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Surgery > Pre And Post Op Care > Flashcards

Pre And Post Op Care Flashcards

1
Q

Earliest indication of hypermagnesemia

A

Loss of deep tendon reflexes

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2
Q

What level and symptoms is symptomatic hyponatremia

A

120 mEq/L

HA, seizure, coma, ICP

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3
Q

How to treat hyponatrmia- moderate vs symptomatic

A

Mild- free water restriction

Symptomatic- hypertonic saline

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4
Q

Complication of jejunoileal bypass

A

Lose ileum–>calcium and oxalate can’t form insoluble compounds –> oxalate gets too absorbed –> hyperoxaluria

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5
Q

FENa less than 1 indicates

A

Prerenal etiology for oliguria

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6
Q

Magnesium deficiency symptoms

A

Potassium wasting by kidney

Functional hypoparathyroidism–> hypocalcemia

Prolonged qt, torsades

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7
Q

Hypocalcemia symptoms

A

Paresthesia
Hyperreflexia
Muscle spasm, tetany

Prolonged qt, heart blocks

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8
Q

When to give antibiotics to prevent surgical site infection in an elective procedure?

A

Single dose Pre-op no more than one hour before incision

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9
Q

What cardiac test should man with history of peripheral vascular disease and MI have before surgery?

A

Persantine thallium stress test and echo - assess need for stent and angiogram

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10
Q

Overdose of what can lead to tinnitus plus mixed metabolic acidosis-resp alkalosis

A

Aspirin

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11
Q

Treatment of Heoarin induced thrombocytopenia

A

Stop heparin plus start direct thrombin inhibitor and convert to warfarin when appropriate

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12
Q

bleeding post-op should first make you think of this etiology

A

bleeding blood vessel in surgical field

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13
Q

biggest risk factors for perioperative MI

A

**recent MI
CHF evidence
frequency of ectopic beats

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14
Q

diagnostic test of choice for acute mesenteric ischemia

A

angiography

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15
Q

suspected symptoms of actue mesenteric ischemia

A

sudden development of abdominal pain out of proportion of physical findings

systemic manifestations of arteriosclerotic disease or low CO states

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16
Q

treatment of acute mesenteric ischemia

A

emergent revascularization or resectional surgery

lapartomy if peritoneal signs

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17
Q

peritoneal signs include

A

acute abdominal pain, abdominal tenderness and abdominal guarding, which are exacerbated by moving the peritoneum, e.g., coughing (forced cough may be used as a test), flexing one’s hips,

Difficulty passing gas or pooping, fever, vomiting

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18
Q

diagnostic modality of choice for infrainguinal DVT

A

duplex US and heparin + warfarin (if not pregnant)

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19
Q

which bleeding disorder is indicated with elevated PTT and abnl bleeding time but normal PT?

A

von Willebrand (prevents inactivation of factor 8)

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20
Q

treatment of vWD and when given

A

desmopressin- activates receptors from storage sites to release vWF

only given before surgery or if severely injured

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21
Q

Systemic inflammatory response syndrome (SIRS) criteria

A

2 or more:

  • temp over 38 (100) or below 36 (97)
  • HR >90
  • resp rate >20 or PaCO2 <32
  • WBC >1,2,000 or <4000 or >10%immature PMNs
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22
Q

sepsis criteria

A

SIRS + documented infection

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23
Q

severe sepsis conditions

A

sepsis + organ dysfunction or hypoperfusion (lactic acdisos, oliguira, altered mental)

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24
Q

septic shock criteria

A

sepsis + organ dysfunction + hypotension (systole<90)

25
Q

class IV hemorrhagic shock (loss of >40% blood volume) treatment

A

infusion of packed RBCs and early administration of frozen plasma and platelets before lab values

26
Q

type of nutrition form that is recommended for patients with predicted prolonged recovery postop abdominal surgery

A

enteral nutrition within 24 hrs post op

(better than parenteral because decreased risk of infections, and better than oral because stomach is uncoordinated for 24 hours post op)

27
Q

woman on heparin gets retroperiotoneal hematoma. treatment?

