Review for PA's Surgery Section

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created 8 years ago by kendradm
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Review for PA's book
updated 8 years ago by kendradm
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1

mneumonic for emergent situations pt hx gathering prior to surgical procedure?

A-allegies
M-meds
P-PMHx
L-last meal
E-events preceding the emergency

2

meds that most likely culprits for increased bleeding?

aspirin
warfarin
NSAIDs
alcohol
chemo
abx

3

what herbal supplements can interfere with coats and cause increased bleeding?

feverfew
garlic
ginger
gingko biloba
gensing
vitamin E

4

most important pre-op exam that can be performed is __________?

an H&P

5

when should a CBC be considered in the pre-op pt?

if pt has S/S compatible with anemia or if EBL predicted for procedure is significant

6

what pts should you consider ordering e'lytes on in the pre-op stage?

pts taking certain meds like warfarin or digoxin because of the assc w/potassium abnormalities and toxicity

not indicated in pts w/o medical problems

useful in post-op eval

7

mneumonic for taking a drug history pre-operatively?

D-dispensed (by doc or other med/dental provider)
R-recreational (alcohol, tobacco, street drugs, anabolic steroids)
U-user (OTC's, herbal supplements)
G-gynecologic (OC's HRT)
S-senstivities (focus is on drug sensitivities rather than allergies)

8

what naturally decreases serum creatinine levels?

age and decreased muscle mass

9

what is creatinine a marker of?

renal function

10

who should get a serum creatinine pre-operatively

all pts over 40

also if they will be given nephrotoxic agents (contrast, exc), if intraoperative hypotension is anticipated, or if cross-clamping of the aorta will be performed.

11

whose glucose should be checked prior to surgery?

-those with PMHx or FHx of DM
-pts undergoing bypass grafting for PVD
-AAA repair
-CABG

12

when would you order liver enzymes in the pre-op pt?

only is S/S of hepatic dysfxn present

not routine

13

what is the best determinate of bleeding tendencies during surgery?

HISTORY!!!!!! ask your pt!!!!!

14

incidence of asymptomatic UTI's?

2-7%

15

what pt population is recommended to get a pre-op ECG and why?

all pts 40yr and older

rationale is that pre-op MI and arrhythmias are assc with higher M&M

16

silent MI's are most common in what two pt populations?

elderly and DM pts

17

who should have a CXR prior to surgery?

pts older than 60

all pts, regardless of age, with hx of pulmonary or cardiac dz

18

what are the recommendations for preoperative spirometry?

recommended in pts being eval'd for thoracic or upper abdominal surgery and its that have a hx of smoking or dyspnea

indicated in abdominal surgery if pulm dz is poorly controlled or if the extent of dz is unclear

19

who needs an ABG preoperatively?

not routine but if there is evidence of severe underlying cardiopulmonary dz or to confirm acid-base disturbance

20

what should be used before considering an ABG?

pulse oximetry

21

who needs a pregnancy test preoperatively?

all women of childbearing age

22

what is the name of the system used for assessing cardiac risk in the surgical pt?

Detsky's modified cardiac risk index

23

explain the points within Detsky's modified cardiac risk index and what they correlate with?

Class I- (0-15 points)-low cardiac risk
Class II- (20-30 points)-intermediate cardiac risk
Class III (31+ points)-high cardiac risk

24

clinical predictors of significant cardiac risk include?

recent MI (w/in 30 days)
unstable or severe angina
active heart failure
high-grade AV block
symptomatic ventricular arrhythmias w/ underlying dz
supraventricular arrhythmias w/ uncontrolled rate
severe valvular dz

25

what is Virchow's triad?

used for assessing risk of DVT

stasis, hypercoagulablility , and intimal damage

26

who is at high risk for DVT's postoperatively?

pts older than 70
surgery lasting 2 hours or more
traumas
ortho

long immobilization

27

which type of surgery should you NOT give DVT prophylaxis agents that alter blood coag's?

CNS surgery

28

Lee's revised cardiac risk index score interpretation?

0 points-class I, very low
1 points- class II, low
2 points-class III, moderate
3 points-class IV, high

29

classification by the American Society of Anes. (ASA)

class I-healthy pt, no medical problems
class II- mild systemic dz
Class III-severe systemic dz, but not incapacitating
Class IV-severe systemic dz that is constant threat to life
Class V-moribund, not expected to live 24 hr regardless of operation

30

what type, dose and timing is used for DVT prophylaxis options?

unfractionated heparin
Warfarin
Enoxparin
Fondaparinux
sequential compression devices
IVC filter
Dextran

31

define a malnourished pt

someone who has lost more than 10% of his/her lean body mass and-or has not had adequate nutritional intake for more than 7 days

32

expected risks of malnutrition include increased incidence of?

-infection
-immune dysfxn
-wound complications
-operative M&M

33

when might increased nutritional requirements present?

-hypermetabolic/catabolic response seen in systemic inflammatory response syndrome

-tumor necrosis factor-a has been shown to enhance muscle catabolism and promote pt cachexia in metabolic stress.

34

clinical features of malnutrition

weight loss, reduction of SQ fat stores, wasting

decreased cognitive fxn may be assc

subtle changes in skin and hair occur, esp with essential fatty acid deficiency syndromes

35

what cardiac manifestations can occur as a result of malnutrition?

decreased myocardial mass
decreased stroke volume
decreased CO

36

what will happen within the respiratory system due to malnourishment?

catabolism of major respiratory muscles, with decreased vital capacity and difficulty in extubation of pts

37

what happens to the GU tract as a result of malnourishment?

atrophy of villi with bacterial overgrowth

overgrowth of bacteria plus mucosal dysfxn may result in bacterial translocation and subsequent multi system organ dysfxn

38

what can happen as a result of bacterial translocation

linked with the occurrence of bacterial translocation from the gut

39

what happens to the immune system as a result of malnourishment?

impaired cell-mediated and humoral immunity

40

what happens in relation to wounds in the presence of malnourishment?

-poor wound healing
-increased incidence of infection, dehiscence, and evisceration

41

in severe malnutrition, what 2 things may develop?

marasmus or kwashiorkor

42

what diagnostic studies can be checked to eval malnutrition?

creatinine
creatinine height index
total lymphocyte count
albumin
prealbumin
+/- transferrin

above list all may abnormal in malnutrition

BMI, arm circumference, and nitrogen balance are good for measuring overall status.

43

complications of malnutrition (3)

aspiration
diarrhea
catheter-related problems
infusion complications