5.preoperative assessment Flashcards
preoperative period
starts from the time the patient is admitted to the hospital
to time the surgey begins
how ?
1.history
2.physical exam
3.investigation
when?
- out patient visit
- emergency room
- pre operative ward round
what to do?
6 steps
1.explain to patient
2.identification of operative mortality and post-operative morbidity
3.assess the fitness of patient
4.identify risk of potential postoperative complications + prophylaxis
5.planning of operation
6.pre-operative orders
step 1 - explain to patient
1.nature of surgery
2. implication of surgery
3. alleate fear
4. give prognosis
step 2 - operative mortality and postoperative morbidity
- assess risk factors
e.g MI, pregnancy, allergies
step 3- assess fitness of patient
by assessing
1. general condition
2. metabolic state
3. cvs
4. respiratory system
4. renal system
how to assess the general condition of patients
by careful clinical examination
1.pulse rate
2.bp
3.full blood count
4.serum urea and electrolytes
5.blood group
how to assess the metabolic state
weight and height
—because obesity is a risk factor for wound infections, venipuncturs, thromboembolism
how to assess the CVS
ecg and echocardiogramm
- Hypertension - increased risk of MI
- MI - avoid techniques which increase the HR
- hypovolemia - fluid restoration before operation
how to assess the respiratory system
1.clinical examination of chest
2.CXR
3.blood gases
4.sputum for bacteriological examination
5.pulmonary functional test
-cold - cancel operation
-asthma - risk for postoperative respiratory failure
how to assess the renal system
1.clinical examination
2.urinanalysis and microscopy
3.serum urea and creatinine
step 4 - identify risk of postoperative complications
1.pulmonary collapse /infection - pre operative breathing exercises
2.cardiac ischemia - avoid fluids postop
3.acute renal failure - due to hypovolemia,sepsis
4.venous thrombosis - avoid leg compression
5.wound infection - give prophylactic antibiotics
step 5- planning of op
1.operation should be properly named after full explanation to the patient
2.side of operation should be marked
3.consent must be taken
4.duration of hospital stay,convalescence and time off work should be indicated
step 6- pre operative orders
- nil per oral should be kept
- prophylactic medications
- prepare area for surgery
-shaving
-enema
-cleaning
ASA assessment
assess pathological changes that cause function reduction and systemic and organ capacity limitation
patients ASA grade
correlates with risk of post-operative complication
ASA grade
I - healthy patient
II - patient with mild systemic disease that does not limit acitivity
III - patient with severe systemic disease that limits acitivity
IV - patient with severe systemic disease that is constant threat to life
V - moribund (dying) patient that is not expected to survive 24hrs with or without surgery
