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Week 11 > PreSurgicalOptimization > Flashcards

PreSurgicalOptimization Flashcards

1
Q

What should a history for preop consist of

A
  • Review of physical health
  • functional status and history of falls (frailty)
  • Cognitive ability
  • competency
  • risk factors for postop delirium
  • screen of alcohol or other abuse/dependence
  • Availability of social support
  • symptoms of depression
  • cardiac eval
  • risk factors for postop pulmonary complications
  • nutritional status
  • Medication assessments
  • determine treatment goals and expectations
  • appropriate preop diagnostic tests
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2
Q

How to do a minicog test

A

-say three words and have them remember and repeat

-have them draw a clock, starting with large circle, numbers and then hands at 11:10
(3 min)

-ask them to repeat the three words again

  • 1 pt for ea word correct
  • 2 for normal clock
  • 0-2 pt is possible impairment
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3
Q

CAGE questions

A
  • have you ever felt you should cut down on your drinking or drug use?
  • have people annoyed you by crtizing you drinking or drug use>
  • have you ever feld bad or Guilty about your drinking or drug use?
  • have you ever had a drink or drug first thing in the morning to steady your nerves or to get rid of a hangover?
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4
Q

Criteria and score for frailty

A
  • Shrinkage
  • weakness
  • exhaustion
  • low physical activity
  • slowe
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5
Q

Criteria and score for frailty

A
  • Shrinkage (unintentional weight loss >10 lb in past year)
  • weakness (decreased grip strength)
  • exhaustion (self-reported poor energy and endurance)
  • low physical activity (low weekly energy expenditure)
  • slowness(slow walking)

4-5: frail
2-3: prefrail

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6
Q

Medications to discontinue before surgery

A
  • nonessential that may inc surgical risk
  • drugs with potential f interactions with anesthesia
  • herbal medications 7 days b4
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7
Q

meds to consider periop

A
  • those with withdrawal potential

- angiotensin-converting enzyme inhibitors

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8
Q

Recommended preop tests

A

Hemoglobin

Renal function test

Serum albumin

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9
Q

Tests for selected patients

A
  • urinalysis
  • chest radiograph
  • electrocardiograms
  • pulmonary function tests
  • noninvasive stress testing
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10
Q

key questions when deciding to perform surgery of someone who is at risk or has CAD

A
  • determine it is urgent
  • determine acute coronary syndrome
  • estimated perioperative risk of mobile acute care of elderly
  • less than 1% (proceed)
  • greater than 1% (dependent on functional capacity)
  • functional capacity greater than 4 (proceed)
  • less than 4 or unknown (will further testing/treatment imapact decision?)
  • no (proceed or alternate)
  • yes (stress test)
  • abnormal (no surgery-intervention)
  • normal (proceed or alternate)
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11
Q

algorithm for cardiac eval for noncardiac surgery

A
  • emergency?
  • active cardiac conditions?
  • low risk?
  • functional capaicty
  • risk factors?
  • risk rank of surgery

look at chart

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12
Q

patient related risk factors for postop pul complications

A
  • advanced age
  • presence of COPD
  • american society of ane class
  • fucntional dependence
  • impaired sensorium
  • frailty
  • cigarette smoking
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13
Q

procedure-related factors for postop pul complications

A
  • emergency surgery
  • thoracic and upper ab procedures
  • prolonged op
  • type of ane and ane agent
  • periop transfusion
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14
Q

risk factors for noncardiac surgical procedures

A
  • history of ischemic heart disease
  • history of compenstaed or prior heart failure
  • history of cerebrovascular disease
  • diabetes
  • renal insufficiency
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15
Q

what are low risk procedures

A

-endoscopice, superficial procedures, cataract surgery, breast surgery, anbulatory

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16
Q

what are intermediate risk surgeries

A

intraperitoneal and intrathoracic, cardiac endarterectomy, head and neck, orthopedic, prostate

17
Q

what are vascular surgies

A

aortic/other major vascular surgery, peripheral vascular surgery

18
Q

1 MET

A
  • take care of yourself?
  • eat, dress, use toilet?
  • walk indoors around the house
  • walk a block or two at ground level at 2-3 mph
19
Q

4 METs

A
  • do light work around the house like dusting or washing dishes
  • climb flight of stairs
  • walk at ground level at 4 mph
  • run short distance
  • do heavy work around the house like scrubbing floors or lifting or moving
20
Q

10 METs

A

participate in moderate rec acivity like golf, bowling, dancing, doubles tennis, or throwing baseball or football

-participate in strenuous sports like swimming, singles tennis, football, basketball or skiing

21
Q

risk for post op venous thromboembolism (VTE)

A
  • Hypercoagulability (congential hypercoag, cancer, cancer therapy, history of VTE, inflamm bowel disease, oral contraceptives, polycythemia, pregnancy, smoking, thrombocytosis)
  • venous statsis (congestive heart failure, immobility, increasing age, obesity, varicose veins, venous compression or obstruction)
  • endothelial injury (recent surgery, severe infection, trauma)
22
Q

risk factors for postoperative delirium

A
  • strongest: preexisting cognitive impairment and dementia
  • untreated or inadequately controlled pain
  • depression
  • alcohol use
  • sleep deprivation
  • severe illness/comorbidities
  • renal insufficiency
  • anemia
  • hypoxia
  • poor nutrition
  • dehydration
  • electrolyte abnormalities
  • poor funct status
  • immobilization
  • hearing or vision impairment
  • over 70
  • polypharm
  • risk of urinary retention or constipation, presence of catheter
23
Q

code of medical ethics on consent

A
  • assess patients ability to understand
  • present relevant information
  • document the informed consent conversation
24
Q

conditions that must be met for valid informed consent in presurgical patients

A
  • patient must have the capacity to make health care decision
  • patients receive adequate information
  • patient consents freely
25
Q

Living will

A

specifies medical treatments- including cardiopul resus- mechanical vent, enteral feeding, dialysis, antibiotics- that the patient would or would not want used to prolong their life, as well as other decisions regarding paiin management or organ/tissue/body donation

26
Q

Durable power of attorney

A

a person (with or without alternatives) named to make decisions on behalf of the patient if ther are unable to

27
Q

do not resus order (DNR)

A

specific medical order instructing providers not to perfrm CPR if the patient’s heart activity or breathing ceases

28
Q

do not intubate (DNI) order

A

specific medical order instructing providers not to intubate the patient and/or place him or her on mechanical ventilation

29
Q

considerations in patients at risk for postop delirium

A
  • avoid starting new rxn for benzodiazepines and reduce them
  • avoid using meperidine
  • caution with rxning antihistamines antagonists and others with strong anticholinergic effects
30
Q

when to initiated statin therapry

A

-preop as soon as possible with people who have known vascular disease, elevated LDL, or ischemia or thallium testing

31
Q

indications of beta blockers

A
  • people already on, especially with independent cardiac indications for beta blockers
  • patients undergoing intermediate or vasular surgery with known coronary artery disease or mult risk factors for heart disease
32
Q

intitation and titration of beta blockers

A
  • started at least days to weeks b4 surgery
  • titrated 60-80 beats/min in absence of hypotension
  • should continue peri and post op

Week 11 (3 decks)

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