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Surgery > Pre-op H&P > Flashcards

Pre-op H&P Flashcards

1
Q

What is the goal of a pre-op H&P?

A

Reduce complications

Health care costs

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2
Q

Role of Medical Consultant Prior to Surgery

A 
Define co-morbidities
Evaluate severity of co-morbidities
Optimize all medical conditions
Provide surgical risk assessment
Recommend peri-op measures to reduce risk
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3
Q

Surgical Physiology

A 
Peripheral dilation
Reduced myocardial contractility
Decrease in tidal volume
Epi & norepi elevated
Cortisol elevated
ADH elevated
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4
Q

Complete ROS with Special Attention to

A

Undiagnosed or inadequately controlled chronic disease
Cardiac & pulmonary
Bleeding disorders
Hx of DVT

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5
Q

What all needs to be included in the medication history of a pre-operative patient?

A 
Anticoagulants
Aspirin
NSAIDs
Echinacea
Ginsent
Garlic
Gingko
St. John's Work
Kava
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6
Q

Effects of Echinacea Important for Surgery

A

Hepatotoxicity

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7
Q

Effects of Ginseng Important for Surgery

A

Platelet inhibitor

Hypoglycemia

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8
Q

Effects of Garlic Important for Surgery

A

Platelet inhibitor

Preload reduction

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9
Q

Effects of Gingko Important for Surgery

A

Platelet inhibitor

Alters vasoregulation

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10
Q

Effects of St. John’s Wort Important for Surgery

A

Up-regulates P450

Drug-drug reactions

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11
Q

Effects of Kava Important for Surgery

A

Potentiates sedation

Drug-drug reactions

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12
Q

Important Factors of Functional Status

A

Exercise tolerance

Activity level

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13
Q

Lee Index Risk Factors for Major Cardiac Complications

A 
High-risk surgery
Hx of ischemic HD
Hx of congestive HF
Hx of stroke/TIA
Insulin-dependent DM
Serum Cr >2 mg/dL
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14
Q

Major Cardiac Complications with Lee Index

A 
MI
Pulmonary edema
V-fib
Primary cardiac arrest
Complete heart block
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15
Q

When is noninvasive cardiac testing performed?

A

Intermediate clinical predictor
Poor functional capacity
High risk surgery

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16
Q

Examples of Intermediate Clinical Predictors

A

Class 1 or 2 angina
Prior MI or pathologic Q waves
Compensated or prior HF
DM

17
Q

Management of Low Risk Patient with CAD

A

4-5% risk of major cardiac complication
Considered for prophylactic revascularization if indications for revascularization exist independent of non cardiac surgery
Preoperative anti-anginal meds should be continued
Prophylactic IV nitro may reduce ischemia

18
Q

Evaluation of High Risk Patient with CAD

A

Surgery delayed until CAD is treated

Delay surgery 3-6 months of recent MI

19
Q

What do you need to know with a CHF patient for surgery?

A

Ejection fraction

20
Q

How is decompensated CHF indicated?

A

Elevated JVP
Audible 3rd heart sound
Evidence of pulmonary edema on exam or CXR

21
Q

Pre-op Necessities with CHF Patients

A

Pre-op control of CHF
Electrolytes & digoxin levels
Anesthesiologist & surgeon aware of severity of CHF

22
Q

Valvular HD & Pre-op Evaluation

A

Echo to determine nature & severity of disease

Severe systemic aortic stenosis are high risk for complications

23
Q

Arrhythmias & Pre-op Evaluation

A

Determine any arrhythmias
A-fib: control with Lovenox window
Symptomatic SVT & VT should be controlled
Indications for pacemaker: placed prior to surgery

24
Q

HTN & Surgery

A

Should be controlled prior to surgery

25
Q

Pulmonary Evaluation & Surgery

A

Highest risk in cardiac, thoracic, & upper abdominal surgery
Patient specific factors associated with increased risk
Highest risk: FEV1 less than 500 mL or arterial pCO2 >45 mmHg
Well controlled asthma?

26
Q

Pulmonary Evaluation: Patient Specific Factors Associated with Increased Risk

A

Chronic lung disease
Morbid obesity
Tobacco use

27
Q

Peri-operative Management of Patients with Lung Disease

A

DVT prophylaxis

Antibiotics

28
Q

Bleeding Risk Assessment

A

History

Hx unavailable: PT, PTT, platelet count, & bleeding time

29
Q

2 Most Common Serious Neurologic Problems After Surgery

A

Acute delirium

Stroke

30
Q

DM & Surgery

A

Increased risk of infection & MI
Regulation of blood sugar
CMP measured & corrected prior to surgery

31
Q

Hypothyroidism & Surgery

A

Severe symptomatic should be corrected

Mild or asymptomatic generally okay

32
Q

Risk of Renal Disease & Surgery

A

Peri-operative complications: hyperkalemia, pneumonia, & fluid overload
Dialysis 24 hours prior to surgery
Monitor volume status closely

33
Q

Medication Recommendations & Surgery

A

Most Rx meds continued morning of surgery
ACEI & diuretics withheld day of surgery
DM: No oral hypoglycemics day of surgery
Discontinue herbals 2 weeks prior
Refrain from ASA, NSAIDs, & Plavix 2 weeks prior
Warfarin: use lovenox window
USE BETA-BLOCKERS

Surgery (20 decks)

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