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