Perioperative Management Flashcards
What are four attributes to reducing peri-op morbidity
have awareness of the patients physical and medical state
allows the provider to make adjustments to the care plan based on the patients presentation
allows the provider to anticipate and prepare for adverse events
eliminate or minimize surprises
What does ASA II mean
mild systemic controlled disease
What does ASA III mean
severe disease but not incapacitating
What does ASA IV mean
severe disease, that is a constant threat to life
What does ASA V mean
moribund, not excessive to lived 24hrs
What seven things make up the patient presenation
CC history of present illness medical history review of systems physical exam impressions/diagnosis treatment plan
Don’t forget this regarding the med history
herbals and OTC medications
When reviewing the systems what is there to look for regarding the head
headaches
nausea/vomiting
swelling/asymmetry
When reviewing the systems what is there to look for regarding the eyes
changes to vision
redness
excessive tearing/watering
When reviewing the systems what is there to look for regarding the ears
hearing loss
tinnitus
vertigo
When reviewing the systems what is there to look for regarding the nose
stuffiness/difficulty moving air
sneezing
epistaxis
When reviewing the systems what is there to look for regarding the throat
pain
hoarseness
sore throat
When reviewing the systems what is there to look for regarding the neck
impaired mobility
pain
When reviewing the systems what is there to look for regarding the heart
angina syncope paroxysmal nocturnal dyspnea palpitations hypertension
When reviewing the systems what is there to look for regarding the pulmonary system
dyspnea orthopena wheezing cough hemoptysis sputum asthma bronchitis URI smoking
When reviewing the systems what is there to look for regarding the GI
dysphagia dyspepsia pain nausea/vomitting diarrhea hematochezia; bloody stool steatorrhea; fatty stool puritis fatigue melena
When reviewing the systems what is there to look for regarding the genitourinary system
urgency to void
frequent voiding
pain upon voiding
fluid overload
When reviewing the systems what is there to look for regarding the hematopoietic system
petechiae
spontaneous bleeding
bleeding inappropriate to the injury
easy bruisabiliy
When reviewing the systems what is there to look for regarding the endocrine system
diabetes; hypoglycemia is worse thyroid adrenal paraythroid Cushing's pheochromatoma
When reviewing the systems what is there to look for regarding the neurologic system
headaches diplopia seizures weakness memory loss
When reviewing the systems what is there to look for regarding the MS system
pain impaired mobility
joint swelling
aching
cramping/numbness
At the time of procedure, a note stating what should be made
that there are no changes to the pre-op evaluation should be made
This is a request to a specialist for assisting in the management of a patient
consultation
What may a consultation entail
information
recommendations
opinions
request for treatment by the consult
True or False
The fact that you don’t know something can’t be an excuse for a negative outcome
True
What are the four purposes of post-op instruction
prepare patient for expected course
identify potential complications
provide reference and point of contact
make no assumptions
What kind of pain is expected post-op
mild to moderate pain, which increases with flap and bone removal
How do you manage post-op pain
with OTC analgesics and appropriate drugs
Can the asthmatic patient take ibuprofen
No, its an NSAID
How much swelling is expected post-op simple extraction
little or none
How much swelling is expected post-op flaps or bone removal
little to substantial
What are the directions for icing swelling post-op
15 mins on 15 mins off for 24 hours
How long should you keep your head eleven post-op
24 hours
How much bleeding is expected post-op
minimal
When should bleeding stop post-op
24-48 hours
What can be used if bleeding persists
gauze pressure to surgery site for 20 minutes
The key to bleeding management is what
to have it stopped before the patient leaves the office
Are post-op antibiotics warranted in a healthy patient
No
True or false
In some patient prophylactic and continuing antibiotics are appropriate
True
Which instances are indicative of prophylaxis
heart valves cyanitis heart disease transplants joint replacement metallic implants
Avoid doing the the first day post-op
rinsing
How should you brush around the surgical site
gently, rinsing gently the first day
good oral hygiene will help healing
Rinse the mouth with this several times a day beginning the DAY AFTER SURGERY
warm saltwater
What is the diet post-op
soft, cool, foods for the first day
chewing gently in the area afterwards
Do not do these after surgery regarding diet
use straws
suck on food, candy or wound
What is the recommendation about exercising after surgery
avoid vigorous exercise on the day of surgery
may resume usual activity as tolerated after (few days for simple, several days+ for surgical)
This condition is when there is an increase in pain 3-5 days post-op and no improvements 3-5 days post-op
dry socket
What is the hallmark of dry socket
worsening taste or odor in mouth
True or False
you can diagnose dry socket over the phone
False; they must come in for a consult
The patient MUST be able to do this
contact someone
