Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Phase 2 > Perioperative Management > Flashcards

Perioperative Management Flashcards

1
Q

Why is smoking history important pre-op?

A

When was their last cigarette? It constricts the airways and makes them hyper-reactive so they may go into bronchospasm more easily
Also heavy smokers may not know they have COPD so take care giving O2 to wake them up

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the main aspects of physical examination pre-op?

A

Airway assessment
CVS
Respiratory

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is ASA grade 1?

A

Normal healthy patient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is ASA grade II?

A

Patient with mild systemic disease and no functional limitations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is ASA grade III?

A

Moderate to severe disease that results in some functional limitations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is ASA Grade IV?

A

Severe systemic disease that is a constant threat to life and functionally incapactitating

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is ASA grade V?

A

Moribund patient not expected to survive 24 hours with or without the surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What does E after ASA grade mean?

A

That the procedure is an emergency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What investigations are performed routinely at pre-assessment?

A 
Urinalysis
ECG if >50y
FBC
Blood glucose in diabetics
Pregnancy test for all females of reproductive age
U&Es if >60y
Coagulation, group&save
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the time limits in NBM?

A

Clear fluids up to 2 hours before procedure

Light meal 6 hours before

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What does -plasty mean at the end of a surgical procedure?

A

Surgical refashioning to regain good function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What does -stomy mean?

A

Artificial Union between a conduit and another conduit/the outside world

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is a cyst?

A

Fluid-filled cavity lined by epi/endothelium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is colic?

A

Intermittent pain from over-contraction or obstruction of a hollow viscus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is a sinus?

A

Blind-ending tract

Typically lined by epithelial or granulation tissue, which opens to an epithelial surface

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is an ulcer?

A

Interruption in the continuity of an epi/endothelial surface

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the aims of preoperative assessment?

A

Know planned procedure
Improve any comorbidities which may increase risk of an adverse outcome
Anticipate potential problems
Informed consent
Appropriate prophylactic measures and premedication
Trusting patient-doctor relationship

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What surgical presentations can warfarin cause?

A

Rectus sheath haematoma
Intraperitoneal bleeding
Retroperitoneal haematoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the main causes of acute pancreatitis?

A

Gallstones

Alcohol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What drugs can cause diarrhoea?

A 
Beta blockers
ACE inhibitors
Statins
Antibiotics
Metformin
Iron
Laxatives
Mefenamic acid
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What drugs can cause constipation?

A 
Antimuscarinics
Opiates
Iron
Laxatives (chronic)
Aluminium-containing antacids
Mebeverine
Gaviscon
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How long before surgery should clopidogrel be stopped?

A

7 days before

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How long before surgery should aspirin be stopped?

A

DO NOT STOP

Cardio and cerebroprotective benefits outweigh slight increased bleeding risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How should statins be managed perioperatively?

A

Don’t stop

Reduce periop mortality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

How should beta blockers be manage perioperatively?

A

Don’t stop

Risk of rebound angina/infarction when stopped suddenly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

How should oral hypoglycaemics be managed perioperatively?

A

Stop from day of surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

How should the OCP be managed perioperatively?

A

Stop at least 4 weeks before surgery (give alternative contraceptive advice)
Restart 2 weeks after surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

How should HRT be managed periop?

A

Stop at least 4 weeks before surgery

Restart 2 weeks post-op

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

How should steroid be managed periop?

A

DO NOT STOP

Can lead to Addisonian crisis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

When should warfarin be stopped before surgery?

A

AF: 5 days
Prosthetic heart valve: 5 days, keep INR 2-3 using heparin
Previous DVT/PE: 5 days, high-dose prophylactic LMWH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

How do you immediately reverse warfarin?

A

Beriplex - synthetic factors 2, 7, 9 and 10

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

How else can you reverse warfarin?

A

IV vitamin K (1-5 mg slowly)

Takes 3hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

How can you check for postoperative ileus?

A

Ask the patient if they have passed wind

If yes, then the colon is working and hence everything else is too

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Which patients should have prophylactic LMWH?

A

All patients over 20 having abdominal surgery

Patients having neck surgery should not

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What dose of dalteparin is used for VTE prophylaxis?

