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Flashcards in Preoperative Care Deck (45):
1

Goldman's Index

Cardiac risk factors in surgery: 1) JVD 2) recent MI 3) PVCs and arrhythmias, age >70, aortic stenosis
JVD: indicates CHF, #1 CV risk factor overall
MI within 30 days: very high risk, delay surgery
PVCs: at risk of arrhythmia due to ventricular dysfunction, indicated for stress and echo
Ejection fraction: SV/EDV; normal EF >67%, an EF <35% increases risk of operative MI

2

Diabetes control before surgery

Should be NPO 8 hours before surgery, administer IVF with D5, check glucose morning of surgery; if glucose >250, 2/3 insulin, if glucose is <250, 1/2 insulin

3

Hyperglycemia preoperatively

ideal glucose is 100-250, delay surgery until glucose is under control

4

Diabetic coma preoperatively

absolute contraindication o surgery; give IVF, correct acidosis and glucose

5

Decreased hct preoperatively

important to determine underlying cause of anemia, consider possible colorectal cancer

6

Increased hct preoperatively

either hypervolemia or polycythemia; if hypovolemic, delay until hydrated, if polycythemic, important to determine underlying cause

7

Obesity preoperatively

Higher risk of hypertension, cardiovascular disease, post-op atelectasis, type 2 diabetes, DVTs; require DCTs prophylaxis and aggressive post-op pulmonary care for preventing atelectasis

8

HTN preoperatively

Diastolic BP >110 is high risk of CV complications, beta blockers reduce overall risk

9

LBBB indicates what?

Underlying ischemic heart disease

10

RBBB indicates what?

Indicates significant pulmonary disease, but can be normal in up to 10% of patients

11

Previous CABG and surgery?

Decreases cardiac risk if performed six months to five years before surgery

12

Previous coronary angioplasty and surgery?

High risk (35%) of coronary restenosis, so stress test is indicated; if angioplasty is recent, delay surgery for several weeks.

13

What is a cardiac bruit?

Indicates carotid stenosis; indicated for CEA if high grade (>70%) stenosis

14

Gangrenous toe and surgery?

Peripheral revascularization is more urgent than a full cardiac work-up

15

Smoking and surgery?

Up to 6+ risk for post-op complications due to compromised ventilation, must quit smoking for 2 months before surgery

16

COPD and surgery?

Give bronchodilators and try to improve pulmonary status as much as possible.
High risk for acute pulmonary failure with surgery; teach patient about incentive spirometry, give bronchodilators, and mobilize post-op to prevent atelectasis

17

Green sputum and surgery?

Give oral antibiotics, and schedule surgery after treatment is complete.

18

Bloody sputum and surgery?

Indicates active infection or lung cancer; requires a full work-up including CXR, CT scan, and bronchoscopy

19

What is acute cholecystits?

Prevents as fever, RUQ pain, WBC>15; get U/S--> IVF, abx, lap chole within 72 hours

20

What is Child's classification?

Stratifies risk of surgery in patients with liver failure; measures three labs (albumin, bilirubin, PT) and three clinical findings (encephalopathy, ascites, nutrition).
Group A: 0-5% mortality
Group B: 10-15% mortality
Group C: >25% mortality; not good surgical candidates until Child's status is improved

21

Alcohol use and surgery

Delay surgery until patient has undergone withdrawal, since post-op withdrawal syndrome has a high risk of morbidity/mortality

22

Liver failure and surgery

Make sure the patient is in a compensated state, abstain from alcohol 6-12 weeks, control ascites, normalize nutrition status and coagulation factors

23

What is pressure necrosis on hernia?

High risk of rupture with a high mortality rate, requires urgent repair

24

Delirium in liver failure causes?

CNS abnormality, electrolyte imbalance, GI bleeding, sepsis, or bacterial peritonitis; evaluate for mental status change, and tap the ascites

25

Ascitic leakage risks and management?

High risk of bacterial peritonitis; manage by sending fluid to lab, giving IV antibiotics, and urgent hernia repair

26

Signs of malnutrition and preoperative care

Recent weight loss (#1), albumin <3.0 (#2), give 7-10 days of pre-op nutritional support

27

Dysuria management

Get urinalysis and urine culture; if positive for UTI, delay surgery until resolved

28

Chronic renal failure (CRF) and surgery

Delay surgery until patient is stable, dialysis started, and any other problems resolved

29

CRF and K+ management

Needs to be obtained immediately before surgery since CRF can result in rapid electrolyte imbalances.

30

CRF and operative bleeding

Renal failure causes platelet dysfunction secondary to uremia; give desmopressin or FFP, but not platelets

31

CRF and operative hypotension

Many possible causes, consider glucocorticoid (aldosterone) deficiency in a patient who has taken steroids before

32

Kidney transplant patient preoperatively

Require perioperative steroids

33

Post-op hyperkalemia management

Check ECG for peaked T waves, Tx C BIG K Die (calcium gluconate, bicarb-insulin-glucose, kayexalate, and dialysis)

34

Mitral stenosis and surgery

Elevated LA pressure can lead to cor pulmonale (PH+RVH); management includes cards consult, prophylactic abx for endocarditis, can go to surgery if stable

35

Mitral stenosis and CHF and surgery

High risk of mortality; requires extensive cardiac work-up, ECG, echo, and operative monitoring of cardiac status

36

Aortic stenosis and surgery

Sx triad of angina, dyspnea, syncope, and high possibility of sudden death; requires cardiac workup and operative monitoring

37

Endocarditis prophylaxis for which procedures?

Recommended for GI procedures, GU procedures, and HEENT procedures

38

Cardiomyopathy and surgery

High risk of arrhythmias, CHF, heart failure, and sudden death, manage with cards consult and full cardiac workup

39

Bowel prep for surgery

Decreases fecal mass and bacterial content in the colon, prevents colon surgery complications; put patient on clears day before surgery, NPO at midnight, and give a cathartic agent

40

What is GoLYTELY?

An isotonic formula that causes no change in electrolyte or water balance; fluid remains in colon and causes a "volume washout"

41

What is Fleet's Phospho-Soda?

A sugar-rich, hypertonic formula that works by drawing fluid into the GI tract; risks include dehydration, metabolic acidosis; avoid in diabetics

42

What is magnesium citrate?

An osmotic agent that draws fluid into the GI tract; risks include dehydration and hypermagnesemia; avoid in renal failure

43

Aspirin use preoperatively

Stop aspirin use 7-10 days prior to surgery, will affect platelet aggregation

44

NSAID use preoperatively

Stop NSAIDs 2 days prior to surgery, will affect platelet aggregation

45

Cellulitis and surgery?

Active infections are associated with higher risk of post-op wound infections; delay surgery until infection is resolved