APPRAOCH TO SURGICAL PATIENT Flashcards
What is the purpose of a preoperative evaluation?
To determine the patients who are at higher risk of complications associated with the procedure and interventions
What are the goals of pre-op evaluation?
Help to determine the risk factors for surgery
Ensure patients understand the procedure/questions
Discuss possible complications
What’s the average time for complete gastric emptying?
90minutes
What are 10 components of the past medical history that are essential to evaluate during the pre-op?
Age (older than 70) Previous MI (within 6 months) or any abnormal ECG Diabetes Angina pectoris CHF Arrhythmias Valvular heart disease CVA Low functional capacity Uncontrolled HTN
What are some examples of functional capacity questions?
Can you do your ADLs?
Can you walk up a flight of stairs?
What should we ask our diabetic pre-op patient?
What do your sugars normally run? What was your last A1c level?
What components of the PE should you perform preoperatively?
Lungs (thorough)
Cardiac (including carotid, abdominal, femoral, and distal arteries)
Vascular
ECG
IF a patient had a recent MI, PCI, severe angina, history of congestive HF, valvular disease, DM, renal insufficiency, or CVA risk – would put the patient at what risk?
Risk of operative/post-op complications
*Must eval, document, and discuss with the surgical team! = AKA ‘cleared’ for surgery
What are some risk factors for pulmonary complications?
Chronic lungs disease (asthma, COPD, TB)
Smoking
Sleep apnea
Obesity, CHF, age
Smokers with a ____ pack year history have an increased risk of op/post-op complications
20
Patients that stop smoking ___ months prior to surgery reduce their risks significantly. Patients that stop smoking ___ months prior to surgery had rates of complications similar to non-smokers.
2 and 6
Patients with a history of valvular heart disease, structural congenital heart defects, prosthetic valves, hypertrophic cardio myopathy, Hx of infectious endocarditis, and those with a heart transplant – should all receive what?
Abx prophylactically!
We should always ask about ____ with regards to family history.
Bleeding disorders
*Along with any prior bleeding problems (with surgery), recurrent epistaxis, gum bleeding, or heavy menses.
If you are concerned your patient has a bleeding disorder – what should you order?
CBC, Platelet, PT, PTT, INR
What do we utilize to evaluate patient perioperative risk level for anesthesiology?
ASA Classification System
If a patient has no limitations with a well-controlled disease of one body system – what ASA category?
2
If a patient has at least one severe disease that is poorly controlled or at end stage; possible risk of death; unstable angina; and symptomatic COPD/CHF – what ASA category?
4
If the patient is moribund and is not expected to survive 24 hours with or without operation – what ASA category?
5
Beta-blockers are debatable if they are necessary in a pre-op patient with known heart disease – what patients would possibly need them
If they’re already on a beta-blocker, stay on a BB
CAD, angioplasty, coronary artery bypass, use of nitrates for chest pain, TIA, Cr 2+, DM
In your pre-op patient, you hear a holosystolic, late systolic, or grade 3+ midsystolic murmur – what should you do?
Echo!
The murmur of aortic stenosis sounds like? Where do you listen?
Harsh mid-systolic ejection murmur
Right 2nd intercostal space, with radiation to the neck
What is the progression of symptoms for aortic stenosis?
ASC
Angina, Syncope, and Congestive heart failure
What would see on EKG with aortic stenosis?
LV hypertrophy
ST depression and T wave inversion
COPD increases the risk of what?
atelectasis, respiratory failure, COPD
