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GK General Surgery > Pre/Post Op > Flashcards

Pre/Post Op Flashcards

(62 cards)

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1
Q

What are possible tx options for DVT?

A

Anticoag w/Heparin (LMWH or unfractionated) w/ bridge to —> Warfarin​

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2
Q

Which anticoagulation agent is safe in pregnancy?

A

LMWH

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3
Q

What are rescue antiemetics and when are they used?

A

if N//V occurs in PACU (post-anesthesia care unit):

Prochlorperazine

Droperidol

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4
Q

What are the Ca+, PTH and phosphate levels in hypocalcemia?

A

Labs: ↓ Ca+ ↓ PTH ↑ phosphate

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5
Q

s/s of hypercalcemia

A

“Stones, bones, abdominal groans, psychiatric moans”

EKG: shortened QT interval.

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6
Q

Adults with ______ risk factors are considered high risk for developing postoperative N/V

A

4

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7
Q

Tx for severe hyponatremia

A

hypertonic 3% saline

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8
Q

What are possible interventions for postoperative N/V?

A

antiemetics

acupuncture

anesthesia modification

non-opioid pain management

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9
Q

What are the Ca+, PTH and phosphate levels in hypocalcemia?

A

Blood: ↑ PTH, ↑ Calcium, ↓ phosphorus

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10
Q

What reduces the incidence of post-op N/V?

A

pre-operative fasting 2-6 hrs prior to operation

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11
Q

S/S of hypernatremia

A

Poor skin turgor, dry mucous membranes, flat neck veins, hypotension, increased BUN/CR ratio > 20:1

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12
Q

What is the biggest risk factor for DVT?

A

virchow’s triad:

  1. venous stasis
  2. hypercoagulability
  3. endothelial damage
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13
Q

What is the antidote for warfarin (coumadin) toxicity?

A

Vitamin K

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14
Q

What are some antiemetic choices for postoperative N/V tx?

A

transdermal scopolamine

dexamethasone

ondansetron

prochlorperazine

droperidol

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15
Q

S/s of hyperkalemia

A
  • peaked T waves
  • muslce fatigue
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16
Q
A
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17
Q

What are the 8 positive wells criteria?

A
  1. active CA or tx w/in 6 mos
  2. paralysis or immobilization of lower extremity
  3. bedridden for more than 3 days due to surgery within 1 mo
  4. localized tenderness along distribution of deep veins
  5. swelling of entire leg
  6. unilateral calf swelling of greater than 3 cm
  7. unilateral pitting edema
  8. collateral SF veins
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18
Q

MOA of unfractionated heparin

A

potentiates anti-T III

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19
Q

What is the MOA of warfarin?

A
  • inhibits vit K-dependent coag factors of EXTRINSIC pathway: 2,7,9, 10.
  • inhibits protein C & S
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20
Q

What is the least emetogenic general anesthetic?

A

Propofol

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21
Q

What is the duration of action of the anticoag drugs?

A
  1. LMWH: 12 h
  2. UFH: 1h p IV drip is discontinued
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22
Q

What is the minimum time a pt should be on anticoagulation for following a DVT?

A

at least 3 months

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23
Q

What is the best test to rule OUT DVT?

A

a negative D-dimer test can rule out DVT in a LOW risk patient

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24
Q

When does postoperative N/V usually take place?

