Term
| 5 phases of normal wound healing |
|
Definition
hemostasis (1-5 days)
inflammation (1-5 days)
proliferation (2-30 days)
epithelialization (2-30 days)
remodeling (closure - 2 yrs)
|
|
|
Term
Which stage of wound healing?
establishes the fibrin provisional wound matrix (initial clot)
platelets provide release of cytokines and growth factors
onset w/in minutes of injury |
|
Definition
|
|
Term
Which stage of wound healing?
Composed of:
1. vascular response: hemostasis, vasoconstriction, transudate/edema, platelet aggregation/activation
2. cellular response: platelet aggregation/activation, cytokine & growth factor recruitment, inflammation mediated by neutrophils and macrophages
MOST CRITICAL PHASE IN WOUND HEALING. |
|
Definition
|
|
Term
small polypeptides w/ powerful action on chemotaxis, proliferation, and differentiation of inflammatory cells
impact non-inflammatory cells such as fibroblasts, endothelial cells, and epithelial cells
Major SIGNALING molecules for immune system
Include: interleukins, lymphokines (interferon) and grwoth factors |
|
Definition
|
|
Term
Which phase of wound healing?
angiogenesis (O2 dependent)
fibroblasts synthesize disorganized extracellular matrixx via collagen synthesis (O2 dependent)
myofibroblasts contract scar
basal epithelial cells migrate over living, MOIST granulation tissue
takes days to weeks to months after initial injury
** wound begins to take on a starburst or puckering appearance, which is a good sign that healing is occurring ** |
|
Definition
|
|
Term
4 key cells in proliferation phase of wound healing
1. forms new blood vessels
2. collagen deposition
3. causes wound contraction
4. reepithelizes wound |
|
Definition
1. angioblast
2. fibroblast
3. myofibroblast
4. keratinocyte |
|
|
Term
What phase of wound healing?
fibroblasts and capillary density decreases
initial scar tissue is removed and replaced by collaged which is more similar to normal skin
collagen remodeling results from balanced, regulated activity of collagenases |
|
Definition
|
|
Term
| Remodeled (scar) tissue after injury has about __% of the tensile strength of normal tissue |
|
Definition
|
|
Term
| Wounds that do not heal in an expected time frame for that wound (4 weeks is critical - should have significant healing at 4 weeks). Failure to progress through wound healing cascade. |
|
Definition
|
|
Term
Chronic wound fluid is rich in ____ and lacking in ___.
they also have a high ____, consistign of biofilm, physical barriers, metabolic stress |
|
Definition
rich in MMP (matrix metalloproteinase)
lacking in TIMP (tissue protease inhibitors)
bioburden (necrotic tissue, senescent cells, eschar, proteinacious secretions, bacteria) |
|
|
Term
| 5 essential factors to evaluate in nonhealing wounds |
|
Definition
| arterial supply, venous return, infection, pressure, other (tobacco use, cellular failure, etc) |
|
|
Term
| 4 risk factors for arterial occlusive disease |
|
Definition
smoking
DM
hyperlipidemia
HTN |
|
|
Term
| a pt with DM and PAD by definition has ___ |
|
Definition
|
|
Term
| A pt with a chronic wound has a monophasic pulse on doppler. what does this mean? |
|
Definition
|
|
Term
| A wound that appears dry, is on a peripheral extremity, has a watershed distribution, and is infected would signify ___ disease |
|
Definition
|
|
Term
2 kinds of periphral venous insufficiency
1. hereditary. more common in females. due to chronic high pressure from standing in one place for a long period of time.
2. shallow-deep communication & low-high pressure communication. Incompetence allows for high pressure backflow into a low pressure system and results in varicose veins |
|
Definition
1. valvular disease
2. saphenous femoral vein junction incompetence |
|
|
Term
PE: varicose veins, skin pigmentation (Hemosiderin staining), edema, dermal hypertrophy.
What dx?
What tests? |
|
Definition
venous insufficiency
ultrasound and venography |
|
|
Term
| 4 Effects of tobacco use: |
|
Definition
vasoconstriction for 45-60 min after each cigarette
impaired endothelial function
platelet activation
atherosclerosis |
|
|
Term
Stages of infection:
1. host control. localized treatment w/ irrigation. dressings and topical antibiotics are of secondary importance
2. established microbial population. host is in control but unable to eradicate microbes. local tx (debridement, dressings, topical antibx)
3. microbial control, host damage. tx: debridement, topical anti-infectives, systemic abx |
|
Definition
1. contamination
2. colonization
3. infection (cellulitis, fasciitis, myositis, osteomyelitis, abscess) |
|
|
Term
| how do you culture an infected wound? |
|
Definition
|
|
Term
| Typical causative organisms of infected wounds |
|
Definition
acute - gram pos (MRSA)
chronic - gram neg (e. coli, pseudomonas, proteus, klebsiella)
anaerobes in deep, poorly oxygenated woudns |
|
|
Term
| 4 m's of cellular failure leading to chronic wounds |
|
Definition
1. metabolic (DM, malnutrition)
- glycemic control is key
- Vit C is key -- make sure pt takes daily multivitamin + vit C every day
2. medication
- corticosteroids, COX2-I's, anti-neoplastics, anti-rhematologic
3. malignancy
- skin cancers!
