Surgery 1 Flashcards

Question

Why is fluid overload or dehydration a common surgical complication

Answer 1

* Under and over hydration * Fluid and blood loss during procedure

Answer 2

* Intestinal blockage in the absence of an actual physical obsturction * Caused by malfunction in the muscles and nerves of the intestine that impairs digestive movement

Answer 3

1. **Inform** patient of procedure + if they need to do anything e.g. food/drinks 2. **Conduct** relevant blood tests, X-rays etc 3. Determine **anaesthetic risk**/**bleeding risk** 4. Consider if any meds should be **stopped** 5. Provide **alternatives** if necessary 6. Plan and predict for any post-op **complications** 7. Highlight if patient will be at risk of **malnutrition** post op (e.g. likely prolonged NBM periods, refer to dieticians)

Answer 4

* Taking DHx * Writing inpatient medication chart * Administration of medicines during pero-operative period * Counselling * Prescribing regular meds * Advising on appropriate medicaiton management during peri-operative period * Forsee post-op complications and recommend appropriate treatment * Smoking cessation * Producing guidelines for pre-op team * Preparing for discharge

Answer 5

1. Healthy patients 2. Mild-moderate systemic disease 3. Severe systemic disease which limits activity but **not** incapacitating 4. Severe disease process that is a constant threat to life 5. Moribund (at death) patient not expected to surivive 24h w/o op 6. Declared brain-dead patient, organs being removed for donor purposes

Answer 6

* Impaired wound healing - RA patients often on immunosuppressants e.g. steroids, MABs, MTX * Elderly - anaesthetic risk, sedation, drug clearance, respiratory impact, risk of VTE as elderly and non-mobilising surgery

Answer 7

ASA 3: severe disease process which limits activity but is not incapacitating

Answer 8

1. Pain 2. Post operative nausea and vomiting (PONV) 3. Nil by mouth (NBM) period 4. VTE prophylaxis 5. Fluid management 6. Anticoagulation in the perioperative period 7. Abx prophylaxis

Answer 9

○ Assess CV risk vs gastro risk ○ Ibuprofen 2.4g is lowest ○ Diclofenac has high cardio risk ○ Naproxen has higher GI risk

Answer 10

* WHO pain ladder * Patient controlled analgesia (PCA) * Spinal * Regional/peripheral nerve LA blocks * Epidural

Answer 11

* Strong opioid based * Gives pt control of pain so they aren't waiting potentially long times for the nurse for PRN doses of analgesia * Pt must be alert to use and have some understanding of process and how to use * Some pt can become very drowsy with morphine PCA - counter productive, as they will not be able to operate PCA effectively

Answer 12

* Diamorphine administered spinally during surgery

Answer 13

* Nerve blocks are good for fracture * Hip fracture (neck of femur NOF) - insert LA to nerve = good results for pain relief

Answer 14

* Form of anaesthetic injected into epidural space * Numbs limb post-op * Alleviates pain * Consists of LA + opioid, synergic action of drugs acting on different sites 1. LA acts on nerve blocks 2. Opioids act on opioid receptors near spinal cord * Less n+v with epidural and less risk of DVT due to mobility

Answer 15

* Patient in control of analgesia * Lockout period protects against OD * Number of requests for drug can be monitored * Fast acting * Rduced patient anxiety on pain * Improved patient experience * Suitable if patient NBM * Useful for incident pain e.g. physio, dressing changes * Patient's don't need multiple injections

Answer 16

* not suitable for all patients * renal impairment - accumulation of morphine metbaolites * SE: n+v, pruritis, constipation, sedation * not to be used with any other opoids * if patients sleeps without PCA, may wake up in pain

Surgery 1 Flashcards

(41 cards)