Pre/Post Operative Flashcards
(159 cards)
1
Q
When can a patient eat prior to major surgery
A
Should be NPO after midnight the night before surgery or at least 8 hours before surgery
2
Q
What risks should be discussed with all patients and documented on the consent form for a surgical procedure
A
Bleeding, Infection, Anesthesia, Scar
Other risks specific to patient such as MI, CVA, Death
3
Q
If the patient is on antihypertensive meds should the patient take them on the day of the procedure
A
Yes
4
Q
If a patient is on oral hypoglycemic agent should the patient take it the day of surgery
A
Not if they are to NPO before surgery
5
Q
If the patient is taking insulin should the patient take it on the day of surgery
A
No
Only half of a long lasting insulin and start D5 NS IV
Check glucose levels often before, during, and after surgery
6
Q
Should a patient who smokes cigarettes stop before an operation
A
Yes, Improvements are seen in just 2-4 weeks after smoking cessation
7
Q
What laboratory test must all women of childbearing age have before enter an OR
A
Beta-HCG and CBC (pregnancy and anemia)
8
Q
What preoperative procedure should be performed before colon surgery
A
Bowel prep with colon cathartic (goLYTELY), Oral antibiotics (Neomycin and Erythromycin base), IV antibiotic before incision
9
Q
What preoperative meds can decrease postoperative cardiac events and death
A
Beta-Blockers
10
Q
What must you always order preoperatively for your patient undergoing a major operation
A
NPO/IVF
Preoperative Antibiotics
Type and Cross Blood
11
Q
What electrolyte must you check preoperatively if a patient is on hemodialysis
A
Potassium
12
Q
What gets a preoperative EKG
A
Patients older than 40 years of age
13
Q
What are the surgical causes of Metabolic Alkalosis
A
Vomiting, NG suction, diuretics, alkali ingestion, mineralocorticoid excess
14
Q
What are the surgical causes of Respiratory Acidosis
A
Hypoventilation, PTX, Pleural effusions, Airway Obstruction
15
Q
What are the surgical causes of Respiratory Alkalosis
A
Hyperventilation
16
Q
What are surgical causes for Hypokalemia
A
Diuretics, antibiotics, steroids, NG aspiration, Vomiting
17
Q
Sx of Hypokalemia
A
Weakness, tetany, N/V, Ileus, Paraesthesia
18
Q
What are EKG findings for Hypokalemia
A
Flattening of T waves
U waves
19
Q
Tx of Hypokalemia
A
KCL IV
20
Q
What electrolyte must you replace first before replacing Potassium
A
Magnesium
21
Q
What are surgical causes for Hypernatremia
A
Inadequate hydration Diabetes Insipidus, Diuresis, Vomiting, Diarrhea
22
Q
Sx of Hypernatremia
A
Seizures, Confusion, Stupor, Pulmonary or Peripheral Edema, Tremors, Resp. Paralysis
23
Q
Tx for Hypernatremia
A
D5W, 1/4 NS or 1/2 NS
24
Q
What is a major complication of lowering sodium level too fast
A
Seizures
25
What are the surgical causes for Hypovolemia
Diuretic excess, hypoaldosteronism, Vomiting, NG suction, burns, pancreatitis, Diaphoresis
26
What are the surgical causes for Euvolemia
SIADH, CNS abnormalities, Drugs
27
What are the surgical causes for Hypervolemia
Renal Failure, CHF, liver failure (cirrhosis), iatrogenic fluid overload
28
Sx of Volume imbalance
Seizures, coma, N/V, ileus, lethargy, confusion, weakness
29
Tx for Hypovolemia
IV NS, correct underlying cause
30
Tx for Euvolemia
SIADH: Furosemide and NS
| Fluid restriction
31
Tx for Hyervolemia
Dilution: Fluid restriction and diuretics
32
What results if you correct hyponatremia too quickly
Central pontine myelionolysis
33
What are sx of Central Pontine Myelinolysis
Confusion
Spastic Quadriplegia
Horizontal gaze paralysis
34
What are causes of Hypercalcemia
```
Calcium Supplements
Hyperparathyroidism
Hyperthyroidism
Immobility
Milk Alkali Syndrome
Paget's Disease (of bone)
Addison's Disease
Neoplasm
Zollinger-Ellison Synddrome
Excess Viatmin D, Vitamin A
Sarcoid
```
35
Sx of Hypercalcemia
Stones, Bones, Groans and psychiatric overtones
36
Tx for Hypercalcemia
Volume expansion with S
| Diuresis with furosemide