multi-organ disease |
|
|
Term
| Baseline protein needs and protein needs when healing a chronic wound |
|
Definition
baseline: 0.8 g/kg/day
Healing: 1.3-2 g/kg/day |
|
|
Term
| Wound that isn't healing as you expect and has no real reason OR a wound on the scalp, think ... ? |
|
Definition
|
|
Term
| Patchy, irregular wound + petechiae + pain with no real cause for the wound --> think ? |
|
Definition
|
|
Term
|
Definition
| pt actively causes injury to themselves or actively keeps a wound from healing |
|
|
Term
these are all examples of passive or active wound healing?
improve arterial supply
treat infection
remove biofilm
reduce edema
improve host metabolic function |
|
Definition
|
|
Term
These are all examples of passive or active wound healing?
free flap closure
grafting
biologic dressings
grwoth factor |
|
Definition
|
|
Term
| conditions for which HBOT is the predominant treatemtn |
|
Definition
air/gas embolism
decompression illness
CO poisoning
delayed radiation injury |
|
|
Term
| 3 most common side effects of HBOT |
|
Definition
barotrauma to ears
visual refractive changes (transient)
seizures from O2 toxicity |
|
|
Term
| 2 absolute contraindications to HBOT |
|
Definition
bleomycin
untreated pneumo |
|
|
Term
autosomal dominant disease triggered by inhaled anesthetics (-fluorines and succinylcholine) that results in a hypermetabolic state wehere Ca channels in muscles increase intracellular Ca and the body overheats
results in arrythmias, renal failure, rhabdomyalysis, metabolic acidsosis, resp alkalosis. and death
tx?
What anesthetic should these pts use in the future? |
|
Definition
malignant hyperthermia
tx: dantrolene + cooling in ice
use TIVA in these pts in future |
|
|
Term
| ASA physical status classifications for surgery pts |
|
Definition
1: normal healthy
2: mild systemic disease ( asthma, smoker, obesity)
3. severe systemic disease (uncontrolled DM or CAD)
4: severe systemic dz that is constant threat to life (ICU pt)
5: moribund pt not expected to survive w/o surgery
6: brain-dead pt whose organs are being harvested
E: emergency |
|
|
Term
| NPO status guidelines for anesthesia |
|
Definition
no solid food for 8 hours prior
formula 6 hours
breast milk 4 hours
sips of clear liquids to take meds only 2 hours |
|
|
Term
| meds that pts must not take before surgery |
|
Definition
herbs: effect platelets
ephedra: can lead to MI/stroke
Vit E |
|
|
Term
|
Definition
amnesia
analgesia
hypnosis
muscle relaxation |
|
|
Term
|
Definition
general
regional (spinal, epidural, peripheral nerve block)
MAC (monitored anesthesia care -- deep sedation) |
|
|
Term
| 3 most common complications of anesthesia |
|
Definition
PONV
sore throat
dental damage/chipped teeth |
|
|
Term
INdications for ____ anesthesia:
- surgery including head, neck, airway, CV, thorax, abd, laparoscopic
- long length of surgery
- emergency surgery |
|
Definition
|
|
Term
| 2 types of airway for general anesthesia |
|
Definition
endotracheal intubation
LMA (laryngeal mask airway) - for surgery w/o paralysis |
|
|
Term
Indications for ___ anesthesia:
- sole anesthetic for lower abd or lower extremity procedures
- in combo w/ general anesthetic
- post-op pain relief
- pt who can't have breathing tube (severe COPD)
- c-section
- hx of malignant hyperthermia
- total knee arthroplasty |
|
Definition
|
|
Term
| absolute contraindications to regional anesthesia |
|
Definition
pt refusal
infection at site of insertion
severe aortic or mitral stenosis
increased ICP
severe hypovolemia
coagulopathy
allergy |
|
|
Term
intravenous deep sedation
used for ERCP (carpal tunnel), cataracts, AV fistula, port-a-cath
uses propofol, dexmedetomidine, fospropofol
contraindications: peds, compromised airway |
|
Definition
|
|
Term
| how does laparoscopic surgery affect intraoperative pulmonary fxn? |
|
Definition
pneumoperitoneum or atelectasis due to increased intra-abd pressure, decreased lung compliance
|
|
|
Term
| how does pt positioning duirng surgery affect oxygenation? |
|
Definition
trendelenburg: shift of abd viscera toward diaphragm
|
|
|
Term
| How does laparoscopic surgery affect cardiac function? |
|
Definition
| higher insufflation pressures = decreased venous return, CO, and preload |
|
|
Term
| what are some possible complications of laparoscopic surgery? |
|
Definition
hemorrhage
CO2 extravasations along tissue planes
venous CO2 embolism
vagal stimulation
pain
ponv |
|
|
Term
What degree burn?
