Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Basic Principles of Anesthesia - CP > Preoperative Evaluation and Anesthesia Documentation > Flashcards

Preoperative Evaluation and Anesthesia Documentation Flashcards

1
Q

purpose of preop evaluation

A

evaluate current physical status and optimize the patient for surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

goals of preop evaluation

A

obtain medical and surgical hx
evaluate the pt and determine the need for preop studies or consults
formulate and deliver safe anesthetic plan
minimize periop morbid/mortality
optimize pt safety and satisfaction
prevent surgical cancellations and delays

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

which standards relate to the preop eval and documentation?

A

standard 2: preanesthesia patient assessment and evaluation
standard 4: informed consent for anesthesia care
standard 5: documentation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what does standard 2 entail?

A

perform and document or verify documentation of a preanesthesia eval of the pt’s general health, allergies, medication hx, preexisting conditions, anesthesia hx, and any relevant diagnostic tests. Perform and document or verify documentation of an anesthesia focused physical assessment to form the anesthesia plan of care

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

anesthesia care documentation

A
  1. name and facility ID number of pt
  2. name all anesthesia professionals involved in the pt’s care
  3. immediate preanesthesia assessment and evaluation
  4. anesthesia safety checks
  5. monitoring of the patient
  6. airway management techniques
  7. name, dosage, route, and time of admin of drugs and anesthetics
  8. techniques used and pt positioning
  9. name and amounts of IV fluids
  10. IV/intravascular lines inserted
  11. any complications, adverse reactions, or problems during anesthesia
  12. status of pt at the conclusion of anesthesia
  13. documentation in a timely and legible manner
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What would be an acceptable modification of the AANA standards?

A

emergency cases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

before the delivery of anesthesia care, the provider is responsible for

A
  1. reviewing the available medical record
  2. interviewing and performing a focused exam of the patient to discuss the medical hx and assess the pt’s physical condition that might affect decisions
  3. ordering and reviewing pertinent available tests and consultations as necessary
  4. ordering appropriate preop meds
  5. ensuring that consent has been obtained
  6. documenting in the chart that the above has been performed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

the record should include documentation of

A
  • patient interview assessing pt and procedure, anticipated dispo, medical, surgical, and anesthetic hx, current meds, allergies, NPO status, advance directives
  • appropriate physical exam
  • objective diagnostic data
  • medical consults
  • ASA
  • the anesthetic plan
  • informed consent
  • appropriate premed and prophylactic antibiotic admin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

essential components of the anesthesia interview

A

BMI, allergies, NPO instructions, meds, previous anesthetics/complications, family hx of MH, possibility of pregnancy, systems review, baseline level of cognition, airway assessment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

BMI - other name, equation

A

Quetelet Index

BMI (kg/m^2) = [weight (pounds) / height (inches)^2] x 703

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Normal range for BMI

A

18.5 - 24.99

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Overweight BMI

A

> 25

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Obese BMI

A

> 30

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Obese class I BMI

A

30-34.99

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Obese class 2 BMI

A

35-39.99

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Obese class 3 BMI

A

> 40

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

preobese BMI

A

25-29.99

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

underweight BMI

A

<18.5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

ask allergies to:

A

drugs, dyes, contrast, latex, foods, and tape

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

things to consider when asking about allergies

A

exaggerated immune response or hypersensitivity?
allergen and the type of reaction
side effects
throat or tongue swelling, difficulty breathing?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

things to consider/ask when asking about anesthetic and surgical histories:

A

previous anesthesia/surgeries: type of surgery, type of anesthesia, date, complications (PONV, MH, difficult intubation, awareness/recall, prolonged wakeup, unplanned postop intubation)
did you receive a letter from anesthesia after your surgery?
prolonged sore throat after surgery?
significant weight gain since last surgery?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

things to ask about history of MH

A

family hx of MH?
did they survive?
have you had genetic testing?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

purpose of NPO guidelines?

A

reduce the risk of aspiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

aspiration

A

accidental inhalation of gastric contents into the lungs = chemical burn of the tracheobronchial tree and pulmonary parenchyma = intense parenchymal inflammatory reaction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

patients typically with longer stomach emptying times

A

diabetics, recent injuries, obesity, abdominal complaints, acid reflux, pregnant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

what do we consider emergency/trauma cases in terms of NPO status?

