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Pre & Post Op

Surgery I

Most common PAC heard: BBB (?)
Bruit heard on pre-op exam: what test next? EKG to check for aortic stenosis
Most common post-op complication Infection
Most common post op EKG abnormality atrial fib
Common causes of post-op fever Atelectasis (POD 1-2); UTI (POD 3); wound infxn / dehiscence (POD 5-7); DVT (POD 7-14); wonder Drug / Abx
Urinary retention d/t injury to nerves of bladder, pain med, or enlarged prostate; TX: foley cath 24 - 48 hr, then another trial of voiding
Pain decrease splinting and improve pulmonary mechanics
Infxn drain and/or wash it out
May assess post-op renal status by calculating: Fractional excretion of sodium
Most MIs occur when: in the first 3 days postop
Risk of postop reinfarction: 37% if operated upon within 3 mos; 16% if within 3-6 mo; 4.5% if after 6 months
Efficacy of Medical Hx 3 X PE; 11 X labs; 75-90% dx combined with PE
Risk assessment: All surgical pts Pneumonia, UTI, wound infxn, DVT; CXR, UA C&S, LE venous ultrasound
Risk assessment: Obesity DVT, wound infxn; Early ambulation, abdominal binder
Risk assessment: Diabetes Hyperglycemia; Diabetic diet, sliding scale insulin, accuchecks
Risk assessment: Bedridden / limited mobility Pneumonia, DVT, bedsores
Risk factors for a post-op cardiac complication: S3 gallop / JVD; MI in last 6 mo; PACs on EKG; >5 PVCs / min; Intraperitoneal, intrathoracic, or aortic operations; Age >70 y.o.; significant aortic stenosis; Emergency operation; Poor medical condition
initial tx for post-op urinary retention foley catheter for 24 to 48 hours then another trial of voiding
Algorithm for post-op low urine output Look at pt (appearance, vitals); first 48 hrs, fluid bolus; if low output persists or S/S of hypovolemia: do CBC to r/o bleeding, also BUN/creatinine
Pre-op for diabetic pt: If no IV fluids overnight: take no insulin or oral meds; if IV fluids given: no oral meds but half the usual insulin dose
To decrease atelectasis: Encourage coughing, turning, deep breaths, incentive spirometer use, and early ambulation
Created by: Abarnard