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1.
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fluids often used to replace volume post-op
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D5/0.5NS plus KCL 20 mEq/Lafter large sx blood loss, use LR or 0.9 NS for first 24 hrs
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2.
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changes in pts fluid requirements in the post-op period
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as the pt regains GI function and recovers, s/he will begin to mobilize fluids from the third space and IV fluid requirements decrease during the recovery periodfailure to adjust for this may lead to fluid overload, edema, or pulmonary edema
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3.
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estimation of maintenance fluid requirements
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1500 mL + 20 mL/kg for every kg over 20
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4.
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normal urine output
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0.5-1 mL/kg/hr
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5.
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electrolyte composition of D5W
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glucose 50 mg/dL
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6.
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electrolyte composition of D10W
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glucose 100 mg/dL
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7.
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electrolyte composition of 0.9 NS
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154 mEq/L of each Na+ and Cl-
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8.
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electrolyte composition of .45 NS
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77 mEq/L of each Na+ and Cl-
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9.
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electrolyte composition of LR
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Na+ 130K+ 4 Ca2+ 3Cl- 110lactate 28
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10.
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evaluation of a post-op pt whose urine output is excessive
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collect urine over timed period to measure osmolalitylow osmolality: pathologic conc defecthigh osmolality: osmotic diuresisusually, post-obstructive diuresis is self-limited, and the BUN and Cr will return to normal in 1-2 days
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11.
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evaluation of a post-op pt who does not have adequate urine output
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first irrigate the catheterthen try volume resuscitationif UOP still not normal, get CVP or pulm artery catheter to determine volume status
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12.
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measurements in prerenal causes of oliguria:urine osmolalityurine [Na+]FeNaBUN/Cr ratio
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>500<20<1%>20
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13.
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measurements in prerenal causes of oliguria:urine osmolalityurine [Na+]FeNaBUN/Cr ratio
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250-300>40>3<10
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14.
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ddx of fever in hospitalized/post-op pt
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pneumonia, URI, UTI, DVT, infected indwelling catheter, drug-related fever
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15.
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most common cause of fever in the immediate post-op periodhow to dxtx
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atelectasisPE and CXRvigorous pulmonary toilet and incentive spirometry**Abx not used b/c this is not an infection**
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16.
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timeline and tx for post-op UTI
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~post-op day 3TMP/SMX or cipro
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17.
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management of infected incision site
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open/drain the incision siteirrigationpacked w/ wet to dry dressingsif evidence of cellulitis, oral Abx
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18.
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pt w/ a drop of pus at his/her venipuncture site:name of dxtx
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suppurative phlebitisremove the catheter; excise the vein to the first patent, non-infected catheter, leaving the wound open; IV Abx
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19.
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management of enterocutaneous fistula in the post-op period
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w/ signs of peritonits, to OR for re-explorationw/o signs of peritonitis, CT to look for a collection, which can be drain percutaneously; if CT negative, medical management w/ NPO, TPN, and daily measurements of fistula output
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20.
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factors that will cause a fistula to remain patent
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F - foreign body in the woundR - radiation damage to the areaI - infection or IBDE - epithelialization of the fistulous tractN - neoplasmD - distal bowel obstruction
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21.
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very high fever in the immediate post-op period:likely dxhow to dxtx
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infection w/ gas-forming organism such as C. perfringensPE and examination of the wound w/ culture; gram (+), spore forming rodsdebridement; PCN G; hyperbaric O2 therapy to stop infxn and inhibit growth of heat-activated spores; tetanus immunization
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22.
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likely causes of post-op hemoptysis
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malignancy (more likely if the hemoptysis was present prior to sx), bronchitis, pneumonia, TB, pulmonary infarct secondary to PE
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23.
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evaluation of pt w/ SOB and yellow sputum in the post-op period (assume smoker)
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lung examination for signs of atelectasis or pneumoniaCXRABGsputum for gram stain and culture
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