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Gen Exam 3 + Final > Pt Assmt > Flashcards

Pt Assmt Flashcards

1
Q

Standardization of Best Practices- enhances the process by

A

Basis for formulating best anesthetic plan

Tailored to the patient

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2
Q

True Emergency

A

Life, Limb or Organ Saving
surgery <6hours-

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3
Q

⭐️
Examples of True Emergency

A

ruptured aortic aneurysm
major trauma to thorax or abdomen
acute increase in ICP

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4
Q

Urgent

A

Conditions threaten life, limb or organ; surgery within 6-12 hours

examples: perforated bowel; compound fracture; eye injury

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5
Q

Time sensitive

A

Stable but requires intervention
surgery within days-weeks

examples: tendon; nerve injuries; cancer

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6
Q

Elective

A

Procedure planned at patient or surgeon convenience

surgery within 1 year- examples: all other procedures that can be planned in advance

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7
Q

Preanesthetic Eval Screen
ROS

A

everything on the ppt came from this chart

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8
Q

Although not life-threatening, ______ after a previous surgery may be the patient’s most negative and lasting memory.

A

persistent nausea and vomiting

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9
Q

⭐️
vomiting after inhalation anesthesia identified four risk factors:

A

female gender
prior motion sickness or postop nausea
nonsmoking,
use of postop opioids

KNOW this chart!

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10
Q

Components of the Airway Examination That Suggest Difficult Tracheal Intubation

A
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11
Q

⭐️
Know Dat Mallampati!

A
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12
Q

standard for assessing the relationship of the tongue size relative to the oral cavity

A

The Mallampati classification

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13
Q

⭐️
assessment of the cervical spine is critical for these pts

A

severe rheumatoid arthritis (RA) or Down syndrome

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14
Q

Evaluation of the airway involves examination of …

A

oral cavity, including dentition
thyromental distance
neck size
potential tracheal deviation/masses
flex the base of the neck/extend head

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15
Q

T/F
POCT slightly high is better than low POCT

A

T

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16
Q

Thyroid strom is a differential Dx to ___

A

MH

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17
Q

Best Bronchodilating IA

A

Sevo

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18
Q

⭐️
Know these OTC drugs

A

Ephedra: (wt. loss) Tachycardia; HTN; increased sympathomimetic effects with others (arrythmia with digoxin and HTN with oxytocin)

Feverfew: (migraines) PLT inhibitor; Increased bleeding risk; rebound H/A with cessation

GBL; BD; & GHB (body building/ wt. loss) Illegal; death; seizures; severe bradycardia; unconsciousness

Garlic: (antioxidant/lowers cholesterol) decreased PLT aggregation

Ozempic- Gastroparesis

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19
Q

The Apfel simplified risk score

A

predicts PONV with 0, 1, 2, 3, or 4 risk factors as 10%, 20%, 40%, 60%, and 80%, respectively

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20
Q

Apfel scoring for pt w/ no risk factors

A

10% risk

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21
Q

Work synergistically to prevent PONV

A

prop
decadron
zofran (5HT3)

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22
Q

The presence of ___ has been associated with a high perioperative risk of myocardial infarction (MI)

A

unstable angina

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23
Q

The perioperative period is associated with a ___ and surges ___, both of which may exacerbate the underlying process in unstable angina, increasing the risk of acute infarction.

A

hypercoagulable state
in endogenous catecholamines

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24
Q

⭐️
Herbal OTC

A

Ginger: (anti-nausea) Potent inhibitor of thromboxane synthetase; Increased bleeding time

Gingko: (blood thinner) Increased bleeding in pts on anti-coags

Ginseng: (energy/ antioxidant) Inhibits PLT aggregation

Goldenseal: (laxative/diuretic) Oxytocic= worsens edema & HTN

Kavakava: (Anxiolytic) potentiates sedatives & hepatotoxicity

Licorice: (Tx of gastric ulcers) HTN; Hypokalemia & edema

St John’s Wort (depression/anxiety) prolongs anesthetic effects

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25
Q

Potent inhibitor of thromboxane synthetase; Increased bleeding time

A

Ginger: (anti-nausea)

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26
Q

Gingko

A

(blood thinner) Increased bleeding in pts on anti-coags

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27
Q

Inhibits PLT aggregation

A

Ginseng: (energy/ antioxidant)

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28
Q

potentiates sedatives & hepatotoxicity

A

Kavakava: (Anxiolytic)

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29
Q

Goldenseal

A

(laxative/diuretic) Oxytocic= worsens edema & HTN

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30
Q

(Tx of gastric ulcers) HTN; Hypokalemia & edema

A

Licorice

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31
Q

St John’s Wort

A

(depression/anxiety) prolongs anesthetic effects

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32
Q

Valerian

A

(anxiolytic/sedative) potentiates sedative effects of anesthesia

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33
Q

Vitamin E

A

(slows aging) Increases bleeding in conjunction with anti-coagulants & anti-thrombin meds

