Flashcards in Health History Deck (20)
Who mandates that a pre-op assessment be completed?
JCAHO, ASA, AANA
Where do you collect data from during the pre-op assessment?
patient's medical record
diagnostic tests (labs, xrays, etc.)
What is the benefit of having the preop assessment completed a week prior at a clinic?
reduced patient anxiety
consents signed then
allows time to schedule consults and get results of diagnostic tests
promotes patient teaching
allows time to develop anesthetic plan
Who requires an early pre-op assessment?
uncontrolled CV disease patients
COPD or reactive airway disease
spinal cord injury/problems
What are the 6 purpose of the pre-op interview?
obtain medical history
obtain informed consent
formulate anesthetic plan of care
motivate patients towards better health
What are some factors to consider when interviewing the patient?
organized and systematic
use lay-person terminology
use open ended questions
progress from general to specific questions
make it individualized
make attempts to control the environment (quiet, family presence, etc.)
What are the goals of pre-operative lab tests?
improve intra-op quality
decrease intra-op costs
return patient to desirable functioning
reduce anesthetic morbidity
What is sensitivity?
It will be positive in a patient who does actually have the disease
What is specificity?
it will be negative in a patient without the disease
For what type of procedures might you consider doing pre-op blood tests?
moderately or highly invasive surgeries
What is an ASA Class 1?
healthy patient with no systemic disease
(excludes neonates and very old patients)
What is an ASA Class 2?
mild to moderate systemic disease, well controlled, no functional limitation
What is an ASA Class 3?
mild to moderate systemic disease with functional limitation
What is an ASA Class 4?
Severe systemic disease that is a constant threat to life
What is an ASA Class 5?
moribund patient, not expected to survive with or without the procedure
What is an ASA Class 6?
patient who has been declared brain dead whose organs are being harvested for transplant
What are the current ASA guidelines for NPO status?
2 hours for clear liquids on all patients
4 hours for breast milk
6 hours formula or solids; light meal
8 hours heavy meal of fried or fatty food, candy, etc.
What are some examples of patients who are considered an aspiration risk?
GERD, hiatal hernia
pyloric stenosis or other mechanical obstruction
metabolic disorders (DM, obesity, ESRD, hypothyroid)
What is the "reasonable practitioner standard"?
what a normal practitioner would consider important for consent