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

-history/physical examination (identify relative/absolute contraindications)
-vascular/neuro tests

-risks and alternative options (informed consent, verbal/written)

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

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)

pt and person managing condition needs to understand and agree to risks (documentation)

Question 7

issues with hepatic disease

Answer 7

immunosuppresion and impaired blood caogulation

Question 8

HIV

Answer 8

immunosupression

CD4 count reviewed before operation

Question 9

smoking and nail surgery

Answer 9

discontinue smoking atleast 1 week prior to surgery

Question 10

sickle cell disease and nail surgery

Answer 10

LA without adrenaline and torniquet to allow for sufficient peripheral circulation for healing

Question 11

pregnancy and nail surgery

Answer 11

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

phenol- potential carcinogen

Question 12

vascular assessment should include what

Answer 12

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

Question 13

what vascular findings are absolute contraindications

Answer 13

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

Question 14

neuro assessment should include

Answer 14

1. monofilament
2. tuning fork or neurothesiometer

Question 15

what is common in post op with anti coag users

Answer 15

bleeding may be prolonged therefore aftercare regime modified to reflect this

-do not tell them to stop taking meds for surgery

Question 16

INR in anti coag users

Answer 16

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

Question 17

what tests do you need to do for anti coag users

Answer 17

INR score

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

Question 18

cytokine inhibitors and nail surgery

Answer 18

dose may need to be adjusted or stopped 2-8 weeks before surgery by managing practitioner
and antibiosis required from day of surgery

Question 19

oral retinod

Answer 19

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

Question 20

what else do you need to consider with surgery

Answer 20

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

Question 21

who can consent?

Answer 21

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