A

full stomach

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

increased abdominal pressure/ascites puts patients at risk for

A

aspiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

clear liquids recommended fast

A

2 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

examples of clear liquids

A

water, black coffee, tea, pulp free juice, carbonated beverages

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

breast milk recommended fast

A

4 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

formula or cows milk, tea, coffee with milk/cream, full liquids, light meal, gum, sweets recommended fast

A

6 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

full meal, fried or fatty food recommended fast

A

8 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is Selleck’s Manuever

A

straight downward force on the cricoid cartilage and cervical spine
attempts to protect against aspiration
compresses the esophageal lumen between the cricoid cartilage and cervical spine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

how much force is used with the selleck’s manuever

A

30-40 Newtons = 3-4 kg = 6.6-8.8 pounds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

baseline physical exam includes

A

heart/breath sounds, breathing pattern, bruising/scarring, peripheral pulses/edema, vital signs, mental status, sensory/motor deficits, airway

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

airway assessment

A

identify hard and soft palate, tonsil, faucial pillars, and uvula
determine Mallampati class (I-IV)
have patient look at you at chin level, open wide, stick tongue out

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Mallampati Class I

A

faucial pillars, hard and soft palate, and uvula

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Mallampati Class II

A

faucial pillars, soft palate, and partial uvula

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Mallampati Class III

A

soft palate and base of uvula

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Mallampati Class IV

A

hard palate only

41
Q

which class(es) are at greatest chance of a difficult airway?

A

Mallampati III and IV

42
Q

Who typically has TMJ disorders?

A

teeth grinders, gum or fingernail chewers, malocclusion, stress (teeth clenchers), jaw trauma

43
Q

What makes up the temporomandibular joint?

A

where the maxilla and mandible meet, muscles, tendons, and bones
it is a ball and socket joint
used to chew, talk, and yawn

44
Q

Thyromental distance assessment

A

have pt fully extend from the mentum to the thyroid notch (Patil’s test)

45
Q

a short thyromental distance indicates

A

visualization during intubation difficult
more acute angle
less space for the tongue to be compressed by the blade

46
Q

What is a normal thyromental distance

A

3 fingerbreadths
>7 cm = easy intubation
<6 cm = difficult intubation most likely

47
Q

Prayer Sign assessment

A

shows if pt has decreased mobility of joints and cartilage

difficult intubation = unable to put palms flat against eachother

48
Q

cervical spine involvement results in limited _____ motion

A

atlanto-occipital joint

indicates difficult intubation

49
Q

decreased cervical mobility

A

prevents proper positioning for intubation

prevents an optimal view of the glottic opening

50
Q

cervical mobility assessment

A

turn head side to side, touch chin to chest, point chin to ceiling

51
Q

aligning airway axis is called

A

sniffing position

52
Q

teeth assessment

A

good, fair, poor according to visible decay
ask if they have any loose, cracked, or chipped teeth
document which tooth/teeth
note dentures, partial plates, caps, or crowns

53
Q

neck circumference risk for difficult intubation

A

> 45 cm + BMI >40 kg/m^2

54
Q

what is a concern with someone who has facial hair?

A

may not want to shave
difficult mask seal
disguises potential airway problems (short thyromental distance, retrognathia)

55
Q

what should you ask females?

A

LMP, possibility of pregnancy, sexually active

look at facility policy for blood or urine Hcg test

56
Q

which categories of meds should prompt further questioning?

A

anticoags, antidysrhythmics, antihypertensives, beta blockers, bronchodilators, diuretics, opioids, vasodilators

57
Q

which meds should patients generally take day of surgery?

A

beta blockers, GERD meds, Ca+Ch blockers, bronchodilators, antiarrhythmics, steroids, diuretics, antipsychotics, thyroid meds

58
Q

which meds should patients generally hold day of surgery?

A

oral hypoglycemics, ACE inhibitors, ARBS, diuretics used for HTN, herbal supplements, and anticoagulants per surgeon order

59
Q

which preop conditions should get a CBC prior to surgery?

A

procedures with blood loss, >60, malignancy, radiation therapy, bleeding disorder, CNS disease

60
Q

which preop conditions should get a PT/PTT?

A

hepatic disease, hepatitis hx, renal disease, bleeding disorder, coumadin therapy

61
Q

which preop condition should get platelet function assay?

A

bleeding disorder

62
Q

which preop conditions should get basic chemistry?

A

cardiovascular disease, renal disease, diabetes, diuretic use, digoxin use, steroid use (long term), CNS disease

63
Q

which preop condition should get glucose testing day of surgery?

A

diabetes, steroid use, CNS disease

64
Q

which preop conditions should get liver panel testing?

A

hepatic disease, hepatitis hx

65
Q

which preop conditions should get an ekg?

A

50-60 year olds, >60, cardiovascular disease, pulmonary disease, malignancy, radiation therapy, hepatic disease, hepatitis hx, renal disease, diabetes, digoxin use, CNS disease

66
Q

which preop condition should get flexion extension c spine films?

