Preoperative Evaluation of Patient Flashcards
What are the six key factors that are looked at in determining the operative risk?
Age Benefits vs Outcome of surgery Urgency Nature of problem Duration of procedure Concurrent medical problems
For a smaller patient, like on going under for a PDA repair, what are four things that should be set aside or used?
Warmed fluids
Glucose
Atropine
Nerve block
What are the five levels of anesthetic risk?
Excellent - Good - Fair - Poor - Guarded
What does a classification of risk of Good mean?
Slight chance for complications but highly likely there will be a good outcome
What does a classification of risk of Fair mean?
Serious complications are possible but uncommon
Prolonged recovery possible
May not return to pre surgical function
What does a classification of risk of Poor mean?
Underlying disease/Procedure itself is associated with severe complications
Recovery will be prolonged
Unlikely to return to pre surgical function
What does a classification of risk of Guarded mean?
Outcome unknown
What three things should you ask when focusing in on a complaint?
When
What did it look like when it first began
Better or Worse
What is the most important part of a pre surgical work up?
PE
What are the levels in rating the physical status of a surgical patient?
I to V
What is a physical status of II mean?
Localized disease or mild systemic disease but otherwise healthy
What is a physical status of III mean?
Severe systemic disease
What is a physical status of IV mean?
Severe systemic disease that is life threatening
What is a physical status of V mean?
Moribund, not expected to live 24 hours with or without surgery
What is part of the intraoperative plan?
Surgical approach
Material/Equipment needed
Personnel you will need on staff
(How - Who - What)
What are the examples of a postoperative plan?
Further testing
Wound care
Support (nutritional, fluid, oxygen, etc)
What is the normal blood volume for a dog?
90 ml/kg
What is the normal blood volume for a cat?
70 ml/kg
What is the rate for the shock dosage of fluids?
30 ml/lb
What do you have to be careful of when giving shock rate of fluids?
Can cause more problems then good if patient has:
Pulmonary + Cardio + Renal issues
When do you know if you need to treat ventricular arrhythmias?
Interfere with CO
Multiform
R on T
Ventricular rate is > 160 rpm
What are the two methods of suppling nutrition?
Enteral + Parenteral
What are the possible complications/problems with total parenteral nutrition?
Expensive formulas
Sepsis
What are the four types of tubes you can place for enteral feeding?
Nasogastric
Pharyngostomy
Gastrostomy
Enterostomy
What are the three clinical methods of using antibiotics?
Therapeutic
Prophylactic
Nosocomial
What is prophylactic antibiotic administration responsible for?
Antibiotic resistance in bacteria
What are the four major reasons given for resistant bacteria?
Prolonged, extensive surgical procedures
Increased invasiveness of supportive measures
Long hospital stays
Inappropriate use of AB’s
Immunosuppressive drugs
What is infection dependent on?
Number/Virulence of bacteria
Competence of host defense
Amount of tissue damage
Dead space resulting from procedure
What four things can be done to decrease infections?
Good wound lavage
Closure of dead space
Appropriate AB prophylaxis
Meticulous surgical technique
Where is the most common place that bacteria come from that cause infection?
Endogenous to patient
How much does the risk increase per person in the surgical suite?
1.3 times
What are the two most common nosocomial infections?
Urinary tract + Surgical site infection
When would you need to use prophylactic AB’s?
Surgery longer than 90 minutes
Prothesis implantation
Prothesis that was there pre-surgery
Severely infected wounds
What are the four types of surgery that need prophylactic AB’s?
Orthopedic + Respiratory + Gastrointestinal + Urogenital
