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HANA PM4B 3 > Surgery 1 > Flashcards

Surgery 1 Flashcards

1
Q

What is pre-medication

A
  • Medication given before surgery
  • May be sedatives, antiemetics etc
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2
Q

What is elective surgery

A
  • Surgeries that are planned in advance i.e. not emergency, life-threatening surgeries
  • May be for serious conditions however, such as cancer
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3
Q

What is the pre-operative assessment

A
  • Ask the patient questions about their health, PMHx and home circumstances to see if any arrangements need to be made prior to the surgery
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4
Q

What is the peri-operative assessment

A
  • Comprehensive review of the patient to determine their stability for surgery and how to optimise existing medical conditions
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5
Q

What is anastomosis

A
  • Artificial connection made between two ends of the same organ during surgery
  • Often between tubular structures e.g. blood vessels, loops of intestine
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6
Q

What is wound dehiscence

A
  • Breaking open of a wound/incision site
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7
Q

What are adhesions

A
  • Fibrous bands that form between tissues and organs as a result of injury during surgery
  • It is scar tissue that attaches to organs
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8
Q

Angio-

A

Relates to blood vessels

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9
Q

Arthr-

A

Related to joints

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10
Q

Colono- or col-

A

Related to large intestine

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11
Q

Cysto-

think cystitis

A

Related to bladder

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12
Q

Gastr-

A

Related to stomach

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13
Q

Lapar-

A

Related to adbominal cavity

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14
Q

Mammo and masto-

think ma to remember

A

Related to breasts

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15
Q

Nephro-

A

Related to kidney

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16
Q

-ectomy

A

To remove e.g. colectomy is removal of the whole colon

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17
Q

-otomy

A

To open up

18
Q

-ostomy or -stomy

A

Artificial opening or hole

19
Q

-oscopic

A
  • Use a scope - keyhole surgery, minimally invasive
20
Q

-plasty

think plastering

A

To modify or reshape

21
Q

8 Common surgical complications

A
  1. n+v
  2. infection
  3. pain
  4. wound dehiscence
  5. VTE
  6. haemorrhage
  7. fluid overload or dehydration
  8. paralytic ileus
22
Q

Why is VTE a risk after surgery

A
  • VTE = blood clot forms in vein
  • Immobility post op
  • Use of plaster casts
  • Disrupted vascular bed-thrombogenic surface
23
Q

8 patient related risks of VTE

A
  • High BMI
  • OCP (pill)
  • HRT
  • Diabetes
  • Malignancy
  • History of thrombosis
  • Thrombophilia
  • Pregnancy
24
Q

Haemorrhage

A
  • Acute loss of blood from a damaged blood vessel
  • Caused by:
    • Blood clotting disorders
    • Complications from surgery
    • Damage to internal organs
25
Q

Why is fluid overload or dehydration a common surgical complication

A
  • Under and over hydration
  • Fluid and blood loss during procedure
26
Q

What is paralytic ileus

A
  • Intestinal blockage in the absence of an actual physical obsturction
  • Caused by malfunction in the muscles and nerves of the intestine that impairs digestive movement
27
Q

Pre-op assessment in elective surgeries - what does it involve

A
  1. Inform patient of procedure + if they need to do anything e.g. food/drinks
  2. Conduct relevant blood tests, X-rays etc
  3. Determine anaesthetic risk/bleeding risk
  4. Consider if any meds should be stopped
  5. Provide alternatives if necessary
  6. Plan and predict for any post-op complications
  7. Highlight if patient will be at risk of malnutrition post op (e.g. likely prolonged NBM periods, refer to dieticians)
28
Q

read over don’t memorise

Roles of pre-op pharmacists (10)

A
  • Taking DHx
  • Writing inpatient medication chart
  • Administration of medicines during pero-operative period
  • Counselling
  • Prescribing regular meds
  • Advising on appropriate medicaiton management during peri-operative period
  • Forsee post-op complications and recommend appropriate treatment
  • Smoking cessation
  • Producing guidelines for pre-op team
  • Preparing for discharge
29
Q

Anaesthesia clasification: ASA

6 classes ASA1-6

A
  1. Healthy patients
  2. Mild-moderate systemic disease
  3. Severe systemic disease which limits activity but not incapacitating
  4. Severe disease process that is a constant threat to life
  5. Moribund (at death) patient not expected to surivive 24h w/o op
  6. Declared brain-dead patient, organs being removed for donor purposes
30
Q

You see Mr Jones in a pre-op assessment clinic 2 weeks before his elective total knee replacement. He is 76 years old and has hypertension as well as RA and osteoporosis.
Why is he at higher risk of post-op complications? What considerations do you need to make?

A
  • Impaired wound healing - RA patients often on immunosuppressants e.g. steroids, MABs, MTX
  • Elderly - anaesthetic risk, sedation, drug clearance, respiratory impact, risk of VTE as elderly and non-mobilising surgery
31
Q

You see Mr Jones in a pre-op assessment clinic 2 weeks before his elective total knee replacement. He is 76 years old and has hypertension as well as RA and osteoporosis. Which class of anaesthesia risk is he likely to be in?

A

ASA 3: severe disease process which limits activity but is not incapacitating

32
Q

7 areas for pharmaceutical intervention in surgical pharmacy

A
  1. Pain
  2. Post operative nausea and vomiting (PONV)
  3. Nil by mouth (NBM) period
  4. VTE prophylaxis
  5. Fluid management
  6. Anticoagulation in the perioperative period
  7. Abx prophylaxis
33
Q

What is the WHO analgesic ladder

A
34
Q

What is the MHRA advice on NSAID selection

A

○ Assess CV risk vs gastro risk
○ Ibuprofen 2.4g is lowest
○ Diclofenac has high cardio risk
○ Naproxen has higher GI risk

35
Q

5 methods of pain management in surgery

A
  • WHO pain ladder
  • Patient controlled analgesia (PCA)
  • Spinal
  • Regional/peripheral nerve LA blocks
  • Epidural
36
Q

What is patient controlled analgesia (PCA)

A
  • Strong opioid based
  • Gives pt control of pain so they aren’t waiting potentially long times for the nurse for PRN doses of analgesia
  • Pt must be alert to use and have some understanding of process and how to use
  • Some pt can become very drowsy with morphine PCA - counter productive, as they will not be able to operate PCA effectively
37
Q

What is spinal pain management

A
  • Diamorphine administered spinally during surgery
38
Q

What is regional/peripheral nerve LA blocks

A
  • Nerve blocks are good for fracture
  • Hip fracture (neck of femur NOF) - insert LA to nerve = good results for pain relief
39
Q

What is an epidural

A
  • Form of anaesthetic injected into epidural space
  • Numbs limb post-op
  • Alleviates pain
  • Consists of LA + opioid, synergic action of drugs acting on different sites
  1. LA acts on nerve blocks
  2. Opioids act on opioid receptors near spinal cord
  • Less n+v with epidural and less risk of DVT due to mobility
40
Q

Advantages of PCA

A
  • Patient in control of analgesia
  • Lockout period protects against OD
  • Number of requests for drug can be monitored
  • Fast acting
  • Rduced patient anxiety on pain
  • Improved patient experience
  • Suitable if patient NBM
  • Useful for incident pain e.g. physio, dressing changes
  • Patient’s don’t need multiple injections
41
Q

Disadvantages of PCA

A
  • not suitable for all patients
  • renal impairment - accumulation of morphine metbaolites
  • SE: n+v, pruritis, constipation, sedation
  • not to be used with any other opoids
  • if patients sleeps without PCA, may wake up in pain

HANA PM4B 3 (67 decks)

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