A

within 24 hrs after surgery

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25
s/s of Hypocalcemia
* **QT prolongation** * **+Trousseau's sign** (placing a blood pressure cuff on the patient’s arm and inflating to 20 mm Hg above systolic blood pressure for 3-5 minutes will ilicit a flexion of the wrist and carpal joints that cannot be controlled) * **+Chvostek's sign** (twitching of lip at corner of mouth to spasm of all facial muscles due to nerv hyperexcitability)
26
Why do many pts prefer LMWH?
no need to monitor PT INR
27
What can rapid overcorrection of hypernatremia cause?
cerebral edema and pontine herniation
28
What are risk factors for postoperative N/V?
**female gender** **history of previous postoperative nausea and vomiting or motion sickness** **nonsmoking status** **opioid administration**
29
**Emetogenic drugs** commonly used in **anesthesia** include what?
**Nitrous Oxide** **Physostigmine** **Opioids** **(**_N_**ausea **_P_**ost **_O_**p)**
30
What is a CI of LMWH?
renal failure
31
s/s of diabetes insipidus
**Low _urine_ sodium** (but **high _serum_ sodium**) and **polyuria**
32
What are the possible causes of hypernatremia?
Diarrhea, burns, diuretics, hyperglycemia, diabetes insipidus, a deficit of thirst
33
What is the antidote for heparin toxicity?
protamine sulfate
34
What causes neurogenic (central) Diabete Insipidus?
**deficient secretion of vasopressin** (**ADH - anti-piss-hormone**) from the posterior pituitary
35
What is 1st line dx for DVT?
venous suplex US: thrombus will show noncompressible echogenecity
36
S/S of hyponatremia
* **Peripheral and presacral edema**, **pulmonary edema,** **JVD**, hypertension, decreased hematocrit, decreased serum protein, decreased BUN/CR * **_muscle cramps and seizures_**
37
Where do most DVTs originate?
the calf
38
How long should coumadin (warfarin) be overlapped with heparin for atleast?
5 days
39
What is recommended therapy for pt with CI to or who failed anticoag tx for DVT?
IVC filter
40
Which tx for DVT do you NEED to check PT INR for?
unfractionated heparin
41
What are the 3 types of hyponatremia?
1. **_Hyper_**volemic(think **_hyper_**volume states): **CHF, nephrotic syndrome, renal failure, cirrhosis** 2. **_Eu_**volemic: **SIADH**, steroids, hypothyroid 3. **_Hypo_**volemic: **Na loss** (renal, non-renal)
42
Tx for asymptomatic hyponatremia
free water restriction
43
What do you need to keep in mind when correct hyponatremia?
Serum Na should be **_corrected slowly—by ≤ 10 mEq/L over 24 h_** to avoid **_osmotic demyelination syndrome_**
44
Tx for hyperkalemia
**insulin, sodium bicarb, glucose** **calcium gluconate (**antagonizes effect of K on heart)
45
What causes nephrogenic Diabetes Insipidus?
**kidneys that are unresponsive to normal vasopressin levels** - usually _inherited X-linked_ or from _lithium_ or _renal disease_
46
What do you want to avoid when you are on warfarin (coumadin)?
avoid cruciferous vegetables with increased Vit K
47
Tx for hypercalcemia
IV normal saline + furosemide
48
s/s of hypokalemia
* EKG: flattened/inverted T waves, U waves * muscle cramps * constipation
49
What is the negative wells criteria category?
alt dx as likely or more likely than DVT (-2)
50
Tx for hypocalcemia
IV Calcium gluconate
51
What are the main s/s of DVT?
1. **_unilateral swelling/edema of lower extremity \>3cm_** (most specific sign of DVT) 2. **_calf pain/tenderness_** 1. **Homan's sign:** pain in calf w/dorsiflexion of affected foot and knee. 2. **Phlebitis:** warmth, erythema, palpable cord.
52
Tx for hypokalemia
* potassium repletion * _**\*\*DO NOT USE DEXTROSE CONTAINING FLUIDS\***_\* * _this will stimulate insulin release and shift potassium within the cell which worsens the hypokalemia_ * Replace Mg if Mg is low
53
Tx fo hypernatremia
IV 5% dextrose in water **(D5W)**
54
tx for moderate hyponatremia
IV normal saline +/- loop diuretics ( decrease H2O volume)
55
What is gold standard for DVT dx?
venography: filling defect ir ninfilling of the deep veins
56
major causes of metabolic alkalosis
GI hydrogen loss: **vomiting, NG suction** Any type of hydrogen loss or shift of hydrogen
57
What is the MCC of metabolic **_alkalosis_**
**volume loss and gastric fluid loss** seen in small bowel tx with NG tube
58
During this type of surgery, **aggressive third-spacing of fluid into the peritoneal cavity**, as well as the intestinal lumen, is the cause of **volume contraction**. What surgery?
small bowel surgery
59
What causes metabolic **acidosis** post op?
**large blood loss or resuscitation causing lactic acidosis**
60
What causes post-op respiratory **acidosis**?
**secondary to hypoventilation from resp depression (narcotics or sedation)**
61
What causes post-op respiratory alkalosis?
pts who **undergo upper abdominal or thoracic surgery** and take **shallow breaths to avoid incisional pain.**
62

GK General Surgery (11 decks)

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