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50 Cards in this Set
- Front
- Back
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What defines acidemia? Alkalemia?
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acidemia: blood pH <7.35
alkalemia: bloog pH >7.45 |
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How do you calculate anion gap?
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AG = Na - Cl + HCO3
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What conditions can cause increased anion gap?
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lactic acidosis
diabetic ketoacidosis alcoholic ketoacidosis acute and chronic renal failure rhabdomyolysis ingestion of toxin (salicylate, methanol, ethylene glycol, paraldehyde) |
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What is the primary event in respiratory acidosis? What is the compensation?
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increase PaCO2
increase HCO3 |
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What conditions cause acute respiratory acidosis?
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airway obstruction
pulmonary disease weakened respiratory muscles depressed respiratory drive |
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What is the body's response to acute respiratory acidosis?
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renal retention of bicarbonate
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What controls respiratory drive?
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PaCO2
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Why should you avoid excessive supplemental oxygen in the treatment of respiratory acidosis?
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because it may suppress spontaneous respiratory efforts
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What is the primary event of metabolic alkalosis? What is the compensation?
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increased HCO3
increased PaCO2 |
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When is metabolic alkalosis saline responsive?
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continuous gastric aspiration
GI loss long-term use of thiazide or loop diuretics |
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When is metabolic alkalosis saline unresponsive?
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normal or increased extracellular volume and elevate urinary Cl
mostly with excess mineralcorticoid - primary aldosteronism - spironolactone or amiloride can block |
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What can cause respiratory alkalosis?
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hyperventilation
- anxiety - hypoxemia - pain - sepsis - iatrogenic (mechanical ventilation) |
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What is the primary event is respiratory alkalosis? What is the compensation?
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decrease PaCO2
decrease HCO3 |
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What are postoperative effects on the body?
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decreased respiratory function
increased frequency of splinting and atelectasis ureteral and bladder hypomotility GI complications: ileus, nausea and vomiting |
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What are some reasons for inadequate postoperative pain relief?
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inadequate dose of narcotic
effective dose underestimated fear of respiratory depression duration of action overestimated exaggerated fear of addiction |
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What is the required maintenance fluid postoperatively?
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100cc/kg first 10kg
50cc/kg second 10kg 20cc/kg after 20kg |
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What kind of fluid do you use on a normal patient?
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D5 1/2 NSS
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What can you add to maintenance fluid after 24 hours if there is good renal function?
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20 mEq/L potassium
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What do you give for fluid bolus in an adult?
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1 liter isotonic fluid (LR)
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How much fluid do you give for a bolus of a child?
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20cc/kg
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What can large amounts of NSS cause?
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metabolic acidosis
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What kind of fluid do you correct hypovolemia with?
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isotonic fluid
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What is third spacing?
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capillary leakage
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In regards to third spacing, what should diuretics be reserved for?
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inadequate renal or cardiac function
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What side effects do NG tubes have?
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sinusitis
discomfort reflux |
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What always needs to be obtained before initiation of tube feeding?
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x-ray
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What is a Penrose tube?
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soft rubber tubes that keep tracks open
- removed slowly, advanced each day |
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What is a Jackson Pratt drain?
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a closed suction drain
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Do drains improve the outcome of cholecystectomy, colon, or thyroid surgery?
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No
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What are the advantages of drains?
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reduces serum formation after mastectomy
good for abscess cavities |
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After 3-4 days with an indwelling Foley catheter, what percentage of patients get an infection?
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95%
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How do you decrease the infection rate of indwelling catheters?
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avoiding nonessential catheterization
only trained personnel to insert meticulous aspeptic technique securing catheter after insertion to prevent in and out movement maintaining proper drainage removing at earliest possible opportunity |
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What are risks associated with central line catheters?
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perforation in vascular system, thrombi, infection, pneumothorax, DVGT
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What are the effects of bedrest?
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increased muscle loss and weakness
impaired pulmonary function and tissue oxygenation predisposed to DVT and pulmonary complications |
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True or False: Postoperative fever is usually associated with a significant infection.
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False: usually not associated with significant infection
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What factors increase risk of postoperative fever?
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operation >2 hours
intraoperative transfusion preexisting infection preoperative antibiotic prophylaxis |
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What are the common causes of fever postoperatively?
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atelectasis
pneumonia uringary tract infection septic and nonseptic phlebitis drug allergies wound infection deep infections DVTs |
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What are cardiac complications postoperatively?
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dysrhythmias
MI ventricular failure hypertension |
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Postoperative hypertension frequently occurs secondary to what?
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pain or hypoxia
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What percentage of patients have atelectasis 5-10 minutes after anesthesia? One hour postoperative? 24 hours?
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100%
90% 50% |
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True or False: Early mobilization is as effective as chest physical therapy for atelectasis.
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True
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What are the risk factors for postoperative pneumonia?
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advanced age
gram-negative bacterial infection emergency operation use of ventilator postoperative peritonitis |
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What is the most common symptom and physical finding of pulmonary embolism?
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dyspnea
tachypnea |
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What test is most sensitive for PE? Most specific?
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Lung scan
CT angiography |
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How do you treat a PE?
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oxygen
fluid rapid IV heparinization |
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What are high risk factors for DVT?
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older than 40
obese malignancy prior DVT prolonged, complicated procedures prolonged bed rest |
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What is the gold standard of diagnosis of DVT?
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Venogram
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What do you do for prophylaxis of upper GI bleeding?
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30-60cc antacid via NG every 1-2 hours to maintain pH above 4
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True or False: H2 blockers have been proven to be more effective than antacids in preventing GI bleeding.
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False
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Do you discontinue oral glycemics before an operation?
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Yes: one day before
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