The Preoperative Interview & Evaluation Flashcards
What is the purpose of the preoperative evaluation?
To evaluate the patient’s current physical status
Optimize the patient for surgery
What does the CRNAs scope of practice include regarding preoperative evaluation?
Requesting consultations and diagnostic studies
Selecting, obtaining, ordering and administering preanesthetic medications and fluids
Obtaining informed consent for anesthesia
Develop and implement an anesthetic plan
What standard set by the AANA addresses the CRNA’s responsibility to perform a thorough and complete pre anesthesia assessment?
Standard I (Except in emergency situations)
What should the preanesthetic evaluation include?
Patient and procedure identification Verification of admission status Medical history Anesthesia history Medicine/allergy history NPO status
How do we calculate BMI?
BMI = weight (pounds)/ [height (inches) ^2] x703
What BMI is considered underweight?
less than 18.5
What BMI is considered normal?
18.5-25
What BMI is considered overweight?
25-30
What BMI is considered obese?
greater than 30-35
What should the anesthetic provider ask if the patient has a known allergy?
What the allergen is and the type of reaction it causes
What symptoms are grounds for considering an anaphylactic reactions?
Throat or tongue swelling and difficulty breathing
What are common allergies that should be mentioned to the patient?
Drugs Dyes Contrast Latex Foods Tape
What are some complications associated with anesthesia the provider should be looking for when interviewing the patient?
PONV Difficult intubation Recall Prolonged Wake-up Unplanned post operative intubation
In order to avoid awareness during anesthesia what monitor could be used and what are its parameters?
BIS monitoring: 40-60 for general anesthesia
What questions should we ask a patient if they have confirmed MH in their family history?
The outcome and if genetic testing has been preformed on the patient
What are known triggers of MH that should be avoided?
Volatile anesthetics and depolarizing NMBA
What is the purpose of the established NPO guidelines prior to surgery?
To reduce the risk of aspiration which has a high incidence of morbidity and mortality
What is the result if aspiration occurs in the anesthetized patient?
Gastric content goes into the lungs and it results in chemical burns of the trachea bronchial tree and pulmonary parenchyma causing an intense inflammatory reaction
How long should a patient remain NPO after drinking water, black coffee, tea, pulp free juice and carbonated beverages?
2hrs
How long should a patient remain NPO after consumption of breast milk?
4hrs
How long should a patient remain NPO after consumption of formula, milk, full liquids, a light meal or gum/hard candy?
6hrs
How long should a patient remain NPO after eating a full meal, fried or fatty food?
8hrs
What is the most important factor if a patient aspirates gastric content?
The pH of the fluid is more important than the amount
What can be used during DL to prevent aspiration if a patient is at high risk?
Selleck’s Manuever, compressed the esophageal lumen between the cricoid cartilage and the cervical spine
What is the correct technique for Selleck’s Maneuver?
Backwards
Upwards
Rightwards
Pressure
How much force should be applied for Selleck’s Maneuver?
6.6-8.8lbs
What assessing for thyromental distance, what else could be assessed in the area?
Look for scars, could be from an old trach
What tool could be used to evaluate joint mobility in patients?
Prayers Sign, subtle or overt joint contractors from decreased joint and cartilage mobility
Why is it important to document the status of the teeth prior to surgery?
We want to make sure we document prior to surgery in order to prevent false claims made later
What neck circumference and BMI indicate a difficult intubation?
BMI > 40
Neck circumference > 45cm
What are two major factors that should not be overlook in men with beards?
Hard to mask ventilate (difficult seal)
Disguise potential airway problems
Why is it vital to find out if a female is pregnant prior to surgery?
Anesthetics have known teratogenic effects on the fetus
In addition to prescribed medications, what other over the counter products would the anesthetic provider want to know about?
Vitamins Minerals Herbs Supplements Home remedies
What medications should further questioning be warranted?
Anticoagulants Anti-dysrhythmics Anti-hypertensives Beta blockers Diuretics Bronchodilators Opioids Vasodilators
In what time period should a patient have cardiac clearance if they have had a recent MI or CHF exacerbation?
Within 6 months of surgery
In what time period should a patient have cardiac clearance if they have aortic stenosis?
12 months prior to surgery
Why is it important to assess exercise tolerance in an individual?
Least invasive indicator of cardiac function
What is an important consideration in narcotic use and patients with sleep apnea?
May want to use smaller doses, the patient is more likely to experience periods of apnea
How long should a smoker stop smoking prior to surgery?
48hrs
What is significant about emergence in a smoker?
It isn’t usually smooth and they may breath hold
They have a higher risk of bronchospasm
Can use lidocaine at the end of the case to help with the irritation
What concerns are present when a patient confirms GI disease?
Aspiration
What is the most common GI disturbance the anesthetist will run into?
Reflux
If a patient were to aspirate, at what pH and volume would it be preferable?
pH >2.5
Volume <25mL
At what press will the LES open?
20cmH2O
Prior to taking a patient back to surgery, what might be important to know about a diabetic patient?
Their blood sugar that morning
If a patient has hypothyroidism what should be checked the morning of surgery?
Radial pulse to ensure the patient is euthyroid
Why is it important to assess a patient with thyroid disease neck?
To see if they have a goiter, if so how might it affect their airway
What are we concerned about occurring in a patient with hyperthyroidism?
Thyroid storm, have beta blockers ready to treat
Why might a patient with rheumatoid arthritis be a difficult intubation?
Potential for TMJ disease, decreased cervical spine mobility and arytenoid joint mobility
What lab values should be checked in a patient with known liver dysfunction?
Coagulation studies: PT/PTT
a liver panel could also be done (not the best indicator for current liver function)
What electrolyte are we most interested in with renal disease?
Potassium
What is a good indicator that the patient may have an elevated potassium?
Peaked T waves on an EKG
What AANA standard addresses the need to formulate a patient specific plan for anesthesia care?
Standard III
What ASA status is given to a patient that has mild systemic disease?
ASA 2
Why is a trauma patient considered a full stomach?
Their blood is shunted to vital organs (fight or flight) decreased flow flow to the gut and decrease in motility
What ASA status is given to a patient that has severe systemic disease that is a constant threat to life?
ASA 4
Which AANA standard addresses the need to obtain informed consent for the planned anesthetic intervention from the patient or legal guardian?
Standard II
What ASA status is given to a patient that is normal and healthy?
ASA 1
What ASA status is given to a patient that has sever systemic disease?
ASA 3
What ASA status is given to a patient that is declared brain dead and organ procurement will be performed?
ASA 6
What ASA status is given to a patient that needs emergency surgery?
E
What ASA status is given to a moribund patient that is not expected to survive without surgery?
ASA 5
