Perioperative Patient Flashcards
(15 cards)
informed consent
-nature, risks, benefits, alternatives
-1. explain dx
-2. sharing proposed tx
-3. exam pro and cons
-4. alternatives
-5. confirming understanding- repeat back
operational vs procedural consent
OPERATIONAL- in operating room, general anesthesia, high complexity
-Scope- For major surgical interventions.
-Setting- Operating room, inpatient surgery centers.
-Complexity- Higher, greater risk .
-Involvement of Anesthesia General or regional anesthesia is often required.
-Examples C-section, cholecystectomy, knee replacement.
PROCEDURAL
-Scope- For minor or non-surgical interventions
-Setting: Outpatient, clinic, emergency room, or bedside.
-Complexity Lower complexity or typically less invasive.
-Involvement of Anesthesia: May involve local anesthesia or sedation.
-Examples Colonoscopy, wound suturing, IV catheter placement.
steps of the informed consent
-explain tx, procedure, test
-discuss purpose
-risk and benefits
-alternatives
-assess understand
-encourage questions
-document the consent
FHCDA- family health care decision act
-hierarchy of surrogate decision makers authorized to make healthcare decisions for pts who lack capacity and havnt appointed a health care agent:
-1. court appointed guardian- guardian appointed under Article 81 of the Mental Hygiene Law
-2. spouse or domestic partner- legally recognized
-3. oldest adult child
-4. parent
-5. adulting sibling- 18+
-6. close friend or relative
-you can reject responsibility
-MOLST form once someone agrees
-if NO ONE - 2 attendings decide and document urgent procedure
-assault if not documented
EMTALA- pediatrics
-must provide medical screening exam
-stabilize pt and life saving procedures
-transfer pt to hospital that has available services if needed
-cant delay due to absence of parent
during surgery consent
-wake the pt up and ask or ask the spouse, parent, child if non emergent
-if emergent and life saving -> just do it
goals of preoperative optimization
-reduce periop complications- infections, thromboembolism, organ dysfunction
-enhance recovery- improve outcomes and decrease stay
-address risk factors- control DM, nutritional status, smoking cessation
-optimize reserve- ensure pt can tolerate physical and metabolic stress of surgery by optimizing cardiorespiratory and functional capacity
-promote decision making- informed consent, expectation of PAIN
-reduce costs- decrease readmission, stay, resource use, by preventing complications
capacity
-proxy -> if no proxy
-FHCDA surrogate
focus on 4 modified areas: strong for surgery
nutrition
-malnutrition
-testing albumin for risk stratification
-eval immunonutrition
-BEST DETERMINANT OF SURGICAL OUTCOME
smoking
-SURGICAL SITE INFECTIONS ARE MORE PREVALENT
-decreases healing
blood sugar
-screen for risk of DM
-screen blood sugar
-monitor periopeative glucose management
medications
-identify drugs that can cause bleeding and cardiac risks
-reconciling herbal meds
ERAS (enhanced recovery after surgery) protocol: NSQIP
-multidisciplinary, evidence based approach to perioperative care that optimizes pt recovery, improves outcomes, and reduced complications
preventing SSI
-evidence based protocols
-preop antibiotics
-normothermia during surgery
-glucose control in DM pts
surgical risk calculator: breakdown comorbidities and risks for surgery to make informed decision
optimization of periop care in older adults
-consensus: colorectal, UGI, hernia, and HPB:
-encourage cessation of smoking and alc
-correct anemia
-colorectal only: prehabilitation - move and be active before surgery
-consensus: UGI, hernia, and HPB
-benefit of minimally invasive surgery (MIS) > open surgery
-benefit of enhanced recovery after surgery (ERAS) > conventional preop care
-evidence:
-supports MIS and ERAS in colorectal surgery for >65yo
-knowledge gaps in perioperative optimization
pre-op note
pre-op orders
post-op check
Important to know what day
- Day 0: same day of the procedure
- Day 1: day after the procedure
How is your pain? Any assoicaed sx? Anesthesia - numbness or tingling anywhere?
Passing gas or bowel movement? - look at chart to but see pt input
-where is the incision
Febrile? - some process is happening
pain meds
-okay if taken correctly
-5 days of pain meds
-assess if pt needs more after