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34
Q

Estimated Energy Requirements for Various Activities

A
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35
Q

1 MET

A

Daily self-care; eat; dress; walk indoors; walk a block or 2 on ground level 2-3mph

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36
Q

Climb a flight of stairs or walk up a hill; walk on ground level 4mph; run a short distance; heavy work around the house; participate in moderate activities (golf, bowling, dancing, doubles tennis)

A

4METs

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37
Q

> 10METs

A

Participate in strenuous sports like swimming; singles tennis; football; basketball or skiing

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38
Q

⭐️
remains one of the MOST important predictors of Peri-op risk for non-cardiac surgery; also helps define the need for further testing

A

Exercise tolerance

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39
Q

Excellent exercise tolerance (even in patients with stable angina) suggests that…

A

the myocardium can be stressed without failing

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40
Q

poor exercise tolerance

A

inability to walk four blocks or climb two flights of stairs)

can be an independent risk factor for serious complications

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41
Q

Indications for Further Cardiac Testing

A

(algorithm integrates clinical hx; surgery specific risk & exercise tolerance)

1) Evaluate urgency of Sx & appropriateness of formal pre-evaluation

2) recent revascularization or CV work up??

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42
Q

Along with the Resp assmt, we should also assess the pts ability to…

A

ability to breathe through their nose

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43
Q

The presence of symptoms of cord compression may require ….

A

X-ray exam

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44
Q

“Metabolic syndrome”

A

disorder comprising a group of risk factors:
-high blood pressure
-atherogenic dyslipidemia (↑TRG, ↓HDL)
-high fasting glucose
-central obesity

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45
Q

Metabolic syndrome has been associated with higher rates of …

A

cardiovascular, pulmonary, and renal perioperative events

wound infections

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46
Q

Asthma Assmt

A

History of asthma
Last time use of a rescue inhaler
Last asthma attack

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47
Q

unstable cardiac disease

A

MI
CHF
Valvular disease
arrhythmia

(use cardiac monitor!)

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48
Q

A preoperative 12-lead ECG can provide important information about the patient’s heart rhythm as well as (2)

A

evidence for left ventricular hypertrophy

prior MI

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49
Q

ECG
____ in high-risk patients are highly suggestive of a past MI

A

Abnormal Q waves

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50
Q

“silent infarctions”

A

30% of MIs
NO symptoms
only be detected on screening ECGs,

highest in DM/HTN patients

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51
Q

murmur radiating to the carotids

A

aortic stenosis

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52
Q

Abnormal rhythm or gallop

A

heart failure

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53
Q

Presence of Bruits over the carotid

A

needs further work up for stroke risk
plaque

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54
Q

❌
M.A.C.E- Major adverse cardiac events

A

Low risk procedure= <1% risk of MACE

High risk procedure= >1% risk of MACE

Advanced age = increased risk of MACE and ischemic stroke

Hx of CV disease; DM; Cerebrovascular disease= Elevated risk of MACE

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55
Q

pt has DMI and angina
CV risk?

A

higher for adverse cardiac event

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56
Q

⭐️
The Revised Cardiac Risk Index (RCRI)-

A

assigns peri-op risk using clinical variables

increased risk factors = more complications

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57
Q

⭐️
Clinical evidence of heart failure:

A

Dyspnea
Limited exercise tolerance
Orthopnea
JVD
Crackles
Third heart sound
Peripheral edema

58
Q

Diabetes associated with CV disease

A

accelerates atherosclerotic disease

higher incidence of silent MI and myocardial ischemia

insulin depdent = RCRI risk factor

pre-op ECG should be evaluated for presence of Q-waves

59
Q

pre-op ECG should be evaluated for

A

presence of Q-waves

(old MI!)

60
Q

When to treat BP

A

Treat SBP > 150mmHg
Treat DBP > 90mmHg (in pts 60yrs old or >)

61
Q

Aggressive treatment of BP is associated with…

A

reduction in long-term MI risk

62
Q

Elective surgery should be delayed for DBP > ___

A

110mmHg

63
Q

highest incidence of complications

A

Major open vascular procedures

64
Q

High risk procedures:

A

major vascular
abdominal
thoracic
orthopedic

65
Q

Which Sx is a/w extremely low incidence of morbidity and mortality

A

Peripheral procedures

66
Q

Patients with good exercise tolerance that have stable angina suggests that

A

myocardium can be stressed without failing

67
Q

Patients with dyspnea associated with chest pain during minimal exertion

A

extensive CAD and greater perioperative risk

68
Q

⭐️
Patients with Coronary Artery Stents

A

Delay non-cardiac surgery for 14 days after balloon angioplasty

Delay non-cardiac surgery for 30 days after bare metal stent

69
Q

⭐️
Early surgery after stent placement

A

adverse cardiac events (incidence of periop death and hemorrhage)

70
Q

⭐️
Delay non-cardiac surgery after drug eluding stents

A

12 months

71
Q

T/F
Delays after CAD procedures only applies to elective surgeries.