A

2,500 or 5,000 for high-risk patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What antibiotics are used for prophylaxis of wound infection?

A

Ceftriaxone + metronidazole

Or augmentin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is the treatment for opiate OD?

A

Naloxone 0.4mg IV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What are the steps involved in reversing anaesthetic?

A

Wellbeing (pain and PONV) then C B A…
CVS stable
Breathing for themselves
Airway (&O2)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Name a muscle relaxant commonly used in anaesthesia

A

Atracurium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Why might atropine be given in laparoscopic surgery?

A

Vagal nerve stimulation can cause bradycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Why is increased pressure needed to ventilate patients during laparoscopic surgery?

A

Abdomen is inflated, making it harder for the diaphragm to move down

42
Q

How are CO2 levels managed during surgery?

A

If pCO2 rises during op, increase rate of ventilation

High pCO2 at the end is good as it stimulates the patient to start self-ventilating

43
Q

What are the potential respiratory complications post-op?

A

Hypo ventilation

Hypoxia

44
Q

What can cause hypo ventilation postop?

A

Upper airway obstruction - decreased muscle tone, secretions, sleep apnoea
Laryngeal obstruction
Opioids causing respiratory depression

45
Q

What can cause hypoxia postop?

A

Hypo ventilation
Ventilation perfusion mismatch eg PE
Pain
Using too much O2 eg shivering

46
Q

Why should patients only be delivered to the ward once they have a normal temperature?

A

Shivering increases O2 demand
Hypothermia reduces enzyme activity in clotting
Heat needed for wound healing

47
Q

What can cause postop hypotension?

A

Drugs
Epidurals
Volume loss

48
Q

What is the main cause of postop hypertension?

A

Pain

49
Q

What are the risk factors for PONV?

A 
Motion sickness
Gynae surgery
Previous PONV
Child
Female
Anxiety
50
Q

What are the anaesthetic causes of PONV?

A

Opioids
Gases
Pain
Not enough fluid

51
Q

What are the 5 parameters measured in EWS?

A 
Heart rate
Resp rate
Temperature
BP
CNS (AVPU)
52
Q

What is the most important parameter in EWS?

A

Resp rate. Indicates hypoxia, hypercapnia and metabolic acidosis (DKA, sepsis, lactic acidosis)

53
Q

How should you give oxygen to a COPD patient?

A

Venturi mask

54
Q

What concentration of oxygen do nasal cannulae deliver?

A

24-35%

55
Q

Define pain

A

An unpleasant emotional and sensory experience resulting from a stimulus causing, or likely to cause, tissue damage

56
Q

What are the effects of pain?

A

Tachycardia, hypotension
Inability to deep breathe or cough
Nausea and poor appetite
Poor mobility
Stress response - sodium and water retention, oedema
Poor sleep, depression, illness behaviour, inability to work

57
Q

What is the pain pathway?

A 
Stimulus
Dorsal horn of spinal cord
Modulation in Rexed laminae
Ascending pathways
Modulation by brain
Descending pathways
Effector site reflexes
58
Q

What does neuropathic pain feel like?

A

Burning

59
Q

What is step 1 in the WHO pain ladder?

A

Non-opioids eg aspirin, NSAIDs or paracetamol

60
Q

What is step 2 on the WHO pain ladder?

A

Mild opioids eg codeine, with or without non-opioids

61
Q

What is step 3 on the WHO pain ladder?

A

Strong opioids eg morphine, with or without non-opioids

62
Q

How does paracetamol work?

A

Inhibits CNS prostaglandin synthesis and blocks bradykinin-sensitive chemoreceptors peripherally

63
Q

What is the adult dose of paracetamol?

A

1g every 4-6hrs

64
Q

How do NSAIDs work?

A

COX inhibition to reduce synthesis of peripherally-acting inflammatory mediators of pain

65
Q

What does COX-1 do?

A

Constitutive production of inflammatory mediators eg GI, renal

66
Q

What are the side effects of NSAIDs?

A

GI: peptic ulcers, erosions and GI haemorrhage
Renal: can reduce renal blood flow
Resp: bronchospasm
Bleeding: anti-platelet effect
Cardiac: fluid retention and cardiac failure in borderline patients

67
Q

What is the relationship between codeine and morphine?

