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Block 4 - CritCareSurg > Clin Lab - Surg Dx > Flashcards

Clin Lab - Surg Dx Flashcards

(50 cards)

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1
Q

Are there any diagnostics considered required prior to all surgeries?

A

NO

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2
Q

What is preop evaluation based on?

A

patient parameters

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3
Q

When is preop evaluation usually not necessary?

A

low-risk surgeries like elective ortho surgeries

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4
Q

What are considered high risk surgeries?

A
  • anything intraabdominal
  • near the neck, spine, brain
  • anything that cracks the chest
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5
Q

What is considered whether preop evaluation is needed?

A

comorbidities & patient Hx

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6
Q

List the preop diagnostics or screenings.

A
  • CBC
  • BMP
  • PT/INR & PTT
  • EKG
  • CXR
  • UA
  • MRSA nasal screening
  • COVID testing
  • Pregnancy test
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7
Q

Guidelines for CBC preoperatively & reasons

A

65+ yrs old / any age - major surg

  • checking for underlying anemia
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8
Q

Guidelines for BMP preoperatively & reasons

A

50+ yrs / intermediate or major surg; no indication for LFTs unless liver dz

  • Intermediate surgeries: Gallbladder surg
    CMP–> known liver dz, MASH, or cirrhosis
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9
Q

Guidelines for PT/INR & PTT preoperatively

A

only if significant RFs or surg where bleeding would be damaging (brain)

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10
Q

Guidelines for EKG preoperatively & reasons

A

50+ yrs / if pt has RFs of cardiac issues or known dz

  • Also, if they have unTx HTN–> LVH–> arrhythmias
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11
Q

Guidelines for CXR preoperatively & reasons

A

no age recommendation / significant lung dz

  • Known COPD, known interstitial fibrosis
  • Ask do they get SOB wheezing w/ normal activity, if yes–> CXR
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12
Q

Guidelines for UA preoperatively & reasons

A

no age recommendation / if hardware implanted

  • Screening before & At the time of surgery–> UTI infx can get seeded on the hardware
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13
Q

Guidelines for MRSA nasal screening preoperatively & reasons

A

open chest / if hardware implanted

  • Nasal swab – many ppl are colonized w/ MRSA
  • Tx: Nasal mupirocin & Chlorhexidine shower
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14
Q

Guidelines for COVID testing preoperatively & reasons

A

ongoing changes to recommendations

  • Not as big of a problem, but if they are symptomatic don’t recommend surg
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15
Q

Guidelines for pregnancy test preoperatively

A

any woman of child-bearing age

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16
Q

What other possible tests can be ran preop?

A
  • Echo
  • Cardiac stress test
  • Exercise tolerance test
  • PFTs / spirometry
  • Nicotine, cotinine, anabasine
  • Albumin
  • Cholinesterase
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17
Q

When would you order an echo?

A
  • SOB w/ normal activity
  • Sleeping in recliner
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18
Q

When would you order a cardiac stress test?

A

Angina/chest pain while doing normal activities

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19
Q

Describe an exercise tolerance test & why they are ordered?

A

Bike or treadmill, changes resistance–> gives metabolic tolerance
The better on the exercise tolerance test–> the better they will recover after surg

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20
Q

When would you order PFTs/spirometry?

A

wheezing &/or SOB

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21
Q

Describe what is assessed about nicotine/cotinine/tobacco product exposure

Study These Flashcards
A
  • Active use vs passive exposure
  • Cotinine – metabolite w/ longer half life
  • Anabasine – found in tobacco but not in nicotine replacement products
22
Q

Does Cotinine pick up vaping?

23
Q

Does Anabasine pick up vaping?

24
Q

What affect does smoking have on the patient after surgery?

Study These Flashcards
A

impaired wound healing

25
Why would albumin be evaluated preop?
Some studies show correlation b/t lower levels & worse outcomes
26
Why are albumin levels so important before surgery?
If body isn’t making PRO it can lead to worse outcomes b/c it can impair healing
27
What is Cholinesterase?
Rare genetic def can cause significant & extended period of apnea when given succinylcholine
28
Why is knowing if a person has Cholinesterase so important?
- Can make it more difficult to wean a person off the ventilator
29
What is another rare condition that would make surgery more difficult?
- Rare anesthesia related hyperthermia
30
What is an alternative to general anesthesia?
spinal anesthesia
31
Why is neuromonitoring used intraoperatively?
to assess integrity of brain/cord/periph nerves during surgery
32
What common surgeries have neuromonitoring?
- intracranial - spine - neck - aorta/carotid
33
Common modalities for neuromonitoring?
- EEG - EMG - Evoked potentials --> Somatosensory – most common --> Motor --> Auditory
34
What must be assessed/assigned postoperatively?
- ICU vs non-ICU - Telemetry or no telemetry (med/surg) - Vital signs - Intake/output - No labs are considered absolutely necessary -- Commonly ordered labs --> CBC or Hgb/Hct --> BMP or CMP
35
Describe the decision b/t ICU vs non-ICU
can they wean off vent
36
Describe the decision b/t Telemetry or no telemetry (med/surg)
- If they go into Afib in PACU, arrhythmia during surg--> telemetry - Most postop pts go the med/surg
37
Describe the measuring of vital signs post op.
First 15 mins after, every 30 mins, every 1hr for 4hrs, then back to regular
38
Why measure intake/output?
- Intraabdo – intestinal surg or if worried about their kidneys - To keep up w/ fluid losses, diet management
39
Why is a CBC or Hgb/Hct ordered post op?
- there is postop Hgb drop b/c pt gets fluids --> Loss blood & replace w/ just fluids--> will cause Hgb to drop --> If <7 Hgb = blood transfusion --> If cardiac Hx/ischemia <8 = blood transfusion
40
Why is a BMP or CMP ordered post op?
- electrolyte monitoring b/c continued losses, drains, didn’t eat the day before procedure - K+ & Mg - Pain response--> secrete ADH inappropriately--> so Na+ will drop causing Hyponatremia
41
Postop Evaluation: Complications/Evaluation Includes
- Delirium - Chest pain - Abdomen: --> N/V --> Diarrhea --> Constipation --> Abdo pain - Fever - Low urine output
42
What is Delirium, assessment tool used & types?
- acute decline in cognitive function - CAM assessment tool - Agitated or Hypoactive **Ask family about pt’s baseline
43
Why is chest pain important postoperatively
during surg we drop BP b/c you bleed less, - but this can cause problems on back end b/c you aren’t getting blood to heart if blockage--> can lead to ischemia
44
What causes N/V postoperatively
anesthesia & pain meds
45
Which is less common postoperatively: diarrhea or constipation
diarrhea
46
Why is the passing of gas so important postoperatively?
Gas is the first sign that the bowels are working after surg
47
What might constipation occur postoperatively?
- Bowels are paralyzed during anesthesia - Regimen of: Colace, Senna or MiraLAX if they haven’t pooped worried about forming an Ileus
48
Reasons of abdominal pain postoperatively
- Obstructions (could be an ileus) - anastomotic leak--> peritonitis - Get an abdo Xray--> looking for air fluid levels
49
Describe a fever postoperatively.
- Common to have a fever (99-100.2) & leukocytosis 1st day post op - Drug rxn or DVTs can cause a fever --> PE: Homer's sign, one leg might be bigger, does one leg hurt more? - Get US **NO D-dimer b/c they just had surgery & body will be forming clots**
50
What does low urine output mean postoperatively?
1st indication that they may be going into AKI

Block 4 - CritCareSurg (2 decks)

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