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Personal APA > Outpatient > Flashcards

Outpatient Flashcards

1
Q

How is cost affected by outpatient facilities?

A
  • Deceased financial burden to patient

- 3rd party payer can identify suitable procedures to reduce costs

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2
Q

How is the medical field affected outpatient centers?

A
  • ↑ inpatient beds

- ↓ noscomial infections

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3
Q

What are some social advantages of outpatient?

A
  • ↓ interuption of ADLs

- Care from parents/caretakers ↓ anxiety,confusion and pain

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4
Q

Staffing advantages of outpatiens.

A
  • Uniform schedules
  • Efficient time utilization
  • Predictable outcomes
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5
Q

Disadvantages of outpatient facilities.

A
  • ↓ privacy
  • Multiple screening trips
  • Need for home care
  • Patient compliance
  • ↓ orientation time
  • ↓ post op observation
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6
Q

What is the only age limit for outpatient?

A

Premature babies

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7
Q

What is the typical length of surgery for outpatient

A
  • Less than 2 hours

- Not to exceed 4 hours

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8
Q

Most common surgeries at outpatient facilities?

A
  • Opthalmologic

- Gynecological

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9
Q

What procedures are acceptable for outpatient?

A
  • Minimal blood loss
  • Minimal fluid shifts
  • High surgeon skill
  • Low post op pain
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10
Q

Why are premies not appropriate for outpatient?

A
  • Anemia
  • Underdeveloped gag reflexes
  • Temperature control
  • Apnea
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11
Q

3 types of premie apnea.

A
  • Short (6-15 sec)
  • Prolonged (>15)
  • Periodic breathing
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12
Q

What can apnea lead to, and when?

A
  • Hypoxemia and bradycardia

- As late as 12 hours post op

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13
Q

When can a premie be an outpatient?

A

-50-60 weeks post conceptual age

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14
Q

What disorders of an infant prevent them from being outpatient?

A
  • Bronchopulmmonary dysplasia

- SIDS risk (until 1 year)

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15
Q

Children should be free from bradycardia and apnea for how long before surgery?

A

6 months

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16
Q

What kind of age should you consider?

A

Physiologic not chronologic age

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17
Q

Those 85 yo and greater are at a great risk of what the week following surgery?

A

-Hospital admission and death

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18
Q

A patient w/ convulsive disorder or MH susceptibility must be scheduled when?

A

-Early in the day for longer obs

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19
Q

What must be managed carefully w/ cystic fibrosis?

A
  • Respiratory distress

- Hydration

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20
Q

When is obese patients acceptable for outpatient?

A

ASA class 1 or 2

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21
Q

When can sickle cell crisis begin?

A
  • Hypoxia
  • Acidosis
  • Dehydration
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22
Q

Sickle cell criteria for outpatient

A
  • No organ disease
  • No crisis in the past year
  • Compliant medical care
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23
Q

Social considerations for outpatient

A
  • Patient compliance
  • Responsible caregiver
  • Discharge accomadations
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24
Q

Unacceptable patients conditions for outpatient?

A
  • Unstable ASA 3 or 4
  • Active substance abuse
  • Physcosocial problems
  • Seizures
  • Untreated sleep apnea
  • Uncontrolled diabetes
  • Isolation needs
  • Pain not controlled w/ oral meds
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25
Q

How old can the H&P be?

A
  • 30 days for stable

- 72 hours for high risk

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26
Q

Lab values can be how old?

A

60 days if stable

  • K 7 days if on diuretic/digitalis
  • Glucose morning of surgery
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27
Q

CXR in downs is looking for what?

A

subluxation of atlantoaxial junction

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28
Q

Indications for EKG

A
  • CV disease
  • Murmur
  • HTN
  • Over 40 yo
  • Family history long QT
  • Sleep apnea
  • Anatommic airway obstruction
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29
Q

Patients that take ACE inhibitors may need what?

A

Vasoprressin for low BP

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30
Q

2 types of noninfectious runny nose?

A
  • Allergic (seasonal)

- Vasomotor (crying)

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31
Q

2 types of infectious runny nose?

A
  • Viral (common cold)

- Bacterial (strep)

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32
Q

Symptomatic URTI should be rescheduled when?

A

4 weeks later

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33
Q

Asymptomatic URTI can be done if?

A
  • Child older than one
  • Surgery not on thorax or abd
  • No ETT planned
34
Q

Anesthesia can increase respiratory complication how much?

A

2-7 fold

35
Q

Risk factors for URTI bronchspasm / comlications?

A
  • < 5 yo
  • Premature
  • 2nd hand smoke
  • Secretions
  • Nasal congestion
  • ENT sx
  • Reactive airway disease
36
Q

Common aspiration prophylaxis?

A
  • Antacids
  • Gastrokinetics
  • H2 agonists
  • PPI
37
Q

General anesthesia in SDS.

A
  • Short acting
  • Rapid onset / offset
  • NSAIDS
  • Minimize physiologic changes
  • Minimize post op side effects
38
Q

Why is ETT use minimized?

A
  • Post op croup
  • Sore throat
  • ↓ ability to resume PO
39
Q

When to give fluids?

