Pre and Postop Care

Question 1

What do you document for informed consent

Answer 1

The procedure was explained

Risks, Benefits, and alternatives were explained

Question 2

When to do an EKG preop

Answer 2

Over 50

Question 3

What test should be done on any female of childbearing age?

Answer 3

HCG

Question 4

When should you order a type and screen (T&S)?

Answer 4

Anemia or Significant blood loss

Question 5

What lab should be ordered preop if the pt is on blood thinners or has liver disease and when?

Answer 5

Cag pannel on DOS

Question 6

Why is past surgical Hx important?

Answer 6

preop planning b/c of scar tissue, expected adhesions

Question 7

What does AMPLE stand for?

Answer 7

Allergies, Meds, Past med hx, Last meal, Events prior to admission

Question 8

When is AMPLE used?

Answer 8

In the setting of emergency surgery

Question 9

What has been shown to decrease mortality with heart disease if given preop?

Answer 9

Beta Blockers

Question 10

No elective surgery within how long of an MI/Stroke?

Answer 10

6 months

Question 11

What should pts with unstable angina ideally have before surgery?

Answer 11

CABG or PTCA

Question 12

What should be given up until DOC with prosthetic heart valves?

Answer 12

Anticoagulation

Question 13

What finding on PFT would signify major pulmonary risk?

Answer 13

FEV1 <50% expected

Question 14

What pulmonary risks should be discussed with the patient?

Answer 14

Atelectasis, postop pneumonia, prolonged ventilation

Question 15

What proportion of postop mortality is pulmonary related?

Answer 15

1/3

Question 16

What complications are associated with chronic renal insufficiency?

Answer 16

Problems with electrolyte balance, volume management, acid-base balance, bleeding risk (high BUN has an anticoag effect)

Question 17

What electrolytes should be avoided in fluids given to pts on dialysis?

Answer 17

K Mg Phos

Question 18

When should surgery be scheduled in relation to pts dialysis?

Answer 18

Shortly after

Question 19

What should be excluded from dialysis treatment before surgery?

Answer 19

Heparin

Question 20

What mortality is associated with Child’s A cirrhosis?

Answer 20

10-15%

Question 21

What mortality is associated with Child’s B cirrhosis?

Answer 21

25-30%

Question 22

What mortality is associated with Child’s C cirrhosis?

Answer 22

> 50%

Question 23

What complications is malnutrition associated with?

Answer 23

Poor wound healing, immunosuppression, respiratory insufficiency

Question 24

What are laboratory signs of malnutrition?

Answer 24

Albumin <18, low total protein

Question 25

Pts who have been on steroids during the past year are at a risk of what?

Answer 25

Postop adrenal insufficiency

Question 26

If postop adrenal insufficiency caused by steroid use is untreated what can it lead to?

Answer 26

Vascular collapse

Question 27

How is post op adrenal insufficiency treated?

Answer 27

Hydrocortisone IV 100 mg IV tid for one day then 50 mg IV for one day

Question 28

What are diabetics high-risk for if their blood sugars are high at the onset of surgery?

Answer 28

Hyperosmolar coma

Question 29

Hyperglycemia in general leads to:

Answer 29

Immunosuppression, poor wound healing

Question 30

For what conditions do you keep on lovenox until DOS?

Answer 30

Mechanical heart valves and a fib

Question 31

Risk of clot is greater with arterial clot within how much time?

Answer 31

6 months

Question 32

Risk of clot is increased with DVT within how much time?

Answer 32

3 months

Question 33

When is DVT prophylaxis given if the patient is still in the hospital post-op?

Answer 33

within 24 hrs

Question 34

When are postop abx given?

Answer 34

Elective colon surgery

Question 35

When can wounds be undressed and left open?

Answer 35

After 48 hours

Question 36

How will an abscess in a wound present?

Answer 36

fluid collection in red, painful wounds

Question 37

What can an abscess not be treated without?

Answer 37

Drainage

Question 38

When can staples be removed in a normal patient?

Answer 38

POD 7

Question 39

What is a seroma?

Answer 39

Fluid collection in a painless wound

Question 40

How is a seroma treated?

Answer 40

It will resolve on its own or can be drained if it is symptomatic

Question 41

When do postop fevers generally occur?

Answer 41

Wind (1) Water (3) Wound (5) Walk (7)

Question 42

What does wind stand for in wind/water/wound/walk?

Answer 42

Atelectasis

Question 43

When should C diff be suspected for a post op fever?

Answer 43

Very high WBC and copious diarrhea

Question 44

What is the classic setup for necrotizing fasciitis?

Answer 44

POD 1, high fever, "dirty dishwater" drainage from wound

Question 45

How is nec fasc treated

Answer 45

Surgical emergency

Question 46

What are common causes of post op hypotension

Answer 46

Hypovolemia, bleeding, septic shock, MI

Question 47

What are common causes of low urinary output?

Answer 47

hypovolemia, bleeding, clogged foley, renal failure

Question 48

How long is a small bowel ileus?

Answer 48

SB ileus does not occur

Question 49

How long does a stomach ileus last?

Answer 49

Maybe one day

Question 50

How long does a large bowel ileus last?

Answer 50

3-5 days

Question 51

How do you manage pain if pt is NPO?

Answer 51

IV or PCA narcotics

Question 52

What are precautions in Toradol?

Answer 52

Elderly, renal insufficiency

Question 53

How long can a pt be treated with Toradol?

Answer 53

Minimal doses for no more than 72 hours