involves only the epidermis
erythmema, tissue damage, edema is minimal
protective fxns intact
no systemic effects
resolves in 48-72 hours
peeling in 5-10 days
ex? |
|
Definition
first degree burn
sunburn |
|
|
Term
what degree burn?
epidermis + some dermis
systemic severity and healing directly related to amount of UNDAMAGED DERMIS
pain, hypersensitive, swollen, dry, mottled
heals in 10-14 days w/ minimal scarring
ex? |
|
Definition
minor 2nd degree partial thickness
blister |
|
|
Term
what degree burn?
deeper dermis is involved
reddish or whitish layer of non-viable tissue
heals over 4-8 weeks w/ severe hypertrophic scarring
high evaporative loss
may convert to full thickness when complicated by bacterial infection
skin grafting may be needed |
|
Definition
| major second degree partial thickness |
|
|
Term
what degree burn?
waxy, dry, white in appearance
lack of sensation - pt may not realize how bad it is
lack of capillary refill
poor blood supply
leathery |
|
Definition
| 3rd degree (full thickness) |
|
|
Term
| How do you determine the % of body burned? |
|
Definition
RULE OF 9's:
Head & Neck: 9%
Ant Trunk: 18%
Post trunk: 18%
each arm: 9%
genitalia: 1%
each leg: 18% |
|
|
Term
| who is at greatest risk of death from burns? |
|
Definition
>60 y/o
<2 y/o
burns to: perineum, hands, face, feet
resp, chemical, electrical burns |
|
|
Term
3 zones of a burn:
1. necrosis w/ irreversible cell death and no capillary blood flow
2. sluggish capillary blood flow and injured cells
3. inflammatory response of healthy tissue to nonlethal injury, vasodilation, and increased capillary permeability |
|
Definition
1. coagulation
2. injury or stasis
3. hyperemia |
|
|
Term
| metabolic response to burns |
|
Definition
increased metabolism
evaporative water loss
heat loss (no skin to keep it from leaving)
secretion of hormones, catecholamines, cortisol, glucoagon |
|
|
Term
| acute management of burns |
|
Definition
1. ADEQUATE AIRWAY
- intubate if comatose, deep burns to face or neck
2. Fluids - lactated ringers (NOT glucose)
3. debridement
4. pain control
5. tetanus prophylaxis
6. nutritional support - caloric and protein supplement
7. Vit A, E, C, zinc supplement
8. low dose heparin |
|
|
Term
|
Definition
1st or 2nd degree: aseptic environment, occlusive dressings
3rd: prevent infection, remove dead tissue, cover wound w/ skin or skin substitute ASAP
ONLY USE TOPICAL ABX IN HIGH RISK WOUNDS - WILL RETARD HEALING |
|
|
Term
| What topical abx should be used in burns? |
|
Definition
silver-containing abx - sulfa sulfadiazine or silver sheets
ONLY USE TOPICAL ABX IN HIGH RISK WOUNDS - WILL RETARD HEALING |
|
|
Term
|
Definition
infection: s. aureus, p. aeruginosa, c. albicans
seizures
sepsis - all major burns |
|
|
Term
| fever + hypermetabolism, catabolism, and leukocytosis after a burn = ? |
|
Definition
|
|
Term
| When to use prophylactic abx |
|
Definition
standard of care for all but 'clean' procedures:
clean = elective, non-traumatic, not associated w/ inflammation, do no enter resp/GI/GU/biliary tract |
|
|
Term
| What is the most commonly used prophylactic abx? |
|
Definition
first generation cephalosporin
(cefazolin/ancef)
- effective against gram pos and gram neg
- moderately long half life
|
|
|
Term
| When do you give prophylactic abx? |
|
Definition
single dose IV at induction or 30-60 min prior to incision
- repeat doses at 3-4 hours
- post op often not necessary
AHA recommends prophylaxis for prosthetic valves or valvular disease |
|
|
Term
|
Definition
1. superficial fascia: camper's and scarpa's
2. deep fascia: ext and int oblique, transverse abdominus, transversalis fascia
3. peritoneum |
|
|
Term
This artery is midline and thus is easily injured in abd surgeries.
What is a good way to avoid cutting an artery during abd surgery? |
|
Definition
superior epigastric
insert first trochar right above umbilicus (no arteries) and then use it as a light to illuminate the abd wall |
|
|
Term
| Keys to opening during abd surgery |
|
Definition
only required exposure
divide muscle in fiber direction (except rectus)
avoid nerves
retract TOWARD nervous |
|
|
Term
Abdominal Incisions:
1. more physiologoic. along langer's lines. in direction of muscle tension = less dehiscence/herniation, less flexible. transection of vascular structures
2. midline (trauma, exlap), good exposure. extendible. no vascular structures. scarring. more tension on repair.
3. good for upper abd organs. often used in morbidly obese or pregnant when laparoscopy isn't an option for cholecystectomy.
