INSTRUCTIONS Postoperative pulmonary complications: Reducing risks for noncardiac surgery
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Postoperative pulmonary complications: Reducing risks for noncardiac surgery
General Purpose: To present evidence-based guidelines for prevention of PPCs in patients undergoing noncardiac surgery. Learning Objectives: After reading the article and taking this test, the reader should be able to: 1. Describe PPCs and their risk stratification methods. 2. Identify evidence-based strategies to prevent PPCs in noncardiac surgical patients.
- What percentage of postoperative mortality is related to PPCs?
- Both pneumonia and acute respiratory failure can be directly attributed to
- postoperative hypoxemia.
- mechanical ventilation.
- general anesthesia.
- Postsurgical reduction in FVC persists for up to
- 1 week.
- 10 days.
- 2 weeks.
- 1 month.
- The most important risk factor for PPCs is related to
- type of anesthesia.
- surgical site.
- duration of surgery.
- elective versus emergency procedure.
- What is the CPRI score for a 72-year-old who had a myocardial infarction 4 months ago and smoked until 6 weeks ago?
- Arozullah and colleagues found the greatest risk for postoperative respiratory failure was associated with
- abdominal aortic aneurysm repair.
- thoracic surgery.
- neck surgery.
- According to Fisher and colleagues, which variable was significantly associated with PPCs after noncardiac surgery in more than one study?
- patient age
- preoperative respiratory infection
- higher ASA class
- postoperative nasogastric tube placement
- According to the ACP's guidelines, the only lab test predictive of PPCs is
- serum albumin.
- preoperative spirometry.
- Which of the following does the ACP notconsider to be a significant risk factor for PPCs?
- age 62
- ASA class 2
- heart failure
- Which of the following does the ACP recommend to reduce PPC risk?
- incentive spirometry
- right-heart catheterization
- total parenteral nutrition
- routine preoperative antibiotic administration
- According to Lawrence and colleagues, which of the following reduced the risk of PPCs?
- epidural anesthesia
- selective use of nasogastric tubes after abdominal surgery
- laparoscopic surgical procedures
- long-acting neuromuscular blocking agents
- Patients at elevated risk for PPCs should start inspiratory muscle training
- within 24 hours after surgery.
- in the postanesthesia care unit.
- 1 day before surgery.
- 2 weeks before surgery.
- Deep-breathing exercises (3 sets of 10 breaths) should be performed
- starting 4 hours after extubation.
- 4 times per day for 7 days postoperatively.
- once per hour when awake for 4 days postoperatively.
- lying on one side.
- Which statement about incentive spirometry is accurate?
- The patient inhales and exhales through a mouthpiece into a measured chamber.
- It increases pleural pressure to promote gas exchange.
- It may prevent but not reverse postoperative atelectasis.
- It encourages at least 5 seconds of sustained lung inflation.
- Which of the following might decrease severe complications in patients who develop hypoxemia after abdominal surgery?
- inspiratory muscle training
- continuous positive airway pressure
- incentive spirometry
- administration of bronchodilators
- Levalbuterol is administered to treat
- respiratory failure.
- Preoperative pulmonary evaluation should always include
- a review of current pulmonary medications.
- pulmonary function testing.
- a chest X-ray.
- spirometry testing.
- Which of the following statements about PPCs is true?
- PPCs are less prevalent than cardiac complications.
- Patients at high risk for PPCs should start lung expansion interventions immediately after surgery.
- The likelihood of PPCs is best predicted using PPC risk indexes alone.
- A multifactorial approach is needed to prevent PPCs.