SA Pre-Operative Patient Assessment & Preparation (20)

Question 1

What ways do we assess a patient preoperatively?

Answer 1

• patient history
• physical exam
• laboratory data
• associated underlying disease
• patient stabilization

Question 2

What are the “Big 4” or “Quats” that young, healthy animals undergoing elective surgery get?

Answer 2

• PCV (hematocrit)
• total protein (TP)
• blood glucose
• BUN

Question 3

What should an animal older than 5 to 7 years get before surgery - laboratory data?

Answer 3

“Minimum Data Base”

• CBC and differential
• serum biochemical profile
• urinalysis

Question 4

How should you assess neoplasia in a dog?

Answer 4

evaluate for metastasis - see if in multiple places

• thoracic imaging
• abdominal ultrasound
• lymph node aspiration

Question 5

How do you evaluate cardiac disease before surgery?

Answer 5

• thoracic radiographs
• cardiac ultrasound scan
• electrocardiogram

Question 6

How should you assess trauma patients before surgery?

Answer 6

• diaphragm
• pleural space
• lungs

Question 7

What is ASA I?

Answer 7

healthy with no discernible disease - elective procedure

Question 8

What is ASA II?

Answer 8

healthy with localized disease or mild systemic disease

patellar luxation, skin tumor, cleft palate without aspiration pneumonia

Question 9

What is ASA III?

Answer 9

severe systemic disease

pneumonia, fever, dehydration, heart murmur, anemia

Question 10

What is ASA IV?

Answer 10

severe systemic disease that is life-threatening

heart failure, renal failure, hepatic failure, severe hypovolemia, severe hemorrhage

Question 11

What is ASA V?

Answer 11

patient not expected to live longer than 24 hours with or without surgery

endotoxic shock, multi organ failure, severe trauma

Question 12

What is E in ASA?

Answer 12

emergency

Question 13

A skin tumor is ASA ___

Answer 13

II

Question 14

A heart murmur is ASA ___

Answer 14

III

Question 15

A declaw is ASA ___

Answer 15

I

Question 16

Hepatic failure is ASA ___

Answer 16

IV

Question 17

Severe trauma is ASA ___

Answer 17

V

Question 18

Endotoxic shock is ASA __

Answer 18

V

Question 19

How should you determine surgical risk?

Answer 19

consider history, physical examination, and laboratory tests

risk of the surgical procedure may outweigh its potential benefits

Question 20

What is a “Fair” prognosis of surgical risk?

Answer 20

serious complications are possible, but uncommon

recovery may be prolonged

animal may not return to its pre surgical function

Question 21

What is a “Poor” prognosis of surgical risk?

Answer 21

underlying disease or surgical procedure is associated with many or severe complications

recovery is expected to be prolonged

likelihood of death during or after the procedure is high

unlikely to return to pre surgical function

Question 22

What is a “Excellent” prognosis of surgical risk?

Answer 22

potential for complications is minimal

high probability that the patient will return to normal

Question 23

What is a “Good” prognosis of surgical risk?

Answer 23

some potential for complications

high probability of a good outcome

Question 24

What is a “Guarded” prognosis of surgical risk?

Answer 24

when the outcome is highly variable or unknown

Question 25

What should owners be informed of before surgery?

Answer 25

- diagnosis - surgical and nonsurgical options - potential complications - postoperative care - prognosis - cost

Question 26

What is indicated for all animals undergoing general anesthesia, **including healthy animals having elective procedures**?

Answer 26

intravenous fluids

Question 27

What are the dietary restrictions for adult animals?

Answer 27

food intake: restrict 6 to 12 hours before induction of anesthesia - helps avoid intraoperative or postoperative emesis and aspiration pneumonia

Question 28

Food prior to surgery should not be withheld from ______ for longer than ______ because hypoglycemia may occur

Answer 28

young animals 4 to 6 hours

Question 29

What is a SSI?

Answer 29

includes infection that directly results from surgical procedures that involve **other areas of the body** as well, such as **organs** or **internal spaces** that are manipulated during the operation

Question 30

What are the most common sources of SSIs?**

Answer 30

staphylococcus aureus streptococcus spp.

Question 31

What are the classifications of SSIs?

Answer 31

incisional - superficial - deep organ/space

Question 32

What is an incisional SSI?

Answer 32

inflection of the actual site of the surgical incision

Question 33

What is a superficial incisional SSI?

Answer 33

involving the skin and SQ tissue at the surgical incision

Question 34

What is a deep incisional SSI?

Answer 34

involving the deep soft tissue layers such as incisional fascia and muscle at the surgical incision

Question 35

What is an organ/space SSI?

Answer 35

infection of an anatomical part that was manipulated during the operation

Question 36

When is something considered an SSI?

Answer 36

- occur within 30 days of the surgical procedure - occur within 1 year if it is associated with a surgical implant and the infection appears to be related to the operation

Question 37

What are resident flora on the skin?

Answer 37

- staphylococcus epidermidis - corynebacterium spp. - pityrosporum spp.

Question 38

What are transient pathogens in SSIs?

Answer 38

- staphylococcus aureus - staphylococcus intermedius - e. coli - streptococcus spp. - enterobacter spp - clostridium spp

Question 39

What is antisepsis?

Answer 39

the prevention of sepsis ban preventing or inhibiting the growth of resident and transient microbes

Question 40

What is antiseptic?

Answer 40

product with antimicrobial activity that formerly may have been referred to as an **antimicrobial agent** an agent capable of producing antisepsis

Question 41

[Chlorohexidine/Povidone Iodine] is superior for preoperative antisepsis for patients

Answer 41

chlorohexidine

Question 42

How can you prevent SSIs?

Answer 42

- administration og antimicrobial prophylaxis - intraoperative antibiotics - proper utilization of skin antiseptic agents for the surgical team and patient

Question 43

T/F: You can shave the site night before a surgery

Answer 43

FALSE - associated with a significant increase in superficial skin infection rates

Question 44

T/F: In a male dog, you should clip the prepuce

Answer 44

TRUE

Question 45

What does this show?

Answer 45

flushing the prepuce of male dogs with antiseptic solution before performing the sterile preparation

Question 46

How do you prepare for a limb procedure that does not include the paw?

Answer 46

place a latex glove over the distal extremity and securing it to the limb with tape wrap the glove with tape or vetwrap

Question 47

What does this image show?

Answer 47

hanging leg preparation - limb is circumferentially clipped and then hung from and IV pole place field drapes around the limb and secure them with towel clamps

Question 48

Sterile preparation begins [before/after] positioning of the animal

Answer 48

after

Question 49

How do you sterilely prep?

Answer 49

dominant hand: handles sterile non dominant hand: non sterile

Question 50

How do you clamp the prepuce for an abdominal incision?

Answer 50

with a sterile towel clamp - clamp prepuce opposite surgeon

Question 51

What instrument do you use to drape a patient?

Answer 51

Backhaus towel clamps

Question 52

What should you NOT do when performing surgery regarding instruments and other materials the surgeon may use during surgery?

Answer 52

- soiled sponges **will not** be placed back on the instrument table - **patient is not a table** to place instruments, soiled sponges, etc on