A
  • Procedure > 30 min
  • Procedures with ↑ PONV and pain
  • Prolonged fasting
  • Bleeding
  • ABX
40
Q

Advantages of regional anesthesia.

A
  • Shorter recovery
  • ↓ inpatient admission
  • Post op pain relief
  • GA alternative
41
Q

Regional disadvantages.

A
  • Patient / surgeon cooperation
  • More time needed
  • Orthostatic Hypotension
  • Inability to pee
  • PDPH
42
Q

Common post op complications

A
  • Nausea / vomiting
  • Pain
  • Peds
  • Certain Procedures
43
Q

Major postop morbidities

A
  • MI
  • Stroke
  • PE
  • Respiratory failure
44
Q

What increases PONV

A
  • Ambulation
  • Postural Hypotension
  • Pain
  • Meds
  • Oral intake
  • low O2
  • Reversal agents
45
Q

What increases PONV?

A
  • HX of PONV
  • Mandibular sx
  • Eye sx
  • Plastic sx
46
Q

What can help PONV?

A
  • Decadron
  • Droperidol
  • Ephedrine
  • Reglan
  • Zofran
  • Phenergan
  • OG tube
47
Q

4 items to help post op pain

A
  • Regional
  • NSAIDS
  • LA wound infiltration
48
Q

Post op phase 1

A
  • VSS
  • Off O2
  • Sit in chair
  • Protect airway
  • Oriented
49
Q

Post op phase 2

A
  • Responsible caregiver
  • pain controlled
  • PONV minimal
  • Void
  • No resp distress
50
Q

In MAC case, a patient must be able to

A
  • Protect airway
  • Breathe independently
  • No LOC
51
Q

ASA guideline for MAC

A
  • Pulse Ox
  • ECG
  • BP
  • Temp
  • Capnography
52
Q

Incidence of brain damage / death is higher in MAC or General?

A

MAC

53
Q

Deep sedation is signified by what?

A
  • Not easily aroused
  • Responds to painful stimuli
  • May need assistance w/ airway
  • CV unaltered
54
Q

What is the difference between MAC and moderate sedation?

A
  • Moderate sedation can be directed by physician performing procedure
  • MAC must have anesthesia personal
55
Q

What things can cause delayed awakening

A
  • Prolonged anesthesia
  • Metabolic causes
  • Neurologic injury
56
Q

Most common cause of hypotension?

A

Hypovolemia

57
Q

Hypothermia causes what?

A

Venoconstriction

58
Q

What causes PAC and PVC’s

A
  • Hypomag
  • Hypokalemia
  • ↑ sympathetic tone
  • Myocardial ischemia
59
Q

What is first line / 2nd line treatment for laryngospasm?

A
  • Positive pressure

- Succs

60
Q

Droperidol concerns

A

dont give QT prolongation

61
Q

What is a D&C used for?

A
  • Removal of endometrial lining
  • Spontaneous abortion
  • Cervical stenosis
  • Bleeding
62
Q

What position of D&C?

A

Dorsal lithotmy (<40 degrees)

63
Q

Meds for D&C bleeding?

A
  • Methergine

- Oxycotcin (uterus contraction)

64
Q

Causes of severe post op bleeding in D&C?

A
  • Cervical injury
  • Uterine atony / Perf
  • Retained conception products
65
Q

What is a hysteroscopy?

A
  • Allows exam of endometrial cavity

- Diagnose uterine bleed

66
Q

Distension may be needed in hysteroscopy, what can be used?

A
  • NS
  • Sorbitol
  • Mannitol
  • CO2
67
Q

What type of needle reduces risk of PDPH?

A

-pencil point

68
Q

What sensory level for hysteroscopy?

A

T10 belly button

69
Q

Reasons for TMJ surgery?

A
  • Ankylosis
  • Tumor
  • Chronic dislocation
  • osteoarthtitis
  • Painful disc dislocation
70
Q

TMJ Complication

A
  • Facial and trigeminal nerve damage
  • Hearing loss
  • Vertigo
  • Ear fullness
  • Hemorrhage
71
Q

Why TMJ arthroscopiclly?

A
  • Better blood and lymphatic flow

- Less periarticular tissue disruption

72
Q

People needing GA for dental surgery?

A
  • MR
  • Children
  • Oral sepsis
  • Seizures
  • TMJ
73
Q

What will lingual nerve damage cause?

A

Tongue numbness

74
Q

What will alveolar nerve damage cause?

A

Lip numbness

75
Q

What is horner’s syndrome and when do you get it?

A
  • Droopy eyelid

- Interscalene block

76
Q

A mouth gag can cause what?

A

-ETT kinks and dislodgement

77
Q

What to check after gag?

A
  • Obstructions
  • BBS
  • Chest movement
  • PIP
78
Q

Where is ETT secure for T and A?

A

Midline lower lip

79
Q

Hypercapnia can cause vasodilation and cause what?

A

increased bleeding

80
Q

What is the most common arthroscopic procedure?

A

Knee

81
Q

Most common complication of knee arthroscopy?

A

-Hemarthrosis

82
Q

Where is knee trocar placed?

A

-Lateral and medial to patellar

Personal APA (4 decks)

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