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Principles I > Pre-Anesthesia Assessment (including CV) > Flashcards

Pre-Anesthesia Assessment (including CV) Flashcards

1
Q

Identify the Major goals of the pre-anesthesia evaluation

A
  • optimize pt care and satisfaction
  • reduce periop morbidity/mortaity
  • minimize surgical delays/cancelations
  • determine ideal postop pt disposition (home, Inpatient, ICU)
  • evaluate pt health status and preop testing needs
  • formulate a plan (can obtain consent)
  • ensure time efficient, cost effective pt evaluation
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2
Q

what are pros of a dedicated pre-op clinic (PAT)

A
  • overall saves money
  • one stop shop
  • pt registered, teaching, consults, diagnostic testing
  • reduced anxiety
  • reduced cancellations
  • reduce length of hospitalizations (shift to out pt sx)
  • reduce wasteful diagnostic testing

-

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3
Q

what are cons of a dedicated pre-op clinic (PAT)

A
  • another appointment to make
  • time consuming
  • transportation problems
  • not very private area
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4
Q

why look at the medical record if you can interview the pt

A
  • the record provides the basis for direction of the pt interview and physical assessment
  • it does this by providing an insight into the pt’s past and present med hx
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5
Q

outline the elements of a pre-anesthesia interview

A
  • current problems
  • current meds
  • allergies
  • ETOH/tobacco/ illicit drug use
  • anesthesia problems (past)
  • Family Hx (and r/t anesthesia)
  • A ROS with emphisis on
  • –CV, lungs, renal, GI, endocrine, hematological, general activity level, psych, dermatological, pregnancy, airway issues
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6
Q

outline the elements of the pre-anesthesia Physical exam

A 
Vital signs
Airway
Heart
Lungs
Extremities 
Neuro
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7
Q

ASA I give description and examples

A
  • a normal healthy pt
  • pt for a
  • bunion repair
  • hernia repair
  • lumpectomy
  • asymptomatic fibroids
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8
Q

ASA II give description and examples

A
  • a pt with a MILD systemic disease that results in NO FUNCTIONAL LIMITATIONS
  • well controlled HTN
  • well controlled Asthma
  • Well controlled DM
  • Mild obesity
  • cigarette use (unless dr. mcd ask)
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9
Q

ASA III give description and examples

A

-a pt with a SEVERE systemic disease that results in FUNCTIONAL LIMITATIONS
-Poorly controlled HTN
-Poorly controlled asthma
-poorly controlled DM
-COPD
-AF with control
-CVA
O2 SATURATION 90-93%

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10
Q

ASA IV give description and examples

A
  • a pt with SEVERE systemic disease that is a CONSTANT THREAT TO LIFE
  • unstable angina
  • CHF
  • debilitating resp disease
  • O2 SATURATION ,90% AT REST
  • hepatorenal failure
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11
Q

ASA V give description and examples

A
  • a MORIBUND pt who is not expected to survive without the operation
  • uncontrolled hemorrhage from ruptured AAA
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12
Q

ASA VI give description and examples

A

-a pt decleared brain dead for organ donation

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13
Q

ASA E give description and examples

A
  • any pt whome an emergency operation is required
  • acute trauma
  • emergent c-section
  • ruptured appy
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14
Q

Evaluation of the CV system includes the determination of what 4 things

A

1) pre-existing CV disease (HTN, Ischemic valve disease, valular dysfunction, etc)
2) disease severity, stability, and prior treatments
3) comorbidities (DM, PVD, COPD)
4) the type of sx being performed

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15
Q

a standard means of categorizing the degree of CV disability is the what

A

New York Heart Association classification

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16
Q

how many classes are in the NYHA class

A

4

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17
Q

NYHA class I

A
  • pt’s with cardiac disease

- NO FUNCTIONAL LIMITATIONS to physical limitations

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18
Q

NYHA class II

A
  • pts with cardiac disease who are comfortable at rest
  • SLIGHT functional limitations to physical activity
  • ORDINARY activity results in fatigue
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19
Q

NYHA class III

A
  • pts with cardiac disease resulting in MARKED LIMITATIONS to physical activity
  • LESS than ordinary activity results in fatigue
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20
Q

