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Surgery > Labs for the Surgical Pt and F/u in Primary Care > Flashcards

Labs for the Surgical Pt and F/u in Primary Care Flashcards

1
Q

List of common Pre-Op labs

A
  1. CBC (40+ yo for sure!)
  2. BMP, Mg, Phos (40+ yo for sure! Mg and Phos = must add separately not included)
  3. LFTs
  4. Urinalysis
  5. Coags
  6. Tumor Markers
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2
Q

Why do we order pre-op labs?

A
  1. Used to screen for asymptomatic dz that may have surgical consequences.
  2. Appraisal of diseases that may contraindicate elective surgery or require treatment prior to sx
  3. To evaluate the nature and extent of metabolic or septic conditions
  4. To evaluate stability of previously diagnosed dz
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3
Q

Radiographic General Testing Guidelines

A

Patients over 50 yo: CXR, EKG

Patients undergoing sx for Cancer: CXR

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4
Q

Normal value for a WBC, and which lab panel is a WBC located?

A

4.5-11 cell/microL; CBC

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5
Q

Normal value for a Hb, and which lab panel is a Hb located?

A

15 g/dl; CBC

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6
Q

Normal value for a Hct, and which lab panel is a Hct located?

A

45%; CBC

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7
Q

Normal value for a Plt, and which lab panel is a Plt located?

A

150-450 cell/microliter; CBC

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8
Q

Normal value for a Na, and which lab panel is a Na located?

A

135-145 meq/L; BMP

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9
Q

Normal value for a K, and which lab panel is a K located?

A

3.5-5.1 meg/L; BMP

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10
Q

Normal value for a Cl, and which lab panel is a Cl located?

A

98-106 meq/L; BMP

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11
Q

Normal value for a CO2, and which lab panel is a CO2 located?

A

22-29 mmol/L; BMP

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12
Q

Normal value for a BUN, and which lab panel is a BUN located?

A

8-20 mg/dl; BMP

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13
Q

Normal value for a Creat, and which lab panel is a Creat located?

A

0.6-1.2 mg/dL; BMP

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14
Q

Normal value for a Glu, and which lab panel is a Glu located?

A

70-115 mg/dL; BMP

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15
Q

Normal value for a Ca, and which lab panel is a Ca located?

A

8.4-10.2 mg/dL; May or may not be in BMP (if it’s not you have to order it separately)

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16
Q

Normal value for a Mg, and which lab panel is a Mg located?

A

1.3-2.1 meq/dL; On its own (have to order separately)

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17
Q

Normal value for a Phos, and which lab panel is a Phos located?

A

2.7-4.5 mg/dL; On its own (have to order separately)

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18
Q

Normal value for a Total Protein, and which lab panel is a Total Protein located?

A

6-8 g/dL; LFTs

19
Q

Normal value for a Alb, and which lab panel is a Alb located?

A

4 grams/dL^3; LFTs

20
Q

Normal value for a Total Bilirubin, and which lab panel is a Total Bilirubin located?

A

0.3-1 mg/dL; LFTs

21
Q

Normal value for a Direct Bilirubin, and which lab panel is a Direct Bilirubin located?

A

0-0.2 mg/dL; LFTs

22
Q

Normal value for a Alk Phos, and which lab panel is a Alk Phos located?

A

Varies with age but 30-120 units/L^3; LFTs

23
Q

Normal value for a LDH, and which lab panel is a LDH located?

A

100-210 IU/L; LFTs

24
Q

Normal value for a AST, and which lab panel is a AST located?

A

7-40 U/L; LFTs

25
Q

Normal value for a ALT, and which lab panel is a ALT located?

A

7-40 U/L; LFTs

26
Q

What are you checking for in a Urinalysis?

A
  1. Specific Gravity (estimates the Urine Osmolality)
  2. Leukocyte Esterase (LE)
  3. Nitrites
  4. WBC
  5. Bacteria
  6. Casts
  7. RBS
  8. Urine Drug Screen (added on)
  9. FeNa (Added on)
27
Q

What is the point of using a PTT (Partial Thromboplastin Time)?