4. for appendectomy
5. GYN procedures
6. time consuming. denervation risk, weak closure. rarely used. |
|
Definition
1. transverse
2. vertical
3. subcostal
4. McBurney/Rocky-Davis
5. Pfannenstiel
6. Paramedian |
|
|
Term
| Advantages, disadvantages, contraindications, complications to laparoscopy |
|
Definition
Advantages: less postop pain, fewer wound complications, often outpt or 1 night stay, quicker return to ADL, decreased ileus
Disadvantages: hand-eye coordination, camera driver, limited movement
Contraindications: potential for adhesions, pregnancy, severe cardiopulmonary disease, inability to tolerate general anesthesia, uncorrectable coagulopathy
Complications: trocar site bleeding, injuries upon entry, CO2 embolus, hernia |
|
|
Term
What surgery is indicated?
Sx: periumbilical pain, RLQ pain, + rovsing's and mcburney's pt, mild leukocytosis, anorexia, emesis, nausea
+ CT (adults) and/or US (kids)
what kind of follow-up/hospitalization |
|
Definition
appendectomy (usually laparoscopic)
no perf = outpt
perf: 1-2 days of IV abx and then 7-10 days of oral abx (cipro/flagyl) |
|
|
Term
What surgical procedure is indicated? What tests should be done first?
Sx: RUQ/epigastric pain, nausea, emesis, reflux, diarrhea, constipation, all increase after eating, + murphy's sign
May present as chest pain
what about if bile spillage occurs? |
|
Definition
Laparascopic (usually) cholescystectomy
RUQ US, HIDA scan first
spillage: rinse and drain for a week |
|
|
Term
| Components of the triangle of calot |
|
Definition
common hepatic duct, cystic duct, inferior edge of liver
cystic artery and node of calot pass through
important to know for cholecystectomy |
|
|
Term
What surgical procedure is indicated?
sx: inguinal pain, bulge, incarceration/strangulation |
|
Definition
mesh inguinal hernia repair
Lichtenstein: mesh sewn in place over internal oblique but bewlow the external oblique. slit cut for spermatic cord
Mesh plug: plug placed into defect
6-13% have chronic pain after repair
cowboy hat mesh
|
|
|
Term
TYpes of hernia:
1. through posterior inguinal wall. no associate w/ processus vaginalis, comes through hesselbach's triangle (rectus sheath, inf epigastric, inguinal lig)
2. through deep inguinal ring and canal, protrusion of peritoneum along the spermatic cord. congential when processus vaginalis remains patent |
|
Definition
|
|
Term
What surgical procedure is indicated? what tests first?
sx: reflux, hiatal hernia, paraesophageal hernia
followup/hospitalization
contraindications
complications
what artery is in danger? |
|
Definition
nissen fundoplication (laprocscopic) - fundus of stomach wrapped around esophagus
tests: endoscopy, barium esophagram, 24 hr pH study, esophageal manometry
1 night stay
clear liquids for 1 week
full liquids for 1 week
no carbonation or straws long term
contraindication: esophageal cancer
complication: pneumo from operating on a stomach that is in the chest cavity
watch for splenic artery |
|
|
Term
what surgical procedure is indicated? what tests to do first?
sx: abd pain, leukocytosis, mass, free air, air-fluid levels, bleeding of unknown origin, transition point, sbo
causes: ischemia, adhesions |
|
Definition
small bowel resection (vert midline incision) or exploratory laparotomy
test: XR, SBFT, CT
5-7 day hospital stay
|
|
|
Term
Most accurate diagnostic tool for colonic pathology
indications: low GI bleed, ibs, stricture, post-tumor removal, pseudo-obstruction, polyp, unequivocal barium enema finding
therapeutic: polyp removal, colonic decompression, stricture dilation, hemorrhage control, foreign body removal
allows visualization of entire colon, rectum, last few cm of ileum |
|
Definition
|
|
Term
| indications for colectomy |
|
Definition
diverticulitis/diverticulosis
carcinoma
volvulus, UC
requires 5-7 day hosp stay
|
|
|
Term
| when is a breast biopsy (lumpectomy) indicated? |
|
Definition
|
|
Term
what procedure is indicated?
Presentation: hx of stroke/tia, carotid bruit, amaurosis fugax, carotid stenosis on US/CTA
diagonal incision from below ear to midline through platysma
1 night hosp stay |
|
Definition
|
|
Term
lesion/mass excision
_:_ or _:_ ratio
involves what layers? |
|
Definition
4:1 or 3:1
skin and subcu |
|
|
Term
| carcinoma of sigmoid colon causes high grade obstruction. what is the classic finding on xray? |
|
Definition
|
|
Term
What happens if each of these is cut?
1. mandibular branch of facial nerve
2. glossopharyngeal nerve
3. recurrent laryngeal nerve
4. sup laryngeal nerve
5. hypoglossal nerve |
|
Definition
1. inability to raise corner of mouth
2. horner syndrome, decreased gag reflex
3. hoarseness
4. voice fatiguability
5. deviation of tongue to side of injury |
|
|
Term
what is the most common emergent surgical procedure?
