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Health Assessment > Intro to pre-operative assessment > Flashcards

Intro to pre-operative assessment Flashcards

1
Q

What are the components of the preoperative evaluation?

A
  • Patient history
  • Physical exam
  • Laboratory testing
  • Medical consultation
  • ASA physical status class
  • NPO status
  • Formulation plan
  • Discussion of plan
  • Informed consent
  • Documentation
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2
Q

What are the goals of the preoperative assessment?

A
  • Optimize care, satisfaction and comfort
  • Minimize morbidity and mortality
  • Minimize surgical delays or cancellations
  • Determine appropriate post-operative disposition
  • Evaluate health status and determine if any further consultative, diagnostic investigations are needed
  • Formulate most appropriate anesthetic plan
  • Optimize communication among members of the surgical and anesthetic teams
  • Evaluation should be efficient and cost-effective
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3
Q

What are the 3 main questions answered by the preoperative assessment?

A
  1. Is the patient in optimal health?
  2. Could health problems or medications unexpectedly influence perioperative events?
  3. Can, or should, the patient’s physical or mental condition be improved before surgery.
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4
Q

Where do you get the data for the pre-operative assessment?

A
  • Patient’s medical record and patient interview
  • Physical examination
  • Diagnostic tests
  • Specialist consultation/reports
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5
Q

What should be done during the preoperative clinic visit and what are the benefits of this visit?

A
  • Patient interview
  • Physical examination
  • Develop anesthetic plan
  • Promotes patient teaching and anxiety reduction
  • Allows time to schedule appointments with medical consultants and complete required pre-operative diagnostic testing
  • Obtain informed consent prior to operative day
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6
Q

What are some examples of patients that would require early pre-operative assessment?

A

Patients with:

  • Angina, CHF, MI, CAD, poorly controlled HTN
  • COPD/severe asthma, airway abnormalities, home O2 or ventilation
  • IDDM, adrenal disease, active thyroid disease
  • Liver disease, ESRD
  • Massive obesity, symptomatic GERD
  • Severe kyphosis, spinal cord injury
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7
Q

What information can you find in the OR schedule?

A
  • Patient demographics
  • Procedure and diagnosis
  • Length of procedure and position
  • Surgeon (s)
  • Type of anesthesia
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8
Q

What information should be reviewed from the patient’s chart?

A
  • Demographics
  • Diagnosis/procedure
  • Surgical consent
  • Prior H&P
  • Nursing notes
  • Patient questionnaire
  • Results of laboratory tests
  • EKG, PFTs, x-ray, etc
  • Vital signs
  • Medication list
  • Allergies
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9
Q

What additional information should you look at for inpatients?

A
  • Progress notes
  • Medication sheets
  • Nursing notes
  • Old anesthetic records
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10
Q

What are the 6 purposes of the preoperative interview?

A
  1. Obtain pertinent medical history
  2. Formulate plan of anesthetic care
  3. Obtain informed consent
  4. Patient education
  5. Improve efficiency, reduce cost of perioperative care
  6. Utilize operative experience to motivate patient to more optimal health status
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11
Q

What are some things you should do/ask in the preoperative interview?

A
  • Introduce anesthesia provider(s) to patient and/or family
  • Confirm patient ID, diagnosis and procedure
  • Look for co-existing diseases: review of systems
  • Medications: allergies including latex (including type of reaction), presctiptive medications, taken this AM?, over the counter (ASA, NSAIDS), herbals
  • Previous anesthetics and surgeries
  • Exercise tolerance
  • Sleep apnea history
  • ETOH abuse?
  • Drug abuse?
  • Tobacco use?
  • Females- LMP?
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12
Q

What are the components of the review of systems?

A
  • CNS/NM
  • Cardiac
  • ENT
  • Pulmonary
  • Vascular/HTN
  • Endocrine
  • GI
  • Hepatic
  • Renal
  • Hematologic
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13
Q

What are some things to look at in the physical exam?

A
  • General impression
  • Airway
  • Heart
  • Lungs
  • CNS/PNS
  • Vital signs
  • Surgical site
  • Height
  • Weight
  • Physical features
  • Mental status
  • Vital signs
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14
Q

What are the components of the airway physical exam?

A
  • Mallampati classification
  • Thyromental distance
  • Head and neck movement
  • Neck circumference
  • Interincisor distance
  • Dentition
  • Relevant craniofacial deformities
  • Any predictors of difficult airway management
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15
Q

What do you assess when listening to the heart?

A
  • Rate
  • Rhythm
  • Murmurs
  • Bruits (carotid)
  • Extremity pulses
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16
Q

What are the components of the CV assessment?

A
  • Bruits(carotid)
  • Extremity pulses
  • Extremity edema
17
Q

What is involved in the physical assessment of the lungs?

A
  • Inspection
  • Auscultation
  • Percussion
  • Palpation
18
Q

What are the components of the CNS physical exam?

A
  • Motor-gait, grip strength, ability to hold arms forward, etc
  • Sensory- distinction of vibration, pain, light touch along dermatomes
  • Muscle reflexes-deep, superficial, and pathologic
  • Cranial nerve abnormalities
  • Mental status
  • Speech
19
Q

What are the components of the musculoskeletal physical exam?

A
  • Gait
  • ROM
  • Deficits
20
Q

What is considered obesity?

A

20% over ideal body weight or BMI of 30-39.9

21
Q

What are the goals of preoperative/preprocedure laboratory testing?

A
  • Reduce anesthetic morbidity
  • Increase quality of perioperative care
  • Decrease cost of perioperative care
  • Return patient to desirable functioning
22
Q

What are some disadvantages of preoperative laboratory testing?

A
  • Lab tests NOT good disease screening tools
  • Follow up of abnormal results is costly
  • Nonindicated tests increase risks for patients
  • Batteries of tests present medicolegal risk to providers
  • Excessive testing decreases facility efficiency and reduces resources available to care for others
23
Q

Describe Minimally invasive, moderately invasive and highly invasive procedures.

A

Minimally invasive: little tissue trauma, minimal blood loss

Moderately invasive: modest disruption of normal physiology, anticipate some blood loss, may need invasive monitors and/or ICU

Highly invasive: significant disruption of normal physiology, commonly require transfusion and ICU care

24
Q

Describe the ASA classifications

A

I- normal, healthy patient; no systemic disease
II- mild to moderate systemic disease, well controlled, no functional limitation
III- severe systemic disease, functional limitation
IV- severe systemic disease that is a constant threat to life
V- moribund patient, not expected to survive with or without the surgical procedure
VI- patient declared brain dead whose organs are being harvested for donation
E- emergency operation required

25
Q

What are the NPO status times based on current ASA guidelines?

A
  • 2 hours for clear liquids all patients
  • 4 hours for breast milk
  • 6 hours for formula or solids/light meal
  • 8 hours for a heavy meal, fried or fatty food, gum and candy
26
Q

What are some factors that put patients at an increased risk for aspiration?

A
  • Age extremes (younger than 1 or older than 70)
  • Ascites
  • Collagen vascular disease, metabolic disorders (DM, obesity, ESRD, hypothryroid)
  • Hiatal hernia/GERD/esophageal surgery
  • Mechanical obstruction (pyloric stenosis)
  • Prematurity
  • Pregnancy
  • Neurologic diseases
27
Q

What are the parts of the anesthetic plan?

A
  • Types of anesthesia
  • Drugs
  • Monitors
  • Airway
  • Positioning
  • Intraoperative monitoring
  • Postoperative care
28
Q

Who should you discuss the anesthetic plan with?

A
  • Supervising staff
  • Patient
  • Surgeon
  • OR team
29
Q

What information does the patient require from the anesthesia professional?

A
  • Discuss choices of anesthetic technique, verbal and written consent
  • Explain IV catheter
  • Describe use of local anesthetics, medications, fluids
  • Discuss airway management plan
  • Explain monitors-placement, purpose
  • Discuss postoperative recovery
  • Discuss pain management plan
  • Explain process of transport to OR
  • Postoperative-PACU, pain relief, airway
  • Possible outcomes-sore throat, blood transfusion, facial swelling, nasal packing, etc.
30
Q

What is required for informed consent?

A
  • Explanation of the planned anesthetic
  • Explanation of options available
  • Risks and benefits
  • Patient understanding and cooperation
  • Without consent-assault and battery
  • Minors- consent from parents or guardian
  • Signature of patient and witness
31
Q

What are the components of the final pre-operative check list?

A
  • IV/Fluid status
  • Pre-medication
  • Anesthetic plan
  • Labwork- results, labwork needed?
  • EKG, CXR needed?
  • Blood products- availability and need
  • Need for inhaler, steroid coverage, antibiotics, aspiration prophylaxis
32
Q

What should be documented from the preoperative evaluation?

A
  • H&P
  • Informed consent
  • NPO status
  • Medications
  • Allergies
  • ASA physical status class
  • Pre-operative vital signs
  • Labs, tests, and consults

Health Assessment (5 decks)

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