Pestana- 3. Pre-Op and Post-Op Care Flashcards Preview

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Flashcards in Pestana- 3. Pre-Op and Post-Op Care Deck (77)
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1

What is the ejection fraction that prohibits noncardiac operations?

2

List the major findings that may predict cardiac risk during surgery?

JVD
Recent MI
PVC or any rhythm other than sinus
Age >70
Emergency surgery
Aortic stenosis
Poor medical condition
Surgery within chest or abdomen

3

What should be used to treat a patient with JVD (marker of CHF) prior to surgery?

ACE Inhibitiors
Beta-blockers
Digitalis
Diuretics

4

How long should you wait after an MI to have surgery?

6 months (drops risk of mortality to around 6%)

5

What is the most common cause of increased pulmonary risk?

smoking

6

What does smoking do to increase pulmonary risk (what does it compromise)?

compromise ventilation (high PCO2, low FEV1) rather than oxygenation

7

What is the first test that should be used to evaluate pulmonary risk in a patient with risk factors (ex. COPD, smoking history, etc)?

FEV1 (do blood gases if this is abnormal)

8

What should you do for a patient at increased pulmonary risk before surgery?

Stop smoking for 8 weeks
Intensive respiratory therapy (PT, Incentive spirometry, expectorants, humidified air)

9

What two clinical findings are used to predict operative mortality in patients with liver disease?

Encephalopathy
Ascites

10

What 3 lab findings are used to predict operative mortality in patients with liver disease?

Serum albumin
Prothrombin time (INR)
Bilirubin

11

What are the 4 findings of severe nutritional depletion?

-Loss of 20% of body weight over a couple of months
-Serum albumin

12

List the major findings that may predict cardiac risk during surgery?

JVD
Recent MI
PVC or any rhythm other than sinus
Age >70
Emergency surgery
Aortic stenosis
Poor medical condition
Surgery within chest or abdomen

13

What should be used to treat a patient with JVD (marker of CHF) prior to surgery?

ACE Inhibitiors
Beta-blockers
Digitalis
Diuretics

14

How long should you wait after an MI to have surgery?

6 months (drops risk of mortality to around 6%)

15

What is the most common cause of increased pulmonary risk?

smoking

16

What does smoking do to increase pulmonary risk (what does it compromise)?

compromise ventilation (high PCO2, low FEV1) rather than oxygenation

17

What is the management of bacteremia?

Blood cultures X3
Empiric antibiotics

18

What should you do for a patient at increased pulmonary risk before surgery?

Stop smoking for 8 weeks
Intensive respiratory therapy (PT, Incentive spirometry, expectorants, humidified air)

19

What two clinical findings are used to predict operative mortality in patients with liver disease?

Encephalopathy
Ascites

20

What 3 lab findings are used to predict operative mortality in patients with liver disease?

Serum albumin
Prothrombin time (INR)
Bilirubin

21

What are the 4 findings of severe nutritional depletion?

-Loss of 20% of body weight over a couple of months
-Serum albumin

22

What is the optimal length of time with preoperative nutritional support if a patient is severely nutritionally depleted?

7-10 days (but 4-5 will do)

23

What drugs can trigger malignant hyperthermia?

halothane
succinylcholine

24

What temperature is reached with malignant hyperthermia?

104 F

25

What electrolyte abnormalities are to be expected in malignant hyperthermia?

metabolic acidosis
hypercalcemia

26

How do you treat malignant hyperthermia?

IV dantrolene
100% oxygen
Cooling blankets
Correction of acidosis

27

What should you expect if patient develops 104F temperature and chills 30-45 minutes after an invasive procedure (urinary tract instrumentation)?

bacteremia

28

What is the management of bacteremia?

Blood cultures X3
Empiric antibiotics

29

Postoperative fever (101-103) is usually caused by what (be time sequential)?

Atelectasis (POD1)
Pneumonia (POD3)
UTI (POD3)
Deep venous thrombophlebitis (POD5)
wound infection (POD7)
deep abscess (POD 10-15)

30

How do you work up possible post-op pneumonia?

-CXR
-Sputum cultures
-Abx