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Adv Phys & Hlth Ass. Spring 2024 > Exam 1/ Lecture1: Pre-Op Unit 1 > Flashcards

Exam 1/ Lecture1: Pre-Op Unit 1 Flashcards

1
Q

Lecture 1/16/23

Which system would lead to serious perioperative adverse events and account for almost the perioperative mortalities?

A

Cardiovascular system

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2
Q

Lecture 1/16/2023

What type of interventions can modify risks for cardiovascular morbidity and mortatlity?

A

Perioperative

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3
Q

Lecture 1/16/23

What are the 2 biggest cardiovascular complication that acconet for almost half the perioperative mortalities?

A

MI and ischemic event

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4
Q

Lecture 1/16/23

What is the parameters to set when monitoring a patients baseline BP?

A

20% above and below the patients baseline

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5
Q

Lecture 1/16/23

Which 2 population of individals that may present ishchemic heart disease symptoms (adominal pain or fatigue) differnently than the regular population ?

This is mostly discovered in the operating room

A

Diabetic patients and female patients

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6
Q

Lecture 1/16/23

Related to Heart Failure: What 2 types of cardiovacular disorder if discovered within a patient that we do not want to take into the OR?

A

Unstable angina and decompensating heart failure

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7
Q

Lecture 1/16/23

Instead of foucusing on EF of a pateint heart what cardiovascular disorder should we focus on

A

Valvular Heart disease

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8
Q

Lecture 1/16/23

When it comes to patients with rhythm disturbances what are the 2 things that we tend to forget?

A

atrial kick and electrolyte imbalance

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9
Q

Lecture 1/16/23

What are some of the question that a CRNA should ask regarding a patient with a coronary stent?

A

What type of stent
How long the stent been place
If they are on any anticoagulation

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10
Q

Lecture 1/16/23

What type of Anesthesia effects the respiratory function and lung physiology and mechanics

A

General Anesthesia

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11
Q

Lecture 1/16/23

What type of adverse respiratroy event can occur during anesthesia

A

Hypoxemia

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12
Q

Lecture 1/16/23

What is an example of a situration given during lecture of an adverse respiratory event?

A

Patient that would receive propfol infusion on room air

may cause periods of apnea and peri- apnea

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13
Q

Lecture 1/16/23

What are the predictors of respiratory function outcomes following anesthesia and surgery?

A

Intergrative measures

back-up plan if stop breathing, open airway with chin

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14
Q

Lecture 1/16/23

What type of pulmonary disorder that we are now starting to see more cases in adults than children?

A

Upper respiratory tract infection

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15
Q

Lecture 1/16/23

What pulmonary disorder the CRNA may not know the extent of the disorder until the patient is in the OR

A

Asthma and COPD

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16
Q

Lecture 1/16/23

True or False. Current the CRNAs are starting to see less chronic smokers

A

True

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17
Q

Lecture 1/16/2023

Which pulmonary disorder is most likely to obstruct their airway when given propfol?

A

Obstructive sleep apnea

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18
Q

Lecture 1/16/23

True or False: A CRNA may see a decrese in young people needing lung resections?

A

False

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19
Q

Lecture 1/16/23

What is the most common endocrine disorder that a CRNA encounter in pre-op?

A

Diabetes Mellitus

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20
Q

Lecture 1/16/23

What is the second most common endocrine disorder a CRNA may encounter in pre-op and what are some other things to take in consideration regarding this endocrine disorder?

A

Thyriod disorders

May cause physical difficults due to mass or change in body habitus

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21
Q

Lecture 1/16/23

What would be a concern of a CRNA regarding adminstering GA to a patient with Hypothalamic, pituitary and /or adrenal disorders?

A

A very strange feed back system
( their medication would interact with our medication ot the GA medication would interact with their disease process)

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22
Q

Lecture 1/16/23

True or False: Surgical stress and anaestheic agent tend to increase GFR

A

False

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23
Q

Lecture 1/16/23

Sedatives/ opioids might have exaggerated effects on patient with what 4 types of advance liver diseases?

A
  • Hepatitis
  • Alcohol liver disease
  • Obstructive jaundice
  • Cirrhosis

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24
Q

Lecture 1/16/23

What type of diseases or disorder have an significant impact on drug metabolism and pharmacokinetics?

A

Liver diseases / Hepatic disorder

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25
Q

Lecture 1/16/23

What are the 4 types of hematologic disorders that may be concerning to a CRNA during pre-op?

A
  • Anemia
  • Sickle cell disease
  • G6PD deficiency
  • Coagulopathies

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26
Q

Lecture 1/16/23

What are the neurologic diseases that may be concerning to a CRNA during pre-op?

There are 7 neurologic disease listed in the lecture

A
  • Cerebrovascular disease
  • Seizure disorders
  • Multiple sclerosis
  • Aneurysm and AV malformation
  • Parkinson disease
  • Neuromuscular junction disorders
  • Muscular dystrophy and myopathy

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27
Q

Lecture 1/16/23

What are the musculoskeletal and connective tissue disorders that may be concerning to a CRNA during pre-op?

A
  • Rheumatoid Arthritis
  • Ankylosing Spondylitis
  • Systemic Lupus Erythematosus
  • Raynaud Phenomenon

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28
Q

Lecture 1/16/23

What are the miscellaneous conditions that may be concerning to a CRNA during pre-op?

4 conditions

A
  • Morbidly obese patient
  • Patient with transplanted organs
  • Patient with allergies
  • Patient with substance abuse

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29
Q

Lecture 1/16/23

What are specific group of patients that may be concerning to a CRNA during pre-op?

A

Children
Pregnant patient
Breast feeding patient
Elderly patient

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30
Q

Lecture 1/16/23

What type of document inform the patient about the risk and alternatives to treatment, procedures, and consequences?

A

Informed consent

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31
Q

Lecture 1/16/23

What is the court case that helped to establish the practice ofinform consentin the practice of modernmedicine?

A

Salgo v. Leland Stanford Jr. University Board of Trustees

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32
Q

Lecture 1/16/23

What are some beneifits from share decision making for the patient?

A

Communicating with pts about the risks and benefits of possible interventions
Eliciting pts’ goals, values, and concerns
Assisting pts in how to conceptualize the risks and benefits/how to approach the decision

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33
Q

Lecture 1/16/23

What type of do-not-resuscitate order in theperioperative period that may refuse certain/specific resuscitation procedures, anesthesia should inform pt/surrogate about which procedures are essential and not essential for the success of the anesthetic and proposed surgery ?

A

Limited attempt at resuscitation defined with regard to specific procedures

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34
Q

Lecture 1/16/23

What type of do-not-resuscitate order in theperioperative period allows the anesthesia and surgical teams to use clinical judgment in determining appropriate resuscitation procedures?

A

Limited attempt at resuscitation defined with regard to the pt’s goals and values

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35
Q

Lecture 1/16/23

What is an example of the high (> 5%) surgical risk of procedures?

A

Aortic and major vascular
Peripheral Vascular

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36
Q

Lecture 1/16/23

What is an example of the Intermediate (1% - 5%) surgical risk of procedures?

A

Intraabdominal surgery
Intrathoractic surgery
Carotid endarterectomy
Head/neck surgery

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37
Q

Lecture 1/16/23

What is the amount of points that is assigned to components of revised cardiac risk index?

A

1

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38
Q

Lecture 1/16/23

What is the risk major cardiac events percentage with a revised cardiac risk index score of 0?

A

Risk of Major Cardiac Events 0.4%

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39
Q

Lecture 1/16/23

What is the risk major cardiac events percentage with a revised cardiac risk index score of 1?

A

Risk of Major Cardiac Events 1.0%

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40
Q

Lecture 1/16/23

What is the risk major cardiac events percentage with a revised cardiac risk index score of 2?

A

Risk of Major Cardiac Events 2.4%

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41
Q

Lecture 1/16/23

What is the risk major cardiac events percentage with a revised cardiac risk index score of >/ = 3?

A

Risk of Major Cardiac Events 5.4%

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42
Q

Lecture 1/16/23

What is an assessment of cardiopulmonary fitness that
estimates pt risk for major post-op morbidity or mortality to determine if further testing is necessary?

A

Functional Capacity

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43
Q

Lecture 1/16/23

What tool is use to measure functional capacity?

A

Measured in METs (metabolic equivalent of task)
Rate of energy consumption at rest
1 MET = 3.5 mL/kg/min
>4 METs

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44
Q

Lecture 1/16/23

What is the equivalent level of exercise with a MET of 1?

A

Eating, working at computer, or dressing

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45
Q

Lecture 1/16/23

What is the equivalent level of exercise with a MET of 12?

A

Running rapidly for moderate to long distances

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46
Q

Lecture 1/16/23

What MET level is ok for surgery?

A

3 to 4 METs

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47
Q

Lecture 1/16/23

What type of urgency of surgery involves life or limb that would be threatened if surgery did not proceed within 6 hours or less?

A

Emergency

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48
Q

Lecture 1/16/23

What type of urgency of surgery involves life or limb that would be threatened if surgery did not proceed within 6 to 24 hour?

A

Urgent

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49
Q

Lecture 1/16/23

What type of urgency of surgery involves delays exceeding 1 to 6 weeks would adversely affect patient ouctomes?

A

Time-sensitive

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50
Q

Lecture 1/16/23

What are the 6 steps of the preoperative cardiac risk assessment algorithmACC/AHA guidelines?

A

Step 1: Emergerncy Surgery
Step 2: Active Cardiac Conditions
Step 3: Estimate risk of perioperative death or MI
Step 4: Assess function capacity
Step 5: Assess whether further testing will iimpact care
Step 6: Proceed to surgery or consider alternative strategies

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51
Q

Lecture 1/16/23

Who described ‘six degree’ ASA PS grading of a patient’s physical state as just one of the components of the operative risk?

A

Meyer Saklad et al- 1941

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52
Q

Lecture 1/16/23

What are 4 components that Meyer Saklad et al- 1941 discuss that may be an operative risk as well?

A
  1. The planned surgical procedure
  2. The ability and skill of the surgeon in the particular
    procedure contemplated
  3. The attention to postoperative care
  4. The past experience of the anesthetist in similar
    circumstances

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53
Q

Lecture 1/16/23

What population of patients needs:
* to inform of surgical risk and identify targets for pre-op optimization
* Goal is to identify modifiable risk factors to optimize surgical outcomes
* Malnutrition, poor physical function, anxiety, and social isolation
* Functional and cognitive impairment = poor post-op outcomes
* Function decline is associated with morbidity, mortality, and loss of function after surgery
* Assess ADLs, history of falls
* Cognitive impairment = delirium, complications, functional decline, and death post-op
* Mild cognitive impairment can critically impact decision-making capacity

A

Elderly and frailty

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54
Q

Lecture 1/16/23

What population of patients as:
* Poor nutritional status = infectious complications, wound complications, and increased length of stay
* Ex: surgical site infections, pneumonia, UTIs, dehiscence, anastomotic leaks
* Associated with adverse health outcomes post medical and surgical interventions and decreased life expectancy
* Underdiagnosed - anxiety, depression, substance abuse, and social isolation

A

Elderly and frailty

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55
Q

Lecture 1/16/23

What 3 factors can effect anesthesia that can influence various components on poor perioperative outcome?

A
  • Provider characteristics
  • Errors in Judgement
  • Mishaps

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56
Q

Lecture 1/16/23

What 3 factors can effect a patient disease that can influence various components on poor perioperative outcome?

A
  • Surgical disease
  • Age and Sex
  • Comorbidity

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57
Q

Lecture 1/16/23

What 2 factors can effect a surgery that can influence various components on poor perioperative outcome?

A
  • Errors in judgement
  • Location of postoperative care

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58
Q

Lecture 1/16/23

What are some examples of poor perioperative outcomes that was influence by various compents?

A
  • Death
  • Major morbidity
  • Minor morbidity
  • Readamission
  • Satifaction

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59
Q

Lecture 1/16/23

How many ASA Physical Status (PS) are there?

A

6

Lecture

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60
Q

Which ASA -PS will always have a E (emeregency) mark with it when identifying risk factors?

A

ASA 5
ASA 6

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61
Q

Lecture 1/16/23

What is the definition of ASA 1 and example?

A

Definition: A normal healthy patient
Example: Healthy, nonsmoker , no alcohol

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62
Q

Lecture 1/16/23

What is the definition of ASA 2 and example?

A

Definition: A patient with mild systemtic disease
Example: pregenacy, Obesity, smoker, drinker, HTN/DM

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63
Q

Lecture 1/16/23

What is the definition of ASA 3 and example?

A

Definition: A patient with serve systemic disease
Example: Poorly controlled DM or HTN COPD, (> 3 months) MI, CVA , TIA CAD/ stent

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64
Q

Lecture 1/16/23

What is the definition of ASA 4 and example?

A

Definition: A patient with severe systemic disease that is a contstant threat to life
Example: (< 3 months) of MI, CVA, or CAD/sents, ongoing cardiac

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65
Q

Lecture 1/16/23

What is the definition of ASA 5 and example?

A

Definition: A moribund patient who is not expected to survive without the operation
Example: ruptureed abdominal/ thoractic aneurysm

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66
Q

Lecture 1/16/23

What is the definition of ASA 6?

A

Definition: A delcared brain - dead patient whose organs are being removed for donor purposes

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67
Q

Lecture 1/16/23

What are the 10 laboratory studies that can be done pre-op?

A
  • CBC/ Hemoglobin/ Hematocrit
  • Renal Function testing
  • Electrolytes
  • liver Funtion testing
  • Coagulation testing
  • Serum Glucose and Glycates Hemoglobin (HbA1c)
  • Urianalysis
  • Pregnancy Test
  • ECG
  • Chest X-ray

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68
Q

Lecure 1/16/23

What type of laboratory study would be order during pre -op:
* Surgery, potential blood loss, individualized pt clinical indications
* Hx of increased bleeding, hematologic disorders, anti-coagulant therapy, poor nutritional status
* ASA-PS 3 or 4 undergoing intermediate-risk procedures
* All pts undergoing major procedures

A

CBC/Hemoglobin/Hematocrit

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69
Q

Lecture 1/16/23

What type of laboratory study would be order during pre -op:
* DM, HTN, cardiac disease, dehydration (N/V, diarrhea), renal disease, fluid overload
* ASA-PS 3 or 4 undergoing intermediate-risk procedures
* ASA-PS 2, 3, or 4 undergoing major procedures

A

Renal Function Testing

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70
Q

Lecture 1/16/23

What type of laboratory study would be order during pre -op:
* Suspected undiagnosed or worsening condition that will affect peri-op management
* Renal or hepatic disease, malnutrition, malabsorption, ETOH abuse, HF, arrhythmias, medications that may cause an imbalance

A

Electrolytes

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71
Q

Lecture 1/16/23

What type of laboratory study would be order during pre -op:
* Liver injury and physical exam findings
* Hepatitis, jaundice, cirrhosis, portal HTN, biliary disease, gallbladder disease, bleeding disorders

A

Liver Function Testing

Slide 37

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72
Q

Lecture 1/16/23

What type of laboratory study would be order during pre -op:
* Known or suspected coagulopathy identified on pre-op evaluation
* Known bleeding disorder, hepatic disease, and anticoagulant use
* ASA-PS 3 or 4; undergoing intermediate, major, or complex surgical procedures; known to take anticoagulant medications or chronic liver disease

A

Coagulation Testing

Slide 38

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73
Q

Lecture 1/16/23

What type of laboratory study would be order during pre -op:
* Known DM (or family history), obesity (BMI > 50), cerebrovascular or intracranial disease, or steroids history
* HbA1c long-term measurement of glucose control (3 months)
* Better assessment of diabetic therapy > random/fasting blood sugar
* HbA1c = ½ from previous 30 days + ½ the time period of 2 to 3 months before
* All diabetic patients

A

Serum Glucose and Glycated Hemoglobin (HbA1c)

Lecture 1/16/23

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74
Q

Lecture 1/16/23

What type of laboratory study would be order during pre -op:
* Suspected UTI and unexplained fever or chills
* instilling hardware

A

Urinalysis

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75
Q

Lecture 1/16/23

What type of laboratory study would be order during pre -op:
* Sexual activity, birth control use, and date of last menstrual period
* Recommendation… all women of childbearing potential of the possibility of pregnancy and women possibly pregnant made aware of the risks of anesthesia/surgery to the fetus

A

Pregnancy Test

Slide 39

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76
Q

Lecture 1/16/23

What type of laboratory study would be order during pre -op:
* Ischemic heart disease, HTN, DM, HF, chest pain, palpitations, abnormal valvular murmurs, dyspnea on exertion, syncope, arrythmia
* Known IHD, significant arrhythmia, PAD, CV disease, significant structural heart disease undergoing intermediate- risk or high-risk procedures
* Routine in ASA-PS 3 or 4 undergoing intermediate- risk
* Routine ASA-PS 2, 3, or 4 major/high-risk procedures

A

ECG

Slide 40

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77
Q

Lecture 1/16/23

What type of laboratory study would be order during pre -op:
* Based on abnormalities identified during pre-op evaluation
* Advanced COPD, bullous lung disease, pulmonary edema, pneumonia, mediastinal masses, suspicious physical exam findings (rales, tracheal deviation)

A

Chest Xray

Slide 40

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78
Q

Lecture 1/16/23

What type of anesthesia:

  • Total loss of consciousness and airway control
  • ET or LMA used
  • Ex: major surgeries… total joints, open-heart surgery, bowel surgery
A

General

Slide 42

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79
Q

Lecture

What is General Anesthesia

A
  • Total loss of consciousness and airway control

Slide 42

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80
Q

Lecture 1/16/23

What type of anesthesia:

  • Level of sedation ranges… minimal (drowsy, able to talk) to deep (sleeping, may not remember surgery/procedure
  • NC or face mask
  • Ex: minor surgeries/procedures or shorter, less complex procedures… biopsy, colonoscopy
A

IV/Monitored Sedation

Slide 42

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81
Q

Lecture 1/16/23

What type of respiratory device is use during General Anesthesia

A

ET/ LMA

Slide 42

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82
Q

Lecture 1/16/23

What is an example(s) of surgeries that will be done under General Anesthesia?

A

major surgeries… total joints, open-heart surgery, bowel surgery

Slide 42

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83
Q

Lecture 1/16/23

What is an example(s) of surgeries that will be done under IV/ Monitored Anesthesia?

A

minor surgeries/procedures or shorter, less complex procedures… biopsy, colonoscopy

Slide 42

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84
Q

Lecture 1/16/23

What type of respiratory device is use during IV/ Monitored Anesthesia?

A

NC or face mask

Slide 42

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85
Q

Lecture 1/16/23

What type of Anesthesia:

Pain management method that numbs a large part of the body using a local anesthetic
Epidural or spinal
Ex: childbirth or joint replacements in elderly pts

A

Regional

Slide 43

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86
Q

Lecture 1/16/23

What are 2 examples procedures that regoinal can be use?

A

childbirth or joint replacements in elderly pts

Slide 43

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87
Q

Lecture 1/16/23

What are the 2 types of regional anesthesia?

A

Epidural or spinal

Slide 43

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88
Q

Lecture 1/16/23

What is the type of Anesthesia:

  • Pain management method, usually a one-time injection of local anesthetic that numbs a small area of the body
  • Can be used with general or conscious sedation depending on the surgery and pt history
  • Ex: skin or breast biopsy, bone/joint repair
A

Local

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89
Q

Lecture 1/16/23

What type of anesthesia can be paired with general or conscious sedation depending on the surgery?

A

Local

Slide 43

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90
Q

Lecture 1/16/23

What are 2 examples procedures that local can be use?

A

skin or breast biopsy, bone/joint repair

slide 43

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91
Q

Lecture 1/16/23

What are 4 things to take in consideration when planning for postoperative pain management?

A
  • All patients have the right to appropriate assessment and treatment of pain
  • A preoperative evaluation should include baseline pain assessment
  • Provides an important opportunity to discuss and plan for the management of acute postoperative pain
  • Specific issues include their tolerance to usual doses of opioid analgesics and the potential for acute withdrawal reactions should be assessed

Slide 44

92
Q

Lecture 1/16/23

What are the most common agents that causes anaphylaxis regarding allergies?

A

Neuromuscular blockers
Antibiotics
Chlorhexidine

Slide 45

93
Q

Lecture 1/16/23

Fill in the blanks:
When a patient describes a symptom (s) from an allergie(s) a CRNA must determine if the symptom will cause ___________ vs ____________.

A

Anaphylaxis vs adverse side effects

Slide 45

94
Q

Lecture 1/16/23

What are the 5 most common agents that can be listed as an allergies in the patient cart?

A
  1. Latex
  2. Antibotics
  3. Local Anesthetics
  4. Neuomuscular block agents
  5. Opiods

Slide 46 - 47

95
Q

Lecture 1/16/23

The describtion below is an example of an allergy to what type of agent:

  • Amide vs ester
  • Ester reactions… due to preservative - para-aminobenzoic acid (PABA)
  • Epinephrine in LA causes adverse side effects, not an allergy
A

Local anesthetics

Slide 47

96
Q

Lecture 1/16/23

The describtion below is an example of an allergy to what type of agent:

  • Quaternary ammonium compounds
  • Cross-reactivity possible with allergy to neostigmine and morphine
  • Ammonium ions
A

Neuromuscular blocking agents

Slide 47

97
Q

Lecture 1/16/23

The describtion below is an example of an allergy to what type of agent:

  • True allergy is rare… related to side-effects (ex. nausea and vomiting)
A

Opioids

Slide 47

98
Q

Lecture 1/16/23

The describtion below is an example of an allergy to what type of agent:

  • Risk factors – history of multiple surgeries, occupational exposure to latex (healthcare workers, food handlers), food allergies that cross-react (mango, kiwi, avocado, passion fruit, banana, and chestnuts)
  • Notify surgical team immediately
A

Latex

Slide 46

99
Q

Lecture 1/16/23

The describtion below is an example of an allergy to what type of agent:

  • PCN and cephalosporins most common causes of anaphylaxis
  • Small risk of cross-reactivity, usually rashes
  • Avoid in true IgE –mediated allergy
  • Vancomycin… distinguish between allergy and “red man syndrome”
  • Histamine-induced side
A

Antibiotics

Slide 46

100
Q

Lecture 1/16/23

What are the 15 categories of medications that a patient should continue taking pre-operatively?

A
  • Antihypertensive medications
  • Cardiac medications (ex. Beta-blockers, digoxin)
  • Anti-depressants, anxiolytics, and other psychiatric medications
  • Thyroid medications
  • Oral contraceptive pills
  • Eye drops
  • GERD medications
  • Opioid medications
  • Anti-convulsant medications
  • Asthma medications
  • Corticosteroids (oral and inhaled)
  • Statin medications
  • ASA
  • COX-2 inhibitor medications (celecoxib)
  • Monamine oxidase inhibitor (MAOIs) medications

Slide 48 - 49

101
Q

Lecture 1/16/23

What type of antihypertensive medications may be discontinue 24 hours before surgery?

A

angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs)

Slide 48

102
Q

Lecture 1/16/23

What anti -depressant medication should the CRNA order an ECG to assess what part of the patient heart rhythm?

A

order an ECG d/t prolonged QT interval

slide 48

103
Q

Lecture 1/16/23

A female that is taking oral contraceptive pills is at a high - risk in developing what disorder?

How soon before surgery should a female stop taking oral contraceptive pills?

A

High-risk pt for post-op venous thrombosis… d/c 4 weeks prior to sugery

Slide 48

104
Q

Lecture 1/16/23

A patient with this type of disease/ disorder should continue taking ASA until how many days prior to surgery?

A

Cont in pts w/ prior percutaneous coronary intervention, high-grade ischemic heart disease, significant cardiovascular disease

Typically, d/c 10-14 days prior to surgery

Slide 49

105
Q

Lecture 1/16/23

What medication should be discointued prior to surgery if there are concerns that the medication will effect bone healing?

A

monamine oxidase inhibitor (MAOIs) medications

Slide 49

106
Q

Lecture 1/16/23

True or False:

Adjust anesthesia plan to avoid meperidine and in-direct acting vasopressors (ephedrine)

A

True

Slide 49

107
Q

Lecture 1/16/23

How soon pre-operatively should the medcations be disconinue:

  • Clopidogrel, ticagrelor
  • Prasugrel
  • Ticlopidine
A
  • Clopidogrel, ticagrelor… d/c 5-7 days
  • Prasugrel… d/c 7-10 days
  • Ticlopidine… d/c 10 days

Slide 50

108
Q

Lecture 1/16/23

True or False:
Do not d/c a P2Y 12 inhibitor drug-eluting stents until 6 months of dual antiplatelet therapy is completed

A

True

Slide 50

109
Q

Lecture 1/16/23

True or False:
Discontinue P2Y 12 inhibitors and wrfarin in pt for cataract symptoms w/ topical or general anesthesia

A

False

Slide 50 -51

110
Q

Lecture 1/16/23

How soon pre-operatively should the medcations be disconinue:

  • Topical medications
  • Diuretics
  • Sildenafil
A
  • Topical medications… d/c day of surgery
  • Diuretics… d/c day of surgery
  • Sildenafil… d/c 24 hours before surgery

Slide 50

111
Q

Lecture 1/16/23

Which class of diurectics should not be discontinue pre-operative

A

Thiazide

Slide 50

112
Q

Lecture 1/16/23

How soon pre-operatively should the medcations be disconinue:

  • NSAIDs
  • Warfarin
  • Post-menopausal HRT
  • Non-insulin anti-diabetic medications
  • SGLT2 inhibitors
A
  • NSAIDs… d/c 48 hours before surgery
  • Warfarin… d/c 5 days before surgery
  • Post-menopausal HRT… d/c 4 weeks prior to surgery
  • Non-insulin anti-diabetic medications… d/c on day of surgery
  • SGLT2 inhibitors… d/c 24 hours before surgery

Slide 51

113
Q

Lecture 1/16/23

How soon pre-operatively should short -acting (regular) insulin be disconinue:

A

day of surgery

Slide 52

114
Q

Leecture 1/16/23

True or False:
If the patient as an inulin pump, continue at basal rate

A

True

Slide 52

115
Q

Lecture 1/16/23

What type and how much insulin should a type 1 DM take pre- operatively?

A

Take a small amount (approx 1/3) of usual dose of morning long-acting insulin on day of surgery

Slide 52

116
Q

Lecture 1/16/23

What type and how much insulin should a type 2 DM take pre- operatively?

A

Take none or up to half of long-acting or combination insulin dose on day of surgery

Slide 52

117
Q

Lecture 1/16/23

What are 5 things to take in consideration when managing steroids and HPA suppression pre - operatively?

A
  • Cortisol is produced by the adrenal gland
  • Hydrocortisone is an equally potent synthetic version
  • Exogenous glucocorticoids suppress cortisol secretion at HPA axis
  • May lead to adrenal insufficiency and adrenal atrophy (Adrenal recovery occurs gradually after steroid therapy is tapered and d/c’d)
  • May blunt the normal cortisol hypersecretion associated with surgery

Slide 53

118
Q

Lecture 1/11/24

What are the 3 main goals of a pre -operative evaluation

A
  • Ensure patients can safely tolerate anesthesia for surgery
  • Mitigate perioperative risks
  • Clinical examination = history and physical examination

Slide 2

119
Q

Lecture 1/11/24

What are 5 examples that can cause a surgery to be delayed

A
  • optimize concerns discused
  • refer to othe specialists
  • refer for specialized testing
  • initiate interventions intneded to decrease perioperative risk
  • identify previously recongnized comorbid condition

Slide 2

120
Q

Lecture 1/11/24

What are 5 ways that a patient benefits from a pre- op evaulation

A
  • Reduces anxiety
  • Provides education
  • Discusses medications
  • Reduces post-op morbidity
  • Answers questions

Slide 4

121
Q

Lecture 1/10/24

What are 4 watys that an anestheris provider benefits from at pre -op evaluation?

A
  • Learn of medical conditions
  • Devise an anesthetic plan intra-op and post -op
  • Time for consultants
  • DNR

Slide 4

122
Q

Lecture 1/11/24

What are 3 ways that a suregeon/ Hospital benefit frm pre-op evaluation?

A
  • Decreases cost of peri-operative care
  • Improves efficiency
  • Decreases cancellations/delays

Slide 4

123
Q

Lecture 1/11/24

What are 9 health care components that will need to be address during pre-op?

A
  • Underlying condition requiring surgery
  • Known medical problems/past medical issues
  • Previous surgeries/anesthetic history
  • Anesthetic-related complications
  • Review of systems
  • Medications
  • Allergies
  • Tobacco/ETOH/Illicit drug use
  • Functional capacity

Slide 5

124
Q

Lecture 1/11/24

What are 2 main concerns from previous surgeries/ anesthetic history regarding side effects of anesthesia?

A
  • malignant hyperthermia
  • Pseudocholinesterase deficiency

Slide 5

125
Q

Lecture 1/11/24

If a certain medication was not taken by the patient pre -opertively what would be concerning to the CRNA?

A
  • Repercussion of not taking the medication

Slide 5

126
Q

Lecture 1/11/24

True or False: Pain medication can be given to a patient pre-opertively to manage their pain.

A

True

Slide 5

127
Q

Lecture 1/11/24

What is functional capacity in correlation to anesthesia?

A

What are you able to do

Slide 5

128
Q

Lecture 1/11/24

What tool is use to classify risk for anesthesia

A

ASA 1-5 (E)

Slide 6

129
Q

Lecture 1/11/24

What are the formulas for calculating the BMI in metric and imperial?

130
Q

Lecture 1/11/24

Base on the body mas index ranges what is the weight status of the patients?
* BMI < 18.5
* BMI 18.5 -24.9
* BMI 25.0 - 29.9
* BMI 30 and above

A
  • BMI < 18.5 = Underweight
  • BMI 18.5 -24.9 = Normal
  • BMI 25.0 - 29.9 = Overweight
  • BMI 30 and above = Obese

Slide 7

131
Q

Lecture 1/11/24

Who develop the BMI?

A

insurance companies

Slide 7

132
Q

Lecture 1/11/24

BMI do not take in account of what type of mass of a patient?

A

Muscle mass

Slide 7

133
Q

Lecture 1/11/24

What are 4 elements that a CRNA should focous on regarding physical examinatin of neruo

A
  • Establish a baseline neuro exam based upon surgery or procedure
  • Seizures
  • CVA
  • TIA

Slide 8

134
Q

Lecture 1/11/24

What are 4 cardiovascular diseases that a CRNA should focous on regarding physical examinatin of cardiovasular system

A
  • CAD
  • MI
  • HTN
    *CHF

Slide 8

135
Q

Lecture 1/11/24

What are 2 diseases examples that a CRNA should focous on regarding physical examinatin of the pulmonary system.

A

Asthma/ COPD

Slide 8

136
Q

Lecture 1/11/24

What are 2 “cardiovascular diseases” (hard stop) that are containdicated for anesthesia?

A

unstable angina (Chest pain)
decompensated heart failure

Slide 8

137
Q

Lecture 1/11/24

What are other items of an physical examination that a CRNA can focus on other than neuro, CV and pulmonary for pre-op ?

7 other items

A

Airway
Endocrine
Hepatobiliary disorders
Renal
Musculoskeletal disorders
Immunocompromised
Obesity

Slide 8

138
Q

Lecture 1/11/24

A CRNA would be very concern about taking a patient to surgery if they found out that a patient had this type of adrenal disorder that would affect the way the CRNA managed their BP ?

A

pheochromocytoma

Slide 8

139
Q

Lecture 1/11/24

Why would a CRNA be concern with patients that have bad liver disease?

A

due to cloting factors

Slide 8

140
Q

Lecture 1/11/24

Why would a CRNA be concern with patients that have bad kidney disease?

A

Blood pressure related to fluid status
Medication clearance

Slide 8

141
Q

Lecture 1/11/24

A patient that has this type of muscloskeletal disorders do not breath very well and my not tolerate muscle relaxants?

A

myasthenia gravis

Slide 8

142
Q

Lecture 1/11/24

What problems may a CRNA run into regarding treating pateints with immunocompromised patients?

A

Limited to what limb can be use

Slide 8

143
Q

Lecture 1/11/24

What does A.M.P.L.E stand for regarding an emerengent physical examination?

A

A = Allergies
M = Medications
P = Past medical history
L = Last meal eaten
E – Events leading up to need for surgery/procedure

Think about the things you would want or need to know!

Slide 9

144
Q

Lecture 1/11/24

What are 6 reasons why a CRNA would do an airway examination?

A
  • Mallampati classification
  • Inter-incisors gap
  • Thyromental distance
  • Forward movement of mandible
  • Range of cervical spine motion: flexion and extension
  • Document loose or chipped teeth, tracheal deviation

Slide 10

145
Q

Lecture 1/11/24

Which of the following is a common sign of COPD?

Kahot

A

Barrel Chest

Slide 1

146
Q

Lecture 1/11/24

Butterfly rashes are assoicated with what auto immune disorder?

Kahot

A

Systemic Lupus Erthematous

Slide 2

147
Q

Lecture 1/11/24

Clubbing of finger is assocciated with what 4 congenital heart defects?

Kahot

A
  • Ventricular spetal defect
  • pulmonary stenosis
  • overriding of aorta
  • right ventricular hypertrophy

Slide 3

148
Q

Lecture 1/11/24

Pill rolling Tremors are associated with what neurologic disorder?

Kahot

A

Parkinsons

Slide 4

149
Q

Lecture 1/11/24

What sign, also known as RUQ pain accompanies cholecystitis?

Kahot

A

Murphys Sign

Slide 5

150
Q

Lecture 1/11/24

What vision change accompanies glaucoma?

Kahot

A

Tunnel Vision

Slide 6

151
Q

Lecture 1/11/24

What is the other name for the chest commonly associated with myocardial infarction?

Kahot

A

Levines Sign

Slide 7

152
Q

Lecture 1/16/23

What musculoskeletal and connective tissue disorders may need for the patient to be pre warmed

A

Raynaud Phenomenon

Slide 20

153
Q

Lecture 1/16/24

What 3 substance that are abuse can be concerning to a CRNA?

A

Meth
cocaine
kratom (Stimulant)

Slide 21

154
Q

Lecture 1/16/23

True or False: A patient that does not have any HPA suppression that receive one dose of steroids should start a low dose steriods

A

False

Slide 54

155
Q

Lecture 1/16/24

True or False, A patient that is receiving > 20mg of prednisone/ day for > 3 weeks pre - operatively or has cushingoid apperance should receive steroid management.

A

True

Slide 54

156
Q

Lecture 1/16/24

During pre- op, what are the 3 things you should assess if the patient is on steroid and HPA supresion medication?

A

Duration Dose, and Potencay of all steroids taken during the past year

Slide 54

157
Q

Lecture 1/16/24

What are 2 things to take into consideration when adminstering a stress dose?

A
  • Physiologic replacement doses are required
  • Dosage varies based on surgical procedures

Slide 54

158
Q

Lecture 1/16/24

What is the go -to amount (mg) of hydrocortisone that a patient could receive pre-opetatively that can be repeated?

A

100mg

Slide 54

159
Q

Lecture 1/16/24

What are 5 consideration that a CRNA should be aware pre-opertatively regarding Herbals and vitmans?

A
  • Direct effects… intrinsic pharmacologic effects
  • Pharmacodynamic interactions… alters action of conventional drugs at effector site
  • Pharmacokinetic interactions… alters absorption, distribution, metabolism, and elimination of conventional drugs
  • Approximately 50% of pts take multiple herbs
  • 25% take prescription drugs

Slide 56

160
Q

Lecture 1/16/24

What is Echinacea
* Common name
* Pharmcologic Effects
* Perioperative Concerns
* How soon to discontinue before suregery

A
  • Common name = Purple coneflower root
  • Pharmcologic Effects= Activation of cell mediated immunity
  • Perioperative Concerns = Allergic reaction, decrease effectiveness of immunosppressants, potential for immunosuppresion with lng -term use
  • How soon to discontinue before suregery = no data

Slide 57

161
Q

Lecture 1/16/24

What is Ephedra
* Common name
* Pharmcologic Effects
* Perioperative Concerns
* How soon to discontinue before suregery

A
  • **Common name **= Ma huang
  • Pharmcologic Effects = increase heart rate and blood direct and indirect sypathomimetic effects
  • Perioperative Concerns = Risk of mycardial ischemia and stroke from tachycardia and hypertension, ventricular arrhymia with halothane, long-term use depletes endogenous catecholamines and may cause intraoperative hemodynamic instability, life- threating interaction with MAO inhibitors
  • How soon to discontinue before suregery= 24 hours

Slide 57

162
Q

Lecture 1/16/24

What is:** Garlic**
* Common name
* Pharmcologic Effects
* Perioperative Concerns
* How soon to discontinue before suregery

A
  • Common name = Ajo
  • Pharmcologic Effects = inhibits platelet aggeration (may be irreversible), increase fibrinolysis, Equivocal antihypertensive activity
  • Perioperative Concerns = My increase risk of bleeding, especially when combined with other medication that inhibit platelet aggregation
  • How soon to discontinue before suregery = 7 days

Slide 57

163
Q

Lecture 1/16/24

What is Ginger
* Common name
* Pharmcologic Effects
* Perioperative Concerns
* How soon to discontinue before suregery

A
  • Common name =none
  • Pharmcologic Effects = antimetic, antiplatelet aggergation
  • **Perioperative Concerns ** = may increase risk of bleeding
    * How soon to discontinue before suregery = no data

Slide 57

164
Q

Lecture 1/16/24

What is Ginkgo
* Common name
* Pharmcologic Effects
* Perioperative Concerns
* How soon to discontinue before suregery

A
  • Common name = duck - foot tree, maidenhair tree, silver apricot
  • Pharmcologic Effects = inhibits platelet- activating factor
  • Perioperative Concerns = May increase risk of bleeding, especially when combined with other medications that inhibits platelet aggregation
  • How soon to discontinue before suregery = 36 hour

Slide 57

165
Q

Lecture 1/16/24

What is Ginseng
* Common name
* Pharmcologic Effects
* Perioperative Concerns
* How soon to discontinue before suregery

A
  • Common name = American, Asian, Chinese, and Korean Ginseng
  • Pharmcologic Effects = Lowers blood glucose, inhibits platelet aggregation (may be irreversible), increase PT/PTT in animals
  • Perioperative Concerns = Hyoglycemia, may increase risk of bleeding, may decrease anticoagulant effect of warfarin
  • How soon to discontinue before suregery= 7 days

Slide 57

166
Q

Lecture 1/16/24

What is Green Tea
* Common name
* Pharmcologic Effects
* Perioperative Concerns
* How soon to discontinue before suregery

A
  • Common name = none
  • Pharmcologic Effects = *inhibits platelet aggregation inhibits thromboxane A2 formation *
  • Perioperative Concerns = May increase risk of bleeding may decrease anticoagulant effect of warfarin
  • How soon to discontinue before suregery = 7 days

Slide 57

167
Q

Lecture 1/16/24

What is** Kava**
* Common name
* Pharmcologic Effects
* Perioperative Concerns
* How soon to discontinue before suregery

A
  • Common name = Awa, intoxicating peper, kawa
  • Pharmcologic Effects = sedation , anxiolysis
  • Perioperative Concerns = may increase sedative effects of anestheics, increase in anesthetic requirements with long - term use unstudied
  • How soon to discontinue before suregery =24 h

Slide 57

168
Q

Lecture 1/16/24

What is Saw
* Common name
* Pharmcologic Effects
* Perioperative Concerns
* How soon to discontinue before suregery

A
  • Common name = palmetto ( dwarf palm, Sabal)
  • Pharmcologic Effects = inhibits 5a reductase, inhibits cyclooxygenase
  • **Perioperative Concerns ** = may increase risk of bleeding
    * How soon to discontinue before suregery =No data

Slide 57

169
Q

Lecture 1/16/24

What is **St John wort **
* Common name
* Pharmcologic Effects
* Perioperative Concerns
* How soon to discontinue before suregery

A
  • Common name = amber goat weed, hardhay, hypericum, klamath weed
  • Pharmcologic Effects = inhibits neurotranmitter reuptake, MAO inhibition unlikely
  • Perioperative Concerns = induction of cytochrome p450 enzymes; affects cyclosporine, warfarin, steroids and protease inhibitors: may affect benzodiazepines, clacium channel blockers, and many other drugs, decreased serum digoxin levels, delayed emergence
  • How soon to discontinue before suregery = 5 days

Slide 58

170
Q

Lecture 1/16/24

What is **Valerain **
* Common name
* Pharmcologic Effects
* Perioperative Concerns
* How soon to discontinue before suregery

A
  • Common name = all heal, garden heliotrope, vandal root
  • Pharmcologic Effects = sedation
  • Perioperative Concerns = may increase sedative effect of anesthetics, benzodiazepine-like acute withdrawal, may increase anesthetic requirements with long -term use
  • How soon to discontinue before suregery = data

Slide 58

171
Q

Lecture 1/16/24

What is the NPO duration in hours for full meals and give an examples?