A

rheumatoid arthritis, down’s syndrome

67
Q

pertinent things to cover in cardiovascular review

A

HTN, angina, CAD, MI, valvular disease, syncope, CHF, edema, cardiac arrhythmias

68
Q

Hypertension things to consider

A

duration of disease, exercise tolerance, recent ekg, medication regimen

69
Q

Angina/CAD/MI things to consider

A

exercise tolerance, symptoms, precipitating factors, last chest pain, date of MI, methods of relief, interventions if any (stents, ED visit, nitro, cath lab), ekg, echo, cardiac cath, most recent cardiologist visit, cardiac clearance

70
Q

recent MI (within past 6 months) cardiac clearance

A

within 6 months

71
Q

newly diagnosed CHF or exacerbation with hospitalization within past 6 months cardiac clearance

A

within 6 months

72
Q

aortic stenosis cardiac clearance

A

within 12 months

73
Q

valvular disease things to consider

A

which valve(s)?, stenosis or regurg? symptomatic?, do you take antibiotics for dental work?, recent ekg, echo, cardiology notes/consults/clearance

74
Q

syncope and cardiac arrhythmias things to consider

A

do you faint or pass out? if yes, what causes it and last episode, what treatment
consider conduction block

75
Q

someone with pacemaker/AICD considerations

A

look at info card, last check of device, facilitate manufacturer representative is there day of surgery, review ekg, notes, cardiac clearance

76
Q

CHF considerations

A

current disease status, recent weight gain, edema, dyspnea, recent exacerbation requiring hospitalization, recent changes to management, current ekg and recent echo with EF
have them take diuretics DOS

77
Q

respiratory diseases/conditions that prompt more investigation

A

asthma, chronic bronchitis, emphysema, recent URI, pneumonia, tuberculosis, OSA, tobacco use

78
Q

things to consider with asthma

A

frequency of attacks, triggers, last attack, hospitalizations, intubations, treatment regimen, do they use an inhaler or nebulizer, how often do they use their meds, any steroid use, do they need oxygen

79
Q

bronchitis/pneumonia/URI considerations

A

date of event, medication regimen, any notes, cxray, PFTs, abgs, what symptoms, antibiotics?
for pediatrics: activity level, appetite, fluid intake

80
Q

emphysema considerations

A

require home o2?, use inhaler, neb, corticosteroids?, notes, PFTs, abgs, cxrs

81
Q

tuberculosis considerations

A

active? symptomatic? new onset or worsening of symptoms? isoniazid therapy? cxray

82
Q

OSA considerations

A

use CPAP or BIPAP? document settings, have patient bring machine with them

83
Q

tobacco use considerations

A

number of packs per day, number years smoked, ask about vaping, chew, dip, if former smoker still ask and when they quit

(# cigarettes per day x years smoked) / 20

84
Q

which conditions should prompt further questioning for nervous system

A

stroke, TIA, headaches, seizures, neuropathy

85
Q

stroke/TIA considerations

A

date of occurrence, cerebral blood flow studies, carotid doppler, angiogram, residual deficits?

86
Q

headache considerations

A

how frequently? precipitating factors? treatment that relieves? are they debilitating?, referred or seen a neurologist?

87
Q

seizure considerations

A

hx? (type, frequency, last seizure, cause, med regimen), assess blood levels, have them take anticonvulsants on DOS

88
Q

neuropathy considerations

A

identify positioning needs, get a baseline, influences choice of anesthetic, where is the neuropathy, what type of neuropathy, is it related to type of procedure they are having (ACDF)?

89
Q

the lower esophageal sphincter can open if

A

exceed 20 cmH2O and manual ventilating

90
Q

anesthetic plan includes

A

type of anesthesia, airway devices, type of induction, medications, monitoring modalities/special equipment

91
Q

ASA 1

A

normal healthy pt

92
Q

ASA 2

A

mild systemic disease

93
Q

ASA 3

A

severe systemic disease

94
Q

ASA 4

A

severe systemic disease that is a constant threat to life

95
Q

ASA 5

A

moribound pt not expected to live without procedure

96
Q

ASA 6

A

declared brain dead, organ procurement

97
Q

ASA/Emergency cases

A

consent if possible, consider full stomach, blood products?

98
Q

what to document?

A

patient ID verified, invasive procedures, techniques used, special equipment used, ventilation modes, incision, induction, intubation, extubation, verified surgical procedure, gas machine check, times (in room, antibiotics), transport, patient status, collaborative efforts, name individuals that did procedures

Basic Principles of Anesthesia - CP (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions