Lec 16: Pre-op Patient Assessment and Prep SA

Question 1

what is a pre op assessment

Answer 1

PE followed by appropriate lab work

Question 2

why do we perform a pre-op assessment

Answer 2

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

Question 3

pre-op assessment consists of:

Answer 3

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

Question 4

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

Answer 4

“big 4” or “quats” at the minimum

Question 5

what is the “big 4”

Answer 5

PCV, TP, BG, BUN

Question 6

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?

Answer 6

minimum data base lab work

Question 7

what is minimum data base lab work

Answer 7

CBC, Chem, UA

Question 8

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

Answer 8

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

Question 9

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?

Answer 9

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

Question 10

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

Answer 10

thoracic radiographs, cardiac ultrasound scan, electrocardiogram

Question 11

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

Answer 11

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

Question 12

should you test for endemic disease?

Answer 12

yes! (ex: heartworm)

Question 13

what ASA status?

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

Answer 13

ASA I

Question 14

what is the ASA status?

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

Answer 14

ASA II

Question 15

what ASA status?

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

Answer 15

ASA III

Question 16

what ASA status?

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

Answer 16

ASA IV

Question 17

what ASA status?

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

Answer 17

ASA V

Question 18

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

Answer 18

E indicates EMERGENCY surgery

Question 19

the risk of the surgical procedure may…

Answer 19

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

Question 20

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

Answer 20

quality of life

Question 21

what is the surgical prognosis?

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

Answer 21

Excellent

Question 22

what is the surgical prognosis?

some potential for complications, high probability of a good outcome

Answer 22

Good

Question 23

What kind of surgical prognosis:

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

Answer 23

Fair surgical prognosis

Question 24

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

Answer 24

Poor surgical prognosis

Question 25

what is the surgical prognosis? when the outcome is highly variable or unknown

Answer 25

Guarded

Question 26

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

Answer 26

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

Question 27

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

Answer 27

- 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

Question 28

if the disease is hereditary than what should you reccomend?

Answer 28

neutering the patient

Question 29

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

Answer 29

- a waiver authorizing surgery and accepting anesthetic/surgical risks - an estimate outlining anticipated costs

Question 30

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

Answer 30

replace fluid deficits and correct acid base and electrolyte abnormalities

Question 31

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

Answer 31

intravenous fluids

Question 32

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

Answer 32

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

Question 33

why is fasting important before induction?

Answer 33

to avoid intraoperative or postoperative emesis and aspiration pneumonia

Question 34

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

Answer 34

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

Question 35

what is a surgical site infection?

Answer 35

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

Question 36

what is the most common source of SSI's?

Answer 36

endogenous microbial flora (staph & strep)

Question 37

what is an incisional SSI?

Answer 37

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

Question 38

what does a superficial incisional infection involve?

Answer 38

skin and subcutaneous tissue

Question 39

what does a deep incisional infection involve?

Answer 39

soft tissue layers such as incisional fascia and muscle

Question 40

what is an organ/space SSI?

Answer 40

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

Question 41

CDC classification of an SSI includes:

Answer 41

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

Question 42

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

Answer 42

staphlococcus epidermidis, corynebacterium spp, pityrosporum spp

Question 43

what flora must we eliminated expsure to during surgery?

Answer 43

resident and transient flora

Question 44

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

Answer 44

no, impossible

Question 45

what is the purpose of preop preparation regarding possible infection?

Answer 45

it reduces the number of bacteria and the likelihood of infection

Question 46

antisepsis is

Answer 46

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

Question 47

antiseptic

Answer 47

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

Question 48

what two options do we have for antisepsis agents?

Answer 48

chlorhexadine gluconate and povidone iodine

Question 49

what antisepsis agent is superior?

Answer 49

CHG

Question 50

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

Answer 50

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

Question 51

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

Answer 51

- antimicrobial prophylaxis - proper utilization of skin antiseptic agents for surgical team and patient

Question 52

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

Answer 52

TWICE

Question 53

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

Answer 53

as close

Question 54

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

Answer 54

the night before

Question 55

where should you NEVER shave your patient?

Answer 55

the OR

Question 56

always clip:

Answer 56

liberally

Question 57

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

Answer 57

#40

Question 58

the higher the blade number...

Answer 58

the closer the clip

Question 59

blade should be placed ____ to the skin

Answer 59

parallel

Question 60

flush the prepuse of male dogs with

Answer 60

antiseptic solution before performing sterile prep

Question 61

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

Answer 61

the operating room

Question 62

position patient so that

Answer 62

the operative site is accessible to the surgeon

Question 63

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

Answer 63

cover it with a latex glove and attach with tape

Question 64

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

Answer 64

clamp the prepuce to one side with a sterile towel clamp

Question 65

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

Answer 65

NON STERILE

Question 66

the hole that you cut in your drape should be:

Answer 66

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

Question 67

who's responsibility is patient positioning?

Answer 67

the surgeon's

Question 68

how should you arrange your surgical table?

Answer 68

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

Question 69

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

Answer 69

wipe them down

Question 70

what do you do with soiled sponges?

Answer 70

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

Question 71

what should you never place instruments or soiled sponges on?

Answer 71

your patient. your patient is NOT a table.