Outpatient - Quiz 5 Flashcards
What are some disadvantages to Outpatient Surgeries?
Privacy
Multiple trips for Screenings
Need of Home Care
Pt. Compliance
Less time for Orientation
Less Post-Op Observation
What is the only age restriction for outpatient surgery?
Pre-Term Babies d/t Anemia, Apnea, Immature Gag & Temp Control
What are some considerations that should be taken for surgery in a pt w/ substance abuse?
Pt. eval & pain management talk the day before surgery
&
Regional Technique
What should be done if a patient comes in intoxicated or on drugs the day of surgery?
Cancel surgery
What should be done for a Pre-Term baby needing surgery w/ a Hematocrit less than 30%?
Further Eval d/t Increased Apnea Episodes
&
Give Iron Therapy
What is the normal drop in Hgb in the first three months for a Premature Baby?
Hgb 7-8 g/dL
When might a Preterm Baby be considered for Outpatient Surgery?
50-60 weeks Postconceptual Age w/ special considerations regarding other problems
What increases the risk of SIDS?
Kids w/ hx of Apnea/Bradycardic Events
Siblings w/ SIDS
When is it ok for kids w/ SIDS risk be considered for surgery?
6 months - 1 yr w/o Apnea/Bradycardic Events
At what age are Geriatric patients at a greater risk for Hospital Admission & Death a week after surgery?
85 years or older
How should pts w/ Convulsive Disorders be scheduled and managed for Outpatient Surgery?
First or Early Case for optimal observation w/ 4-8 hrs Post-Op
What should be evaluated for pts w/ Cystic Fibrosis needing Outpatient Surgery?
Pulmonary Function
Pts w/ Morbid Obesity are acceptable candidates for Outpatient Surgery if they are which ASA Class?
ASA I & II - all others should be inpatient
What makes a pt w/ Sickle Cell Disease a candidate for Same Day Surgery?
No Major Organ Disease
No crisis in the last year
Compliant
What conditions make pts unacceptable for Same Day Surgery?
ASA III or IV
Active Drug/ETOH Abuse
Psych Problems
Uncontrolled Disease
New/Untreated OSA
Isolation
Need for IV Post-Op Pain Control
For Same Day Surgery, how recent should the documented H&P be?
Within 30 days or 72 hrs for High Risk Patients
For SDS, Lab values are good within 60 days of surgery, but the potassium level should aat least be within ____ days
For SDS, Lab values are good within 60 days of surgery, but the potassium level should aat least be within 7 days
How should a pt on Coumadin be managed for SDS?
If Held - 4-5 day minimum
Draw PT Morning of Surgery
Restart 1-7 Days Post-Op
What should be done if a child comes in for SDS w/ symptoms of an Upper Respiratory Tract Infection?
Reschedule surgery 4 weeks later
When is surgery appropriate for a child w/ an Upper Respiratory Tract Infection?
If kid is older than 1, Asymptomatic with no other problems, and the surgery is not in the Thorax or Abdomen
What are the top 2 Post-Op complications that would result in Inpatient Admission?
N/V & Excessive Pain
What is Phase I Post-OP?
Stable VS
No Resp. Problems
Can Protect Airway
Alert & Oriented
What is Phase II Post-Op?
Ambulation
Caregiver Present
Min. Bleed
Pain Controlled
Min. N/V
Voiding
Oral Intake
When does a MAC become a General?
Prolonged Airway Manipulation
Which type of Anesthesia carries a higher incidence of Brain Damage or Death?
MAC
What is considered Deep Sedation?
Unable to be easily aroused
Responds to Painful Stimuli
May need help maintaining patent airway
CV Function unaltered
What is consdered Minimal Sedation?
Cognitively impaired, but can respond verbally
Resp. & CV Unaltered
What is Moderate Sedation?
Can be directed to an RN by MD performing procedure, but depth should not cause loss of protective reflexes
What can be the cause of Delayed Awakening in the PACU?
Prolonged Anesthetics
Metabolic Causes
Neuro Injury
What are causes of Hypotension in the PACU?
Hypovolemia - most common
Hypothermia - vasoconstriction
Sepsis, Acidosis, Hypoxemia
LV Dysfunction
What can cause PACs and PVCs in the PACU?
Hypomagnesemia
Hypokalemia
↑Sympathetic Tone
Myocardial Ischemia
What is used to treat Post-Op Laryngospasms?
Positive Pressure
&
Succinylcholine 0.1mg/kg
What is the Positioning for a D&C?
Dorsal Lithotomy w/ < 40 degree Abduction
What meds can be given to limit blood loss during a D&C?
Methylergonogvine (Merthergine) 0.2mg IM
&
Oxytocin 10-20u IV
What are some causes of Severe Post-Op Bleeding from a D&C?
Cervical Injury
Uterine Atony
Uterine Perf
Retained Conception Products
How is a Hysteroscopy done?
Tenaculum secures Cervix for Hysterscope
Distend w/ NS, Sorbitol, Mannitol, or CO2
What are some considerations when using CO2 for Distension?
Use < 1200 mL/min flow
Keep Intrauterine Pressures < 200 mmHg
Expect Shoulder Pain
What’s an adequate level of block for a Hysteroscopy?
T10 Sensory
What kind of airway should be used for Dental Surgeries?
Nasotracheal Tube
What happens if the Lingual Nerve is damaged during a tooth extraction?
Tongue Numbness
What happens if the Inferior Alveolar Nerve is damaged during a Surgical Tooth Extraction?
Lip Numbness
What is one of the major concerns w/ Shoulder Arthroscopy?
Major Pain
Should use Interscalene Block w/ GA, which can cause Horner’s Syndrome
What are the concerns when positioning a pt in a Sitting Beach Chair position for Should Arthroscopy?
Air Embolism
&
Severe Postural Hypotension
What should be avoided w/ Tonsilectomies & Adenoidectomies?
Avoid Nasal Airways to decrease bleeding risk
When should Tonsielectomies & Adenoidectomies be postponed or rescheduled?
If pt comes has symptoms of Upper Respiratory Infection - fever, nasal secretions, purulent sputum
What are problems associated with using a GAG?
ETT Kinks, Obstructions, BBS, or Dislodgement
What should the Post-Op positioning be after a Tonsillectomy or Adenoidectomy?
Lateral w/ Head Down - Tonsilar Position
What is the positioning for a T&A?
Supine w/ Shoulder Roll & Arms Tucked
Possibly Reverse TBerg
What are Post-Op complications of T&As?
Laryngospams
Bleeding
Retained Throat Pack
Postobstructive Pulm. Edema
What is the most common complications of Knee Arthroscopies?
Hemarthrosis
