Exam 2: Lecture 20: Pre-operative Patient assessment and preperation - LA Flashcards
what are the 5 things we should have in our preoperative assessment
- patient history
- physical exam
- lab data
- associated underlying disease
- patient stabilization
what are the 2 things we need to get from our patient history prior to the details
signalment and presenting complaint
what 3 questions should we ask when we are figuring out the presenting complaint
- when did the current problem start
- what did the problem look like when it first began
- has the problem gotten better or worse, and if so how much and associated with what therapy
what are some details we need to get during the patient history after we get the signalment and presenting complaint
diet, exercise, environment, past medical probs, recent treatments, any infections, any V/D, altered appetite, toxins, coughing, history of previous drug reactions or seizures
what kind of evaluation should we do during our PE
a systemic eval including all of the body systems
what are the 3 things we look for in general condition during our PE
BCS, attitude, mental status
what are the 6 systems we should make sure we evaluate
neuro, ortho, respiratory, GI, cardio, urinary
what type of situation do we allow a cursory exam until the animal has been stabilized
emergency situations!
what is the best way to determine the likelihood of cardiopulmonary emergencies during sx
evaluation of the preanesthetic physical status
T/F: The more deteriorated the physical status, the higher risk of anesthetic and surgical complications
True!!
what type of labwork should we do for a young, healthy animal undergoing elective procedures
PCV (Hematocrit)
total protein (TP)
blood glucose
BUN
what type of labwork should we do for an animal that is 5 to 7 years old or having systemic signs
should get a CBC and differential, serum biochemical profile, an urinalysis
what does ID of associated or underlying disease influence
preoperative management, surgical procedure performed, prognosis, and postoperative care required
how do we eval for neoplasia
look for mets via thoracic imaging, CT, positron emission tomography, abdominal ultrasound, LN aspiration
how do we evaluate for cardiac disease
thoracic rads, cardiac ultrasound, electrocardiogram
what should we do for trauma patients and why
they should have thoracic rads to eval the diaphragm, pleural space, and lungs
what is ASA I
healthy with no discernible disease
what is ASA II
healthy with localized disease or mild systemic disease
what is ASA III
severe systemic disease
what is ASA IV
severe systemic disease that is life threatening
what is ASA V
moribund, patient is not expected to live linger than 24 hours with or without sx
what is important to remember when determining surgical risk
risk of the procedure may outweigh its potential benefits
why should we care about quality of life for veterinary patients
patient with severe, debilitating, untreatable disease may not benefit from surgery and for some patients surgery may improve quality of life even if length of life is limited
what is an excellent surgical prognosis
potential for complications is minimal and high probability that the patient will return to normal
what is a good surgical prognosis
some potential for complications, high probability of a good outcome
what is a fair surgical prognosis
serious complications are possible but uncommon, recovery may be prolonged, or may not return to its pre-surgical function
what is a poor surgical prognosis
many or severe complications, recovery is expected to be prolonged, likelihood of death during or after the procedure is high, and unlikely to return to its pre-surgical function
what is a guarded surgical prognosis
given with the outcome is highly variable or unknown
what should we informed owners about before surgery
- diagnosis
- surgical and nonsurgical options
- potential complications
- post operative care
- prognosis
- cost
what is important to remember about cost and client communication
cost cannot always be predicted because of unanticipated complications. Owners should be kept apprised of the animals status and of procedures that may affect the initial cost estimate
T/F: If the disease is hereditary, neutering should be recommended
true
T/F: A waiver signed by the owner that authorizes surgery and accepting anesthetic/surgical risk is not mandatory and does not need to be in the medical record
false! It is mandatory and should be a part of the medical record
T/F: A signed estimate form that outlines the anticipated costs of diagnostics, preoperative care, surgery, and post operative care should be included in the record
true!
