Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

NURA 606 Adv Health Assessment > Intro to Hx Taking, Pre op Eval, Lab Testing & Chart Review > Flashcards

Intro to Hx Taking, Pre op Eval, Lab Testing & Chart Review Flashcards

1
Q

components of the pre op evaluation

A
  1. detailed pt hx (chart review + hx taking) - ROS
  2. physical and airway exam
  3. medications/allergies
  4. lab testing/diagnostic testing
  5. previous surgeries
  6. medical consultation (if indicated)
  7. ASA status
  8. NPO status (fasting status and aspiration risk)
  9. anesthetic plan
  10. discussion of plan (educate and decrease anxiety)
  11. informed consent
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Where is the pre op eval performed?

A

presurgical testing centers (early testing)

hospitals

  • OR settings (holding)
  • critical care units
  • specialty departments

outpatient centers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Pre op eval clinics:

A

1 week prior to surgery

  • pt interview
  • physical exam
  • medical records to be acquired and collated
  • promotes pt teaching and anxiety reduction
  • allows time to schedule appts with medical consultants and complete required pre operative diagnostic testing/interventions
  • abnormalities addressed immediately
  • obtain informed consent prior to operative day
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Early pre op assessment: populations that would benefit

A

Includes, but not limited to:

  • angina, CHF, MI, CAD, poorly controlled HTN
  • COPD/severe asthma, airway abnormalities, home 02 or ventilation
  • IDDM, adrenal disease, active thyroid disease
  • liver disease, ESRD
  • morbid obesity, symptomatic GERD
  • severe kyphosis, spinal cord injury
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Chart Review:

A
  • demographics - name, age, sex
  • diagnosis/procedure
  • surgical consent
  • prior H&P (from surgeon or internist)
  • prior anesthetics records
  • nursing notes
  • patient questionnaire
  • results of lab tests
  • EKG, PFTs, XRay, etc.
  • vital signs (when)
  • medication list
  • allergies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Past Anesthetic Hx

A

Complications

  • difficult airway
  • slow wake up
  • MH

family history complications
-MH

Obstetrical deliveries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Physical exam: components

A
  • general assessment: appearance
  • disposition
  • cognition/mental status
  • record of VS/day of
  • airway exam
  • auscultation - CV/Pulm
  • neuro exam
  • peripheral veins
  • examine site for RA (regional anesthesia)
  • examine surgical site
  • AICD/pacemaker (other)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Physical Exam: Airway

A

anesthesia perspective - most important aspect of physical exam

  • mallampati score
  • dentition
  • neck mobility (ROM, how far can lift your chin?)
  • neck circumference
  • neck length
  • thyromental distance
  • mandibular protrusion (bite your upper lip)
  • mouth opening (mallampati, fingerbreadth test)
  • pertinent deformities (ROM, radiation, tumors, head and neck sx)
  • airway pathology
  • facial hair
  • past surgical hx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Difficult mask ventilation

A
  • age >55
  • OSA/snoring
  • edentulous
  • facial hair
  • BMI>26
  • neck circumference
  • Mallampati 3 or 4
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Difficult DL

A
  • h/o difficult airway
  • OSA
  • congenital abnormaliies
  • obesity
  • cervical spine dx
  • non reassuring airway exam findings
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Physical Exam: CV

A

VS (rate, rhythm, BP)

Auscultation (murmurs, abnormal heart tones, carotid bruits)

Inspection

  • peripheral pulses (consider sick pt or if need for a line)
  • IV access (consider access and if need for central line)
  • JVD
  • peripheral edema
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Physical Exam: Resp

A

VS (RR, spo2)

Auscultation (wheezing, dec breath sounds, abn breath sounds)

Inspection (cyanosis, clubbing, accessory muscle use, resp effort, res pattern)

need for post op CPAP or vent support??

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Physical Exam: Neuro/MS

A

motor - gait, grip strength, ROM, ability to hold arms forward, etc

sensory - distinction of vibration, pain, light touch along dermatomes

muscle reflexes

cranial nerve abnormalities

mental status

speech

surgical positioning - limitations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Exercise Tolerance: purpose

A

cardiopulm fitness or functional capacity

predictor or cardiac risk & need for further testing

quantified by METs - estimated energy requirement for various activities (metabolic equivalents)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

1 MET - 3 MET: activity

A

self care

eating, dressing, or using the toilet

walking indoors and around the house

walking one to two blocks on level ground at 2 to 3 mph

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

4 MET - 9 MET: activity

A

light housework (dusting, washing dishes)

climbing a flight of stairs or walking up a hill

walking on level ground at 4mph

running a short distance

heavy housework (scrubbing floors, moving heavy furniture)

moderate recreational activities (golf, dancing, doubles tennis, throwing a baseball or football)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

> 10 METs

A

strenuous sports

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Johns Hopkins Surgery Risk Classification System: Category 1

A

minimal risk

minimally invasive

little or no blood loss

still consider that SURGICAL RISK may be minimal, but overall risk could be high

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Johns Hopkins Surgery Risk Classification System: Category 2

A

mild risk

minimal to moderately invasive

EBL not exceeding 500 ml

20
Q

Johns Hopkins Surgery Risk Classification System: Category 3

A

moderate risk

moderate to significantly invasive

EBL 500-1500 ml

21
Q

Johns Hopkins Surgery Risk Classification System: Category 4

A

major risk

highly invasive

EBL > 1500 ml

22
Q

Johns Hopkins Surgery Risk Classification System: Category 5

A

critical risk

highly invasive

EBL>1500 ml

Post op ICU, life saving procedure

23
Q

ASA + surgical risk = ?

A

overall perioperative risk!!