A

True

72
Q

AICDs can be impaired by electromagnetic interference from…

A

Bovie (cauterization)

could shock the pt!
put a magnet on it

73
Q

Which cardiac device always needs to have magnet on it during cautrztn surgery?

A

AICD

pacemaker doesn’t always need

74
Q

Risk of re-infarction under general anesthesia after previous MI

A

MI within 3 months or less = 30% incidence
MI within 3-6 months = 15% incidence
MI greater than 6 months = 6% incidence

75
Q

⭐️
IF re-infarction occurs, the mortality rate is

A

50%!

76
Q

⭐️
T/F
POST-OP RESPIRATORY FAILURE = MAJOR CAUSE OF M&M

A

lol true

77
Q

Post-operative pulmonary complications occur more frequently than cardiac in patients having …

A

non-cardiac surgery

78
Q

T/F
ExTT too early can cause pulm edema

A

True
pulling against against closed glottis

79
Q

proven to have limited benefit in predicting peri-operative respiratory failure and complications

A

Pulmonary functions testing (PFT) and chest X-rays (CXR)

80
Q

increases risk of peri-operative pulmonary morbidity

A

Decreased serum Albumin levels & Increased BUN

81
Q

⭐️
procedures associated with the HIGHEST RISK of peri-operative pulmonary morbidity

A

Open aortic, thoracic and upper abdominal

82
Q

surgeries associated with a HIGH RISK of peri-operative pulmonary morbidity

A

Cranial, vascular and neck

83
Q

Smoking effects

A

Increased carboxyhemoglobin levels

Decreased ciliary function

Increased sputum production

CV stimulation from Nicotine

84
Q

⭐️
amount of time smoking cessation needed to decrease the incidence of post-operative complications

A

4-8 weeks

85
Q

T/F
Airways of smokers are very reactive

A

True
don’t have them quit the day before pls

86
Q

“stress dose” of inhaler may be helpful in asthmatics that

A

take regular corticosteroids (d/t renal insuff)

87
Q

Obstructive Sleep Apnea (OSA)

A

periodic obstruction of upper airway during sleep

88
Q

Obstructive Sleep Apnea (OSA)
clinical effects

A

chronic sleep deprivation

Chronic pulmonary HTN

RHF

89
Q

⭐️
OSA
considerations for anesthesia

A

These patients are susceptible to respiratory depressants!

Use judiciously!

90
Q

⭐️
These surgeries lead to decreased vital capacity, FRC, & diaphragmatic dysfunction= hypoxemia and atelectasis

A

Open aortic, thoracic and upper abdominal
Cranial, vascular and neck

91
Q

⭐️
decreased vital capacity, FRC & diaphragmatic dysfunction leads to

A

hypoxemia and atelectasis

92
Q

leading cause of renal failure requiring dialysis

A

DM

93
Q

DM
care considerations

A

Increased risk for CAD; HTN; CHF & Peri-op MI

Higher incidence of cerebral vascular, peripheral vascular and renal vascular disease

peripheral neuropathies= careful positioning

Gastroparesis= theoretical increased aspiration risk

Stiff joints d/t glycosylation of proteins (could affect airway)

94
Q

⭐️
When to delay a Diabetic pt’s elective surgery

A

A1c above target range (DM1:<7.5% for DM2: <7%),
abnormal electrolytes,
or
ketonuria

95
Q

POCT Goalz

A

Cardiac surgery= maintain sugar 80-100 mg/dL

non-cardiac surgery= maintain sugar <200mg/dL

(trust the pt, they know their body best)

96
Q

T/F
Hold oral hypoglycemic meds the day of surgery

A

True

97
Q

Screen for s/sx of hyper/hypothyroidism-

A

Hypo= hypothermia; hypoglycemia; hypoventilation; hyponatremia & heart failure

Hyper= THYROID STORM- tachycardia; A-fib; CHF; tremor; muscle weakness & anemia

98
Q

⭐️
T/F
enlarged thyroid may create airway difficulty

A

True

99
Q

Draw which lab for hyperparathyroidism

A

Ca

100
Q

Thyroid storm
S/S

A

Diff Dx for MH

101
Q

hyperparathyroidism
S/S

A

HYPER Ca
weakness
lethargy
headache
insomnia
apathy
bone pain
epigastric pain

102
Q

⭐️
When to stress dose Adrenal cortical suppression pts

A

if steroids were taken for one month or greater within the last 6-12 months (if more than a minor procedure)

103
Q

Which to use in Renal Dz?
Nimbex
Roc

A

Nimbex

104
Q

Liver Dz
drug binding is affected by

A

decreased plasma proteins

105
Q

Liver Dz pt needs regional anesthesia. What should we do first?

