preop evaluation (Mod 5) Flashcards

1
Q

Know the American Society of Anesthesiologist physical status system (ASA PT) table

A

Adding E denotes an emergency

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2
Q

have to be able to classify MET score, but don’t have to calculate it (slide 16)

A
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3
Q

What is the purpose of the pre operative assessment?

A

To identify medical conditions that may adversely affected by the administration of anesthetic meds

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4
Q

What part of the med history especially noted from a patient history?

A

symptoms and diseases related to cardiovascular, respiratory, and neuromuscular systems bc they directly influence the anesthetic

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5
Q

What is Functional Capacity?

A

A predictor of post op cardiopulmonary or neurocognitive complications

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6
Q

What is defined as a poor exercise tolerance?

A

</= 4 METS

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7
Q

What is exercise capacity measured by?

A

Metabolic equivalents (MET)

  • 1 MET = Consumption of 3.5 ml oxygen/kg/min of body weight
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8
Q

How much is 1 MET equivalent to?

A

1 met = consumption of 3.5 ml oxygen/kg/min of body weight

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9
Q

American Society of Anesthesiologists Physical Status (ASA PS) 1?

A

A fit and healthy patient (healthy, nonsmoking, exercise daily)

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10
Q

American Society of Anesthesiologists Physical Status (ASA PS) 2?

A

A pt with mild systemic illness

  • Mild disease without substantive functional limitations
  • Current smoker, obesity, well controlled DM/HTN, mild lung disease, milkd lung disease
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11
Q

American Society of Anesthesiologists Physical Status (ASA PS) 3

A

A pt with severe systemic disease, substantive functional limitations.

  • one or more moderate to severe diseases
  • i.e uncontrolled HTN, DM with vascular issues, pervious MI, COPD, Reduced EF
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12
Q

American Society of Anesthesiologists Physical Status (ASA PS) 4

A

A pt with severe, systemic disease that is a constant threat to life

  • CHF, Renal or hepatic failure, unstable angina
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13
Q

American Society of Anesthesiologists Physical Status (ASA PS) 5

A

Moribund pt who is expected to die without surgery

  • Ruptured AAA, PTE, Increased ICP, multi organ failure
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14
Q

American Society of Anesthesiologists Physical Status (ASA PS) 6

A

Brain dead

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15
Q

What is a good predicator of post op cardiopulmonary or neurocognitive complications?

A

Functional capacity (or incapacity)

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16
Q

Which patients are most at risk throughout the perioperative period?

A

Those who had a recent MI and those with unstable angina

  • Any Coronary Artery Disease (CAD) really
17
Q

Levels of Canadian Cardiovascular Society (CCS) Classification of Angina?

A

4, with decreasing level of activity with risk of causing severity

18
Q

CCS Functional Classification of Angina: Class 1?

19
Q

CCS Functional Classification of Angina: Class 2?

20
Q

CCS Functional Classification of Angina: Class 3?

21
Q

CCS Functional Classification of Angina: Class 4?

22
Q

The New York Heart Association Functional Classification of Heart Failure (NYHA) classification?

A

4 classes that assess discomfort with physical activities that shows general signs of SOB and fatigue that would point towards CHF

23
Q

The New York Heart Association Functional Classification of Heart Failure (NYHA) classification: 1

24
Q

The New York Heart Association Functional Classification of Heart Failure (NYHA) classification: 2

25
The New York Heart Association Functional Classification of Heart Failure (NYHA) classification: 3
26
The New York Heart Association Functional Classification of Heart Failure (NYHA) classification: 4
27
what would increase the risk of adverse affect for surgery from the respiratory system side? - Reword
- severe systemic infection or Pneumonia - Upper resp tract infections or hyperactive airways may require several weeks to normalize before assessment
28
What affect does smoking have on the respiratory system
- Increases risk of hypertension, tension, and PVD - Decreases clearance of pulmonary secretions - promotes bronchitis and exacerbates asthma…leading to development of COPD - Increases risk of hypoxemia and impairs wound healing and the immune response
29
What would improve the outcome for smokers periopertvly?
- Quantify smoking history (pack years) - Initiation cessation program 4-8 weeks prior to surgery - At the min, cease smoking for a min of 12-24 hrs prior to help reduce delirious effects of smoking
30
What perioperative respiratory complications are COPD pts most at risk of
- Respiratory depression - Atelectasis - Retained secretions - Pneumonia - Respiratory insufficiency or failure
31
Preoperative care of COPD patients?
- Smoking cessation - Avoidance of bronchospasm via preop bronchodilation via SABAs (also for asthmatics) - Treatment of AECOPD (antibiotics)
32
What is typically performed prior to extensive surgery and why?
Spirometers and ABGs - Resp function deteriotates following upper abdominal or thoracic surgery - Lung detox ration will increase the risk of post op resp complications
33
Assessment of patients at risk for CHF?
Inquire s&s of fatigue: - syncope - dyspnea - orthopnea - paroxysmal nocturnal dyspnea (PND) - and cough And refer to the NYHA classifcation of heart failure