wk 2- patient assessment for surgery Flashcards
when is nail surgery indicated
- conservative options have not been successful
- conservative is not indicated due to
-onychocryptosis
-painful onychauxis
-painful onychomycosis
-painful involuted nails
-trauma
american society of anaesthesiologists (ASA) physical state classification system
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
pre operative care involves
- medical history (identify relative/absolute contraindications)
- vascular/neuro tests
- informed consent
nail surgery and autoimmune diseases
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
raynauds phenomenon and nail surgery. absolute or relative contraindication?
never perform nail surgery on vasospasm
nail surgery and diabetes
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)
issues with hepatic disease
immunosuppresion and impaired blood caogulation
HIV
immunosupression
CD4 count/ Tcell count >200 cells is similar post op risks as general population
smoking and nail surgery
discontinue smoking atleast 1 week prior to surgery
anaemia
concern- delayed wound healing
haematocrit values <30 for surgery
haemophiliacs or other clotting disorders
concern- bleeding
platelet count
sickle cell disease and nail surgery
concern- clotting
pregnancy and nail surgery
LA should be used with caution during 1st and 3rd trimester pregnancy
phenol- potential carcinogen, do not use
obese patients
increased risk of DVT and wound complications like infection and dehiscence
vascular assessment should include what
- doppler/ABI
- visual assessment
- SVFPT
- perfusion
- edinburgh claudication questionaire
what vascular findings are absolute contraindications
ABPI- <0.6 or ASP <70mmHg
ABPI >1.4 AND foot pulses
TPI <40mmHg
neuro assessment should include
- monofilament
- tuning fork or neurothesiometer
what is common in post op with anti coag users
bleeding may be prolonged therefore aftercare regime modified to reflect this
-do not tell them to stop taking meds for surgery
INR in anti coag users
betwen 2-3 meaning it takes 2-3 times longer for blood to clot than normal pop
what tests do you need to do for anti coag users
INR score
new anti coag medications dont monitor INR therefore need to seek opinion of practitioner managing prior to surgery
cytokine inhibitors and nail surgery
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
oral retinoid
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
what else do you need to consider with surgery
-transport to and from surgery
-assitence with dressing changes
-work
-hobbies/acitvities ceased for healing
who can consent?
- person over 18
- power of attorney
- advanced health of directive
- statutory health attorney
- person under 18- gilick competent
- legal parent/guardian
