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Chapter 4. Postoperative Care

A 65-year-old woman undergoes a thyroid lobectomy for a follicular neoplasm. She has a history of coronary artery disease, hypertension, insulin-dependent diabetes, and stroke. The procedure lasted 2 hours, during which the patient required occasional neosynephrine for brief intraoperative hypotension. Two hours after the procedure, the nurse called from the post anesthesia care unit to report that the patient is agitated and hypertensive. Which of the following is not likely to be the cause for her agitation?

A. Hypoxia.

B. Stroke.

C. “Unmasking” of cognitive dysfunction.

D. Hyperglycemia.

E. Hypocalcemia.

The correct answer is E. Hypocalcemia

A 43-year-old man with a distant history of intravenous drug use is now status post right inguinal hernia repair and is complaining of severe groin pain on the side of the operation. All of the following are appropriate actions except:

A. Evaluate the patient for necrotizing fasciitis.

B. Reassure the patient that his use of preoperative Suboxone that morning may have blocked his postoperative response to narcotics.

C. Allow the nurse to administer a postoperative parenteral nonopioid analgesic.

D. Discharge the patient with a prescription for pain medication and a plan for follow-up in 2 weeks.

E. Perform a nerve block with local anesthetics.

The correct answer is D. Discharge the patient with a prescription for pain medication and a plan for follow-up in 2 weeks

A 56-year-old woman is being prepared for an elective ventral hernia repair in the preoperative care unit. She is overweight, with a history of non–insulin-dependent diabetes, hypertension, and smoking. Her fingerstick glucose is 326, and you note that her most recent HgA1c was 8.4%. She wants to proceed with the operation, and has traveled a long distance to see you and has taken the day off from work. The most appropriate choice of management is to:

A. Proceed with the operation and plan for an intraoperative insulin drip.

B. Repeat the fingerstick after insulin administration and proceed with the operation if the glucose is improved, with the plan for consultation of the diabetes team postoperatively for management.

C. Cancel the operation with the plan for improved preoperative preparation.

D. Admit the patient for preoperative glucose management and reschedule ...

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