24
Q

What is ASA status?

A

perioperative risk assessment (does not consider risks inherent to operative procedure)

informs clinical decision making:

  • enhanced levels of monitoring
  • less invasive treatment options
  • interventions to reduce risk

correlation of ASA scores and M&M, complications

LIMITATION: clinician subjectivity

25
ASA I
normal, healthy patient; no systemic disease
26
ASA II
mild to moderate systemic disease, well controlled, no functional limitation HTN, DM - well controlled, perform ADLs
27
ASA III
SEVERE SYSTEMIC DISEASE | functional limitations - interventions outside of medication (i.e. home O2)
28
ASA IV
SEVERE SYSTEMIC DISEASE that is a constant threat to life
29
ASA V
morbund patient, not expected to survive with or without the surgical procedure
30
ASA VI
patient declared brain dead whose organs are being harvested for donation
31
ASA: addition of "E"
emergency operation required CAN BE ADDED TO ANY ASA STATUS
32
Pregnancy Testing Considerations
- consider premenopausal women of childbearing age - surgical considerations (harm to fetus): - --direct injury - --reduced blood flow - --teratogenic agents -sensitive subject, don't force the pt **Full discussion of risks, benefits, alternatives - DOCUMENT**
33
CBC, HGB, HCT: considerations and NICE guidelines
proposed sx potential blood loss clinical indications: hematologic dx, CKD, chronic liver dx, anticoag therapy, etc. NICE guidelines: ASA 3 or 4 intermediate procedures, all patients having major procedures
34
Electrolytes & Glucose: considerations
clinical indications for electrolytes: CKD, cirrhosis, certian meds, DM, type of sx, dialysis clinical indications for glucose: DM, steroid use, cirrhosis
35
Renal function: considerations and NICE guidelines
Assess tubular function & GFR clinical indications: DM, HTN, dehydration, known renal dx, h/o transplant, etc NICE guidelines: -Routine in ASA 3 or 4 having intermediate procedure & ASA 2, 3 or 4 having major procedure -Risk for AKI: ASA 3 or 4 having minor procedure, ASA 2 for intermediate
36
Liver Function: considerations
Hx of liver injury & exam findings Clinical Indications: hepatitis, jaundice, cirrhosis, portal HTN, bleeding disorders, etc.
37
Coagulation Profile: considerations and NICE guidelines
routine testing not indicated unless known or suspected coagulopathy clinical indications: bleeding disorder, hepatic dx, anticoagulant use NICE guidelines: ASA 3 or 4: intermediate, major, complex procedures; known anticoagulant meds or chronic liver disease
38
Urinalysis: considerations
no indication for routine use clinical indications: suspected UTI, unexplained fever or chills acute drug toxicity
39
T&S/T&C: considerations
decision is usually guided by institutional policy (surgical blood order schedule) - reduce unnecessary blood orders ($$) clinical indications: suspect blood transfusion
40
ECG: clinical indications and NICE guidelines
no indication for routine use clinical indications: h/o IHD, HTN, DM, HF, CP, syncope, DOE, etc. 2014 ESC/ESA guidelines: risk factors for IHD, CVD, sig arrhythmia, or symptomatic; intermediate/high risk surgery NICE guidelines: ASA 3 or 4, intermediate procedure; ASA 2, 3 or 4, major procedures
41
Chest xray: clinical indications
no indication for routine use clinical indications: advanced COPD, bullous lung disease, suspected pulmonary edema, suspected pulmonary edema, suspected PNA, suspected mediastinal mass, suspicious findings on exam patients undergoing thoracic, upper abdominal, AAA sx
42
ECHO: clinical indications
no indication for routine use clinical indications: heart murmur and symptomatic, S&S of HF, unexplained dyspnea; clinical stable, ventricular dysfunction not tested in previous year
43
PFTs: clinical indications
considered for type and invasiveness of surgery (CABG, lung resection clinical indications: severe asthma, symptomatic COPD, scoliosis, restrictive lung dx
44
NPO status: CURRENT ASA guidelines for 2, 4, 6, 8 hours
balance risk factors of fasting with pulmonary aspiration risk 2 hours: clear liquids; all patients 4 hours: breast milk 6 hours: formula or solids; light meal 8 hours: heavy meal, fried or fatty food, candy, gum (controversial; some say it promotes gastric emptying, some say it promotes HCl production) Consider: difficult airway & co-morbidities
45
Populations with potential aspiration risk
No separate guidelines currently available up to clinician judgment/institution) 1. age extremes <1 yr or >70 yr 2. ascites (ESLD) 3. collagen vascular disease, metabolic disorders (DM, obesity, ESRD, hypothyroid) 4. hiatal hernia/GERD/esophageal sx - -how bad? How do you sleep @ night? 5. mechanical obstruction (pyloric stenosis) 6. prematurity (extreme of age) 7. pregnancy 8. neurologic diseases 9. having eating food or non-clear drinks - -Be CLEAR with how you ask!!
46
Continue meds day of procedure EXCEPT:
- ACEIs and ARBs - ASA: stop 3 days prior unless perc. coronary intervention, high grade IHD, sig CVD - P2Y12 inhibitors: stop 5-10 day prior unless drug-eluding stent (6 month dual antiplatelet therapy) & bare metal stents (1 month dual antiplatelet therapy) * **discuss risk w/ surgeon/cardiologist*** -short acting insulin; none or 1/2 dose of long-acting insulin day of *** insulin pump - basal rate only - topical - non insulin anti-diabetic meds - diuretics - sildenafil or similar - NSAIDS: 48 hour - Warfarin: 5 days prior

NURA 606 Adv Health Assessment (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions