withdrawl
  • bring inhalers, sleep apnea machines
  • chlorohexadine soap given for preop showers
  • patient education
18
Q

operating room

A
  • hair removal: no razors, use clippers
  • skin prep
  • patient positioning: nerve palsies, traction injuries, pressure points
18
Q

operating room prep

A
  • sterile packages
  • techs
  • scrubbing
  • sterilization- flashing
18
Q

operating room plans

A
  • case cards
  • special hardware instrument needs
  • surgeon is responsible for coordination

environmental plans:
- fire
- tornado
- electricity- generators
- air handlers
- temperature

19
Q

surgery team

A
  • surgeon is in charge
    crew resource management
  • command
  • leadership
  • communication
  • situational awareness
  • workload management
  • resources management
  • decision making

clinical skills JM (7 decks)

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