Periop care SA (Kim)

Question 1

Objectives

Answer 1

• know factors needed for eval of pre-op surgical risk
• be able to classifly status of patient
• list and understand principles of common pre-, intr- and post-operative problems

Question 2

pre-op care entails

Answer 2

• signalment
• presenting complaint
• history
• physical exam
• diagnostics
• treatment/stabilization

Question 3

signalment

Answer 3

• age
• gender
• species
• breed

Question 4

presenting complaint

Answer 4

• trauma
• vomiting
• urinary obstruction

Question 5

History

Answer 5

• establish characteristics of signs
• prior diagnostics, treatment, surgery
• concurrent illness
• other
  
  • vaccination/heartworm status
  • travel history
  • diet

Question 6

PE

Answer 6

• complete exam
  
  • general
  • orthopaedic
  • neurologic
• be systematic
• document findings

Question 7

General exam

Answer 7

• mentation
• vital signs
• weight
• hydration status
• auscult, palpate

Question 8

Orthopaedic exam

Answer 8

• ambulation
• swelling, instability
• range of motion
• pain

Question 9

Neurologic exam

Answer 9

• intracranial
  
  • mentation, CN, ocular
• spinal cord/peripheral nerves
  
  • ambulation, proprioception, reflexes, pain sensation
• orthopaedic vs neurologic?

Question 10

Diagnostic lab tests

Answer 10

• Lab test
  
  • PCV/TS/BUM/USG
  • CBC/Chem/UA
  • blood gas analysis
  • coag profile
  • cross-match/typing

Question 11

Diagnostic imaging

Answer 11

• thoracic/abd survey rads
  
  • HBC
• abd ultrasound

Question 12

other diagnostic tests

Answer 12

• EKG
• blood pressure measurement
• SPO2

Question 13

Minimal surgical risk

Answer 13

• little effect of sx
• minimal complications
• likely normal after sx

Question 14

moderate surgical risk

Answer 14

• some potential for complication
• high probability of a successful outcome

Question 15

high surgical risk

Answer 15

• serious problems or procedure associated with moderate probability of complications

Question 16

Extreme surgical risk

Answer 16

• high chance of major complications
• permanent change in health
• sx only if necessary for life

Question 17

ASA Class 1

Desc

Ex

Tests

Answer 17

• Description
  
  • normal patient, no systemic disease
• ex
  
  • elective OHE
• tests
  
  • PCV/TP AZO

Question 18

ASA Class II

Answer 18

• Description
  
  • disease with minimal or no systemic effects
• Ex
  
  • fracture
• Tests
  
  • CBC
  • Chem
  • UA
  • abdominal US

Question 19

ASA Class III

Answer 19

• Description
  
  • disease with sig systemic effects
  • dz that effects sx or anesthesia
• Ex
  
  • anemia
  • liver dz
• tests
  
  • CBC
  • Chem
  • UA
  • abdominal US

Question 20

ASA Class IV

Answer 20

• Description
  
  • severe, potentially life-threatening dz
• Ex
  
  • decompensated heart/renal failure
• Test
  
  • CBC
  • Chem
  • UA
  • blood gas
  • imaging

Question 21

ASA Class V

Answer 21

• Description
  
  • Moribound, not expected to survive 24 hours
• Ex
  
  • severe trauma
  • shock
• Tests
  
  • CBC
  • chem
  • UA
  • blood gas
  • +/- imaging

Question 22

Pre-op Tx/ Stabilization

Answer 22

• IV Access
• Fluid therapy
• Oxygen
• Analgesia
• antihistamines

Question 23

Blood transfusion

Answer 23

• indications
  
  • surgical PCV < 20-25%; > 30% blood loss
• packed cells
  
  • 1 ml/kg inc PCV by 1%

Question 24

Blood products

Answer 24

• fresh whole blood
• packed red cells
• fresh frozen plasma
• frozen plasma
• cyroprecipitate

Question 25

perioperative abx

Answer 25

• given within hours of surgery
• prophylactic: must be given within < 60 minutes but > 30 mins from start of Sx
• to have high conc of abx when wound is exposed
• to avoid cont from skin staph
• administered
  
  • soft tissues: q 2hrs
  • orthopaedics: q 90 minutes
• Do not give over 24 hours out of sx

Question 26

Fasting

Answer 26

• careful with hypoglycemic prone animals
  
  • small
  • liver dz
  • young animals

Question 27

Pre-Op prep

Answer 27

• asepsis
  
  • clip wide
  • appropriate antiseptic
  • sterile draping
  • surgeon aseptic technique

Question 28

Intra-op

Answer 28

• positioning
• anticipate special instrumentation
• anticipate blood loss
• sponge counts/hemostat counts
• anticipate surgical time
• appropriate assistance

*checklist manifesto

Question 29

Post-op care

Answer 29

• Examine patient
  
  • vital signs
  • surgical site
• ancillary monitoring
  
  • bloodwork
  • ABP, CVP, SPO2, EKG, Body weight, urine output, USG

Question 30

Post op check list

Answer 30

• analgesia
• protect wound (E-collar)
• abx?
• sedation?
• fluid therapy?
• O2 therapy?
• ventilatory support?
• on-going wound care?

Question 31

Nutritional support

Answer 31

• oral
• feeding tube
  
  • NE
  • esophageal
  • Gastric
  • Jejunal
• PPN, TPN

*post op patient may have higher calorie needs

Question 32

Nutritional requirement equations

Answer 32

• Basal Energy Requirements: BER
  
  • BER (KCal/day) = 70 x BW^0.75
• Maintenance energy requirement: BER
• MER = BER x factor
  
  • post-surgical: x 1.3, sepsis: x 1.6

Question 33

Nursing care

Answer 33

• Bedding
• Walks
• Physical therapy
• rotate sides
• keep clean and dry
• ambient temp
• bandage care

Question 34

Summary

Answer 34

• collate and assess as much info as reasonably possible
• surgical care begins before surgery
• every patient has basic needs following surgery
  
  • which vary widely according to individual and type of procedure