Surgery Pre And Post Op

Front 1

diagnostic workup purpose

Back 1

determines cause & extent of patient's condition

Front 2

preoperative evaluation

Back 2

overall assessment of pt's health to identify operative risks that may influence recovery period
-anesthetic plan: considers pt's medical condition
-requirements of surgical procedure
-pt's preference

Front 3

Preoperative preparation

Back 3

procedures implemented based on nature of expected operation
-plus findings of diag workup & preop eval

Front 4

what do you have to make sure you do if patient is ready for surgery?

Back 4

obtain a consent!

Front 5

informed consent

Back 5

-explain procedure in detail, risk vs benefits, alternative tx before getting consent
-parental consent <18 yrs
-if pt incompetent -- consent from power of attorney
-if unsure pt's competency, get psych consult
-if pt no power attorney, then next of kin
-court order if no next of kin

Front 6

What is informed consent in an ER situation?

Back 6

procedure performed if 2 physicians agree & document necessity for procedure

Front 7

what are the different types of anesthesia?

Back 7

general (ET, LMA, MAC - monitored)
Spinal
Nerve block
Local +/- epinephrine

Front 8

ASA 1

Back 8

normal healthy individual

Front 9

ASA 2

Back 9

pt w/mild systemic dis (controlled HTN)

Front 10

ASA 3

Back 10

pt w/severe systemic disease that limits activity (angina)

Front 11

ASA 4

Back 11

pt w/severe systemic disease
-poses constant threat to life
(heart failure or advanced pulm, renal/hepatic dysfunction)

Front 12

ASA 5

Back 12

Moribund pt not expected to survive w/o surgery
(ruptured AAA)

Front 13

ASA 6

Back 13

pt declared brain dead whose organs being removed for donation

Front 14

Pierre Robin Syndrome

Back 14

micrognathia or retrognathia
cleft palate (usu U shaped, but also can be V shaped)
glossoptosis, downward displacement or retraction of tongue (w/airway obstruction)

Front 15

Cardiac function

Back 15

if no hx of cardiac dz & <50; NO extensive work up necessary
-post MI can reduce complications if surgery delayed 6-8 wks
-Basic test: EKG
Stress test: r/o ischemia
Echo: eval ejection fraction
Cardiac angiogram: assess vessels

Front 16

pulm function

Back 16

COPD needs FEV1; if <70% it inc risk of post-op complications
ABG done as baseline
Bronchodilator therapy, incentive spirometry, smoking cessation, abx tx

Front 17

when would you get a CXR preop?

Back 17

no definitive indication
order for anyone w/clinical suspicion for pulm disease
(smokers, exercise intolerance, hx of pneumonia)

Front 18

Liver function test

Back 18

establish absence or presence of hepatic injury & degree of hepatic reserve in disease states
(indication: hepatitis, infiltration, cirrhosis, gallbladder/biliary tract dz, jaundice)

Front 19

Renal function test

Back 19

determine extent of renal tubular function & glomerular filtration in pts w/known or suspected renal dysfunction
-HTN, fluid overload, dehydration, N/V, CVA pain, etc

Front 20

What is the basic blood work test for pre-op?

Back 20

Chem 7
if suspicious of liver dz get chem 18

Front 21

NPO-nothing per oral

Back 21

NPO at least 8 hrs prior to surgery
-anesthesia can induce N/V --> aspiration pneumonia
-NPO past midnight unless surgery in afternoon
-PO meds allowed w/sips of waters
-Hydrate pt due to NPO status
-Monitor DM pts during NPO
-in ER, place NGT to decompress stomach

Front 22

What are the checkpoints at Pre-op?

Back 22

correct pt identification
make procedure side or site
team agreed on procedure (dr, nurses, OR techs)
-implants available if needed; check expiration date
-special equipment or requirements available (think ahead, be ready!)
if Yes then.....

Front 23

what do you do after surgery?