NYHA class IV

A
  • pts with the INABILITY TO CARRY ON ANY PHYSICAL activity

- symptoms of CV insufficiency are PRESENT AT REST

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21
Q

guidlines for ordering pre-anesthesia lab test

A
  • cost effective
  • positive benefit risk ratio
  • ready for evaluation prior to sx
  • test should yeild information that can’t be obtained from h&p
  • abnormal results in asymptomatic pts would influance pt and anesthesia care
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22
Q

men > 40-50 yo should have what prior to sx

A

ECG

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23
Q

women < 40 yo should have what prior to sx

24
Q

Men and women 50-64 yo should have what test prior to sx

25
Q

Men and women 65-74 should have what test prior to sx

A

H/H
BUN/ Creat
Glucose
ECG

26
Q

men and women > 74 should have what test prior to sx

A 
H/H 
ECG
BUN/ Creat
Glucose
CXR
27
Q

what is the main question we ask to asses for CV health

A

Activity tolerance

28
Q

*** where are the most points earned on the goldman critera

A

S3 gallop or JVD (11points)

next is MI in past months with 10

29
Q

brisk walking 3-5 mph or walking up stairs is what METS

30
Q

what are 3 pre-operative risk factors for CV related problems while under anesthesia

A

Smoking
DM
HTN

31
Q

Characteristics of TRUE angina

A

retrosternal diffuse pain
Lt arm, Jaw, Back
aching dull pressure or squeezing

32
Q

what are thought to be but are probally not true angina signs

A 
Lt inframam localized pain
Rt arm pain
sharp, cutting, shooting
seconds, hours, days
increase with respiration, motion
very nonspecific
33
Q

Cardiac causes of chest pain

A 
CAD
Aortic valve disease
pulm htn
MVP
pericarditis
IHSS
34
Q

Pulmonary causes of chest pain

A

PE
PNE
pleuritis
pneumothorax

35
Q

musculoskeletal causes of chest pain

A

costochondritis
arthritis
muscular spasm
Bone tumor

36
Q

GI causes of chest pain

A 
ulcer disease
bowel disease
hiatial hernia
pancreatitis
cholecystitis
37
Q

Vascular causes of chest pain

A

aortic dissection

38
Q

Emotional causes of chest pain

A

anxiety

depression

39
Q

what is the most reliable indicator of how a pt will tolerate GA

A

their description of exercise tolerance (METS)

40
Q

what is HTN criteria

A

normal 160 or >100

41
Q

what extracts the largest amt of 02 in the body

42
Q

Myocardial demand consumption is affected most by what

A

contractility

43
Q

The heart uses this ______ for energy to produce a contraction?

44
Q

what is the most important factor in maintaining balance between supply and demand

45
Q

what affects supple in the heart

A

hr
O2 content in blood
Coronary perfusion

46
Q

What affects demand in the heart

A

HR
contractility
Afterload
Preload

47
Q

Why do we monitor lead II

A

rate/rhythm/ PVCs

48
Q

why do we monitor lead V5

A

ST elevation

49
Q

where is lead V5 supose to be placed

A

slightly lateral and under left breast

50
Q

***** who needs endocarditis prophylaxis

A

Artificial heart valves
Hx on endocarditis with valve dysfunction
Hx of partial or total repair of VSD

51
Q

***** who no longer needs endocarditis prophylaxis

A

MVP
Hypertrophic cardio myopathy
rhumatic fever

52
Q

**myocardial DEMAND O2 comsumption is most affected by what

A

contractility

53
Q

STOP BANG for sleep apnea

A 
Snoring (do you)
Tired (feel tired)
Observed (seen stop breathing)
BP (HTN)
Age (>50)
Neck circumference (> 40cm)
Gender (male)
54
Q

with the STOP BANG what score indicates a high risk? and what indicates a low risk

A

high- yes to 3 or more

low- yes to < 3

55
Q

how much wood could a wood chuck chuck if a wood chuck could chuck wood?

A

a wood chuck could chuck as much wood as a wood chuck could chuck if a wood chuck could chuck wood

56
Q

How to treat MH

A 
diagnose early 
stop the trigger
call staff
dantrolene
IV fluids
ice
treat dysrythmias

Principles I (7 decks)

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