A

Obtain coags
(also do this for ETOH Hx)

106
Q

When to draw coags

A

liver or kidney disease; bleeding disorder; anticoagulant use; chemotherapy

107
Q

Serum chem (glucose, lytes, renal & liver function)
when to draw

A

liver or kidney disease; DM; CNS disease; Endocrine disorder; Elderly; Malnutrition; type & invasiveness of surgery

108
Q

When to draw CBC

A

extremes of age; liver or kidney disease; anticoagulant use; bleeding; hematologic disorders; malignancy; type & invasiveness of surgery

109
Q

T/F
ECG is ordered in pts with pulmonary tests.

A

True

110
Q

T/F
Patients can refuse a preop pregnancy test.

A

True

the anesthesia provider can ALSO refuse to do that case

111
Q

Which pts get pregnancy test

A

all women of childbearing age

112
Q

The decision to go forward with surgery-

A

Are risk factors modifiable?

Will delaying the procedure add to peri-op risk or morbidity?

What can we do peri-op to decrease risk?

Do we have enough information to make an informed decision?

113
Q

T/F
Emergency surgeries are all considered full stomach

A

True

114
Q

Aspiration Risk:

A
115
Q

NPO times

A
116
Q

Bicitra

A

Increases gastric pH in 100% of the cases it is used – Highly effective antacid

117
Q

Famotidine

A

Increases gastric pH

118
Q

Reglan

A

Increases gastric emptying

(obese; pregnant; diabetics; trauma & emergency surgery)

119
Q

T/F
Advanced directives are part of the pre op eval.

A

True (in ppt slide 72)

120
Q

Innervation of larynx

A
121
Q

Structures of larynx

A
122
Q

Preop eval
Renal Dz

A

Assess electrolytes

Make patient euvolemic prior to induction (likely dry if hemodialysis recently)

Be mindful of meds metabolized by kidneys

123
Q

Adrenocortical Suppression
S/S

A

Be suspicious of those on long term steroid use

(Cushing’s- moon face; skin striation; truncal obesity & HTN)

124
Q

periop experience comes with increased serum glucose d/t ….

A

stress (cortisol and catecholamine release)

125
Q

Glycemic control
benefits

A

decreases:
morbidity
infection rate
stroke incident

+improves wound healing

126
Q

T/F
continue insulin @ full dose of insulin for DM.

A

Continue insulin (consider half dose)

127
Q

“prayer sign”

A

DM
unable to completely oppose their hands (with no space between) = changes in other joints = potentially impacting airway manipulation

128
Q

Malam. Score
if pt cant open mouth

A

automatic 4

129
Q

When can we perform elective noncardiac surgery after stent placement?

A

-elective noncardiac surgery may be considered after 6 months
(surgery benefits vs stent thrombosis and myocardial ischemia)

-after drug-eluting stents: 12 months

130
Q

A patient with CHF is an ASA _

A

4

131
Q

T/F
Unstable angina = ASA 3

A

False

Stable angina = ASA 3

132
Q

ASA class?
Mild-to-moderate systemic disease that is well controlled and causes no organ dysfunction or functional limitation (e.g., treated hypertension)

A

2

133
Q

For patients using inhaled steroids, they should be administered regularly, starting at least ___ prior to surgery for optimal effectiveness.

A

48 hours

134
Q

T/F
DM patients are more susceptible to positioning injuries both during and after surgery

A

true

134
Q

Preop assmt interventions for DM

A

blood glucose
hemoglobin A1c
serum electrolytes
creatinine
ECG

134
Q

Systems Approach
CV goal

A

identify clinical risk and need of pre-op cardiac testing

134
Q

Forms are Rated using 3 Categories:

A

Informational Content
Ease of Use
Ease of Reading

135
Q

Pre-op Eval required components

A

Review medical record
H&P (pertinent to Sx)
diagnostic tests
Pre-op consultations
Can pt condition be improved by Sx?
Answer all questions
Obtain Informed Consent

136
Q

What happens when we place a magnet over an ICD?

A

PACEMAKER fxn unaffected
BUT
electromagnetic interference still possible
most often causes bradycardia
(depends on pacer)

best option: reprogram to asynchronous mode

137
Q

To avoid electromagnet interference, it’s best to put the pacemaker into __ mode

A

asynchronous mode

138
Q

When to place magnet over ICD

A

if Sx above umbilucus & using cuatery

Gen Exam 3 + Final (13 decks)

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