What is the most common general surgical procedure? |
|
Definition
emergent: appy
general: cholecystectomy |
|
|
Term
| what determines whether or not a penetrating neck injury must be further investigated (taken to OR)? |
|
Definition
| if it penetrates platysma (evaluated by having pt stick mandible out) |
|
|
Term
| what anatomic landmark is located at the duodenaljejunal junction? |
|
Definition
|
|
Term
signs of ____?
marked hemodynamic response to infection, apparent cellulitis, ecchymosis, dermal gangrene, crepitus |
|
Definition
| necrotizing soft tissue infection -- go to OR |
|
|
Term
| at what age should pts get a screenig colonoscopy? |
|
Definition
|
|
Term
| what HIDA scan results indicate surgery for cholecystectomy? |
|
Definition
| <35% ejection fraction or >75% |
|
|
Term
93 y/o male presents to ER w/ abd pain for 1 hr + fever
5 hours later, pain at mcburney's pt
CT: Stranding in fat in RLQ |
|
Definition
| needs to go to surgery - appy |
|
|
Term
| Aspects of Routine admission orders |
|
Definition
ADCVANDIIMAL
Admit pt
Diagnosis
Condition
Vitals
Activity (bed rest, up in chair)
Nursing instructions
Diet
I&O
IV fluids
Meds
Allergies
Labs |
|
|
Term
| contents of daily progress note for surgical pt |
|
Definition
Subjective - pt comments, family observations, general observations
Observation - vital signs, daily weight, I & O, UA, meds, lab results
Assessment - how's pt progressing?
Plan - what should be done for pt, address physical findings, when is pt going home?
|
|
|
Term
Used for aspiration of gas or fluid in the stomach
Important part of managing intestinal obstruction or ileus
Nosenasopharynxpharynxesophagusstomach
Check patency hourly
Uses
Complications: |
|
Definition
NG tube
complications:Ulceration and necrosis of the nares- prevented by proper taping
Esophageal reflux, esophagitis, esophageal erosion and stricture
Mouth breathing
Fluid loss
|
|
|
Term
Uses:
chest trauma
after intrathoracic surgical procedure
Remove any accumulating fluid or blood, any air leakage from the lungs and any air entering pleural space through the wound
Connect to water seal drainage or to a suction apparatus |
|
Definition
|
|
Term
Pulmonary Postoperative Care:
General anesthesia = Decrease in pulmonary function
Consider total lung capacity, vital capacity, functional residual volume and compliance
Low doses of ____ at frequent intervals promotes respiration
other steps? |
|
Definition
analgesics
Early post-operative mobilization and frequent position changes
Liquefy secretions
Oxygen when needed
Respiratory therapy |
|
|
Term
| ___ is often the most reliable clue to net fluid balance |
|
Definition
|
|
Term
what do these indicate?
Weight loss
I/O
Extraneous fluid losses
Medications – diuretics, IV fluids
Hx of renal disease
c/o lightheadedness/weakness/dizziness - hyponatremic
Orthostatic hypotension
Tachycardia
Pulses weak
Poor skin turgor
Neck veins or central venous pressure
Lab tests |
|
Definition
| decrease in extrecellular fluid |
|
|
Term
what do these indicate?
Sudden weight gain
Edema, ascites, dyspnea
Sodium replacement exceeding estimated losses
History suggesting severe renal, cardiac or hepatic disease
Hypertension
Distended neck veins
High central venous pressure
Gallop rhythm
Hyponatremia |
|
Definition
| increase in extracellular fluid |
|
|
Term
| daily fluid requirements for healthy pt |
|
Definition
water: 2000-2500 ml/day
Na: 75 meq/day
K: 40-60 meq/day
glucose: 100 g/day |
|
|
Term
How to calculate daily maintenance fluids
what about if fever? |
|
Definition
first 10 kg = 100 ml/kg
next 10 kg = 50 ml/kg
each additional kg = 20 ml/kg
estimate: weight of pt in kg x 30
Fever:
add 2 ml/kg/day for each degree over 100 |
|
|
Term
Types of post-op pain meds:
1. morphine, meperidine (demerol), hydromorphone (delotid), methadone
2. ketorolac (toradol)
3. Morphine, hydromorphine
4. percocet, darvocet, hydrocodone
5. morphine, depodur
6. intercostal/femoral nerve and bupivacaine |
|
Definition
1. parenteral opioids
2. parenteral NSAID
3. patient-controlled analgesia
4. oral analgesics
5. epidural
6. blocks |
|
|
Term
|
Definition
wind
water
wound
wonder drug
walk
womb |
|
|
Term
| postop fever increases ___ and ___ |
|
Definition
fluid loss
caloric requirement (increased 5-8%/deg/day) |
|
|
Term
| sensible v. insensible fluid loss |
|
Definition
sensible: sweat and fever - 250ml/deg/day
insensible: evaporation from skin and lungs. 50-75 ml/deg/fever/day |
|
|
Term
|
Definition
antipyretics
sponge baths |
|
|
Term
Post-op fever cause
most common cause of post-op morbidity
second most common cause of postop death in pts >60y/o
more common after emergency procedures & those involving chest and upper abd
risk factors: any lung dz (COPD, smoking, etc)
complications? |
|
Definition
WIND - resp complications
complications: atelectasis, pneumonia, pleural effusion, pneumo, fat embolism |
|
|
Term
most common pulmonary complication following surgery
- affects 25% w/ abd surgery
Fever w/in first 48 hours after surgery, think this
sx: fever, tachypnea, tachycardia, elevation of diaphragm, rales, decreased breath sounds, low O2 sat, cyanosis, trachial shift, bronchial breath sounds
prevention?
