SURG - Admission Note

13 Questions

What is NOT a element of your admission note?

Type and amount of anesthesia used

If there is high bleeding risk or life-threatening hemorrhage risk, what correctly matches anticoagulation agents?

Heparin:Protamine, Warfarin:VitK, DOAC:KCentra

A nasogastric tube placement MUST be confirmed with x-ray. It should be centrally located distal to the carina (does not deviate laterally) and continues inferiorly.

True

Indications!

restoration of intestinal continuity is not feasible = Ostomies decompression or administration of medications or enteral nutrition = Nasogastric Tube Maintenance IVF, Resuscitation IVF = Fluids Urinary retention, Strict I/Os monitoring, Hourly urine output in select patients = Foley Cath

Complications for ostomy: Early v Late complications

Hypokalemia, hyponatremia = early Stomal necrosis, retraction = early Skin breakdown, dermatitis, fungal infection = late Stomal prolapse = late

Esophageal stricture, bleeding varices, skull base fractures are still OK to get a NG tube.

False

What catheter should I use?

Female difficult Foley due to atropy = 18F Coude + UroJet enlarged prostate = 18F Coude + UroJet used to irrigate bladder post- op or for clot retention/hematuria CBI = continuous bladder irrigation = 3-way catheters Traumatic catheter removal (with balloon inflated) = LARGE Foley

PPN- peripheral parenteral nutrition VERSUS TPN- total parenteral nutrition

Lower concentration and Short time periods (<2 weeks) = PPN Contraindicated for patients that cannot tolerate large fluid volumes = PPN Requires central access (PICC or central line) and made of Mixture of amino acids, dextrose, lipids, vitamins, minerals, and electrolytes = TPN Indicated when no enteral feeding > 7 days or non-functional GI tract = TPN

You should have a DVT/PE Prophylaxis plan and timing of restarting chemical DVT PPx post-op (if app) in the admission note.

True

What is a sign of URGENT surgery?

Fever, leukocytosis, tachycardia, tachypnea, radiography free air sign (swirl sign)

When it comes to the interruption of DOAC for Elective Surgery for a high risk bleeding procedure, when should the patient STOP their DOAC?

Two days prior to surgery

When it comes to interruption of DOAC for Elective Surgery, when should a patient stop their regular DOAC for a low risk of bleeding surgery?

1 days before surgery

A patient takes DOAC/anticoagulation medications on a regular basic and needs emergent surgery. What do you need to consider if there is a high risk of bleeding or life threatening hemorrhage?

Reversal Agent

Study Notes

Elements of Admission Note

Admission note should include patient's DVT/PE prophylaxis plan and timing of restarting chemical DVT prophylaxis post-op, if applicable.

Nasogastric Tube Placement

Nasogastric tube placement must be confirmed with x-ray.
The tube should be centrally located distal to the carina and continue inferiorly without lateral deviation.

Contraindications for Nasogastric Tube Placement

Esophageal stricture, bleeding varices, and skull base fractures are not contraindications for nasogastric tube placement.

Parenteral Nutrition

PPN stands for peripheral parenteral nutrition.
TPN stands for total parenteral nutrition.

Anticoagulation Agents

In cases of high bleeding risk or life-threatening hemorrhage, anticoagulation agents should be carefully managed.
For elective surgery with high risk of bleeding, DOACs should be stopped 2-3 days before surgery.
For elective surgery with low risk of bleeding, DOACs can be stopped 1-2 days before surgery.
If a patient is taking DOACs regularly and needs emergent surgery, the risk of bleeding or life-threatening hemorrhage should be carefully considered.

Urgent Surgery Indications

Urgent surgery is indicated in life-threatening situations.

Ostomy Complications

Early complications of ostomy include bleeding and infection.
Late complications of ostomy include bowel obstruction and hernia.

Test your knowledge on the elements typically found in an admission note and identify what is NOT a part of it. This quiz covers key concepts related to documenting patient admissions in healthcare.

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