Term
| What is the decision to proceed with an operative procedure is based upon? |
|
Definition
| analysis of the risk:benefit ratio |
|
|
Term
| What is a Is a contract made between the surgeon and the pt before a procedure called? |
|
Definition
|
|
Term
| What are the components of an informed consent? |
|
Definition
Pts dx
Course of action being performed (risks and purpose) |
|
|
Term
| What must be signed and in a pts chart before the surgery can proceed? |
|
Definition
|
|
Term
| What term describes persons (usually family) who make decisions when a pt cannot speak for themselves? |
|
Definition
| Surrogate decision makers |
|
|
Term
| What term describes a legal doc that Inform health care providers about the pt’s wishes regarding the level of care to be delivered when the pt is unable to do so? |
|
Definition
|
|
Term
| What are the MOST critical Hx questions you should ask for a surgical emergency? (AMPLE) |
|
Definition
A – allergies
M – meds (including OTCs)
P – past medical (surgical) history
L – last meal?
E – events preceding the emergency |
|
|
Term
| In ROS for a surgery, what four things should you pay particular attention to? |
|
Definition
Bleeding disorders
Pulmonary function
Cardiac function
Renal function |
|
|
Term
| When should coumadin be d/c before a surgical procedure? |
|
Definition
|
|
Term
| When should ASA be d/c before a surgery? |
|
Definition
| 7 - 10 days prior to surgery |
|
|
Term
| What 2 things should be part of a smokers pre-op assessment? Why? |
|
Definition
| Assess Intermittent claudification and Respiratory Ability (smoking of 8 pack-yr ↑ the risk 2-6 fold of pulmonary complications after surgery) |
|
|
Term
| What tool os important to use post-op to reverse pulmonary changes that occur with surgery? |
|
Definition
|
|
Term
| Why are NPO guidelines put into place before surgery? |
|
Definition
| To prevent aspiration of gastric contents |
|
|
Term
| Based on ASA guidelines, what is the minimal fasting period for clear liquids and foods? |
|
Definition
Minimal fasting period of 2 hrs for ingestion of clear liquid
6 hrs for solids & nonclear liquids (milk or orange juice) |
|
|
Term
| What is the MC cause of post-op morbidity? |
|
Definition
|
|
Term
| What does the catecholamine surge result from? What are the effects on the heart? |
|
Definition
resulting from anxiety about the procedure or pain from the procedure
Effects: ↑ HR and contractility & Vasoconstriction |
|
|
Term
| Prior to surgery what is the risk of MI post op for a pt who has NO hx of previous MI? What is the risk if a pt HAS had a previous MI? |
|
Definition
w/o Hx of CAD, risk of MI is <0.5%
+ H/O previous MI, risk for MI post-op is 5-10% |
|
|
Term
| How long should you wait post-MI to perform an elective surgical procedure? |
|
Definition
| Wait 6 mos S/P MI for elective procedures |
|
|
Term
| If pt has hx of unstable MI, how does this effect their approval for surgery? |
|
Definition
| SHOULD NOT have any surgery, except CABG |
|
|
Term
| What are the 3 MAJOR complications for Diabetics undergoing surgery?> |
|
Definition
1. derangements in blood sugar
2. CV complications
3. ↑ risk of infection |
|
|
Term
| What sugar levels should diabetics be kept at (in general) during surgery? |
|
Definition
| KEEP Hyperglycemic to meet the metabolic demands! |
|
|
Term
| If pt has hyperthyroidism, what does surgery increase their risk of in these pts? |
|
Definition
↑ risk of thyroid storm,
arrhythmia (A-fib)
muscle weakness,
↓ healing |
|
|
Term
| What special considerations are there for an alcoholic going for suregery? |
|
Definition
Withdrawal Sx
DTs
Deficiencies - give "cocktail" = vitamins, thiamin, folate |
|
|
Term
| If pt has been on steroids for >5 days, are they a candidate for surgery, why or why not? |
|
Definition
| Acute adrenal insufficiency seen in pts on steroids for > 5 days - postpone surgery if possible! |
|
|
Term
| What are some considerations when operating on a pt with renal dz? |
|
Definition
Do NOT access dialysis catheters
Fluid balance is critical
Avoid K+ in IV fluids
Use “renal dose” with antibiotics |
|
|
Term
| What prophylactic antibiotic is used with suspected colonic anaerobes or with suspected Bacteroides? |
|
Definition
|
|
Term
| What prophylactic antibiotic is commonly used in colonic surgeries? |
|
Definition
|
|
Term
| What prophylactic antibiotic is used if anaerobic flora is NOT suspected? |
|
Definition
|
|
Term
| With what abdominal or GU surgeries should prophylactic antibiotics be given? |
|
Definition
High risk GI procedures: Biliary procedures, Colon/small intestine resections
GU: Hysterectomy, C-section |
|
|
Term
| With what CV surgeries should prophylactic antibiotics be given? |
|
Definition
Cardiac surg via median sternotomy
Vascular surg: Lower extremities, Aorta, Amputations for ischemia
Pre-existing valvular disease |
|
|
Term
| In what situations are prophylactic antibiotics NOT effective? |
|
Definition
With continuing contamination:
- Tracheostomy
- Indwelling catheters
- Burns |
|
|
Term
| If malnutrition is suspected prior to surgery, what labs should you draw? |
|
Definition
|
|