A

8 hours
Full meals, fatty foods, enternal tube feeds

Slide 59

172
Q

Lecture 1/16/24

What is the NPO duration in hours for light meals and give and examples?

A

6 hours
toast and liquids, infant formula, nonhuman milk, coffee with milk

Slide 59

173
Q

Lecture 1/16/24

What is the NPO duration in hours for clear liquids and give an examples?

A

2 hours
water, sports drinks,carbonated beverages, coffee, tea, juice without pulp

Slide 59

174
Q

Lecture 1/16/24

What is the NPO duration in hours for breast milk?

A

4 hours

Slide 59

175
Q

Lecture 1/16/24

What is the name of the person that discovered that a person as an increase risk of aspiration if > 25 ml of residual volume is still in the stomach and pH <2.5?

the syndrome was named after him

A

Curtis Lester Mendelson

Slide 60

176
Q

Lecture 1/16/24

What are 6 ways premedication can prevent aspiration?

A
  • Decrease gastric volume and acidity
  • Non-particulate antacids (sodium citrate)… increase gastric pH
  • Histamine-2 receptor antagonists (ranitidine, cimetidine, famotidine… increase gastric pH, decrease gastric acid secretion
  • Proton pump inhibitors (omeprazole, pantoprazole)… increase gastric pH, decrease gastric acid secretion
  • Dopamine-2 antagonist (metoclopramide)… reduces gastric volume
  • how long they take to work

Slide 60

177
Q

Lecture 1/16/24

Which medication to prevent aspiration can cause anxiety to develop in patient?

given a benzo as well

A

metoclopramide

Slide 60

178
Q

Lecture 1/16/24

What are the 2 scoring systems in the adlut risk scoring system?

A

Koivuranta Risk Score System (2)
Simplified Apfel Sore (3)

Slide 61

179
Q

Lecture 1/16/24

What are the risk factors for PONV: Koivuranta Risk Score System (2) in decreasing order of significance?

A
  • female gender
  • history of PONV/motion sickness
  • nosmoking status
  • age (less than 50 years old)
  • duration of surgery

Slide 61

180
Q

Lecture 1/16/24

What are the risk factors for PONV: Simplified Apfel Sore (3) in decreasing order of significance?

A
  • Female gender
  • history of PONV/ montion sickness
  • nonsmoking status
  • Postoperative opiods

Slide 61

181
Q

Lecture 1/16/24

If a patient has 1 to 2 PONV risk factors what would be the range class of risk level and how can we prevent it from happening?

Class of risk factors : low, moderated, severe

A
  • 1 to 2 risk factors = moderate-to-severe risk
  • Prevention with 2 to 3 drugs from different classes

Slide 62

182
Q

Lecture 1/16/24

If a patient has 3 to 4 PONV risk factors what would be the class range risk level and how can we prevent it from happening?

Class of risk factors : low, moderated, severe

A
  • 3 to 4 risk factors = severe risk
  • Consider avoiding GA or use a propofol-based anesthetic
  • Minimize opioids
  • Prevention with 3 drugs from different classes

Slide 62

183
Q

Lecture 1/16/24

What is the name of this PONV medication?
* acetylcholine muscarinic antagonist
* Crosses blood-brain barrier
* TD patch can be applied night before surgery, lasts up to 72 hours
* S/E: sedation, dry mouth, blurry vision, confusion, mydriasis… can worsen narrow-angle glaucoma

A

Scopolamine

Slide 63

184
Q

1/16/24

What is the name of this PONV medication?
* GABA analogue
* Effects on PONV unclear, reduces opioid requirement
* Administered pre-induction
* S/E: visual disturbances

A

Pregabalin

Slide 63

185
Q

What is the name of this PONV medication?
* serotonin antagonist
* Administer before conclusion of surgery
* S/E: blurred vision, headache, prolong QTc

A

Ondansetron

Slide 63

186
Q

1/16/24

What is the name of this PONV medication?
* histamine H1 antagonist
* Administer small doses
* S/E: sedation, dry mouth, blurred vision, prolong QTc

A

Promethazine

slide 63

187
Q

1/16/24

What is the name of this PONV medication?
* steroid
* Administer after induction
* May modulate release of endorphins or inhibit prostaglandin synthesis
* S/E: perineal irritation/burning, increased blood sugars

A

Dexamethasone

Slide 63

188
Q

1/16/24

What are 3 things to consider while premedicating a patient to prevent pain

A
  • Baseline pain assessment
  • Develop pain management plan
  • Adjunct analgesics

Slide 64

189
Q

Lecture 1/16/24

What is the time frame you should administer antibiotics to the patient?

A

1 hour before surgical incision

Slide 65

190
Q

Lecture 1/16/24

How soon should a patients receive vancomycin or a fluoroquinolone for prophylactic antibiotic before the surgical incision?

A

antibiotics initiated within 2 hours before surgical incision

Slide 65

191
Q

Lecture 1/16/24

What is the name of this antibiotic?
Most commonly administered antibiotic for surgery
Broad-spectrum β-lactam antimicrobial agent
Most aerobic gram-positive bacteria that cause surgical site infections
Staphylococci, streptococci strains
Cross-reactivity to PCN

A

Cefazolin (cephalosporin)

Slide 66

192
Q

Lecture 1/16/24

What is the name of this antibiotic?

  • Effective against gram-positive aerobic bacteria Staphylococci, streptococci, pneumococci strains
  • Most gram-positive and gram-negative anaerobic bacteria
  • Alternative for a β-lactam allergy or a MRSA infection
  • Treats infections of the head and neck, respiratory tract, bone, soft tissue, abdomen, and pelvis
  • Recommended in hysterectomies, cesareans, appendectomies, gastroduodenal tract, biliary tract, small intestine, colon, and rectum
A

Clindamycin (lincosamide)

Slide 66

193
Q

Lecture 1/16/24

What is the name of this antibiotic?