A

10% of codeine is metabolised to morphine

Side-effect profile may be similar

68
Q

What is the adult dose of codeine?

A

30-60mg hourly

69
Q

Give 3 examples of strong opioids

A

Morphine
Pethidine
Fentanyl

70
Q

How does morphine work?

A

Acts on M and K opioid receptors in brain and spinal cord

Reduce membrane excitability to nociceptive impulses

71
Q

What are the side effects of morphine?

A 
Respiratory depression
Reduced response to hypoxia and hypercapnia
Anti-tussive (stops coughing)
Nausea, vomiting, constipation
Urinary retention
Drowsiness
72
Q

What is the adults dose of morphine?

A

0.1-0.2 mg/kg

73
Q

What is PCA?

A

Patient controlled analgesia
Pump programmed to deliver a bolus dose of drug when the patient operates a hand set
Dose is 1mg with a lock-out of 5 mins

74
Q

Where is an epidural put?

A 
Epidural space (potential space)
Space in which nerves run to join the cord
75
Q

Where is spinal analgesia inserted?

A

Into the CSF

Blocks fibres at the cord level

76
Q

What is entonox?

A

Gaseous mixture of 50% O2 and 50% nitrous oxide

77
Q

Why may hospital patients be malnourished?

A 
Increased nutritional requirements
Increased losses eg stoma
Decreased intake eg dysphagia
Treatment effects (nausea, diarrhoea)
Enforced starvation
Missing meals
Difficulty feeding
Unappetising food
78
Q

What is the best form of nutrition?

A

Enteral - through GI tract

79
Q

When should parenteral nutrition be considered?

A

If the patient will become malnourished without it

Eg small bowel Crohn’s when food not being absorbed

80
Q

How is TPN given?

A

Central venous line or PICC line

81
Q

What are the potential complications of TPN?

A

Sepsis from central line insertion

Thrombosis in central vein may lead to PE

82
Q

What are the 3 indications for IV fluids?

A

Maintenance
Resuscitation of pre-existing deficit
Replacement of ongoing losses

83
Q

What proportion of bodily fluid is extracellular?

A

1/3

84
Q

What proportion of body fluid is intravascular?

A

1/15

85
Q

What is the minimum urine output that is considered adequate?

A

0.5ml/kg/hr

86
Q

Why are even small changes in plasma potassium bad?

A

Potassium is mainly intracellular

There may be large changes before plasma levels change

87
Q

Why do IV fluids need to be isotonic with plasma?

A

If hypotonic - red cell haemolysis

If hypertonic - red cell crenation

88
Q

Name 3 crystalloid fluids

A

Normal saline
Dextrose
Hartmann’s

89
Q

Name 4 colloid solutions

A

Volpex
Starch
Albumin
Blood products

90
Q

What does 1 litre of 0.9% normal saline contain?

A

154mmol Na+

154mmol Cl-

91
Q

What does 1 litre of Hartmann’s contain?

A

131mmol Na+
5mmol K+
111mmol Cl-

92
Q

What is the maximum safe rate to deliver IV potassium?

A

5mmol/hr

93
Q

What proportion of 5% dextrose solution remains in plasma?

A

1/15

Glucose taken up rapidly by cells, so solution acts just like water

94
Q

What proportion of 0.9% saline remains in plasma?

A

1/5

95
Q

What proportion of colloid solutions stays in plasma and why?

A

All of it
Contains proteins, which can’t cross the capillary membrane. Their osmotic effect means all the water remains in plasma too

96
Q

What are the maintenance requirements of sodium for adults?

A

2mmol/kg/24h

97
Q

What are the maintenance requirements of water for adults?

A

40ml/kg/24h

98
Q

What are the potassium requirements for adults?

A

1 mmol/kg/24h

99
Q

When may fluid replacement be required?

A

Vomiting
Diarrhoea
High output stoma
Enterocutaneous fistula

100
Q

What ions is diarrhoea rich in?

A

K+ and HCO3-

101
Q

What ions is vomit rich in?

A

K+, H+ and Cl-

102
Q

How do you assess a patient’s fluid status?

A 
Peripheral perfusion
Pulse rate, blood pressure
JVP
Flow-based measurements
Urine output

Phase 2 (21 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions