L08: Peri-Operative Care of the SA Patient (Kim) Flashcards Preview

Surgery (Spring 2015) > L08: Peri-Operative Care of the SA Patient (Kim) > Flashcards

Flashcards in L08: Peri-Operative Care of the SA Patient (Kim) Deck (24):
1

SOAP =

subjective
objective
assessment
plan

2

peri-operative includes:

pre, intra, and post-op
-signalment
-presenting complaint
-Hx
-PE
-diagnostics
-tx/stabilization

3

signalment includes:

age, gender, species, breed

4

components of general exam

mentation
vital signs
weight
hydration status
auscult, palpate

5

components of ortho exam

ambulation
swelling, instability
range of motion
pain
(not needed by all patients)

6

components of neuro exam

-intracranial: mentation, CN, ocular
-Spinal cord/peripheral nerves: ambulation, proprioception, reflexes, pain sensation
-Ortho vs. neuro?

7

Common lab tests

PCV/TS/BUN/USG
CBC/Chem/UA
Blood gas analysis
Coag profile
Cross-match/typing
Imaging (rads, U/S)
ECG, blood pressure, SPO2

8

"minimal" surgical risk

little effect of sx, minimal complications, likely normal after Sx

9

"moderate" surgical risk

some potential for complication but high probability of successful outcome

10

"high" surgical risk

serious problems or procedure assoc. with moderate probability of complications

11

"extreme" surgical risk

high chance of major complications, permanent change in health, sx only if necessary for life

12

ASA Class I***

normal p, no systemic dz
ex: elective OHE
tests: PCV/TP Azo

13

ASA Class II***

disease with minimal or no systemic effects
ex: fracture
tests: CBC, chem, UA, rads

14

ASA Class III***

disease with significant systemic effects affecting anesthesia/sx. Not in critical state.
ex: anemia, liver dz
test: CBC, chen, UA, abdominal US

15

ASA Class IV***

severe, potentially life threatening
ex: decompensated heart or renal failure
test: CBC, chem, UA, blood gas, imaging

16

ASA Class V***

moribound, not expected to survive 24 hrs
ex: severe trauma, shock
test: CBC, chem, UA, blood gas, +/- imaging

17

Pre-Op Tx/Stabilization

IV access
fluid therapy
oxygen
analgesia*

18

what should be given pre-op for p with biliary obstruction

vitamin K (b/c can't absorb fat soluble vitamins)

19

what should be given pre-op for mast cell tumor?

anti-histamines in case of degranulation

20

don't take animals to surgery with less than what percent PCV?

20-25% (or if PCV has dropped >30%)

21

Pre-op preparation

-Fasting: withhold morning meal, but be careful for hypoglycemic prone animals
-Peri-operative prophylactic abx: controversial; give >30mins but 24hrs after sx. Use abx effective against native flora (ie. cephazolin)

22

intra-op considerations

positioning
anticipate special instrumentation, blood loss, sx time
sponge counts/hemostat counts
appropriate assistance

23

post-op care

-EXAMINE patient!
ancillary monitoring (bloodwork, henodynamic factos, ECG, body weight, urine output, USG)
-analgesia
-protect wound
+/- abx, sedation, fluids, O2, ventilatory support, wound care

24

Nutritional Support

-oral
-feeding tube (NE, esophageal, gastric, jejunal)
-PPN, TPN
-esp. important in cats due to hepatic lipidosis
-animals with illness will have higher energy requirements