Preoperative Flashcards
Health care proxy-
who will represent them in case of emergency-name a health care agent to carry out those wishes if you cannot.
Admission Documentation
Age- accurate birth date
Religion- for AM admits we ask if they would like to see a chaplain while in the hospital
Mode of transportation- must have a responsible party to drive them home
Vs,
ht,
wt (anesthesia, analgesics weight based)
Health Care Proxy vs Living Will
Statement by the patient appointing someone to manage health care treatment decisions. You can do this in the hospital no lawyer is needed.
vs
Document prepared by the patient & Lawyer providing specific instructions about what medical treatment the patient chooses to accept or refuse if the patient is unable to make such decisions. CANNOT CHANGE YOUR MIND must go through a lawyer.
MOLST-The Medical Orders for Life-Sustaining Treatment (MOLST)
Intended for patients with serious health conditions who:
Want to avoid or receive any or all life-sustaining treatment.
MOLST documents a patient’s goals and preferences regarding
-Resuscitation instructions when the patient has no pulse and/or is not breathing
-Instructions for intubation and mechanical ventilation when the patient has a pulse and the patient is breathing
-Treatment guidelines
-Future hospitalization and transfer
-Artificially administered fluids and nutrition
-Antibiotics
Personal item inventory
Dentures- upper/lower/partial, place name sticker on denture cup
Eyeglasses / contacts- place name sticker on, contacts in sterile NS individual containers marked with pt name and right contact/left
Hearing aid
Walker / cane brought with them
Any prosthesis- leg, eye (tell story of pt losing eye while he was in surgery.
Mark with name sticker and room number.
Valuables given to family or locked up
Essential in EMR
Drugs – what reaction did they have?
Foods-gluten, tomatoes
Soaps (esp. betadine for surgical pts), contact dermatitis
Environmental allergies- dust, plants, grass
LATEX allergy or sensitivity- inquire about fruits/veg in latex family
Red bracelet on pt, and sticker on chart, EMR, MARS
Pre-Admission Diet
Altered d/t illness? NPO status-
History of recent weight loss- gastric bypass, cancer, illness
Diet preferences – Kosher, no pork, vegetarian, cardiac, low Na
NPO or liquid for specific surgery / diagnostic xray study
Alcohol use- anesthesia needs to know, if admitted observe for DT’s ( delrrium tremors)within 72 hrs,
Smoking history- cigarettes/packs per day- NYS guidelines, nurses counsel pts on smoking cessation upon admission, pamphlet
Smoking can increase gastric secretions even though a pt is NPO, incr risk for aspiration. Pt wakes up coughing, mucus.
Social History
Occupation –working or retired
Position in family- responsible financially, or housewife
Who lives in household- post D/C, anyone to help?
Layout of home- esp if they just had orthopedic surgery and have stairs to climb- HT one stair at a time, slowly
Medical History
Previous hospitalizations- document prior surgeries
Serious illness or injury- Diabetes, cancer, renal disorders, bowel disorders, recent cough, rhonchi, or infection?
Family history- including effects of anesthesia
What are some medical conditions that increase a patient risk during surgery?
Obesity
Smoking
Age
Pregnant
Allergies
Social issues
Medical History
Sleep apnea
Anesthesia awareness
Informed Consent
Surgeon obtains pt informed consent
Nurse witnesses signature
Emergency Consent
Surgery Patients on Beta-Blocker Therapy Prior to arrival who Received a Beta-Blocker During the Perioperative Period
Problems to report
to surgeon/anesthesia provider
Consent signed after sedative given
Consent does not correspond to OR schedule or patient statement
Abnormal lab values, Low pulse ox
Temp or VS unstable, infection, rash
Not NPO as required
Delay in giving pre-op med- antibiotic
High state of anxiety
Prophylactic Antibiotic Received Within
One Hour Prior to Surgical Incision
