wk 2- patient assessment for surgery

Question 1

when is nail surgery indicated

Answer 1

1. conservative options have not been successful
2. conservative is not indicated due to
   -onychocryptosis
   -painful onychauxis
   -painful onychomycosis
   -painful involuted nails
   -trauma

Question 2

american society of anaesthesiologists (ASA) physical state classification system

Answer 2

1- healthy
2- mild systemic disease
3- severe “
4- “ threat to life
5- not expected to survive 24 hours with or without surgery

3-5 state should be managed in hospital setting

Question 3

pre operative care involves

Answer 3

1. medical history (identify relative/absolute contraindications)
2. vascular/neuro tests
3. informed consent

Question 4

nail surgery and autoimmune diseases

Answer 4

DMARDs/ immunosupression- increased risk of post operative infection and delayed healing time

-important to get ESR/CRP before procedure to know severity and that there’s no flare present

-specialist may change dosage to minimise ADRs

Question 5

raynauds phenomenon and nail surgery. absolute or relative contraindication?

Answer 5

never perform nail surgery on vasospasm

Question 6

nail surgery and diabetes

Answer 6

HBA1c should be below 9% within last 12 months
if thats not doable then a risk/benefit decision needs to be done

risk- poor glycaemic control impiars wound healing and increased immunosuppresion (risk of infection)

Question 7

issues with hepatic disease

Answer 7

immunosuppresion and impaired blood caogulation

Question 8

HIV

Answer 8

immunosupression

CD4 count/ Tcell count >200 cells is similar post op risks as general population

Question 9

smoking and nail surgery

Answer 9

discontinue smoking atleast 1 week prior to surgery

Question 10

anaemia

Answer 10

concern- delayed wound healing

haematocrit values <30 for surgery

Question 11

haemophiliacs or other clotting disorders

Answer 11

concern- bleeding
platelet count

Question 12

sickle cell disease and nail surgery

Answer 12

concern- clotting

Question 13

pregnancy and nail surgery

Answer 13

LA should be used with caution during 1st and 3rd trimester pregnancy

phenol- potential carcinogen, do not use

Question 14

obese patients

Answer 14

increased risk of DVT and wound complications like infection and dehiscence

Question 15

vascular assessment should include what

Answer 15

1. doppler/ABI
2. visual assessment
3. SVFPT
4. perfusion
5. edinburgh claudication questionaire

Question 16

what vascular findings are absolute contraindications

Answer 16

ABPI- <0.6 or ASP <70mmHg
ABPI >1.4 AND foot pulses
TPI <40mmHg

Question 17

neuro assessment should include

Answer 17

1. monofilament
2. tuning fork or neurothesiometer

Question 18

what is common in post op with anti coag users

Answer 18

bleeding may be prolonged therefore aftercare regime modified to reflect this

-do not tell them to stop taking meds for surgery

Question 19

INR in anti coag users

Answer 19

betwen 2-3 meaning it takes 2-3 times longer for blood to clot than normal pop

Question 20

what tests do you need to do for anti coag users

Answer 20

INR score

new anti coag medications dont monitor INR therefore need to seek opinion of practitioner managing prior to surgery

Question 21

cytokine inhibitors and nail surgery

Answer 21

dose may need to be adjusted or stopped 2-8 weeks before surgery by managing practitioner
and prophylactic antibiotics required from day of surgery and during healing process

Question 22

oral retinoid

Answer 22

need to be reviewed post op more frequently due to increased risk of infections and pyogenic granuloma

if being used short term then finish course before surgery- reason for surgery may be a side effect of the treatment

side effects of retinoids- skin fragility, pygenic granulomas, paronychia

Question 23

what else do you need to consider with surgery

Answer 23

-transport to and from surgery
-assitence with dressing changes
-work
-hobbies/acitvities ceased for healing

Question 24

who can consent?

Answer 24

1. person over 18
2. power of attorney
3. advanced health of directive
4. statutory health attorney
5. person under 18- gilick competent
6. legal parent/guardian