The Preoperative Interview & Evaluation Flashcards

1
Q

What is the purpose of the preoperative evaluation?

A

To evaluate the patient’s current physical status

Optimize the patient for surgery

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2
Q

What does the CRNAs scope of practice include regarding preoperative evaluation?

A

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

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3
Q

What standard set by the AANA addresses the CRNA’s responsibility to perform a thorough and complete pre anesthesia assessment?

A

Standard I (Except in emergency situations)

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4
Q

What should the preanesthetic evaluation include?

A
Patient and procedure identification
Verification of admission status
Medical history
Anesthesia history
Medicine/allergy history
NPO status
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5
Q

How do we calculate BMI?

A

BMI = weight (pounds)/ [height (inches) ^2] x703

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6
Q

What BMI is considered underweight?

A

less than 18.5

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7
Q

What BMI is considered normal?

A

18.5-25

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8
Q

What BMI is considered overweight?

A

25-30

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9
Q

What BMI is considered obese?

A

greater than 30-35

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10
Q

What should the anesthetic provider ask if the patient has a known allergy?

A

What the allergen is and the type of reaction it causes

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11
Q

What symptoms are grounds for considering an anaphylactic reactions?

A

Throat or tongue swelling and difficulty breathing

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12
Q

What are common allergies that should be mentioned to the patient?

A
Drugs
Dyes
Contrast
Latex
Foods
Tape
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13
Q

What are some complications associated with anesthesia the provider should be looking for when interviewing the patient?

A
PONV
Difficult intubation
Recall
Prolonged Wake-up
Unplanned post operative intubation
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14
Q

In order to avoid awareness during anesthesia what monitor could be used and what are its parameters?

A

BIS monitoring: 40-60 for general anesthesia

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15
Q

What questions should we ask a patient if they have confirmed MH in their family history?

A

The outcome and if genetic testing has been preformed on the patient

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16
Q

What are known triggers of MH that should be avoided?

A

Volatile anesthetics and depolarizing NMBA

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17
Q

What is the purpose of the established NPO guidelines prior to surgery?

A

To reduce the risk of aspiration which has a high incidence of morbidity and mortality

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18
Q

What is the result if aspiration occurs in the anesthetized patient?

A

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

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19
Q

How long should a patient remain NPO after drinking water, black coffee, tea, pulp free juice and carbonated beverages?

A

2hrs

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20
Q

How long should a patient remain NPO after consumption of breast milk?

A

4hrs

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21
Q

How long should a patient remain NPO after consumption of formula, milk, full liquids, a light meal or gum/hard candy?

A

6hrs

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22
Q

How long should a patient remain NPO after eating a full meal, fried or fatty food?

A

8hrs

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23
Q

What is the most important factor if a patient aspirates gastric content?

A

The pH of the fluid is more important than the amount

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24
Q

What can be used during DL to prevent aspiration if a patient is at high risk?

A

Selleck’s Manuever, compressed the esophageal lumen between the cricoid cartilage and the cervical spine

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25
Q

What is the correct technique for Selleck’s Maneuver?

A

Backwards
Upwards
Rightwards
Pressure

26
Q

How much force should be applied for Selleck’s Maneuver?

A

6.6-8.8lbs

27
Q

What assessing for thyromental distance, what else could be assessed in the area?

A

Look for scars, could be from an old trach

28
Q

What tool could be used to evaluate joint mobility in patients?

A

Prayers Sign, subtle or overt joint contractors from decreased joint and cartilage mobility

29
Q

Why is it important to document the status of the teeth prior to surgery?

A

We want to make sure we document prior to surgery in order to prevent false claims made later

30
Q

What neck circumference and BMI indicate a difficult intubation?

A

BMI > 40

Neck circumference > 45cm

31
Q

What are two major factors that should not be overlook in men with beards?

A

Hard to mask ventilate (difficult seal)

Disguise potential airway problems

32
Q

Why is it vital to find out if a female is pregnant prior to surgery?

A

Anesthetics have known teratogenic effects on the fetus

33
Q

In addition to prescribed medications, what other over the counter products would the anesthetic provider want to know about?

A
Vitamins
Minerals
Herbs
Supplements
Home remedies
34
Q

What medications should further questioning be warranted?

A
Anticoagulants
Anti-dysrhythmics
Anti-hypertensives
Beta blockers
Diuretics
Bronchodilators
Opioids
Vasodilators
35
Q

In what time period should a patient have cardiac clearance if they have had a recent MI or CHF exacerbation?

A

Within 6 months of surgery

36
Q

In what time period should a patient have cardiac clearance if they have aortic stenosis?

A

12 months prior to surgery

37
Q

Why is it important to assess exercise tolerance in an individual?

A

Least invasive indicator of cardiac function

38
Q

What is an important consideration in narcotic use and patients with sleep apnea?

A

May want to use smaller doses, the patient is more likely to experience periods of apnea

39
Q

How long should a smoker stop smoking prior to surgery?

A

48hrs

40
Q

What is significant about emergence in a smoker?

A

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

41
Q

What concerns are present when a patient confirms GI disease?

A

Aspiration

42
Q

What is the most common GI disturbance the anesthetist will run into?

A

Reflux

43
Q

If a patient were to aspirate, at what pH and volume would it be preferable?

A

pH >2.5

Volume <25mL

44
Q

At what press will the LES open?

A

20cmH2O

45
Q

Prior to taking a patient back to surgery, what might be important to know about a diabetic patient?

A

Their blood sugar that morning

46
Q

If a patient has hypothyroidism what should be checked the morning of surgery?

A

Radial pulse to ensure the patient is euthyroid

47
Q

Why is it important to assess a patient with thyroid disease neck?

A

To see if they have a goiter, if so how might it affect their airway

48
Q

What are we concerned about occurring in a patient with hyperthyroidism?

A

Thyroid storm, have beta blockers ready to treat

49
Q

Why might a patient with rheumatoid arthritis be a difficult intubation?

A

Potential for TMJ disease, decreased cervical spine mobility and arytenoid joint mobility

50
Q

What lab values should be checked in a patient with known liver dysfunction?

A

Coagulation studies: PT/PTT

a liver panel could also be done (not the best indicator for current liver function)

51
Q

What electrolyte are we most interested in with renal disease?

A

Potassium

52
Q

What is a good indicator that the patient may have an elevated potassium?

A

Peaked T waves on an EKG

53
Q

What AANA standard addresses the need to formulate a patient specific plan for anesthesia care?

A

Standard III

54
Q

What ASA status is given to a patient that has mild systemic disease?

A

ASA 2

55
Q

Why is a trauma patient considered a full stomach?

A

Their blood is shunted to vital organs (fight or flight) decreased flow flow to the gut and decrease in motility

56
Q

What ASA status is given to a patient that has severe systemic disease that is a constant threat to life?

A

ASA 4

57
Q

Which AANA standard addresses the need to obtain informed consent for the planned anesthetic intervention from the patient or legal guardian?

A

Standard II

58
Q

What ASA status is given to a patient that is normal and healthy?

A

ASA 1

59
Q

What ASA status is given to a patient that has sever systemic disease?

A

ASA 3

60
Q

What ASA status is given to a patient that is declared brain dead and organ procurement will be performed?

A

ASA 6

61
Q

What ASA status is given to a patient that needs emergency surgery?

A

E

62
Q

What ASA status is given to a moribund patient that is not expected to survive without surgery?

A

ASA 5