tx? |
|
Definition
atelectasis
prevention: early mobilization
tx: self limiting, may need to remove mucus and re-exampnd lung segments |
|
|
Term
post-op fever:
most common pulmonary complication among pts who die after surgery
predisposing factors: aspiration, atelectasis, copius secretions
usually due to gram neg
sx: fever 4-6 days after surgery, tachypnea, increased secretions (prooductive cough)
tx? |
|
Definition
post-op pneumonia
tx: clear secretions, resp exercises, deep breahting, coughing, abx |
|
|
Term
post-op fever:
occurs due to NG or endotracheal tube, drugs causing CNS depression, pregnancy, food in stomach, position of pt, traum pts, pts w/ increased intra-abd pressure
- 2/3 are after abd or thoracic surgery
Sx: tachypnea, reales, hypoxia
often seen in emergency pts who haven't been npo
prevention?
tx? |
|
Definition
pulmonary aspiration
prevention: preoperative fasting
tx: establish airway, prevent further damage, endotrachial suction, bronchoscopy, abx |
|
|
Term
post-op fever:
- normal after upper abd fusion
- no tx if no complication
- drain w/ tube or thoracentesis if resp compromise |
|
Definition
|
|
Term
post op fever:
- common after subclavian line or when pleura injured
- do cxr after placing line
- tx: thoracostomy |
|
Definition
|
|
Term
post-op fever:
relatively common but usually asymptomatic
- often s/p ortho surgery
sx: neuro dysfunction, fever, resp insufficiency
12-72 hours after surgery
UA: fat droplets
Decreased Hematocrit and thrombocytes
tx? |
|
Definition
fat embolism
tx: O2, improves over time |
|
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Term
post-op fever:
- most common nosocomial infection
- risk: indwelling catheter
sx: bacturia, dysuria, fever, flank pain, ileus
Fever around day 3-5
tx? |
|
Definition
UTI
tx: hydration, drainage of bladder and abx |
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Term
| ____ is generally the first clue to a wound infection |
|
Definition
|
|
Term
accumulation of blood in a wound due to inadequate hemostasis
- wound edges may become discolored and raise
- increase risk of wound infection
- tx; evacuation of clot |
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Definition
|
|
Term
accumulation of clear serus fluid in the wound that is not pus or blood
- often benign but bothersome
- delays wound healing
- increased risk of infection
- tx: needle aspiration or reabsorption by body |
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Definition
|
|
Term
partial or total disruption of any or all layers of the operative wound
- risk factors: adequacy of closure, increased intra-abd pressure, deficient wound healing, DM, immunosuppression, uremia, sepsis, jaundice, hypoalbuminemia, ca, obesity, corticosteroids
- sx: serous-sanguinous discharge from wound POD 5-8, popping sensation w/ coughing, fever, pain, vomiting, inflammation |
|
Definition
|
|
Term
inflammation to an IV site
- one of the most common causes of fever after day 3
- sx: triad - induration, edema, tenderness
tx? |
|
Definition
phlebitis
tx: remove catheter |
|
|
Term
presence of an infected thrombus around an indwelling catheter
- staph
- local signs of inflammation and pus from venipuncture site
- sx; high fever + pos blood culture
tx? |
|
Definition
suppurative phlebitis
tx: excise affected vein, leave wound ope to heal secondarily |
|
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Term
post-op fever beginning at day 5-7
sx: unreliable. palpable cord, edema, calor, erythema, tenderness, pos homan's sign
dx: doppler
tx: anticaogulation |
|
Definition
|
|
Term
|
Definition
risk for DVT
venous stasis, hypercoagulable state, injury to vessel wall |
|
|
Term
|
Definition
|
|
Term
multiplication and distribution of bacteria in blood stream
sx: tachypnea, tachycardia, hypotension, fever, oliguria, chills, mental status changes
labs: leukopenia OR leukocytosis, metabolic acidosis
tx? |
|
Definition
septicemia
tx: broad spectrum abx, maintain circulatory volume, monitor urine output, vasopressors, inotropic agents, corticosteroids |
|
|
Term
post-op complication:
- generally during or w/in 3 days
- incidence: 20%, mostly when being anesthetized
- generally reversible
- many asymptomatic
- may be first sign of MI - check electrolytes, EKG |
|
Definition
|
|
Term
post-op complication:
- 0.4% of all pts having surgery have this
- 5-12% in surgery for atherosclerosis
- risk factors: CHF, ischemia, >70 y/o
- precipitation by hypotension and hypoxemia
- sx: CP, hypotension, dysrhythmia, none |
|
Definition
|
|
Term
post-op complication:
- due to fluid overload, MI, dysrhythmia,
sx: progressive dyspnea, hypoxemia, normal CO2, diffusion congestion on CXR |
|
Definition
|
|
Term
| sudden increase in O2 requirement in post-op pt, think ___ or ___ |
|
Definition
| cardiac failure or pneumonia |
|
|
Term
rapidly evolving, life threatening post-op complication
- usually apparent w/in 24 hours of surgery
