Student Memory Support
Topic 4: Perioperative Fluids, Nutrition, Recovery & Pain Care
4th Year MBBS · Foundation Module · High-yield revision
1. High-Yield Flashcards
Tap each question to reveal the answer.
What must be distinguished when planning perioperative intravenous fluids?
Resuscitation, routine maintenance, replacement of losses, redistribution and reassessment.
Which findings help reassess a postoperative fluid prescription?
Clinical fluid status, fluid balance, urine output, weight and blood electrolytes.
How do maintenance needs differ from replacement needs?
Maintenance covers ordinary daily needs; replacement addresses an existing deficit or abnormal ongoing loss.
What do hypotension, tachycardia and cool extremities suggest after surgery?
Possible impaired perfusion; assess urgently for causes such as bleeding or reduced circulating volume.
Why must potassium in intravenous fluids be reviewed when urine output falls?
Reduced kidney excretion can cause potassium to accumulate.
Which nutritional route is preferred when a patient can swallow safely and use the gut?
Oral intake, with oral nutritional support if intake is inadequate.
When does enteral feeding become useful?
When oral intake cannot meet needs but the gastrointestinal tract can be used.
When may parenteral nutrition be required?
When adequate nutrition cannot be provided through the gastrointestinal tract.
What complication is suggested by coughing and breathlessness during tube feeding?
Pulmonary aspiration.
Which electrolyte may fall markedly when a severely malnourished patient is fed?
Phosphate; a marked fall suggests refeeding syndrome.
Which two complications are important during parenteral nutrition?
Catheter-related infection and metabolic disturbance, including hyperglycaemia.
Which observations help detect early postoperative deterioration?
Pulse, blood pressure, respiratory rate, oxygen saturation and urine output.
What does ERAS coordinate across the surgical journey?
Preoperative preparation, intraoperative care and postoperative recovery measures.
Why assess postoperative pain during coughing or movement?
Pain at rest may seem controlled while pain during activity prevents breathing exercises and mobilisation.
What do increasing sedation and a slow respiratory rate suggest during opioid analgesia?
Possible opioid-induced respiratory depression requiring urgent assessment.
2. Mnemonics
Mnemonic Title: Intravenous fluid decisions
Mnemonic Word: 5 Rs
Meaning: Resuscitation, Routine maintenance, Replacement, Redistribution and Reassessment.
Mnemonic Title: Structured assessment of deterioration
Mnemonic Word: ABCDE
Meaning: Airway, Breathing, Circulation, Disability and Exposure: a sequence for assessing an acutely unwell postoperative patient.
3. Memory Tables
Which fluid need is being treated?
| Need | Key clue | Aim |
|---|---|---|
| Resuscitation | Poor perfusion | Restore circulation |
| Maintenance | Cannot meet daily needs orally | Provide routine requirements |
| Replacement | Vomiting, drains or stoma output | Replace measured losses |
Choosing nutritional support
| Route | When it fits | Key concern |
|---|---|---|
| Oral | Safe swallowing; adequate gut function | Insufficient intake |
| Enteral | Oral intake inadequate; gut usable | Aspiration or intolerance |
| Parenteral | Gut cannot meet nutritional needs | Catheter or metabolic complications |
4. Rapid Revision Points — Last-Minute Revision
Must Remember:
- Prescribe fluids for a defined need, then reassess the response.
- Maintenance fluid does not automatically replace abnormal losses.
- Review electrolytes when vomiting, stoma losses or reduced urine output are present.
- Nutritional risk matters before major surgery, not only after it.
- Use oral or enteral nutrition when clinically suitable and the gut can function.
- A marked phosphate fall after starting feeding suggests refeeding syndrome.
- Fresh blood loss with tachycardia and hypotension suggests postoperative haemorrhage.
- Increasing abdominal pain with fever and tachycardia after bowel surgery needs urgent assessment.
- ERAS links preparation, suitable early intake, analgesia and mobilisation.
- Effective analgesia should support breathing, coughing and movement.
5. Clinical Memory Hooks
Clinical Hook: High stoma output with dizziness → assess fluid and electrolyte losses for replacement.
Clinical Hook: Poor intake with a functioning gut → consider enteral support if oral intake remains inadequate.
Clinical Hook: Sudden postoperative breathlessness with pleuritic pain → assess urgently for pulmonary embolism.
Clinical Hook: Comfortable at rest but unable to cough because of pain → reassess functional pain control.
6. Starred High-Yield Exam Points
- ⭐ Maintenance requirements and ongoing abnormal losses are separate parts of a fluid prescription.
- ⭐ Low urine output with high serum potassium requires review of prescribed potassium.
- ⭐ A usable gastrointestinal tract favours enteral over parenteral support when oral intake is inadequate.
- ⭐ Sudden fresh drain bleeding with circulatory deterioration suggests postoperative haemorrhage.
- ⭐ ERAS includes measures before, during and after surgery.
- ⭐ Increasing sedation and slow breathing during opioid treatment suggest respiratory depression.