Exam 2: Lecture 20: Pre-operative Patient assessment and preperation - LA

Question 1

what are the 5 things we should have in our preoperative assessment

Answer 1

1. patient history
2. physical exam
3. lab data
4. associated underlying disease
5. patient stabilization

Question 2

what are the 2 things we need to get from our patient history prior to the details

Answer 2

signalment and presenting complaint

Question 3

what 3 questions should we ask when we are figuring out the presenting complaint

Answer 3

1. when did the current problem start
2. what did the problem look like when it first began
3. has the problem gotten better or worse, and if so how much and associated with what therapy

Question 4

what are some details we need to get during the patient history after we get the signalment and presenting complaint

Answer 4

diet, exercise, environment, past medical probs, recent treatments, any infections, any V/D, altered appetite, toxins, coughing, history of previous drug reactions or seizures

Question 5

what kind of evaluation should we do during our PE

Answer 5

a systemic eval including all of the body systems

Question 6

what are the 3 things we look for in general condition during our PE

Answer 6

BCS, attitude, mental status

Question 7

what are the 6 systems we should make sure we evaluate

Answer 7

neuro, ortho, respiratory, GI, cardio, urinary

Question 8

what type of situation do we allow a cursory exam until the animal has been stabilized

Answer 8

emergency situations!

Question 9

what is the best way to determine the likelihood of cardiopulmonary emergencies during sx

Answer 9

evaluation of the preanesthetic physical status

Question 10

T/F: The more deteriorated the physical status, the higher risk of anesthetic and surgical complications

Answer 10

True!!

Question 11

what type of labwork should we do for a young, healthy animal undergoing elective procedures

Answer 11

PCV (Hematocrit)
total protein (TP)
blood glucose
BUN

Question 12

what type of labwork should we do for an animal that is 5 to 7 years old or having systemic signs

Answer 12

should get a CBC and differential, serum biochemical profile, an urinalysis

Question 13

what does ID of associated or underlying disease influence

Answer 13

preoperative management, surgical procedure performed, prognosis, and postoperative care required

Question 14

how do we eval for neoplasia

Answer 14

look for mets via thoracic imaging, CT, positron emission tomography, abdominal ultrasound, LN aspiration

Question 15

how do we evaluate for cardiac disease

Answer 15

thoracic rads, cardiac ultrasound, electrocardiogram

Question 16

what should we do for trauma patients and why

Answer 16

they should have thoracic rads to eval the diaphragm, pleural space, and lungs

Question 17

what is ASA I

Answer 17

healthy with no discernible disease

Question 18

what is ASA II

Answer 18

healthy with localized disease or mild systemic disease

Question 19

what is ASA III

Answer 19

severe systemic disease

Question 20

what is ASA IV

Answer 20

severe systemic disease that is life threatening

Question 21

what is ASA V

Answer 21

moribund, patient is not expected to live linger than 24 hours with or without sx

Question 22

what is important to remember when determining surgical risk

Answer 22

risk of the procedure may outweigh its potential benefits

Question 23

why should we care about quality of life for veterinary patients

Answer 23

patient with severe, debilitating, untreatable disease may not benefit from surgery and for some patients surgery may improve quality of life even if length of life is limited

Question 24

what is an excellent surgical prognosis

Answer 24

potential for complications is minimal and high probability that the patient will return to normal

Question 25

what is a good surgical prognosis

Answer 25

some potential for complications, high probability of a good outcome

Question 26

what is a fair surgical prognosis

Answer 26

serious complications are possible but uncommon, recovery may be prolonged, or may not return to its pre-surgical function

Question 27

what is a poor surgical prognosis

Answer 27

many or severe complications, recovery is expected to be prolonged, likelihood of death during or after the procedure is high, and unlikely to return to its pre-surgical function

Question 28

what is a guarded surgical prognosis

Answer 28

given with the outcome is highly variable or unknown

Question 29

what should we informed owners about before surgery

Answer 29

1. diagnosis 2. surgical and nonsurgical options 3. potential complications 4. post operative care 5. prognosis 6. cost

Question 30

what is important to remember about cost and client communication

Answer 30

cost cannot always be predicted because of unanticipated complications. Owners should be kept apprised of the animals status and of procedures that may affect the initial cost estimate

Question 31

T/F: If the disease is hereditary, neutering should be recommended

Answer 31

true

Question 32

T/F: A waiver signed by the owner that authorizes surgery and accepting anesthetic/surgical risk is not mandatory and does not need to be in the medical record

Answer 32

false! It is mandatory and should be a part of the medical record

Question 33

T/F: A signed estimate form that outlines the anticipated costs of diagnostics, preoperative care, surgery, and post operative care should be included in the record

Answer 33

true!

Question 34

Should we stabilize patients prior to surgery

Answer 34

yes as much as we can

Question 35

can we over-stabilize a patient

Answer 35

no! It is impossible and surgical intervention must be done rapidly

Question 36

how long do we restrict food from adult animals

Answer 36

6 to 12 hours before induction

Question 37

how long should we withhold food from young animals and why

Answer 37

no longer than 4 to 6 hours because hypoglycemia may occur

Question 37

do we restrict water intake for surgery patients

Answer 37

not usually

Question 37

T/F: operations of the large intestine often require specialized preparations

Answer 37

true!

