Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

EOR - Surgery > PreOp/PostOp Care > Flashcards

PreOp/PostOp Care Flashcards

(156 cards)

Start Studying
1
Q

6 predictors of surgical cardiac complications

A

ischemic heart dz
CHF
cerebrovascular dz
high risk operation
pre op tx w. insulin
pre op SCr > 2.0

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

5 other rf for surgical cardiac complications

A

age
smoking
abnl cardiac stress test
long term bb therapy
COPD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

pre op management of pt w. rheumatic heart dz

A

prophylactic abx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

who should get a pre op EKG

A

all pt’s >/= 40 yo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

2 indications for noninvasive stress testing prior to noncardiac operations

A

active cardiac conditions: unstable angina, recent MI, significant arrhythmias, severe valvular dz
high risk vascular ops

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

6 indications for coronary revascularization prior to noncardiac ops

A

-significant left main coronary artery stenosis
-stable angina w. 3 vessel coronary dz
-stable angina w. 2 vessel dz
-significant proximal LAD coronary artery stenosis w. EF < 50% OR ischemia on noninvasive testing
-high-risk unstable angina or NSTEMI
-acute STEMI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

why may it be dangerous to give a COPD pt supplemental O2 during surgery

A

pt relies on relative hypoxia for respiratory drive -> supplemental O2 may remove this drive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

when should smokers stop smoking prior to surgery

A

at least 8 weeks prior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

mc perioperative complications involve which system

A

pulmonary

pcc: post op pulmonary complications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

2 determinants of pulmonary perioperative risk

A

lung dz
operative site

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

pre op management of COPD pt

A

minimum of one week of aggressive treatment:
-smoking cessation
-abx if purulent sputum
-bronchodilators

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

t/f: pt w. well controlled asthma is not at higher risk for perioperative complications

A

t!

but poorly controlled asthma is high risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

pre op management of poorly controlled asthma

A

-step up therapy
-systemic steroids if FEV < predicted value or personal best
-pre elective surgery goals: wheezing free, peak flows > 80% predicted or personal vest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

intubation consideration for pt’s w. poorly controlled asthma

A

-SABA 2-4 puffs vs nebulizer w.in 30 mins before intubation

+/- systemic steroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

preop management of pulmonary fibrosis pt (3)

A

treat infxns
remove sputum
smoking cessation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

pre op management of acute lower respiratory tract infxns (tracheitis, bronchitis, pna)

A

-elective surgeries are contraindicated!
-emergent surgeries: humidification, removal of secretions, bronchodilators, abx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

location of operation for operative pulmonary risk

A

high to low:
torachotomy
upper abdomen
lower abdomen
periphery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what test is used for pre op pulmonary function eval

A
  1. spirometry to measure FEV
  2. if low FEV: measure response to bronchodilators, obtain ABGs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

spirometry indications for increased risk for pulmonary complications (2)

A

FEV1 < 50% of normal
PaCO2 > 45 mm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

surgeries lasting > _ are associated w. higher risk of pulmonary complications

A

3-4 hr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

greatest risk ops for pulmonary complications (3)

A

upper abd
open aortic aneurysm repair
head/neck

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

lung protective ventilation should be used for _ ops, and involves _

A

abdominal ops

low tidal volume ventilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

post op management of pulmonary complications (3)

A

lung expansion
incentive spirometry
early mobilization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what is atelectasis

