Pre- and Postop Care

Question 1

if a patient is over 50 what should they get before surgery

Answer 1

EKG

Question 2

if a person is on blood thinners or has liver disease what should you get on the day of surgery

Answer 2

Coags

Question 3

What does AMPLE stand for ?

Answer 3

Allergies
Meds
Past med hx
Last meal
Events prior to admission

Question 4

preop beta blockers are shown to _____ mortality, so they should still take them the day of surgery.

Answer 4

decrease

Question 5

There should be no elective surgery within ____ months of a MI/stroke

Answer 5

6

Question 6

Before elective surgery, those with unstable angina should have what?

Answer 6

CABG or PTCA

Question 7

Prosthetic heart valves may require anticoagulation up to the _________

Answer 7

day of surgery

Question 8

someone on _____ is at a much higher risk of bleeding, and it isn’t reversible.

Answer 8

Plavix

Question 9

If FEV1 is <__%, there is major pulmonary risk

Answer 9

50%

Question 10

about 1 out of three postop mortality is ____ in nature

Answer 10

pulmonary

Question 11

Pts with Chronic Renal Insufficiency (CRI) present problems with

Answer 11

electrolyte balance,
volume management,
acid-base balance,
bleeding risk

Question 12

High BUN has an ______ effect

Answer 12

anticoagulation

Question 13

Surgery should try to be scheduled ____ after dialysis

Answer 13

as soon as possible (day after)

Question 14

people with cirrhosis have a huge _____ risk

Answer 14

mortality (due to infection from acsities)

Question 15

Malnutrition predisposes to poor (or non-) (3 things)

Answer 15

wound healing, immunosuppression, resp insufficiency

Question 16

are skinny people the only malnourished people?

Answer 16

No, alcoholics also commonly malnourished

Question 17

what are alcoholic commonly deficient in?

Answer 17

thaimine

folate

Question 18

Albumin below what is a sign of malnutrition

Answer 18

3

Question 19

what is a better depiction of malnourishment in the past 3 days

Answer 19

prealbumin

Question 20

a prealbumin below what is considered malnourished?

Answer 20

18

Question 21

what is prealbumin?

Answer 21

Transthyretin

Question 22

Pts with steroid use (typically more than just inhalers) within last year are at risk for ________ __________ ___________.

Answer 22

postop adrenal insufficiency.

Question 23

If a patient is on chronic steroids and needs surgery what should you do to help them heal better?

Answer 23

leave staples in longer

hydrocortisone 100 mg IV TID then 50 mg IV tid for a day

Question 24

diabetes insipidus is usually caused by what?

Answer 24

a head injury (turn off ADH from pituitary)

Question 25

high sugars in general lead to ____ and ________

Answer 25

immunosuppression and poor wound healing

Question 26

Diabetes patients are at a high risk or _________ coma

Answer 26

hyperosmolar

Question 27

who are hypercoaguable

Answer 27

``` cancer obese trauma prolonged cases (stasis) known clotting disorders ```

Question 28

What is an acronym for Post op care?

Answer 28

ADC | VAANDIMIL

Question 29

What does ADC VAANDIMIL stand for?

Answer 29

``` (A)dmit (D)iagnosis (C)ondition (V)itals (A)llergies (A)ctivity (N)ursing – I&Os, foley, drain care, SCD’s, IS, wound care (D)iet (I)VF (M)eds (I)maging (L)abs ```

Question 30

What is IS

Answer 30

incentive spirometry

Question 31

What is IS used for?

Answer 31

prevent pneumonia or other pulmonary complications

Question 32

when should postop DVT prophylaxis be given?

Answer 32

anyone inpatient for more than 24 hours post op

Question 33

when should you give postop abx?

Answer 33

elective colon surgery

Question 34

Fluid collections in red, painful wounds are called what?

Answer 34

abscesses

Question 35

What must you treat and abscesses with?

Answer 35

Drainage

Question 36

Generally most wounds can be undressed and left open after ____ hours

Answer 36

48

Question 37

When should staples be taken out?

Answer 37

POD 7

Question 38

when should you leave staples in longer?

Answer 38

if immunocompromised, malnourished, etc.

Question 39

Fluid collections in painless wounds are typically

Answer 39

seromas (will resolve over time, can drain if symptomatic)

Question 40

what is a pneumonic to remember sources of post op fevers?

Answer 40

Wind Water Wound Walk

Question 41

If POD 1 what is the likely cause of the post op fever?

Answer 41

wind (lungs) | atelectasis

Question 42

If POD 3 what is the likely cause of the post op fever?

Answer 42

water (UTI)

Question 43

If POD 5 what is the likely cause of the post op fever?

Answer 43

Wound infection or abdominal abscess

Question 44

If POD 7 what is the likely cause of the post op fever?

Answer 44

Walk (DVT)

Question 45

when should foleys be removed?

Answer 45

48 hours or less (unless still needed)

Question 46

what would you suspect if POD 1 high fever with “dirty dishwater” fluid leaking from a surgical wound.

Answer 46

Necrotizing fasciitis

Question 47

how do you treat necrotizing fasciitis?

Answer 47

get back to OR IMMEDIATELY

Question 48

when should you suspect C Diff colitis

Answer 48

very high WBC or copious diarrhea

Question 49

Important things with HPOTN

Answer 49

low volume (most common) give saline bleeding septic shock MI (get EKG)

Question 50

common causes of low urine output

Answer 50

Hypovolemia bleeding clogged foley renal failure (usually from hypovolemia)

Question 51

common causes of N/V post op

Answer 51

drugs from anesthesia use antiemetic drugs give NGT if drugs aren't doing the trick

Question 52

any GI surgery should be expected to have what?

Answer 52

postop ileus

Question 53

Does the SB ever have an ileus?

Answer 53

No

Question 54

does the stomach have an ileus?

Answer 54

usually not

Question 55

what is a great alternative pain med but not good for people with renal insufficiency and elderly

Answer 55

Toradol

Question 56

Toradol doses shouldn't span more than how many hours?

Answer 56

72 hours

Question 57

what do pain balls do?

Answer 57

placed intraop | local meds, decrease need for opioids post op

Question 58

3 things you shouldn't suprise a surgeon with

Answer 58

transfusion antibiotics diet changes (b/c surgeons fear change)