LECTURE #1 Flashcards
The ultimate goals of preoperative medical
assessment are to
- reduce the patient’s surgical and anesthetic perioperative morbidity or mortality,
- Return him/her to desirable functioning as quickly as
possible.
Surgical procedures and administration of anesthesia are associated with a complex stress response that is proportional to the
Magnitude of injury
Total operating time
Amount of intraoperative blood loss
Degree of postoperative pain.
Basic information
ALACPI
Allergies, • (to foods or medicines) • Latex • Adhesives • Chemicals • Prep solutions • IV Contrast
Current medications: QUESTIONS TO ASK
a. What did they take today?
• b. if anything taken, what is their NPO status?
Neuro history: ASK
• Stroke, TIA, seizures, paraplegia, etc
Cardiovascular history
• HTN, CAD, MI, Valvular disease, previous surgery
What are the most important factors to consider
when assessing your patient’s cardiovascular
status?
ENAD
EXERCISE TOLERANCE: Ask about your patient’s activity level and usual amount of exercise done daily or
weekly. Ask what type of exercise they participate in.
NUTRITION:RECENT DIET, WEIGHT GAIN/LOSS
ALCOHOL: alcohol per day or per week. Last drink was and the usual number of drinks per episode.
DRUGS: Ask your patient about all medication they take including anti‐hypertensives, betablockers,
calcium channel blockers, digoxin, (ABCDig)
(DAAOdHStreet)
diuretics, aspirin, anticoagulants, over‐the‐counter drugs, herbal supplements, or street drugs.
Smoking:
Ask your patient if they smoke cigarettes or other
tobacco. Ascertain the pack per year smoking history.
Smoking History
This is done by multiplying the number of years your patient has smoked with the number of packs per day they have smoked
Smokers Pack Per Day History
• 2 packs per day x 10 years =
• 1 pack per day x 20 years =
3 packs per day x 7 years• =
20 pack‐year history
20 pack‐year history
21 pack‐year history
Respiratory status,
• Work History…if they worked in a chemical plant?
• (just because someone has copd, doesn’t mean
they have a smoking history!)
Hx. of asthma, copd, uri, tb, osa,
if so, do they wear cpap and did they bring their
machine with them? Smoking hx??? Exposure to
any hazardous chemicals, etc.
Postoperative pulmonary complications (PPCs) such as
Pneumonia
Atelectasis
Bronchitis,
Bronchospasm, hypoxemia, respiratory failure with prolonged mechanical ventilation or exacerbation of underlying chronic lung disease, increase patient morbidity and mortality and prolong the length of hospital stay after surgery
. PPCs occur in approximately
20-30% of patients undergoing major, non thoracic surgery.
GI Assessment (4)
1.Do they have a hx. of GERD, hiatal hernia, PUD,
any recent nausea/vomiting, diarrhea.
• 2. Have they had a bowel-prep?
• 3. Again, NPO status
• 4. NG Tube in place, if so, is it draining and what
color is the drainage?
Hepatic/Renal
- Hepatitis, or history of:
• 2 Cholecystitis/ Cholelithiasis
• 3.Pancreatitis, Cirrhosis, etc.
• 4. ETOH hx?
Kidney disease, dialysis,(if so, When last dialyzed,
and how is it performed? Do they have an a/v
shunt, or catheter?