A

collapse of alveoli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
7 rf for atelectasis
intubation high flow O2 COPD smoking abd/thoracic surgery oversedation poor pain control
26
5 sx of atelectasis
fever decreased breath sounds rales tachypnea/tachycardia increased densities on CXR
27
mc cause of fever POD 1-2
atelectasis
28
prevention for atelectasis (7)
pre op smoking cessation incentive spirometry good pain control coughing early ambulation NT suctioning chest physiotherapy
29
what is post op pulmonary failure
respiratory impairment w.: increased RR SOB dyspnea
30
indications for intubation/ventilation (3)
-unconscious -excessive wob -progressive hypoxemia despite supplemental O2: PaO2 < 55, pH < 7.3, RR > 35
31
4 causes of post op pleural effusion
fluid overload pna diaphragmatic inflammation subphrenic abscess
32
tx for absorption atelectasis
nitrogen
33
what is a non rebreather mask
100% O2 w. reservoir bag
34
max FiO2 delivered by nonrebreather mask
80-90%
35
PaO2 to O2 sat equivalents
PaO2 40, 50, 60 = O2 sat 70, 80, 90
36
each liter of increased NC O2 increases FiO2 by _
3%
37
max flow for NC O2
6 L
38
BG levels > _ are a predictor for surgical site infxn
140
39
best management of post op hyerglycemia
IV insulin
40
DM pt's are at higher risk for _ post oc complications
cardiac
41
management of periop hyperglycemia (2)
IV short acting insulin SQ SSI
42
patient-related conditions associated w. higher risk for surgical infxns (11)
advanced age DM malnutrition smoking obesity immunosuppressive therapy systemic steroids PVD malignancy/anti neoplastic tx HIV/AIDS liver failure renal failure
43
what is virchow's triad
stasis hypercoagulable states trauma
44
4 hypercoagulable states that Smarty PANCE stresses
factor V leiden cancer OCP + smoking pregnancy
45
imaging for DVT: first line vs gs
first line: duplex US gs: venography
46
tx for DVT
IV heparin bridge to warfarin
47
is DVT mc in left or right iliac vein
left
48
what surgery is especially high risk for post op DVT
colorectal
49
what 2 scoring systems are used to assess probability of developing post op DVT
caprini score american college of chest physicians
50
heparin prophylaxis for DVT reduces risk for what 3 complications
wound hematomas mucosal bleeding reoperation
51
smoking w.in _ of surgery increases risk of complications
1 year
52
best pharm for perio-op smoking cessation
bupropion
53
screening rec for lung ca
low dose CT annually for adults 50-80 yo w. a 20 pack/year smoking hx and currently smoke or have quit in the last 15 yr
54
when can lung ca screening stop
no smoking x 15 years contraindication lung surgery
55
3 types of NRT
patch gum lozenges
56
NRT recommended for people who smoke 25 or more cigs/day
gum
57
NRT recommended for pt's who smoke w.in 30 min of waking up
lozenges
58
what should be avoided w. NRT gum
acidig beverages
59
s.e of nicotine patches
vivid dreams/insomnia -> remove at bedtime
60
2 meds for smoking cessation
varenicline (chantix) bupropion (zyban, wellbutrin)
61
moa for bupropion
enhances noradrenergic and dopaminergic release
62
how does varenicline work (3)
reduces withdrawal sx reduces reward aspects
63
surgical problems associated w. SUD (7)
venous access arterial injury DVT abscess formation gas gangrene compartment syndrome neuropraxia
64
who should be screened pre op for SUD
all pt's
65
NIAAA definition of AUD
> 2 drinks/day for men > 1 drink/day for women or >/= 65
66
CAGE questionnaire
cut down? annoyed? guilt? eye opener?
67
how many drinks may cause BAC >/= 0.08
2
68
complications of stimulant use
greater pressor/intubation response need for more anesthetic
69
complications fo volatile solvent abuse (4)