37
What are surgical causes for Hypocalcemia
```
Short bowel syndrome
Intestinal bypass
Vitamin D deficiency
Sepsis
Acute Pancreatitis
Osteoblastic Mets
```
38
What is Chvostek's Sign
Facial muscle spasm with tapping of facial nrve
39
What is Trousseau's Sign
Carpal spasm after occluding blood flow in forearm with blood pressure cuff
40
Sx of Hypocalcemia
Chvostek's and Trousseau's Sign, Increased DTR, Confusion, Abdominal Cramps
41
What are EKG findings for Hypocalcemia
Prolonged QT and ST intervals
42
Tx for Hypocalcemia
Calcium Gluconate IV
43
What is a complication of infused calcium if th IV infiltrates
Tissue necrosis
44
What are surgical causes for Hypermagnesemia
TPN, Renal Failure
45
Sx of Hypermagnesemia
Respiratory Failure, CNS Depression, Reduced DTR
46
Tx of Hypermagnesemia
Calcium gluconate IV, Insulin plus Glucose, Dialysis
47
What are surgical causes for Hypomagnesemia
TPN, Hypocalcemia, Gastric Suctioning, Aminoglycosides, Renal Failure, Diarrhea, Vomiting
48
What are sx of Hypomagnesemia
Increased DTR, Tetany, Asterixis, Tremor, Chvostk's Sign
49
Tx for Hypomagnesemia
MgSO IV
50
What are surgical causes for Hyperglycemia
DM, Infection, Stress, TPN, Drugs
51
Sx of Hyperglycemia
Polyuria, Hypovolemia, Confusion/coma
52
Tx of Hyperglycemia
Insulin
53
What are surgical causes for Hypoglycemia
Excess insulin, decreased caloric intake, drugs, liver failure
54
Sx of Hypoglycemia
Diaphoresis, Tachycardia, Palpitations, Confusion, Coma, Headache, Diplopia, Neurologic deficits, seizures
55
Tx for Hypoglycemia
Glucose (IV or PO)
56
What are sx of a transfusion reaction
Fever, Chills, Nausea, Hypotension, lumbar pain, chest pain, abnormal bleeding
57
Tx for transfusion hemolysis
Stop transfusion, provide fluds, perform diuresis (Lasix) to protect kidenys, give pressors if needd
58
What factor is deficient in Hemophilia A
Factor 8
59
What is the preoprative treatment for Hemophilia A
Factor 8 infusion to more than 100% normal preoperative levels
60
What coagulation study is elevated with Hemophilia A
PTT
61
What factor is deficient in Hemophilia B
Factor 9
62
What is Von Willebrand's Disease
Deficiency of vWF and Factor 8:C
63
What is used to correct Von Willebran'd Disease
DDAVP or Cryoprecipitate
64
What coagulation is abnormal with
Hemophilia A
Hemophilia B
vWF
```
Hem.A = PTT is elevated
Hem.B = PTT is elevated
vWF = Bleeding Time
```
65
What is the effect on the coagulation of a patient with deficiency in Protein C, Protein S, or Antithrombin III
Hypercoaguable state
66
What is the most common inherited Hypercoaguable state
Factor V Leiden
67
What is the most common cause of fever during post-op day 1 or 2
Atelectasis = Collapse of Alveoli
68
Tx of Atelectasis
Incentive Spirometry, deep breathing, coughing, early ambulation, NT suctioning and chest PT
69
What are causes of postoperative pleural effusions
Fluid overload, pneumonia, diaphragmatic inflammation with possible subphrenic abscess formation
70
Tx for posoperative wheezing
Alubetrol Nebulizer
71
What is a PE
DVT that embolizes to pulmonary arterial system
72
Sx of DVT
Lower extremity pain, swelling, tenderness, Homan's Sign, PE
73
Dx of DVT
Duplex Ultrasound
74
What is Virchow's Triad
Stasis, Endothelial Injury, Hyprcoaguable state
75
Sx of PE
SOB, Tachypnea, Hypotension, CP, Fever, Hemoptysis
76
Dx for PE
CT Angiogram, V/Q Scan
77
What are Chest Xray signs of PE
Westermark's Sign (Wedge shaped area of decreased pulmonary vasculature)
Opacity with base at pleural edge from pulmonary infarct
78
Tx for PE if patient is stable
Anticoagulation (Heparin followed by Coumadin)
79
Tx for PE if patient is unstable
Thrombolytic Therapy
80
What are risk factors for aspiration pneumonia
Intubation/Extubation, drugs, alcohol, dysphagia, nonfunctioning NGT
81
Sx of Aspiration Pneumonia
Respiratory failure, CP, Increased Sputum, Fever, Cough, Mental Status Changes
82
What organisms are involved in Aspiration Pneumonia
CAP: Gram Positive
