medportal CDB | Pre and Post operative care

Pre and Post operative care

Activity
Large Group Session

Review of basic fluid physiology and management. Pre-operative and postoperative assessment of the surgical patient.

Curriculum Block

Clerkship / Surgery Rotation

- Indicates most relevant

Objectives

Clerkship Objectives

Indicate the mechanisms, methods of compensation, differential diagnosis, and treatment of the following acid base disorders: acute metabolic acidosis; acute respiratory acidosis; acute metabolic alkalosis; acute respiratory alkalosis.
Describe the factors which can give rise to alterations in cognitive function postoperatively, as well as their evaluation and treatment. Alterations in cognitive function: hypoxia; metabolic; alcohol withdrawal; hyponatremia
Discuss disorders of alimentary tract function following laparotomy which may produce nausea, vomiting, and/or abdominal distension: paralytic ileus; acute gastric dilatation; intestinal obstruction; fecal impaction
Describe factors which can lead to abnormal bleeding postoperatively, and discuss its prevention and management: Surgical site - inherited and acquired factor deficiencies; DIC; transfusion reactions; operative technique; gastroduodenal (i.e. stress ulcerations)
Describe the management of postoperative chest pain.
Discuss the possible causes of hypotension which may occur in the postoperative period. For each etiology describe its pathophysiology and treatment: hypovolemia; sepsis; cardiogenic shock - including postoperative myocardial infarction; fluid overload; arrhythmias; pericardial tamponade; medication effects
Discuss the diagnostic work-up and treatment of oliguria in the postoperative period. Include pre-renal, renal, and post-renal causes (including urinary retention).
Discuss the various causes of respiratory distress and respiratory insufficiency that may occur in the postoperative patient. For each complication, describe the etiology, clinical presentation, management, and methods of prevention: atelectasis; pneumonia; aspiration; pulmonary edema; pulmonary embolism (including deep venous thrombosis); fat embolism.
Discuss the following wound complications in terms of predisposing risk factors (patient condition, type of operation, technique), as well as their recognition, treatment, and prevention: hematoma and seroma; wound infection; dehiscence; incisional hernia.
Describe the differential diagnosis of a patient having postoperative fever. For each entity, discuss the clinical manifestations, appropriate diagnostic work-up, and management: Within 24 hours: response to surgical trauma; atelectasis; necrotizing wound infections. Between 24 and 72 hours: pulmonary disorders (atelectasis, pneumonia); catheter related complications (IV-phlebitis, Foley-UTI). After 72 hours: infectious (UTI, pneumonia, wound infection, deep abscess, anastomotic leak, prosthetic infection, parotitis); noninfectious (deep vein thrombosis).
Discuss methods for DVT prophylaxis and identify high-risk patients.
List the normal range of Na+, K+, HCO3-, Cl- in serum and indicate how these ranges change in perspiration, gastric juice, bile and ileostomy contents.
List the factors that effect oxygen delivery and consumption.
List the physiological limits of normal blood gases.
Describe the concept of a “third space” and list those conditions that can cause fluid sequestration of this type.
Describe the possible causes, appropriate laboratory studies needed, and treatment of the following conditions: hypernatremia; hyponatremia; hyperkalemia; hypokalemia; hypochloremia
In the following situations, indicate whether serum and urine Na, K, HCO3, Cl and osmolality will remain stable (0), rise considerably (++), rise moderately (+), fall moderately (-), or fall considerably (--): acute tubular necrosis; dehydration; secretion (SIADH); diabetes insipidus; congestive heart failure
In the following situations, indicate whether serum Na, K, HCO3, Cl and blood pH will remain stable (0), rise considerably (++), rise moderately (+), fall moderately (-), or fall considerably (--): excessive gastric losses; high volume pancreatic fistula; small intestine fistula; biliary fistula; diarrhea
List the electrolyte composition of the following solutions: normal (0.9%) saline; half normal saline; one third normal saline; 5 percent dextrose in water; Ringer's lactate.
List and describe the objective ways of measuring fluid balance.
List least six symptoms or physical findings of dehydration.

Curriculum Block

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