Pre-operative management Flashcards
Elements of informed consent
1) nature of potential risks: more common and more serious risks require disclosure
2) nature of the proposed procedure: complex interventions require more information as do procedures when the patient has no illness
3) the patient’s desire for information: patients who ask questions make known their desire for information and they should be told
4) temperament and health of the patient: anxious patient and patients with health problems or other relevant circumstances that make a risk more important for them may need more information
5) general surrounding circumstances: the information required for elective procedures might be different from that required in the emergency department
Pre-operative assessment
Goals of pre-operative assessment:
1) identify important medical issues in order to
- optimise treatment
- inform pt of the risks associated with surgery
- ensure care is provided i an appropriate environment
2) to identify important social issues which may have a bearing on the planned procedure and the recovery period
3) to familiarise the pt with the planned procedure and the hospital processes
incl: careful hx and pe
Patient factors which indicate the use of abx prophylaxis even if not usually used for the procedure
1) immunosuppressed pt
2) pre-existing implants and pt at risk for developing infective endocarditis
Must receive appropriate prophylaxis even if not usually indicated in procedure
Definition of procedures: Clean clean-contaminated contaminated dirty
1) Clean - no contamination, gastrointestinal, genitourinary or respiratory tracts not breached
2) clean-contaminated - gastro, rest tract opened but without spillage
3) contaminated - acute inflammation, infected urine, bile, gross spillage from gastrointestinal tract
4) dirty - established infection
DVT prevention - what is used?
1) graduated compression stockings - reduce venous pooling in lower legs
2) heparin - used in un-fractionated form or as one of the newer fractionated LMW derivatives
the fractionated LMW derivatives have the convenience of OD dosing but the anticoagulant effect cannot be easily reversed. If reversal is important the std un-fractionated forms must be used.
3) mechanical calf compression devices: work by intermittent pneumatic calf compression and encourage venous return
Diabetes mellitus - management prior to surgery
1) oral hypoglycaemic agents
2) insulin dependent diabetics
1) oral hypoglycaemic agents should be ceased the night before surgery
2) insulin dependent diabetes - start IV insulin infusion
a) variable rate insulin infusion - blg monitored regularly and rate of infusion adjusted - infusion of dextrose is continued throughout the period of insulin infusion
b) single infusion of glucose and insulin and potassium - advantage of simplicity it is not possible to adjust the rates of glucose and insulin infusion separately and the technique can lead to the administration of excessive amounts of free water
Without the use of prophylaxis the risk of DVT in pt undergoing and anterior resection for rectal cancer is likely to be at least a 10% b 20% c 30% d 50%
d
which of the following measures is most likely to reduce the risk of post-operative wound infection with MRSA?
a 5 days of broad spectrum prophylactic abx
b ensuring the pt showers with chlorhexadine wash prior to surgery
c a policy of staff hand washing between puts
d screening pts for RSA carriage prior to surgery
c
which of the following consitute the legal std of the information that should be passed to a pt to meet the requirements of ‘informed consent’?
a what a patient in that position would regard as reasonable
b what a reasoned body of medical opinion hold as reasonable
c a list of all possible complications contained within a pt information booklet
d all serous complications that occur in more than 1% of pets
a