cardiomyopathy dysrhythmia sensitivity to sympathomimetics myocardial dpn
70
PCA usually involves what analgesic
morphine
71
pharm for SUD (7)
naltrexone acamprosate disulfiram topiramate methadone buprenorphine naltrexone
72
what are the 6 w's of post op infxn
wind: atelectasis water: UTI wound: infxn walking: thrombophlebitis wonder drugs: anesthetic/sulfas causing fever whopper: abscesses -> ileus, anastomotic leaking
73
mc nocosomial infxn in hospital setting
UTI
74
mc pathogen associated w. post op infxn
staph
75
mcc of infxn > 72 hr post op
staph infxn
76
mcc of superficial vs deep thrombophlebitis
superficial: intravascular catheter deep: indwelling catheter
77
tx for post op atelectasis
incentive spirometry mucolytics expectorants SABA/LABA *best tx is prevention: smoking cessation*
78
tx for post op DVT
LMWH heparin contraindication: greenfield filter
79
definition of post op fever
> 38.5/101.5
80
timeline of 5 w's
wind: 24-48 hr water: anytime after POD 3 wound: mc after pod 5 walking: pod 7-10 wonder drugs: anytime
81
mcc of post op atelectasis
cytokine release from tissue damage
82
4 causes of post op fever < 24 hr post op
**atelectasis** cytokine release strep vs clostridial infxn anastomotic leak
83
4 causes of fever POD 3-5
UTI PNA IV site infxn wound infxn
84
cause and tx of fever intraoperatively
malignant hyperthermia dantrolene
85
cause of fever POD 5-10 (lots!)
wound infxn pna abscess infected hematoma cdiff anastomotic leak DVT peritoneal abscess drug fever PE abscess parotitis
86
causes of wound infxn POD 1-2
strep clostridia *painful bronze-brown wound weeping*
87
3 anytime causes of post op fever
IV site infxn central line infxn meds
88
surgical site infxns mc occur POD
5-7
89
common bacteria associated w. surgical site infxns
**staph - mc** e.coli enterococcus
90
what makes you think of clostridium infxn
bronze-brown weeping tender wound
91
management of surgical site infxn (5)
remove sutures/staples rule out fascial dehiscence pack wound open cultures abx
92
wounds that have been opened due to infxn usually heal by
secondary intention
93
what is a clean contaminated wound
operation on GI or respiratory tract w.o unusual contamination or entr into biliary or urinary tract
94
what is a contaminated wound (4)
acute inflammation traumatic wound GIT spillage major break in sterile technique
95
what is a dirty wound (3)
pus present perforated viscus dirty traumatic wound
96
what factors influence the development of infxns (8)
foreign body decreased blood flow excessively tight sutures excessive bovie (tissue destruction) ops > 2 hr hypothermia in OR hematoma/seroma dead space
97
pt factors that increase rate of infxn
uremia hypovolemic shock vascular occlusive states advanced age distant area of infxn
98
4 indications for abx after drainage of subcutaneous abscess
DM surrounding cellulitis prosthetic heart valve immunocompromised
99
what type of operation increases risk for AKI
cardiac
100
how to reduce risk of AKI (2)
push fluids avoid NSAIDs/IV contrast
101
what should you avoid adding to fluids in the first 24 hr post op
K+ *it is already high from stress*
102
3 indications for urinary catheter placement
long procedure urologic/pelvic surgery need to monitor fluid balance
103
what electrolyte d.o causes prolonged QT
hypocalcemia
104
what electrolyte d.o causes short QT
hypercalcemia
105
what electrolyte d.o causes tall T waves
hypomagnesemia
106
what electrolyte d.o causes prolonged PR interval and wide QRS
hypermagnesemia
107
sx of hyponatremia (6)
peripheral/presacral edema pulmonary edema JVD htn decreased Hct decreased BUN/Cr
108
2 high risk pt pops for hyponatremia
etoh malnourished
109
3 types of hyponatremia
hypervolemic hypovolemic euvolemic
110