Should we stabilize patients prior to surgery
yes as much as we can
can we over-stabilize a patient
no! It is impossible and surgical intervention must be done rapidly
how long do we restrict food from adult animals
6 to 12 hours before induction
how long should we withhold food from young animals and why
no longer than 4 to 6 hours because hypoglycemia may occur
do we restrict water intake for surgery patients
not usually
T/F: operations of the large intestine often require specialized preparations
true!
what are the most common sources of surgical site infections
endogenous microbial flora (staphylococcus aureus and streptococcus spp)
what is the CDCs classification of incisional infection
infection of the actual site of the surgical incision
what is the CDCs classification of superficial incisional infection
involving the skin and subq tissue
what is the CDCs classification of deep incisional infection
involving deep soft tissue layers such as incisional fascia and muscle
what is the CDCs classification of organ/space infection
infection of anatomic part that was manipulated during the operation
how does the CDC determine if it is a surgical site infection
occur within 30 days of the surgical procedure or occurs within 1 year if it is associated with a surgical implant and the infection appears to be related to the operation
what organisms live in the skins superficial cornified layers and the outer hair follicles of dogs
staphylococcus epidermidis
corynebacterium spp
pityrosporum spp
what are the transient pathogens
- staph aureus
- staph intermedius
- e. coli
- steptococcus spp
- enterobacter spp
- clostridium spp
T/F: it is impossible to sterilize skin without impairing its natural protective function and interfering with wound healing
true! You cannot sterilize skin
T/F: Preoperative prep does not really reduce the number of bacteria and the likelihood of infection
false! It does REDUCE
what is antisepsis
the prevention of sepsis by preventing or inhibiting the growth of resident and transient microbes
what is an antiseptic
product with antimicrobial activity that formerly may have been referred to as an antimicrobial agent
an agent capable of producing antisepsis
T/F: The current literature strongly suggests that chlorohexidine glyconate is superior to povidone iodine for preoperative antisepsis for patients
TRUE!!
what are the 7 characteristics of an ideal preoperative antiseptic
- kill all bacteria, fungi, viruses, protozoa, tubercle bacilli, and spores
- be hypoallergenic
- be nontoxic
- have residual activity
- not be absorbed
- be nontoxic and able to be used repeatedly safely
- be safe to use on all parts of the body and in all body systems
why is the prevalence of surgical site infections in humans a major concern
because it increases incidence of morbidity and mortality, length of hospitalization, and cost of care for post operative patients
what are the 2 ways we can use preventative preoperative measures to reduce the risk of surgical site infection
- administration of antimicrobial prophylaxis
- proper utilization of skin antiseptic agents for the surgical team and the patient
T/F: Infections should be identifies and addressed prior to surgery
true!
explain the 4 things we should remember when shaving hair
- do it as close to the time of surgery as possible
- shaving the night before is associated with a significant increase in superficial skin infection rates
- NEVER CLIP IN OR
- clip liberally so incision can be extended within sterile field
what # blade of clippers should we use
40 blade
what do we do once we shave the patient
loose hair should be vacuumed
what are your landmarks for shaving for an OHE
clip from just above the xyphoid to the pubis and laterally beyond the nipple line
T/F: You should flush the male prepuce with an antiseptic solution prior to doing a sterile prep
true!
what should we do prior to sterile prep once we have shaved and dirty prepped the patient
patient should be moved to OR, positioned for surgery, and secured with ropes/sandbags/troughs/tape
if we are using electrosurgery what do we need to remember to do
put the ground plate under the patient!!
When do we hang limbs for surgery
for limb procedures prior to our sterile prep….we sterile prep once it is hung
what are the 3 purposes of preoperative skin prep
- removal of soil and transient microorganisms from the skin
- reduce the resident microbial count to subpathogenic levels in a short time and with the least amount of tissue irritation
- inhibit rapid rebound growth of microorganisms
when do we begin the sterile prep
once we have moved into OR and patient has been placed/positioned for surgery
T/F: The tips of towel clamps are considered non-sterile once they have been placed through the skin and should be handled properly
true!!
what should we do if the drape does not have fenestration
you should cut one to an appropriate size
what is this picture showing us
the limb being placed through the fenestration of the drape and a plastic adhesive drape has been applied to the skin
T/F: Patient position is ultimately the responsibility of the surgeon
true!
T/F: you should arrange your surgical table in a manner that is logical to allow you to find instruments quickly and accurately
true
T/F: Assistants do not wipe instruments when returning them to the table
false, they should!
T/F: Soiled sponges should be placed back on the instrument table
false, they should NOT be placed back on the instrument table
T/F: Your patient is not a table to place instruments, soiled sponges, etc, on
true! You should not put those things on the patient