Question 38

what are the most common sources of surgical site infections

Answer 38

endogenous microbial flora (staphylococcus aureus and streptococcus spp)

Question 39

what is the CDCs classification of incisional infection

Answer 39

infection of the actual site of the surgical incision

Question 40

what is the CDCs classification of superficial incisional infection

Answer 40

involving the skin and subq tissue

Question 41

what is the CDCs classification of deep incisional infection

Answer 41

involving deep soft tissue layers such as incisional fascia and muscle

Question 42

what is the CDCs classification of organ/space infection

Answer 42

infection of anatomic part that was manipulated during the operation

Question 43

how does the CDC determine if it is a surgical site infection

Answer 43

occur within 30 days of the surgical procedure or occurs within 1 year if it is associated with a surgical implant and the infection appears to be related to the operation

Question 44

what organisms live in the skins superficial cornified layers and the outer hair follicles of dogs

Answer 44

staphylococcus epidermidis corynebacterium spp pityrosporum spp

Question 45

what are the transient pathogens

Answer 45

1. staph aureus 2. staph intermedius 3. e. coli 4. steptococcus spp 5. enterobacter spp 6. clostridium spp

Question 46

T/F: it is impossible to sterilize skin without impairing its natural protective function and interfering with wound healing

Answer 46

true! You cannot sterilize skin

Question 47

T/F: Preoperative prep does not really reduce the number of bacteria and the likelihood of infection

Answer 47

false! It does REDUCE

Question 48

what is antisepsis

Answer 48

the prevention of sepsis by preventing or inhibiting the growth of resident and transient microbes

Question 49

what is an antiseptic

Answer 49

product with antimicrobial activity that formerly may have been referred to as an antimicrobial agent an agent capable of producing antisepsis

Question 50

T/F: The current literature strongly suggests that chlorohexidine glyconate is superior to povidone iodine for preoperative antisepsis for patients

Answer 50

TRUE!!

Question 51

what are the 7 characteristics of an ideal preoperative antiseptic

Answer 51

1. kill all bacteria, fungi, viruses, protozoa, tubercle bacilli, and spores 2. be hypoallergenic 3. be nontoxic 4. have residual activity 5. not be absorbed 6. be nontoxic and able to be used repeatedly safely 7. be safe to use on all parts of the body and in all body systems

Question 52

why is the prevalence of surgical site infections in humans a major concern

Answer 52

because it increases incidence of morbidity and mortality, length of hospitalization, and cost of care for post operative patients

Question 53

what are the 2 ways we can use preventative preoperative measures to reduce the risk of surgical site infection

Answer 53

1. administration of antimicrobial prophylaxis 2. proper utilization of skin antiseptic agents for the surgical team and the patient

Question 54

T/F: Infections should be identifies and addressed prior to surgery

Answer 54

true!

Question 55

explain the 4 things we should remember when shaving hair

Answer 55

1. do it as close to the time of surgery as possible 2. shaving the night before is associated with a significant increase in superficial skin infection rates 3. NEVER CLIP IN OR 4. clip liberally so incision can be extended within sterile field

Question 56

what # blade of clippers should we use

Answer 56

#40 blade

Question 57

what do we do once we shave the patient

Answer 57

loose hair should be vacuumed

Question 58

what are your landmarks for shaving for an OHE

Answer 58

clip from just above the xyphoid to the pubis and laterally beyond the nipple line

Question 59

T/F: You should flush the male prepuce with an antiseptic solution prior to doing a sterile prep

Answer 59

true!

Question 60

what should we do prior to sterile prep once we have shaved and dirty prepped the patient

Answer 60

patient should be moved to OR, positioned for surgery, and secured with ropes/sandbags/troughs/tape

Question 61

if we are using electrosurgery what do we need to remember to do

Answer 61

put the ground plate under the patient!!

Question 62

When do we hang limbs for surgery

Answer 62

for limb procedures prior to our sterile prep....we sterile prep once it is hung

Question 63

what are the 3 purposes of preoperative skin prep

Answer 63

1. removal of soil and transient microorganisms from the skin 2. reduce the resident microbial count to subpathogenic levels in a short time and with the least amount of tissue irritation 3. inhibit rapid rebound growth of microorganisms

Question 64

when do we begin the sterile prep

Answer 64

once we have moved into OR and patient has been placed/positioned for surgery

Question 65

T/F: The tips of towel clamps are considered non-sterile once they have been placed through the skin and should be handled properly

Answer 65

true!!

Question 66

what should we do if the drape does not have fenestration

Answer 66

you should cut one to an appropriate size

Question 67

what is this picture showing us

Answer 67

the limb being placed through the fenestration of the drape and a plastic adhesive drape has been applied to the skin

Question 68

T/F: Patient position is ultimately the responsibility of the surgeon

Answer 68

true!

Question 69

T/F: you should arrange your surgical table in a manner that is logical to allow you to find instruments quickly and accurately

Answer 69

true

Question 70

T/F: Assistants do not wipe instruments when returning them to the table

Answer 70

false, they should!

Question 71

T/F: Soiled sponges should be placed back on the instrument table

Answer 71

false, they should NOT be placed back on the instrument table

Question 72

T/F: Your patient is not a table to place instruments, soiled sponges, etc, on

Answer 72

true! You should not put those things on the patient