A

reverse heparin with antidote-protamine sulfate

28
Q

indications for IVC filter

A
  • failure or complciation of anticoagulation
  • known free floating venous clot
  • prior history of PE
29
Q

complications of refeeding syndrome

A

hypophosphatemia, hypokalemia, hypomagnesemia (as insulin shifts electrolytes into cells)

hypoglycemia, hyperchloremic acidosis, volume overload –> HF

30
Q

acute adrenal insufficiency signs

A 
changing mental status, 
increased temp
CV collapse
hypoglycemia
hyperkalemia
31
Q

causes of adrenal insuff

A

severe stress
infection
trauma
cessation of chronic gluocorticoids

32
Q

treatment of adrenal insuff

A

IV steroids

volume rescucitation

33
Q

transusions of FFP to replenish vit K dep clotting factors should be administered when for patient with abnl coag factors going into surgery

A

on call to the operating room- transfusion complete prior to incision

34
Q

most common post op nosocomial infection?

A

UTI

35
Q

factors that predispose to fistula formation

A

FRIENDS

foreign body
radiation
inflammation
epithelization of tract
neoplasms
distal obstruction
steroids
36
Q

hemolytic vs allergic nonhemolytic transfusion reactions

A

hemolytic: preexisiting antibodies against ABO incompatible blood

37
Q

symptoms of hemolytic transfusion reactions

A

fever, chills, pain, redness along infused veins, oozing from IV sites, resp distress, anxiety, hypotension, oliguria

38
Q

treatment for bleeding complication in surgery with someone with mild vs severe hemophilia A

A

mild: desmopressin (increases factor 8 and vWF)
severe: desmopressin plus e-aminocaproic acid (inhibits fibrinolysis)

39
Q

when should you stop NSAIDs vs aspirin before surgery?

A

NSAIDs- 3-4 days before

aspirin: 7 days before

40
Q

treatment of megaloblastic anemia post gastrectomy

A

IV vit B12 (cyanocobalamin) every 3-4 months for life

41
Q

tests you could do post-op when you suspect a ureteral injury

A

pyelogram or nuclear medicine scan

42
Q

treatment for mild vs severe hypocalcemia post thyroid surgery

A

mild: oral calcium gluconate
severe: continuous infusion of calcium gluconate for few days

43
Q

which type of fluid is appropriate for replacing enteric losses?

A

ringer lactate solution

44
Q

which med counteracts effects of potassium (cardio) without decreasing the amount of potassium?

A

calcium gluconate

45
Q

which deficiency: alopecia, poor wound healing, night blindness or photophobia, anosmia, neuritis, skin rash

A

zinc

46
Q

which deficiency: cardiomyopathy

A

selenium

47
Q

molybdenum deficiency

A

encephalopathy- toxic accumulation of sulfur containing amino acids

48
Q

chromium deficiency

A

difficult hypoglycemia,
peripheral neuroapthy
encephalopathy

commonly occurs in long term TPN

49
Q

thiamine def

A

beri beri- encephalopathy, peripheral neuropathy

CV symptoms and HF

50
Q

malignant hyperthermia antidote

A

dantrolene- stop the anesthetic

51
Q

typical case of malignant hyperthermia

A

after induction of anesthesia

fever, shaking rigors, rhabdo (blood-tinged urine)

52
Q

how to replace blood loss in jehovas witness

A

lactated ringers or normal saline in 3:1 ratio

53
Q

whats a good solution for maintenance fluid?

A

0.45% normal saline with or without KCl (depends on kidney function)

54
Q

early signs of sepsis

A 
changing mental status
tachypnea --> resp alkalosis
flushed skin (dilated peripheral arteries)
55
Q

treatment for non-anion gap metabolic acidosis

A

fluid replacement and stool bulking agents

56
Q

treatment for transfusion reactions

A

stop transfusion. replace fluids

inducing diuresis to clear hemolyzed RBC membranes

alklanize urine to prevet Hgb clumping–>renal damage

57
Q

do you use antidiarrheal agents for c dif?

A

no!

58
Q

should you take in more or less calories post starvation?

A

less

59
Q

how many calories should you increase (relative to baseline) in following situations:

  • post routine operation
  • multiple organ failure or severe injury
  • more than 50% surface area burns
A
  • post routine operation: 1.1
  • multiple organ failure or severe injury: 1.5
  • more than 50% surface area burns: 2.0

Surgery (22 decks)

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