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Perioperative Care

SUGGESTED READINGS PERIOPERATIVE CARE

Current Surgical Diagnosis & Treatment, 12th Edition, Ch. 1, 2, 3, 4, 5.
Perioperative Care handout

OBJECTIVES PERIOPERATIVE CARE

1. Discuss which diagnostic tests are appropriate for preoperative evaluation.
2. List Goldman’s criteria for cardiac risk in patients undergoing non-cardiac surgery.
3. Discuss cardiovascular effects of different types of anesthesia.
4. Discuss prevention of peri-operative cardiac events.
5. According to Virchow what are the three factors that predispose patients to DVT and which interventions are used in prophylaxis?
6. Discuss proper fluid management and appropriate use of blood products in the postoperative patient. 7. Discuss the causes of postoperative fever. (5 Ws)
8. Discuss the differential diagnoses for patients with postoperative respiratory difficulty.
9. What can be done preoperatively and intraoperatively to decrease the incidence of postoperative infection in surgical patients?
10. Discuss methods of pain control in the postoperative patient.
11. Discuss the criteria used to perform a nutritional assessment and when and by what route should nutritional support be started.

CASE HISTORIES PERIOPERATIVE CARE

1. A 64-year-old white female is in the clinic for evaluation of adenocarcinoma of the sigmoid colon. The patient is a good historian and the diagnosis is not in doubt. You are requested to see the patient and “get her ready for surgery”. a. What is the first step? b. Evaluate the patient on the above systems?

2. The surgical procedure was without complications, with an estimated blood loss of 300 cc. Intraoperatively, she received four liters of crystalloid (Ringers Lactate). You are the physician caring for this patient in the postoperative period. For each of the following time intervals, suggest the potential complications and sources of fever you are most concerned about, As well, suggest what data (vital signs, exam findings, laboratory studies, etc.) you consider most important to assess the patient for these potential complications. What forms of pain management would be appropriate in each of these settings?
a. Recovery room
b. Evening rounds, day of surgery
c. Morning rounds, POD # I d. POD#3
e. POD#5 3.

On POD #5, the patient has a red, warm wound with some drainage. What do suspect is going on and what is the treatment? If the wound was not red and there was drainage, what would you suspect?

Perioperative Care handout

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