Category Archives: General Surgery

General Surgery: Week 3

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Worked up patients affected by:
Upper GI Bleed
Cholecystitis
Small bowel obstruction
Post-operative nausea & vomiting

Nursing in service to 3rd year nursing students from Douglas College
Topic: Analgesics for acute pain

Nursing In Service: Pain Medications

Journal Club presentation
Topic: Record 1 Trial

Journal Club RECORD 1 TrialActivities performed:

General principles\ of surgical prophylaxis guidelines:

Complete antibiotic infusion prior to skin incision. Recommendations regarding administration times:
Cefazolin, metronidazole or clindamycin: begin infusion 60 min or less, prior to the initial skin incision
Vancomycin and Ciprofloxacin: 60-120 min prior to skin incision
Oral ciprofloxacin tabs must be administered 2-4 hrs prior to incision
Guidelines recommend that antimicrobials must be discontinued within 24 hrs after the end of surgery

Redosing guideline: repeat antimicrobial dose if procedure is > 4 hrs or if there is rapid blood loss and/or fluid administration that will reduce (or dilute) effective serum antimicrobial conc. during the surgery

Suggestions:
1. Speak slower
2. Try to give audience time to register information being presented
3. There were times when I sounded nervous, so I need to improve on that.
How? Practice few times before final presentation.

I have become more familiar with signs/symptoms patients present with in terms of types of intra-abdominal infections. For example right upper quadrant pain for cholecystitis, right lower quadrant pain for appendicitis. We will discuss intra-abdominal infections in more detail this coming week.

Wednesday: Academic Half-Day on Electrolyte Imbalance
Topics discussed: Potassium, magnesium and phosphate imbalances. This is one topic I was not comfortable with in terms of treatment and have always wanted to learn it since we were introduced to it in second year pharmacy. Pharmacists are consulted about dose on a everyday basis. Therefore, it was great that we got to work on cases in groups and apply the knowledge acquired. I need to read it in more detail and practice it few times, until it becomes second nature to me.

General Surgery so far….

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Goals for the rotation:

1. Be familiar with peri-operative medication use
2. Become familiar with peri-operative use of anticoagulants
3. Understand the roles of other health care professionals (PT,OT, dietician)
4. Perform pharmacokinetic interpretation of drug levels in the care of at least 3 patients
5. If feasible, become familiar with TPN: calculations, indications and long-term complications

Topics discussed so far:
Peri-operative antibiotic use
Types of anticoagulants and anti-platelet agents
Peri-operative medication use
Digestive System Anatomy
Post-Op Nausea and Vomiting
GI Bleed
Surgical Prophylaxis Guidelines
Small bowel obstruction
Pre-Procedure Crossover Therapy

Attended class delivered by nurse, OT and PT to patients going for knee replacement in 2 weeks

Worked up patients on:

1. Knee replacement
2. Hip replacement
3. Infected knee prosthesis
4. Infected hip prosthesis