4 causes of hypervolemic hypoNa
CHF nephrotic syndrome renal failure cirrhosis
111
causes of hypovolemic hypoNa
renal vs non renal sodium loss
112
3 causes of euvolemic hypoNa
SIADH steroids hypothyroid
113
consequences of acute hypoNa (3)
brainstem herniation coma sz
114
sx of chronic hypoNa
motor/gait dysfxn falls
115
consequence of correcting chronic hypoNa too quickly
osmotic demyelination syndrome
116
tx for hypoNa: asymptomatic: moderate: severe:
asymptomatic: fluid restriction moderate: IVNS, +/- diuretics severe: 50 mL bolus 3% NS
117
goal for chronic hypoNa correction
118
6 causes of hyperNa
diarrhea burns diuretics hyperglycemia dm insipidus deficit of thirst (elderly)
119
5 sx of hyperNa
poor skin turgor dry mm flat neck veins hypotn BUN:Cr > 20:1
120
tx for hyperNA
D5W
121
2 consequences of correcting hyperNa too quickly
cerbral edema pontine herniation
122
presentation of diabetes insipidus
low urine Na high serum Na polyuria
123
2 types of diabetes insipidus
neurogenic (central) nephrogenic
124
what causes neurogenic diabetes insipidus
deficient secretion of vasopresin (ADH) from posterior pituitary
125
what causes nephrogenic diabetes insipidus
kidneys are unresponsive to vasopressin (ADH) think lithium vs renal dz
126
3 causes of hyperK
AKI late CKD meds
127
tx for hyperK (4)
insulin sodium bicarb glucose calcium gluconate
128
why must hyperK w. EKG changes must be treated asap
sine waves -> v-tach -> v-fib
129
2 causes of hypoK
diuretics cushing's
130
tx for hypoK
replace Mg first oral vs IV K+
131
what fluid should you not use when correcting hypoK
dex containing fluids *this will stimulate insulin release and shift K+ into the cell -> worse hypoK*
132
mcc of hypoCa
**hypoparathyroidism** other: thyroid surgery, renal dz
133
involuntary contraction of the muscles in the hand and wrist after compression of the upper arm
trosseau's sign -> hypoCa
134
tapping the cheeck ellicits twitching of the facial muscles
chvostek sign -> hypoCa
135
tx for hypoCa
IV calcium gluconate vs calcium chloride
136
lab findings of hypoCa
low: Ca, PTH elevated: phosphate
137
mcc of hyperCa
**hyperparathyroidism** also: sarcoidosis TB paget dz metastatic ca multiple myeloma
138
presentation of hyperCa
stones bones abdominal groans psychiatric moans
139
labs of hyperCa
elevated: Ca, PTH low: phos
140
tx for hyperCa
IV NS furosemide
141
hyperCa in elderly is _ until proven otherwise
cancer
142
presentation of hypoMg
muscle weakness hyperreflexia tachycardia
143
EKG finding of hypoMg
torsades prolonged QT wide QRS
144
tx for hypoMg
acute: IV Mg chronic: oral Mg
145
tx for hyperMg
IV isotonic saline +/- diuretics
146
cause of hyperphos
CKD
147
tx for hyperphos
replace Ca restrict K+
148
4 sx of hyphoPhos
weakness muscle/bone pain osteomalacia rickets
149
norma range: pH PCO2 HCO3
pH: 7.34-7.45 PCO2: 35-45 HCO3: 20-26
150
5 causes of respiratory acidosis
**lungs fail to excrete CO2:** pulmonary dz neuromuscular dz drug induced hypoventilation opiates barbituates
151
7 causes of respiratory alkalosis
**excessive ellimination of CO2:** tachypnea PE fever hyperthyroid anxiety salicylate intoxication septicemia
152
causes of metabolic acidosis w. increased anion gap
**mudpiles:** methanol uremia dka paraldehyde infxn lactic acidosis ethylene glycol salicylates overdose
153
2 types of metabolic acidosis
increased anion gap >16 low anion gap < 16
154
3 causes of metabolic acidosis w. low anion gap
diarrhea pancreatic/biliary drainage renal tubular acidosis
155
3 causes of metabolic alkalosis
vomiting bulimia overdose of antacids
156
what 2 organs play a major role in maintaining pH in the body
lungs kidneys

EOR - Surgery (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions