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Surgery I > Lec 16: Pre-op Patient Assessment and Prep SA > Flashcards

Lec 16: Pre-op Patient Assessment and Prep SA Flashcards

1
Q

what is a pre op assessment

A

PE followed by appropriate lab work

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2
Q

why do we perform a pre-op assessment

A

allows us to compare the animal’s status before and after sx

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3
Q

pre-op assessment consists of:

A

patient hx, PE, labs, associated underlying disease, patient stabilization

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4
Q

what kind of lab work should a young, healthy animal get undergoing an elective procedure?

A

“big 4” or “quats” at the minimum

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5
Q

what is the “big 4”

A

PCV, TP, BG, BUN

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6
Q

what kind of lab work should an animal older than 5-7 years OR having systemic signs (dyspnea, heart murmur, anemia, ruptured bladder, GDV, shock, hemorrhage) get?

A

minimum data base lab work

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7
Q

what is minimum data base lab work

A

CBC, Chem, UA

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8
Q

what can change in your sx plan when you have identified underlying disease in a patient?

A

pre op management, the surgical procedure, prognosis, post op care

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9
Q

if your sx patient has neoplasia, what do you want to look for & what additional diagnostics do you want to run before going to surgery?

A

we want to evaluate the patient for metastasis.
we can do this by thoracic radiographs, abdominal ultrasound, lymph node aspirate

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10
Q

if your sx patient has cardiac disease, what additional diagnostics do you want to run before going to surgery?

A

thoracic radiographs, cardiac ultrasound scan, electrocardiogram

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11
Q

if your sx patient has experienced trauma, what diagnostics do you want to do before going to surgery?

A

thoracic radiographs
(patient could have a diaphragmatic hernia, pneumothorax, pleural effusion, pulmonary contusions –> these all decrease the chances of doing well under anesthesia)

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12
Q

should you test for endemic disease?

A

yes! (ex: heartworm)

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13
Q

what ASA status?

healthy with no discernible disease
ex: elective procedure (OVH, neuter, declaw)

A

ASA I

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14
Q

what is the ASA status?

healthy with localized disease or mild systemic disease
ex: patellar luxation, skin tumor, cleft palate without aspiration pneumonia

A

ASA II

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15
Q

what ASA status?

severe systemic disease
(ex: pneumonia, fever, dehydration, heart murmur, anemia)

A

ASA III

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16
Q

what ASA status?

severe systemic disease that is life threatening
(ex: heart failure, renal failure, hepatic failure, hypovolemia, severe hemorrhage)

A

ASA IV

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17
Q

what ASA status?

moribund, patient not expected to live longer than 24 hours with or without surgery
(endotoxic shock, multiorgan failure, severe trauma)

A

ASA V

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18
Q

what does it mean if you add an E to your ASA status?

A

E indicates EMERGENCY surgery

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19
Q

the risk of the surgical procedure may…

A

outweigh its potential benefits
(ex: removal of an apparently benign skin mass may not be warranted in an animal with hepatic or renal dysfunction)

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20
Q

what important factor must be considered for veterinary patient’s undergoing surgery?

A

quality of life

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21
Q

what is the surgical prognosis?

potential for complications is minimal, high probability that patient will return to normal

A

Excellent

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22
Q

what is the surgical prognosis?

some potential for complications, high probability of a good outcome

A

Good

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23
Q

What kind of surgical prognosis:

serious complications are possible but uncommon, recovery may be prolonged, may not return to presurgical function

A

Fair surgical prognosis

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24
Q

what kind of surgical prognosis?

many and/or severe complications, recovery expected but PROLONGED, likelihood of death during or after procedure is high, unlikely to return to presurgical function

A

Poor surgical prognosis

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25
Q

what is the surgical prognosis?

when the outcome is highly variable or unknown

A

Guarded

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26
Q

what should owners be informed of before surgery via client communication?

A

diagnosis, surgical and non surgical options, potential complications, post op care, prognosis, cost

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27
Q

what are a couple important things to keep in mind about cost when discussing with owners?

A
  • cost cannot always be predicted due to unanticipated complications
  • owners should be kept informed of animal’s status and of procedures that may affect the initial cost estimate
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28
Q

if the disease is hereditary than what should you reccomend?

A

neutering the patient

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29
Q

what needs to be signed by the owner prior to surgery?

A
  • a waiver authorizing surgery and accepting anesthetic/surgical risks
  • an estimate outlining anticipated costs
30
Q

what should you do regarding patient stabilization before induction of anesthesia?