  • Gram-positive bacteria
  • Staphylococci, streptococci strains
  • Alternative for a β-lactam allergy or MRSA infection
  • Recommended for distal ilium, colon, appendix surgical sites
A

Vancomycin (glycopeptide)

Slide 66

194
Q

Lecture 1/16/24

What is Cefazolin
* Adult dosage
* Pediatric dosage (mg/kg)
* Half-life in adults (h)
* redosing interval (h)
* infusion time, minimum

A
  • Adult dosage = 2g, 3g, if weight >= 120kg
  • **Pediatric dosage (mg/kg) **= 30
  • Half-life in adults (h) = 1.2 - 2.2
  • redosing interval (h) = 4
  • infusion time, minimum = 30 min

Slide 67

195
Q

Lecture 1/16/24

What is Clindamycin
* Adult dosage
* Pediatric dosage (mg/kg)
* Half-life in adults (h)
* redosing interval (h)
* infusion time, minimum

A
  • Adult dosage = 900 mg
  • Pediatric dosage (mg/kg) = 10
  • **Half-life in adults (h) **= 2- 4
    * redosing interval (h) = 6
    ***infusion time, minimum **= 30-60min

Slide 67

196
Q

Lecture 1/16/24

What is Vancomycin
* Adult dosage
* Pediatric dosage (mg/kg)
* Half-life in adults (h)
* redosing interval (h)
* infusion time, minimum

A
  • **Adult dosage **= 15mg
  • Pediatric dosage (mg/kg) = 15
  • Half-life in adults (h) = 4 -8
  • redosing interval (h) = NA
    *** infusion time, minimum **= 15mg/min

Slide 67

197
Q

What should be indicated ONLY if it can identify abnormalities, change diagnosis, management plan and pt’s outcome?

198
Q

What 4 criteria should be satisfied for the testing to be useful?

A
  • Diagnostic efficacy
  • Diagnostic effectiveness
  • Therapeutic efficacy
  • Therapeutic effectiveness
199
Q

Which lab study should be done prior to major surgery with potential blood loss as well as for patients w/ ASA-PS 3 or 4, hematologic disorders, poor nutritional status, and/or on anticoagulant therapy?

A

CBC/Hemoglobin/Hematocrit

200
Q

Which lab study should be done in patients who has DM, HTN, cardiac disease, renal disease, fluid overload, and have ASA 2,3 or 4?

A

Renal Function Testing

201
Q

What lab study is required for someone with suspected undiagnosed or worsening condition that will affect peri-op management? This study should be done in anyone with renal or hepatic disease, HF, and are on meds that may cause an imbalance?

A

Electrolytes

202
Q

What lab study is required for someone with liver injury, hepatitis, and jaundice?

A

Liver Function Testing

203
Q

Who would require a coagulation testing prior to surgery?

A

Someone with:
-Known or suspected coagulopathy
- Hepatic disease
- Anticoagulant use
- ASA- PS 3 or 4 undergoing major surgery

204
Q

Who would require a serum glucose and HbA1c testing done prior to surgery?

A
  • ALL diabeti patients
  • Obese (BMI >50)
  • CV or intracranial disease
  • Hx of steroid use
205
Q

What is HbA1c testing?

Hb1C is better assessment of diabetic therapy than random/fasting blood sugar (TRUE/FALSE)

A

HbA1C is a long-term measurement of glucose control (3 months)

TRUE

206
Q

Who needs urinalysis testing done?

A

Someone with suspected UTI and unexplained fever or chills

207
Q

Who would need a pregnancy test done in pre-op?

What should potential pregnant women be aware of going into the surgery?

A
  • all women of childbearing potential.

Women possible pregnant should be made aware of the risks of anesthesia/surgery to the fetus.

208
Q

What study/testing should be done in someone with heart disease, chest pain, palpitations, murmurs, arrhythmia?
This testing is routine in ASA-PS 2,3,4 undergoing intermediate or high- risk procedures.

209
Q

Which lab study is required for someone with advanced COPD, pulmonary edema, PNA, mediastinal masses or with any suspicious physical exam findings?

A

Chest X-ray

210
Q

What is general anesthesia?

What type of airway device would you use?

What type of surgeries requires GA?

A

Total loss of consciousness.

ETT or LMA used.

Major surgeries: open- heart surgery, bowel surgery, etc.

211
Q

What is IV/Monitored sedation?

What type of airway device would you use?

What type of surgeries requires IV/ Monitored sedation?

A

Level of sedation ranges: Minimal (drowsy, able to talk) to deep (sleeping, may not rememebr surgery/procedure).

NC or face mask used.

Minor surgeries/procedures: biopsy, colonoscopy.

212
Q

What is regional anesthesia?

What type of procedures would require regional anesthesia?

A

Pain management method that numbs a large part of the body using a local anesthetic.
- Epidural or spinal.

Procedures: childbirth or joint replacement in elderly pts.

213
Q

What is local anesthesia?

What procedures would you use local anesthesia for?

A

Pain management method, usually a one-time injection of local anesthetic that numbs a small area of the body. Can be used w/ general or conscious sedation depending on the surgery and pt’ hx.

Procedures: skin or breast biopsy, bone/joint repair.

214
Q

What should be taken into account when planning postoperative pain management?

A

Tolerance to usual doses of opioid analgesics.

215
Q

All patients have the right to appropriate assessment and treatment of pain.

True or False?

216
Q

What should a preoperative evaluation include?

A

Baseline pain assessment

217
Q

What are the 3 most common agents that may cause anaphylaxis?

A

-Neuromuscular blockers
-Antibiotics
-Chlorhexidine

218
Q

What are the risk factors for having a latex allergy?

A

History of multiple surgeries, occupational exposure to latex (healthcare workers, food handlers), food allergies that cross-react (mango, kiwi, avocado, passion fruit, banana, and chestnuts)

219
Q

What are 2 common antibiotics that would most likely cause anaphylaxis?

A

PSN and cephalosporins

220
Q

“Red man syndrome” is a reaction known to which antibiotic?

A

Vancomycin

221
Q

What is the reason for the ester type of allergic reactions in local anesthetics?

A

due to preservative- para- aminobenzoic acid (PABA)

222
Q

What compound in NMBA can cause allergy?

A

Quaternary ammonium compound

223
Q

It is rare to have a true allergy to _____, it is mostly related to its side effects of N/V.

224
Q

What pre- op medications would you continue?

A

-Antihypertensives (except ACEi and ARBs- d/ 24hr before)
- Cardiac medications (BB, digoxin)
- Anti- depressants, anxiolytics, and other psychiatric meds
- Thyroid meds
- Oral contraceptive pills
- Eye drops
- GERD meds
- Opioid meds
-Anti-convulsant meds
- Asthma meds
- Corticosteroids
- Statin meds
- ASA (pt w/ prior PCI, ischemic heart disease, CV disease)
- COX2 inhibitor meds
- MAOIs meds (avoid meperidine and ephedrine)

225
Q

What pre-op meds would you discontinue?

A
  • ASA (10-14 days before).
  • P2Y inhibitors (clopidogrel, ticagrelor, prasugrel, ticlopidine)
  • Topical meds
  • Diuretics ( d/c day of surgery…except Thiazide diuretics- should be cont)
  • Sildenafil (24 hr before surgery)
  • NSAIDs (48 hr prior)
  • Warfarin (5 days before)
  • Post menstrual HRT (4 weeks prior)
  • Non- insulin anti- diabetic meds (d/c on day of surgery)
  • SGLT2 inhibitors d/c 24 hr before surgery.
  • Short-acting (regular) on day of surgery (if an insulin pump, cont at basal rate)

Adv Phys & Hlth Ass. Spring 2024 (6 decks)

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