- sx: hypovolemia, increase in abd girth, tachy, hypotension, oliguria
tx? |
|
Definition
hemoperitoneum
tx: infusions to expand volume, another operation |
|
|
Term
rare but life threatening post-op infection of parotid gland associated w/ NG intubation
- risk: dehydration, poor oral hygeine
- sx: jaw pain, high fever, leukocytosis, edema, erythema over jaw
tx? |
|
Definition
parotitis
tx: culture fluid from stenson's duct
- vanc, moist, warm packs, mouth irrigation, surgical drainage |
|
|
Term
post-op complication:
- prolonged meds (opioids) + electrolyte abnormalities + inflammation + no bowel sounds + nausea + abd distension |
|
Definition
|
|
Term
| peristalsis should return w/in __ hours of non-abd surgery and w/in __ hours of laparotomy |
|
Definition
|
|
Term
rare, life-threatening complication consists of massive distension of the stomach by gas and fluid
- sx: abd distension, hiccups, ill appearing pt
- labs; hypochloremia, hypokalemia, metabolic alkalosis
tx? |
|
Definition
gastric dilation
tx: early - NG, late - gastrectomy |
|
|
Term
failure of bowel function to return after surgery
- XR: air fluid levels
- tx: NG or laparotomy |
|
Definition
| bowel obstruction (paralytic ileus or mechanical obstruction) |
|
|
Term
result of colonic ileus and inability to recognize rectal fullness after surgery
sx: anorexia, obstipation, diarrhea |
|
Definition
|
|
Term
most common cause of postop jaundice
- caused secondarily to hepatic cell death, meds, sepsis, malnutrition
- occurs after intestinal bypass procedures for morbid obesity |
|
Definition
| hepatocellular insufficiency |
|
|
Term
|
Definition
| metronidazole (flagyl), vanc, contact isolation |
|
|
Term
Alcoholics that stop drinking suddenly
Hyperventilation and metabolic acidosis contribute to syndrome
Hypomagnesemia and hypokalemia secondary to alkalosis or nutritional deficits may precipitate seizures
Readaptation to ethanol free metabolism takes 2 weeks
Prodrome
personality changes, anxiety, tremor |
|
Definition
delirium tremens
tx - benzo, B1, magnesium sulfate |
|
|
Term
May occur during or after insertion of venous catheter or as a result of accidental introduction of air into the line
Air lodges in right atrium and prevents it from filling
Clinically
hypotensino, jugular venous distention and tachycardia
Prevention
patient in Trendelenburg position when a central venous line is inserted
Treatment
aspiration of air with syringe or position patient right side up with head down dislodges air and returns circulatory dynamics to normal |
|
Definition
|
|
Term
| pts under __ w/o significant medical problems are at low risk for perioperative complications |
|
Definition
|
|
Term
| recommendation is to stop smoking __ weeks before surgery |
|
Definition
|
|
Term
| All pts > ___ y/o should have an EKG |
|
Definition
|
|
Term
Cardiac risk assessment:
1. RCRI score >/= ____: consider coronary revascularization prior to noncardiac surgery
2. Defer surgery for __-___ days after placement of bare metal stent and ___ for drug-eluding stent |
|
Definition
|
|
Term
| When use B blocker before surgery? |
|
Definition
1. if pt already on it
2. MI pts
3. probably if multiple clinical predictors or undergoing high risk procedures
4. maybe if intermediate risk pt and undergoing high risk procedure
5. maybe if low risk and undergoing vascular surgery
6. YES if RCRI >/= 2
|
|
|
Term
What to do w/ each med before/during surgery?
statins
aspirin
ACE-I or ARB
nitrate
CCB |
|
Definition
statin - yes atherosclerotic disease pts
aspirin - discontinue 5-7 days before
ACE/ARB - discont 24 hrs before
NItrates - continue
CCB - continue |
|
|
Term
| hypotension, hypoxemia, SOB, delirium after surgery |
|
Definition
|
|
Term
Cause of 1/3 of perioperative deaths
compensated LV dysfunction - increased risk of ______ |
|
Definition
|
|
Term
| advice for pts with severe aortic stenosis? |
|
Definition
no elective surgery
get echo |
|
|
Term
| predisposing risk factors for pulmonary complications |
|
Definition
URI
>60 y/o
COPD
ASA class >2
functionally dependent
CHF
albumin >3/5
FEV1 <2L
MVV <50%
PEF <100L or 50%
PCO2 > 45 mmHg
PO2 < 50 mmg
pts should recieve incentive spirometry and/or deep breathing exercises and selective use of NG tube |
|
|
Term
instructions for DM control perioperatively
1. glycemic control at ___-___ mg/dL
2. No ____ the morning of surgery |
|
Definition
90-110
oral hypoglycemics |
|
|
Term
risk factors for developing postop ARF
what do you do if this happens? |
|
Definition
pre-op renal problem
aortic or cardiac surgery
CHF
preop jaundice
>70 y/o
DM
COPD
dialysis w/in 24 hr of surgery
watch for hyperkalemia
|
|
|
Term
| very general risk stratification diff between general and spinal anesthesia |
|
Definition
spinal/epidural has lower rates of mortality due to lower rates of PE, DVT, pneumonia, and resp depression
No significant diff in cardiac events |
|
|
Term
What electrolyte imbalance?