A

replace fluid deficits and correct acid base and electrolyte abnormalities

31
Q

what should ALL animals receive while undergoing general anesthesia and surgery? (including healthy animals having elective procedures)

A

intravenous fluids

32
Q

what dietary restrictions should be followed for adult animals undergoing surgery?

A

food intake should be restricted 6-12 hours before induction of anesthesia

33
Q

why is fasting important before induction?

A

to avoid intraoperative or postoperative emesis and aspiration pneumonia

34
Q

what dietary restrictions should be followed for young animals undergping surgery?

A

food should not be withheld longer than 4-6 hours before induction due to possible hypoglycemia

35
Q

what is a surgical site infection?

A

infection that directly results from surgical procedures that involve other areas of the body as well such as organs or internal spaces that are manipulated during the operation

36
Q

what is the most common source of SSI’s?

A

endogenous microbial flora (staph & strep)

37
Q

what is an incisional SSI?

A

infection of the actual site of surgical incision (can be superficial or deep)

38
Q

what does a superficial incisional infection involve?

A

skin and subcutaneous tissue

39
Q

what does a deep incisional infection involve?

A

soft tissue layers such as incisional fascia and muscle

40
Q

what is an organ/space SSI?

A

infection of an anatomic part that was manipulated during the operation (ex: pissing off the pancreas)

41
Q

CDC classification of an SSI includes:

A

SSI infection must occur within 30 days of surgical procedure, occur within 1 year if it is associated with a surgical implant

42
Q

what normal resident organisms live in the skin’s superficial cornified layers and the outer hair follicles of dogs?

A

staphlococcus epidermidis, corynebacterium spp, pityrosporum spp

43
Q

what flora must we eliminated expsure to during surgery?

A

resident and transient flora

44
Q

can you sterilize skin without impairing its natural protective function and interfering with wound healing?

A

no, impossible

45
Q

what is the purpose of preop preparation regarding possible infection?

A

it reduces the number of bacteria and the likelihood of infection

46
Q

antisepsis is

A

the prevention of sepsis by preventing/inhibiting growth of resident and transient microbes

47
Q

antiseptic

A

product with antimicrobial activity that formerly may have been referred to as an antimicrobial agent (an agent capable of producing antisepsis)

48
Q

what two options do we have for antisepsis agents?

A

chlorhexadine gluconate and povidone iodine

49
Q

what antisepsis agent is superior?

A

CHG

50
Q

prevalence if SSI in humans is a major concern because of the associated…

A

increase incidence of morbidity, mortality, length of hospitlization and cost of care for post op patients

51
Q

preventive preop measures that can reduce the risk of SSI include:

A
  • antimicrobial prophylaxis
  • proper utilization of skin antiseptic agents for surgical team and patient
52
Q

SSI patients are ___ as likely to die compared to uninfected patients

A

TWICE

53
Q

shaving the patient should be ___ to the time of surgery as possible

A

as close

54
Q

shaving _____ is associated with a significant increase in superficial skin infection rates

A

the night before

55
Q

where should you NEVER shave your patient?

A

the OR

56
Q

always clip:

A

liberally

57
Q

what size blade should you use to clip your surgery patient?

A

40

58
Q

the higher the blade number…

A

the closer the clip

59
Q

blade should be placed ____ to the skin

A

parallel

60
Q

flush the prepuse of male dogs with

A

antiseptic solution before performing sterile prep

61
Q

before sterile application of epidermial germicide, you should move your patient to ____

A

the operating room

62
Q

position patient so that

A

the operative site is accessible to the surgeon

63
Q

if a limb surgery doesn’t involve the paw, you should:

A

cover it with a latex glove and attach with tape

64
Q

if an abdominal incison extends to the pubis in male dogs, you should:

A

clamp the prepuce to one side with a sterile towel clamp

65
Q

are the tips of towel clamps sterile or non sterile once placed through skin?

A

NON STERILE

66
Q

the hole that you cut in your drape should be:

A

the same size and shape as the hole created when you placed your quarter drapes (towels) underneath

67
Q

who’s responsibility is patient positioning?

A

the surgeon’s

68
Q

how should you arrange your surgical table?

A

in a manner that is logical to allow you to find instruments quickly and accurately

69
Q

what should assistants do with instruments before returning them to the table?

A

wipe them down

70
Q

what do you do with soiled sponges?

A

throw them in the trash or on the ground (DO NOT PUT THEM BACK ON THE INSTRUMENT TABLE!)

71
Q

what should you never place instruments or soiled sponges on?

A

your patient. your patient is NOT a table.

Surgery I (10 decks)

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