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Chapter 4. Postoperative Care

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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 Neo-Synephrine for brief interoperative hypotension. Two hours after the procedure, the nurse calls from the PACU to report that the patient is agitated and hypertensive. Which of the following is unlikely to be the cause for her agitation?

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A. Hypoxia

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B. Stroke

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C. “Unmasking” of cognitive dysfunction

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D. Hyperglycemia

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E. Hypocalcemia

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E. Hypocalcemia

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

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A. Evaluate the patient for necrotizing fasciitis

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

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

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

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E. Perform a nerve block with local anesthetics

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

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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 is 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

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

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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

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

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D. Admit the patient for preoperative glucose management and reschedule the operation for several days from now

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C. ...

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