Pestana - Pre-Op and Post-Op Care

anroldan's version from 2015-04-14 04:53

Section 1

Question Answer
what ejection fraction poses prohibitive cardiac risk for noncardiac operations?<35%
whats the worst single finding predicting high cardiac risk?jugular venous distension > recent MI
name 9 Goldman's index of cardiac risk factors?1) JVD 2) recent MI 3) PVC 4) rhythm other than sinus 5) age over 70 6) emergency surgery 7) aortic valvular stenosis 8) poor medical condition 9) surgery within chest or abd
if patient had recent MI, when should you operate?6 months after MI (not 3 months, bc operative mortality is 40% vs. 6% at 6 mo)
whats the most common cause of increased pulmonary risk?smoking --> which causes compromised VENTILATION (high PCO2, low FEV1)
if pt has pulmonary risk (smoking or COPD), what should he do prior to surgery?1) quit smoking for 8 WEEKS and intensive respiratory therapy (PT, expectorants, incentive spirometry, humidified air)
what makes up intensive respiratory therapy?PT, expectorants, incentive spirometry, humidified air
name 5 predictors of mortality in terms of HEPATIC risks?1) bilirubin 2) serum albumin 3) prothrombin time 4) ascites 5) encephalopathy
what is severe nutritional depletion?loss of 20% of body weight over a couple of months
name 4 pre-op nutritional risk factors?1) loss of 20% of body weight over couple of months 2) serum albumin < 3 3) anergy to skin antigens 4) serum transferrin level < 200 mg/dL

Section 2

Question Answer
term for fever that occurs shortly after onset of anesthetic (halothane or succinylcholine)malignant hyperthermia
whats the tx for malignant hyperthermia?IV dantrolene, 100% oxygen, correction of acidosis, cooling blankets
what causes fever within 30-45 minutes of invasive procedures?bacteremia
what are 6 causes of post-op fevers (101-103F)1) atelectasis 2) pneumonia 3) UTI 4) deep venous thrombophlebitis 5) wound infection 6) deep abscesses
whats the most common source of post-op fever on first PO day?atelectasis
what are 4 ways to improve ventilation in pt with atelectasis?1) deep breathing 2) coughing 3) postural drainage 4) incentive spirometry
whats the ultimate therapy for atelectasis?bronchoscopy
what can post-op atelectasis turn into 3 days later?pneumonia!
what causes fever on PO day 5 or after? day 7?day 5: DVT day 7: wound infection
what imagine test do you order to diagnose deep abscesses?PO day 10-15

Section 3

Question Answer
whats the tx for preoperative MI (as indicated on EKG monitoring by ST depression and T wave flattening)?emergency angioplasty and coronary stent (NOT heparin or tPA)
what most commonly triggers preoperative MI?hypotension
what does arterial blood gases of PE show?hypoxemia and hypocapnia
whats the tx for PE?heparin
why do we want pts to be NPO after midnight? what are we trying to avoid?aspiration
what are 2 ways to reduce risk of aspiration prior to surgery?NPO and antacids before induction
whats the tx for ARDS?positive end-expiratory pressure (PEEP)
what complication may occur when excessive ventilatory volumes (in PEEP) are used when treating ARDS?barotrauma
2 ways to tx delirium tremensIV benzos or IV alcohol (5% in 5% dextrose)
if there is no spontaneous urinary voiding at 6 hours post-op what do you do?in and out bladder cath
2 causes of zero urine output post-opplugged or kinked catheter

Section 4

Question Answer
what are 3 causes of post-op abdominal dissension?1) paralytic ileus 2) early mechanical bowel obstruction d/t adhesions 3) ogilvie syndrome
what prolongs paralytic ileum?hypokalemia
large amounts of pink "salmon colored" fluid noted to be soaking wound dressings (peritoneal fluids)wound dehiscence
whats evisceration?complication of wound dehiscence where skin opens up and abdominal contents rush out
every 3 mEq/L that serum sodium concentration is above 140 represents how many LITERS or water loss?for every 3 mEq/L of serum sodium above 140, 1 L of water is lost
what fluids do you use to tx hypernatremia?1/2 D5W>> D5W
whats the safe amount of IV potassium that you can give to a pt who is hypokalemic?10 mEq/HOUR of IV potassium