Back 23

decide whether pt needs ventilator support of can be extubated
-consider: type of surgery, pt's medical history, complications, blood loss, length of surgery
-both anesthesiologist & surgeon agree prior to extubation
-extubated pts will transfer to PACU, or ICU directly

Front 24

transfer to ICU

Back 24

careful w/transfer!
-pt transfer w/at least anesthesiologist +/- surgeon
-if surgeon not needed, arrive at ICU in advanced & report to nurse
-check puls ox, O2, EKG monitor, accidental injury during transfer

Front 25

What is in an admission order?

Back 25

ABC DAVID
admit
because: diagnosis
condition: stable?
diet: NPO, clear liquid, full, regular
allergies
vitals
IVF: type & rate
Drugs: meds

Front 26

Transfer to PACU

Back 26

surgeon may leave OR after extubation
talk to PACU nurse about surgery & address issues (catheter, spirometry, ice packs to wound)
-talk to designated person post op (pt, family)
-OR dictation is LAST thing on list
after leaving locker room, re-check pt w/nurse & anesthesiologist prior to depart

Front 27

What are the 5 P's of musculoskeletal injury?

Back 27

Pain: assess location, severity, quality
Paresthesia: loss of sensation w/end of safety pin if present
Paralysis: move affected area?
Pallor: paleness, discolor, coolness of injured side
Pulse: check distal to injury site

Front 28

Manage fever post op
-number of days, what it could be

Back 28

24 hrs: atelectasis
2-3 days: UTI
5 days: wound infection (skin)
7 days: wound (abdomen)
Pulm embolism
Drug fever
(5 W's)
-wind, water, wound, walking, wonder drug

Front 29

Atelectasis
-what to do?

Back 29

encourage pt to perform deep breathing & coughing exercises
-incentive spirometer
-give humidified air or O2
-reposition every 2 hrs & elevate head of bed

Front 30

What can cuase atelectasis, what to look for?

Back 30

hypotension, excessive retained secretions can lead

look for:
-dec breath sounds
-dullness to percussion
-dec chest expansion

Front 31

Sanguineous wound drainage

Back 31

red & thin

Front 32

serosanguineous

Back 32

pink to light red
thin & watery

Front 33

serous

Back 33

clear or light yellow, thin & watery

Front 34

Purulent

Back 34

creamy yellow, white, tan
thick & opaque
also salmon color

Front 35

Bilious

Back 35

dark green

Front 36

Virchow's triad

Back 36

venous stasis
endothelial damage
hypercoagulation
--> predisposes to form DVT

Front 37

SS of DVT

Back 37

leg swelling
discoloration
calf pain
bed ridden patients

Front 38

What is study of choice to r/o DVT?

Back 38

venous duplex

Front 39

Tx for DVT

Back 39

pneumatic stockings
pre & post op SQ heparin
vena cava filter placement

Front 40

PE, what can cause it?

Back 40

after surgery, immobility & venous stasis can cause PE
-want to encourage out of bed ambulation ASAP

Front 41

What to look for in Pulm embolism

Back 41

dyspnea, rapid shallow breathing
sudden anginal or pleuritic chest pain
fine coarse crackles over affected lung area
possible cynosis or blood tinged sputum
low grade fever, tachycardia, hypotension

Front 42

What do you DO for pulm emboli?

Back 42

give O2; prepare for intubation & mechanical ventilation
-put pt in comfy position
-cardiac monitoring, watch for arrhythmias
-give heparin & fibrolytics, give vasopressors for hypotension
-prepare pt for insertion of vena cava filter or surgical embolectomy

Front 43

Paralytic Ileus
-when?

Back 43

first 24-72 hours after surgery
-pt may have sluggish peristalsis & ileus causing abdo distention
-
after 72 hours --> post op adynamic ileus or paralytic ileus (accumulation of gas)
-GI tract innervation disrupted (hypoK, wound infection, morphine, atropine, codeine)

Front 44

what to look for in paralytic ileus

Back 44

abdo distension
abdo pain
N/V
no flatus or bowel movements

Front 45

what to DO in paralytic ileus

Back 45

encourage ambulation
withhold food & fluids
adequate IVF, electrolyts & nutrition
Insert NG tube
Monitor for N/V & give anti emetic
-R/O obstruction