A
  • Evaluates intrinsic clotting cascade

- Increased HeparIN (Antithrombin III)

28
Q

What is the point of using a PT (Prothrombin Time)?

A
  • Evaluates Extrinsic Clotting Cascade

- Increased by Coumadin (Factors II, VII, IX, X, Protein S and C)

29
Q

What is the point of using an INR (International Ratio)?

A

It is a standardized/universal marking of how the bleeding is. Normal should be 0.9-1.1.

30
Q

Common Tumor Markers

A
  1. CEA (Carcinoembryonic Antigen) – Colon Cancer
  2. CA 19-9 – Pancreatic Cancer
  3. AFP (Alpha Fetal Protein) – Testicular and Hepatocellular Cancer
  4. PSA (Prostate Specific Antigen) – Prostate Cancer
31
Q

What is important to note about tumor markers?

A

Tumor markers are SCREENING not Diagnostic

32
Q

Things to think about with pre-op and post-op labs?

A
  1. Who is undergoing surgery (Age, PMH, Meds, Bleeding Hx)?

2. What Sx will they be undergoing? (Level of invasiveness, Pre-op tumor markers for post-op monitoring)

33
Q

What is a rule of thumb to think about with Post-Op orders?

A

You are essentially re-admitting them to the hospital!

34
Q

That being said, what do you order? (ADCVANDIML)

A 
Admit
Dx
Condition
Vitals
Activity
Nursing (i/o, drains, resp, monitors, dressings, accucheck)
Diet
IV Fluids
Meds
Labs
Others
35
Q

This is the pressure of blood in the thoracic vena cava, near the right atrium of the heart. It reflects the amount of blood returning to the heart and the ability of the heart to pump the blood into the arterial system.

A

Central Venous Pressure

36
Q

What things should be monitored pre/post op?

A
  1. TPRBPO2 - Telemetry and/or Pulse Oximetry
  2. CVP (want to see if there is a large blood loss or fluid shifts)
  3. Intraventricular Catethers
37
Q

What are drains used for?

A
  1. Used to prevent or treat an unwanted accumulation of fluid
  2. Prophylactic drains are placed in a sterile area
  3. External portion of the drain must be handled with aseptic technique
38
Q

What are the two types of Drains?

A
  1. Closed (preferable) – Connected to a suction device. MOST COMMON = Jackson Pratt (JP) drain
  2. Open – open to air
  3. Pleur-Evac (Also very common)
  4. Vacuum Drain – common in rehab facilities. Usually for “ugly” wounds.
39
Q

What are the types of Post-Op Analgesia?

A
  1. Patient Controlled Analgesia
  2. Parenteral Opioids
  3. Nonopioid Parenteral Analgesics
  4. Oral Analgesics
40
Q

What is a patient controlled analgeia (PCA)?

A
  1. Patient controls the boluses
  2. Sometimes has a basal rate (usually a narcotic)
  3. Has a “timeout” to prevent OD (if you fall asleep, you can’t press it)
  4. Patient must be awake to push the button
41
Q

What are parenteral Opioids?

A
  1. Direct effect on opioid receptors
  2. Stimulation of descending brain stem system that contributes to pain inhibition
  3. The mainstay of therapy for post-op pain.

***Commonly what is in your PCA

42
Q

What are non-opioid parenteral analgesics?

A

NSAIDS

  • Ketorolac potent analgesic and moderate anti-inflammatory
  • Only IV NSAID, but is prone to causing GI bleeding
43
Q

What are oral analgesics?

A

Usually used several days post-op (depending on severity of surgery)

44
Q

Primary Care Follow Up!

A

ALL Post-Op patients should see their PCP! For basic knowledge, medication checks, wound checks, etc.

If there is an issue, then they’ll go back to the surgeon.

Surgery (12 decks)

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