causes: decreased intake, adrenal insufficiency, excessive ADH, CHF, cirrhosis, diuretics, burns, blood/GI loss, hyperlipidemia
sx: nausea, malaise, HA, confusion, lethargy, coma, seizure |
|
Definition
|
|
Term
What electrolyte imbalance?
cause: water loss, Diabetes insipidus, hypertonic saline use, burns/sweating
sx: polydipsia, polyuria, HA, confusion |
|
Definition
|
|
Term
What electrolyte imbalance?
Cause: decreased intake, adrenal cortex hyperfuction (hyperaldosteronism), diuretic therapy, alkalosis, vomiting, cushings
sx: arrhyhtmias, muscle weakness, muscle cramps, palpitations, polyuria, polydipsia, ileus |
|
Definition
|
|
Term
What electrolyte imbalance?
causes: increased intake, renal failure, hypoaldosteronism, acidosis, RBC hemolysis, K sparing diuretics, ACE/ARB, NSAIDs, dig toxicity
sx: cardiac depression, paresthesias, paralysis |
|
Definition
|
|
Term
What electrolyte imbalance?
cause: decreased intake, vit D deficiency, hypoparathyroid, hypomagnesemia, alcohol abuse, liver failure, pancreatitis, meds
sx: increased neuromuscular activity (seizures), skeletal muscle tetany, tremors, ataxia, depression, anxiety, confusion |
|
Definition
|
|
Term
What electrolyte imbalance?
causes: increased intake, immobility, hyperparathyroidism, cancer, renal failure
sx: decreased neuromuscular activity (stupor, coma), renal calculi, increased fx risk, nausea/constipation |
|
Definition
|
|
Term
What electrolyte imbalance?
causes: poor intake from diet, excessive loss from guy, chronic alcohol use, DKA
Sx: muscle weakness, tremors, + chvostky/trosseau signs, seizures |
|
Definition
|
|
Term
What electrolyte imbalance?
causes: RENAL DISEASE, laxatives, antacids
Sx: weakness, lethargy, n//v, hypotension, decreased reflexes |
|
Definition
|
|
Term
What electrolyte imbalance?
causes: hyperparathyroidism, chronic alcohol use, DNA, burns
sx: irritability, conufsion, muscle weakness, paresthesias |
|
Definition
|
|
Term
What electrolyte imbalance?
Cause: RENAL DISEASE, crush tauma, tumor lysis, resp acidosis
sx: usually none |
|
Definition
|
|
Term
sodium is mostly ___cellular
potassium is mostly ___cellular |
|
Definition
sodium - extracellular
potassium - intracellular |
|
|
Term
|
Definition
fluid flows only when there is a difference in pressure
2 major forces: hydrostatic presssure, osmotic pressure |
|
|
Term
| the pulling force of albumin in the intravascular space is called ____ pressure. Thus, a pt wtih low albumin won't be able to hold water in intravascular compartment, which leads to ____. |
|
Definition
|
|
Term
deficiency of both water and electrolytes. extracellular fluid deficit
- caused by vomiting, diarrhea, fluid shift
- may see elevated BUN
- tx with isotonic fluid
sx: hypotension, tachy, tenting, dry mucus membranes |
|
Definition
|
|
Term
deficiency of JUST water (not electrolytes) - hypertonic, extracellular fluid deficit
sx: hypotension, tachy, tenting, dry mucus membranes
- causes: water loss due to high blood glucose, low ADH, high fever, diabetes insipidus |
|
Definition
|
|
Term
| edema, jvd, tachypnea, increased weight, elevated pulmonary artery & central venous pressure = ? |
|
Definition
|
|
Term
| raised hematocrit = __cellular volume loss |
|
Definition
|
|
Term
___cellular fluid excess is usually due to kidney disease or overload w/ isotonic IV fluids
___cellular fluid excess is usually due to overhydration due overload w/ hypotonic fluid |
|
Definition
intracellular
extracellular |
|
|
Term
the human body generally requires
__L water/day
__ meq sodium/day
__ meq potassium/day |
|
Definition
|
|
Term
| rate of sodium correction should be no more than ___ meq/L in 24 hours or ___ meq/L in 48 hours due to risk of ____. |
|
Definition
10 in 24
18 in 48
central pontine myelinolysis - dysarthria, dysphagia, paraparesis, behavioral changes, confusion, obtundation
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