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SURGERY > APPRAOCH TO SURGICAL PATIENT > Flashcards

APPRAOCH TO SURGICAL PATIENT Flashcards

1
Q

What is the purpose of a preoperative evaluation?

A

To determine the patients who are at higher risk of complications associated with the procedure and interventions

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2
Q

What are the goals of pre-op evaluation?

A

Help to determine the risk factors for surgery
Ensure patients understand the procedure/questions
Discuss possible complications

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3
Q

What’s the average time for complete gastric emptying?

A

90minutes

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4
Q

What are 10 components of the past medical history that are essential to evaluate during the pre-op?

A 
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
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5
Q

What are some examples of functional capacity questions?

A

Can you do your ADLs?

Can you walk up a flight of stairs?

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6
Q

What should we ask our diabetic pre-op patient?

A

What do your sugars normally run? What was your last A1c level?

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7
Q

What components of the PE should you perform preoperatively?

A

Lungs (thorough)
Cardiac (including carotid, abdominal, femoral, and distal arteries)
Vascular
ECG

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8
Q

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?

A

Risk of operative/post-op complications

*Must eval, document, and discuss with the surgical team! = AKA ‘cleared’ for surgery

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9
Q

What are some risk factors for pulmonary complications?

A

Chronic lungs disease (asthma, COPD, TB)
Smoking
Sleep apnea
Obesity, CHF, age

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10
Q

Smokers with a ____ pack year history have an increased risk of op/post-op complications

A

20

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11
Q

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.

A

2 and 6

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12
Q

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?

A

Abx prophylactically!

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13
Q

We should always ask about ____ with regards to family history.

A

Bleeding disorders

*Along with any prior bleeding problems (with surgery), recurrent epistaxis, gum bleeding, or heavy menses.

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14
Q

If you are concerned your patient has a bleeding disorder – what should you order?

A

CBC, Platelet, PT, PTT, INR

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15
Q

What do we utilize to evaluate patient perioperative risk level for anesthesiology?

A

ASA Classification System

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16
Q

If a patient has no limitations with a well-controlled disease of one body system – what ASA category?

A

2

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17
Q

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?

A

4

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18
Q

If the patient is moribund and is not expected to survive 24 hours with or without operation – what ASA category?

A

5

19
Q

Beta-blockers are debatable if they are necessary in a pre-op patient with known heart disease – what patients would possibly need them

A

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

20
Q

In your pre-op patient, you hear a holosystolic, late systolic, or grade 3+ midsystolic murmur – what should you do?

A

Echo!

21
Q

The murmur of aortic stenosis sounds like? Where do you listen?

A

Harsh mid-systolic ejection murmur

Right 2nd intercostal space, with radiation to the neck

22
Q

What is the progression of symptoms for aortic stenosis?

A

ASC

Angina, Syncope, and Congestive heart failure

23
Q

What would see on EKG with aortic stenosis?

A

LV hypertrophy

ST depression and T wave inversion

24
Q

COPD increases the risk of what?

A

atelectasis, respiratory failure, COPD

25
Q

Does mild to moderate asthma increase the risk of perioperative pulmonary risk?

A

Nope

26
Q

If we have a COPD patient going into surgery, how would we treat them?

A 
Scheduled nebulizers (albuterol and ipratroprium)
	Need to discuss steroids with the surgical team
	Use their incentive spirometry
27
Q

What social history question should we always ask our pre-op patient?

A

Alcohol use (consider CAGE questionnaire)

28
Q

If you do not detect alcoholism in your patient what are they at increased risk for post-op?

A

AWS that can further develop into DT’s (potentially life threatening)

29
Q

If we identify a patient at risk of AWS – how would you treat them prophylactically?

A

Benzo’s

30
Q

If a patient has pain associated with irritation of the viscera secondary to cholecystitis and gallstones – what is the pain known as?

A

Biliary Colic

31
Q

What diagnostic imaging might we use to see gallstones?

A

Plain XR

32
Q

When do we use an ERCP?

A

To Dx/Tx Choledocholithiasis

33
Q

How do you document the location of a peri-anal abscess?

A

Ant/Posterior

34
Q

If a peri-anal abscess is associated with signs of sepsis or an extensive abscess – how would we treat it?

A

In the operating room

35
Q

If we are concerned about pancreatitis what should the INITIAL treatment involve?

A

NPO, aggressive IV fluids, and pain control

36
Q

What are more advanced signs of pancreatitis?

A

Hemodynamic instability, tachycardia, hypotension, peritonitis, respiratory depression

37
Q

What are the most common causes of pancreatitis?

A

Alcohol, smoking, and gallstones

38
Q

IF we see Turner or Cullen’s what should we be sure to ask about, in order to R/O?

A

Was there any blunt trauma?

39
Q

If a burn blisters, is painful, and blanches – what type is it?

A

Second degree

40
Q

If a patient is going into surgery, what type of needle should we put in their IV?

A

18G

41
Q

What type of topical agent can you use in children prior to giving an IV?

A

Emla (topical agent)

42
Q

What must we ALWAYS get from a patient prior to performing the surgery?

A

INFORMED CONSENT!

43
Q

How many witnesses must you have sign the consent form?

A

2

SURGERY (6 decks)

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