Preop Evaluation Flashcards
what is one of the most important features of a surgical history?
pain
what is one of the most important aspects of pain?
the patient’s reaction to it
what is a common complaint that is often of no significance?
change in bowel habits
what should be suspecting if a patient presents with intermittent alterations of constipation and diarrhea?
colon cancer
what is the most common error in hematemesis or hematochezia?
assuming hemorrhoids
what is the most frequently acquired nosocomial infection?
UTI
what are 3 pre-op precautions regarding home medications?
continue critical meds with sip of water
do not take ACEI on day of sx
withhold diuretic on morning of sx
when should prophylactic antibiotics be given?
within 1 hour of incision
when are prophylactic antibiotics normally discontinued?
< 24 hours after surgery
in which 4 operative conditions are prophylactic antibiotics continued for longer in?
GI tract
implantation of foreign body
contaminated wounds
immunocompromised patients
in which operative case is a cephalosporin usually given as a pre-op antibiotic and discontinued within 24 hours post-operatively?
elective hernia repair
right-sided colectomy
left-sided hemi-colectomy
pulmonary repair d/t thoracic stab wound
bilateral mastectomy with overlying cellulitis
elective hernia repair
classify: healthy patient with no systemic disorder
class I
classify: mild to moderate systemic disorder that need not be associated with the surgical problem
class II
what is a major cause of morbidity and mortality in surgical patients?
cardiovascular complications
what are 6 independent predictors of cardiac complications?
hx of ischemic heart disease
CHF
cerebrovascular disease
high risk operation
preop treatment with insulin
preop serum Cr > 2
findings suggestive of ischemic heart disease should be screened by what?
stress test
how long after an MI should surgery be postponed?
> 6 months
patients undergoing which surgery would be best evaluated by the Revised Cardiac Risk Index for risk of perioperative major adverse cardiac event (MACE)?
aortic valve replacement
hip surgery
coronary stent placement
coronary artery bypass grafting
hip surgery
to minimize retained gastric volume and maximize gastric pH before general anesthesia, refrain from drinking clear liquids for at least?
2 hours
before receiving anesthetics or sedatives, avoid eating light meals for at least ____ hours and fatty meals for ____ hours
6
8
what increases the risk for multiple complications after elective surgeries?
hepatic dysfunction
what are the 3 signs of liver failure?
spider telangiectasias
jaundice
prolonged bleeding
what are 2 things used to treat hepatic/liver dysfunction?
vitamin K
fresh frozen plasma
what are the two scoring systems used to assess liver function?
child-turcotte-pugh (CTP) score
Model for end-stage liver disease (MELD)
how to treat worsening encephalopathy due to increased ammonia levels?
lactulose
what does elevated BUN usually indicate?
dehydration
elevated creatinine is correlated with increased _______ in surgery patients
mortality
how to treat post op oliguria?
IV fluids
treatment for severe renal dysfunction? (2)
dialysis
kidney transplant
what are the pre-op positioning rules to protect neuro? (2)
pad pressure points
avoid overstretching joints
high ______ levels have an increased hospital length of stay
Hgb A1c
what is the best option for perioperative glucose control? what is required?
IV insulin
hourly glucose monitoring is required
how to manage a chronically hyperglycemic patient that is frequently dehydrated?
dextrose containing IV solutions while NPO
what are 2 endocrine stress responses to operations?
pain
intravascular volume loss (Na and water retention)
what can a sudden stoppage of steroids cause?
addisonian crisis
what can hyperthyroidism lead to during surgery? hypothyroidism?
thyroid storm
cardiac failure
what 3 medications should be stopped 1 week before an operation?
warfarin
aspirin
NSAIDs
what does pre-op albumin < 3 indicate?
chronic malnutrition
what does pre-op albumin < 16 indicate?
acute malnutrition
