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Pre, Peri and Post-Operative Care > Pre-Operative Assessment > Flashcards

Pre-Operative Assessment Flashcards

1
Q

What examinations are performed prior to surgery

A
  • General examination to determine health of patient

- Airway exam be anaesthetists

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2
Q

What grading system is used to determine someones risk with intubation

A

ASA (American society of anesthesiologists)

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3
Q

what is ASA I

A

Healthy Patient

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4
Q

what is ASA 2

A

Mild Systemic Disease

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5
Q

what is ASA 3

A

Severe Systemic Disease

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6
Q

what is ASA 4

A

Severe Systemic Disease that is a constant threat to life

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7
Q

what is ASA 5

A

Would not survive without the operation

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8
Q

what is ASA E

A

Emergency Procedure

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9
Q

give examples of a minor surgery

A

Skin lesion excision

Incision and drainage or abscess

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10
Q

what two investigations may be ordered in minor surgery

A

ECG

U+E

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11
Q

when is U+Es required for minor surgery

A

Risk of AKI

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12
Q

when is ECG required for minor surgery

A

Not had an ECG in past 12-months

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13
Q

Give examples of intermediate surgery

A
  • Inguinal hernia repair
  • Tonsillectomy
  • Excision varicose veins
  • Knee arthroscopy
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14
Q

What investigations may be ordered for ASA 2 in intermediate surgery

A

ECG

U+E

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15
Q

When are U+Es ordered for intermediate surgery

A

CKD, Risk AKI

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16
Q

When is an ECG ordered in intermediate surgery

A

CVD

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17
Q

What tests may be ordered for ASA 3 or 4 in intermediate surgery

A
  • FBC
  • Coagulation studies
  • ABG and Lung Function Tests
  • U+E. always
  • ECG = always
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18
Q

When is FBC ordered

A

ASA 3/4 and CVD or Renal Disease

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19
Q

When are coagulation studies ordered

A

ASA 3/4 and chronic liver disease or taking anti-coagulants

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20
Q

When are ABG or LFTs ordered

A

ASA 3/4 and rest disease

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21
Q

What counts as a major surgery

A

TURP
Hysterectomy
Thyroidectomy
Joint replacement

22
Q

what is ordered if blood loss is expected in the surgery

A

Group and Save, Cross-Match

23
Q

what tests are ordered in all female patients prior to surgery

A

Pregnancy Test

24
Q

when is a sickle cell test ordered pre-operatively

A

Afro-Carribean Patients with a History of Sickle Cell

25
Q

when are MRSA swabs ordered

A

All patients

26
Q

how long should patients stop eating prior to surgery

A

6 hours

27
Q

how long should patients stop the intake of clear fluids

A

2 hours

28
Q

what is a mnemonic to remember drugs to stop prior to surgery

A

CHOW

29
Q

what drugs should be stopped prior to surgery

A

Clopidogrel
Hypoglycaemic
Oral contraceptive
Warfarin

30
Q

how long before surgery is clopidogrel stopped

A

7-days

31
Q

how long is COCP and HRT stopped prior to surgery

A

4 Weeks

32
Q

why is COCP stopped prior to surgery

A

Due to increased VTE risk

33
Q

how long is warfarin stopped prior to surgery

A

5-days

34
Q

if warfarin is stopped what is it bridged with

A

LMWH

35
Q

how long prior to surgery is LMWH stopped

A

24h

36
Q

what INR is required for surgery to proceed

A

< 1.5

37
Q

what should SC insulin regimens be changed to prior to surgery

A

Variable rate infusion insulin

38
Q

if a patient is on long-term steroids, should these be stopped and why

A

Continue steroids as otherwise on stopping can cause addisonian crisis

39
Q

what should all patients have prior to surgery

A

VTE Risk assessment

40
Q

how long following surgery are individuals given LMWH for

A

28 days

41
Q

what are individuals given in addition to LMWH

A

TED Stockings

42
Q

in addition to VTE, what else may be prescribed in surgery

A

Antibiotic prophylaxis

43
Q

how long should patients be advised to stop smoking prior to the operation

A

2 months

44
Q

explain corticosteroids during surgery

A

Continue corticosteroids - as stopping corticosteroids can risk addisonian crisis

45
Q

in diabetic patients what should be measured prior to surgery

A

HbA1C

46
Q

in what HbA1c should the surgery be delayed

A

> 69

47
Q

where should diabetic patients be put on the surgery list

A

First patients - as they are kept NBM overnight

48
Q

in T1DM, what is done the night before surgery

A

Given 1/3 of their SC dose of insulin

49
Q

in T1DM, what should be done the morning of surgery

A

SC insulin is switched to IV variable infusion rate insulin

50
Q

what is a sliding scale of insulin

A

50 Units actarapid in 49.5 ml Saline

51
Q

how much dextrose should be given if NBM

A

5% Dextrose at a rate of 125ml/h

52
Q

how often are BM’s checked

A

Every 2-hours

Pre, Peri and Post-Operative Care (4 decks)

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