Surgery I
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| Most common PAC heard: | BBB (?)
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| Bruit heard on pre-op exam: what test next? | EKG to check for aortic stenosis
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| Most common post-op complication | Infection
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| Most common post op EKG abnormality | atrial fib
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| 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
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| 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
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| Pain | decrease splinting and improve pulmonary mechanics
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| Infxn | drain and/or wash it out
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| May assess post-op renal status by calculating: | Fractional excretion of sodium
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| Most MIs occur when: | in the first 3 days postop
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| Risk of postop reinfarction: | 37% if operated upon within 3 mos; 16% if within 3-6 mo; 4.5% if after 6 months
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| Efficacy of Medical Hx | 3 X PE; 11 X labs; 75-90% dx combined with PE
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| Risk assessment: All surgical pts | Pneumonia, UTI, wound infxn, DVT; CXR, UA C&S, LE venous ultrasound
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| Risk assessment: Obesity | DVT, wound infxn; Early ambulation, abdominal binder
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| Risk assessment: Diabetes | Hyperglycemia; Diabetic diet, sliding scale insulin, accuchecks
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| Risk assessment: Bedridden / limited mobility | Pneumonia, DVT, bedsores
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| 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
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| initial tx for post-op urinary retention | foley catheter for 24 to 48 hours then another trial of voiding
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| 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
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| 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
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| To decrease atelectasis: | Encourage coughing, turning, deep breaths, incentive spirometer use, and early ambulation
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Created by:
Abarnard
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