| Hospital/ICU: Gram Negative Rods
83
Dx of Aspiration Pneumonia
CXR, Sputum Culture
84
Tx for Aspiration Pneumonia
Bronchoscopy, Abx
85
What are possible NGT complications
Aspiration-Pneumonia/Atelectasis
Sinusitis
Minor UGI bleeds
86
Sx of Gastric Dilatation
Abdominal Distension, Hiccups, Electrolyte Abnormalities, Nausea
87
Tx for Gastric Dilatation
NGT Decompression
88
What is Postoperative Pancreatitis
Pancreatitis resulting from manipulation of pancreas during surgery or low blood flow during procedure, gallstones, hypercalcemia, meds
89
What lab tests are performed for pancreatitis
Lipase and Amylase
90
Tx for Pancreatitis
NPO, Aggressive fluid resuscitation, NGT PRN
91
What are postoperative causes for Constipation
Narcotics, Immobility
92
Tx for Constipation
Ortho Bowel Routine: Docusate sodium, Dicacoyl suppository if no bowel movement occurs, Fleet enema if suppository is ineffctive
93
What is Short Bowel Syndrome
Malabsorption and diarrhea resulting from extensive bowel resection
94
Tx for Short Bowel Syndrome
TPN early, followed by many small meals chronically
95
What causes SBO
Adhesions, Incarcerated hrnia
96
What causes Ileus
Laparotomy, Hypokalemia or Narcotics, Intraperitoneal Infection
97
What are the signs of resolving ileus/SBO
Flatus, Stool
98
What is the order of recovery of bowel function after abdominal surgery
First small intestine
Second stomach
Third Colon
99
What is Blind Loop Syndrome
Bacterial Overgrowth in the small intestine
100
What are causes of Blind Loop Syndrome
Anything that disrupts the normal flow of intestinal contents
101
What are surgical causes of B12 Deficiency
Gastrectomy (decreased secretion of intrinsic factor) and excision of ileum (site of B12 absorption)
102
What is Dumping Syndrome
Delivery of hyperosmotic chyme to the small intestine causing massive fluid shifts into the bowel
Normally the stomach will decrease the osmolality of the chyme prior to its emptying
103
With what condition is Dumping Syndrome associated with
Any procedure that bypasses the pylorus or compromises its function (Gastroeterostomies or pyloroplasty)
104
Sx of Dumping Syndrome
Postprandial Diaphoresis, Tachycardia, Abdominal Pain/Distention, Emesis, Increased Flatus, Dizziness, Weakness
105
Dx of Dumping Syndrome
History
106
Tx of Dumping Syndrome
Small, multiple, low fat/carb meals that are high in protein
| Avoid liquids with meals to slow gastric emptying
107
Surgical tx of Dumping Syndrome
Converstion to Roux-en-Y
108
What is DKA
Deficiency of body insulin, resulting in hyperglycemia, formation of ketoacids, osmotic diuresis and metabolic acidosis
109
Sx of DKA
Polyuria, tachypnea, dehydration, confusion, abdominal pain
110
Lab values seen with DKA
Elevated glucose, increased anion gap, hypokalemia, urine ketones, acidosis
111
Tx of DKA
Insulin drip, IVF rehydration, Potassium Supplement
112
What is Addisonian Crisis
Acute Adrenal Insufficiency in the face of a stressor (surgery, trauma, infection)
113
Cause of Addison Crisis
Postoperative, inadequate cortisol release usually results from steroid administration in the past year
114
Sx of Addison Crisis
Tachycardia, N/V, diarrhea, abdominal pain, hypotension, eventual hypovolemic shock
115
What are typical lab values seen with Addison Crisis
Decreased Sodium
| Increased Potassium
116
Tx of Addison Crisis
IVF, hydrocortisone IV, Fludrocortisone PO
117
What is SIADH
Inappropriate ADH Secretion
118
What does ADH do
ADH increases sodium and water resportion in the kidney
| Increases intravascular volume
119
What causes SIADH
Mainly lungs/CNS
| CNS trauma, oat-cell lung cancer, pancreatic cancer, duodenal cancer, pneumonia/lung abscess
120
Tx of SIADH
Restrict fluid intake
| Tx underlying cause
121
What is Diabetes Insipidus
Failure of ADH renal fluid conservation resulting in dilute urine in large amounts
122
What is the source of ADH
Posterior Pituitary
123
What are the 2 types of Diabetes Insipidus
Central: Decreased production of ADH
