SURG: Admission of the Surgical Patient PDF

SURG: Admission of the Surgical Patient Study online at https://quizlet.com/_ejunwi 1. What are specific important questions to ask a patient upon hospital admission for surgery? last PO intake (consider anesthesia), coagulopathies (disorders?), anesthesia complications, recent surgeries, recent ant...

SURG: Admission of the Surgical Patient Study online at https://quizlet.com/_ejunwi 1. What are specific important questions to ask a patient upon hospital admission for surgery? last PO intake (consider anesthesia), coagulopathies (disorders?), anesthesia complications, recent surgeries, recent antibiotics (c. diff risk), if taking anticoagulant medications 2. Explain important elements of the admission history and physical exam for the surgical patient. The admission history and physical exam for a surgical patient are crucial for gathering information about the patient's medical history, current condition, and identifying any potential risks or complications related to surgery. Important elements include obtaining a detailed medical history, including past surgeries, allergies, medications, and any chronic medical conditions. A thorough physical examination helps assess the patient's overall health status, including vital signs, cardiovascular and respiratory function, neurological status, and any signs of infection or organ dysfunction. 3. Discuss the assessment of risk factors for complications in the surgical patient. Assessing risk factors for complications in the surgical patient involves evaluating factors such as age, comorbidities (e.g., diabetes, hypertension), smoking status, obesity, nutritional status, history of previous surgeries, and any pre-existing conditions that may impact surgical outcomes. Additionally, factors like the type and complexity of the surgery, duration of anesthesia, and intraoperative blood loss contribute to assessing the risk of complications. 4. Explain factors in selecting the level of care for the surgical patient. Factors in selecting the level of care for the surgical patient depend on the patient's medical condition, type of surgery, anticipated post-operative recovery, and potential for complications. Factors such as the need for intensive monitoring, specialized nursing care, availability of critical care resources, and the patient's overall health status influence the decision to admit to a general ward, intermediate care unit, or intensive care unit (ICU). 1/6 SURG: Admission of the Surgical Patient Study online at https://quizlet.com/_ejunwi 5. Discuss appropriate pre-operative work-up for the surgical patient. Pre-operative work-up for the surgical patient typically includes laboratory tests (e.g., complete blood count, electrolytes, coagulation profile), imaging studies (e.g., chest X-ray, electrocardiogram), and specialty consultations (e.g., cardiology, anesthesia) based on the patient's medical history and the type of surgery planned. The goal is to identify any underlying medical issues that may impact surgical outcomes and optimize the patient's health before surgery. 6. A patient taking an- minimal = 1 day interruption total ticoagulation medications that prelow/moderate = 2 day interruption total sents for elective surgery will need to high= 4 day interuption total pause their medication for how long based on low/high risk of bleeding? (if using DOAC) 7. What is the heProtamine parin reversal agent that might need to be used for anticoagulation reversal in emergency surgery? 8. What is the is Kcentra or Andexxa the reversal agent for DOAC in the case of emergency surgery? 9. What are radiolog- free air, signs of intestinal ischemia, closed loop obical signs that instruction, high grade obstruction, "swirl sign" and high dicate the need for density free fluid surgery? 2/6 SURG: Admission of the Surgical Patient Study online at https://quizlet.com/_ejunwi 10. Which of the follow- ALL of these!! ing are indications for surgery? 1. Acutely incarcerated hernia with obstruction 2. Hernia attempt manual reduction; OR if fails to reduce 3. Hernia has signs of strangulation, do not attempt reduction 4. Volvulus 5. Intussusception 11. Indications for a wound drain/vac Wound drains are placed during surgery to remove excess fluid or blood from the surgical site, reducing the risk of hematoma or seroma formatio 12. Indications for IV fluids Intravenous fluids are used to maintain hydration, replace electrolyte losses, and provide perioperative support, especially in patients undergoing prolonged fasting or significant fluid losses during surgery. 13. What is the indica- Can be used for decompression or administration of tion for a nasogas- medications or enteral nutrition tric tube? Ï Bowel obstruction symptom mgmt. Ï Aspirationofingestedtoxins 14. What are the con- Contraindications: esophageal stricture, bleeding traindications for a varices, skull base fractures nasogastric tube? 15. What type of naso- Dual lumen sump tubes "Salem Sump" gastric tube is most commonly used for decompression? 16. 3/6 SURG: Admission of the Surgical Patient Study online at https://quizlet.com/_ejunwi How is placement of Radiographic confirmation a nasogastric tube confirmed? - Centrally located distal to the carina (does not deviate laterally) and continues inferiorly - Tip should be visualized below the diaphragm, approx. 10 cm beyond the GE junction 17. What are the compli- misplaced tube, irritation, reflux, bleeding/gastritis, cations of the naso- pressure necrosis gastric tube? 18. What are the indica- "Fecal diversion by creating an ostomy when restorations for ostomies? tion of intestinal continuity is not feasible" Both emergent and elective procedure for stool diversion 19. What are EARLY ostomy complications? High output, fluid losses, dehydration, stomal necrosis, stomal retraction due to tension on site 20. What are LATE osto- Skin breakdown, dermatitis, fungal infection, stomal my complications? prolase 21. What is always a po- decrease urine output, parastomal hernia, leakage tential concern for patients with ostomies 22. What are indications for foleys? Urinary retention Strict ins and outs monitoring, Hourly urine output in select patients, Post-operative 23. What type of catheter is best indicated for a difficult female placement due to atrophy? 18F Coude + UroJet successful in MOST BPH cases 4/6 SURG: Admission of the Surgical Patient Study online at https://quizlet.com/_ejunwi 24. Traumatic catheter LARGE removal (with balloon inflated) replace with ___________ (large/small) Foley to tamponade bleeding for 5-7 days 25. What is used for 3-way catheters - large (22 or 24F) to irrigate bladder post- op or for clot retention/hematuria CBI = continuous bladder irrigation 26. T/F: you want to TRUE avoid keeping your patient NPO for long periods of time 27. What are enteral feeding options? Nasogastric tube and PEG tube 28. What are advantages of enteral feeds? preserved gut integrity, costs less, increased compliance 29. What are contraindi- intratable vomiting, diarrhea, ileus, GI obstruction, difcations of enteral fuse peritonitis feeds? 30. What is the concentrations, contraindications and time duration of peripheral parenteral nutrition? Lower concentration Contraindicated for patients that cannot tolerate large fluid volumes Short time periods ( 7 days or nonfunctional GI tract Mixture of amino acids, dextrose, lipids, vitamins, minerals, and electrolytes 32. List the component to post-operative/admissions orders (See Image) Components required for post-operative/admissions orders include pain management (analgesia), fluid management, electrolyte replacement, antibiotic prophylaxis, wound care instructions, activity restrictions, diet instructions, and monitoring parameters (vital signs, intake/output). 6/6