Nephrogenic: Deceased ADH effect on kidney
124
What are causes of Central Diabetes Insipidus
Brain injury, tumor, surgery and infection
125
What are causes of nephrogenic Diabetes Inspidus
Amphoterecin B, Hypercalcemia and Chronic Kidney Infection
126
Tx for Diabetes Insipidus
Fluid replacement
Central: Pressin
Nephrogenic: Thiazide
127
What are the common causes of dyspnea following central line placement
Pneumothorax
Pericardial Tamponade
Carotid puncture, air embolism
128
What is the most dangerous period for postoperative MI following a previous MI
6 months after an MI
129
What are risk factors for postoperative MI
History of MI
Angina
Q waves
JVD, CHF, Aortic Stenosis, Advanced Age, MI within 6 months, EKG changes
130
How do postoperative MI's present
Without chest pain
New onset CHF, new onset dysrhythmia
Hypotension, Tachypnea, Tachycardia, N/V
131
What lab tests are indicated for suspected MI
Troponin
| CK (Cardiac Isoenzymes)
132
Tx for postoperative MI
```
MONA-BASH (for CHF), for MI it's MONA-BH
Morphine
Oxygen
Nitrates
ASA
Beta Blockers
Ace-I
Statins
Heparin
```
133
What is a CVA
Cerebrovascular Accident
134
Sx of CVA
Aphasia, Motor/Sensory Deficits
135
Dx of CVA
CT (rule out hemorrhage)
| Carotid Doppler Ultrasound
136
Tx for CVA
ASA, Heparin
| Thrombolytic therapy not usually post-op option
137
Perioperative prevention for CVA
Avoid Hypotension
| ASA
138
What is Postoperative Renal Failure
Increase in serum creatinine and decreas in creatinine clearance, usually associated with decreased urine output
139
What are reasons for prerenal Renal Failure
Inadequate blood perfusion to kidney
| Inadequate fluids, Hypotension, CHF
140
What are reasons for intrarenal Renal Failure
Kidney Parechymal Dysfunction
| Acute Tubular Necrosis, Nephrotoxic Contrast, Drugs
141
What are reasons for Postrenal Rena Failure
```
Obstruction to outflow of urine from Kidney
Foley catheter obstruction
stone
Ureteral/urethral injury
BPH
Bladder dysfuntion
```
142
What is Abdominal Compartment Syndrome
Increased intra-abdominal pressure usually seen after laparotomy or after massive IVF resuscitation (burn patients)
143
Sx of Abdominal Compartment Syndrome
Tight distended abdomen, decreased urine output, increased airway pressure, increased intra-abdominal pressure
144
Tx for Abdominal Compartment Syndrome
Release the pressure by placing a drain or by opening the abdomen and place a sheet of synthetic material to the skin to allow for more intra-abdominal volume
145
Sx of Wound Infection
Erythema, Swelling, Pain, Heat
146
Tx of Wound Infection
Open wound, leave open with wet to dry dressing changes, abx if cellulitis
147
What is fascial dehiscence
Acute separation of fascia that has been sutured closed
148
Tx for Fascial Dehiscence
Bring back to OR for reclosure of fascia
149
What is a wound infection
Infection in an operative wound
150
When do wound infections typically arise
5-7 days postoperatively
151
Sx of Wound Infection
Pain at incision site, erythema, drainage, induration, warm skin, fever
152
Tx of Wound Infection
Remove skin sutures/staples, perform digital exam to rule out fascial dehiscence, pack wound open, snd wound cultures, give abx
153
What are common bacteria found in Wound Infections
Staph Aureus
E.Coli
Enterococcus
154
What bacteria cause fever in wound infections in the first 24 hours after surgery
Streptococcus
| C.Diff
155
What is post-operative Fever
Temperature >101.5
156
What are the classic W's (causes) of postoperative Fever
```
Wind: Atelectasis
Water: UTI
Wound: Infection
Walking: DVT/Thrombophlebitis
Wonder Drugs: Drug Fever
```
157
What is the most common cause of fever on postoperative day 1 and 2
Atelectasis
158
What causes fever from postoperative day 3-5
UTI, Pneuonia, IV site infection, wound infection
159
What causes fever from postoperative day 5-10
Wound infection, pneumonia, abscess, infected hematoma, C.Diff Colitis, DVT, Peritoneal Abscess, Drug Fever
