Flashcards in Pre-Anesthesia Assessment (including CV) Deck (56)
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1
Identify the Major goals of the pre-anesthesia evaluation
-optimize pt care and satisfaction
-reduce periop morbidity/mortaity
-minimize surgical delays/cancelations
-determine ideal postop pt disposition (home, Inpatient, ICU)
-evaluate pt health status and preop testing needs
-formulate a plan (can obtain consent)
-ensure time efficient, cost effective pt evaluation
2
what are pros of a dedicated pre-op clinic (PAT)
-overall saves money
-one stop shop
-pt registered, teaching, consults, diagnostic testing
-reduced anxiety
-reduced cancellations
-reduce length of hospitalizations (shift to out pt sx)
-reduce wasteful diagnostic testing
-
3
what are cons of a dedicated pre-op clinic (PAT)
-another appointment to make
-time consuming
-transportation problems
-not very private area
4
why look at the medical record if you can interview the pt
-the record provides the basis for direction of the pt interview and physical assessment
-it does this by providing an insight into the pt's past and present med hx
5
outline the elements of a pre-anesthesia interview
-current problems
-current meds
-allergies
-ETOH/tobacco/ illicit drug use
-anesthesia problems (past)
-Family Hx (and r/t anesthesia)
-A ROS with emphisis on
---CV, lungs, renal, GI, endocrine, hematological, general activity level, psych, dermatological, pregnancy, airway issues
6
outline the elements of the pre-anesthesia Physical exam
Vital signs
Airway
Heart
Lungs
Extremities
Neuro
7
ASA I give description and examples
-a normal healthy pt
-pt for a
-bunion repair
-hernia repair
-lumpectomy
-asymptomatic fibroids
8
ASA II give description and examples
- a pt with a MILD systemic disease that results in NO FUNCTIONAL LIMITATIONS
-well controlled HTN
-well controlled Asthma
-Well controlled DM
-Mild obesity
-cigarette use (unless dr. mcd ask)
9
ASA III give description and examples
-a pt with a SEVERE systemic disease that results in FUNCTIONAL LIMITATIONS
-Poorly controlled HTN
-Poorly controlled asthma
-poorly controlled DM
-COPD
-AF with control
-CVA
O2 SATURATION 90-93%
10
ASA IV give description and examples
-a pt with SEVERE systemic disease that is a CONSTANT THREAT TO LIFE
-unstable angina
-CHF
-debilitating resp disease
-O2 SATURATION ,90% AT REST
-hepatorenal failure
11
ASA V give description and examples
-a MORIBUND pt who is not expected to survive without the operation
-uncontrolled hemorrhage from ruptured AAA
12
ASA VI give description and examples
-a pt decleared brain dead for organ donation
13
ASA E give description and examples
-any pt whome an emergency operation is required
-acute trauma
-emergent c-section
-ruptured appy
14
Evaluation of the CV system includes the determination of what 4 things
1) pre-existing CV disease (HTN, Ischemic valve disease, valular dysfunction, etc)
2) disease severity, stability, and prior treatments
3) comorbidities (DM, PVD, COPD)
4) the type of sx being performed
15
a standard means of categorizing the degree of CV disability is the what
New York Heart Association classification
16
how many classes are in the NYHA class
4
17
NYHA class I
-pt's with cardiac disease
- NO FUNCTIONAL LIMITATIONS to physical limitations
18
NYHA class II
-pts with cardiac disease who are comfortable at rest
- SLIGHT functional limitations to physical activity
-ORDINARY activity results in fatigue
19
NYHA class III
-pts with cardiac disease resulting in MARKED LIMITATIONS to physical activity
-LESS than ordinary activity results in fatigue
20
NYHA class IV
-pts with the INABILITY TO CARRY ON ANY PHYSICAL activity
-symptoms of CV insufficiency are PRESENT AT REST
21
guidlines for ordering pre-anesthesia lab test
-cost effective
-positive benefit risk ratio
-ready for evaluation prior to sx
-test should yeild information that can't be obtained from h&p
-abnormal results in asymptomatic pts would influance pt and anesthesia care
22
men > 40-50 yo should have what prior to sx
ECG
23
women < 40 yo should have what prior to sx
Preg HCG
24
Men and women 50-64 yo should have what test prior to sx
H/H
ECG
25
Men and women 65-74 should have what test prior to sx
H/H
BUN/ Creat
Glucose
ECG
26
men and women > 74 should have what test prior to sx
H/H
ECG
BUN/ Creat
Glucose
CXR
27
what is the main question we ask to asses for CV health
Activity tolerance
28
*** where are the most points earned on the goldman critera
S3 gallop or JVD (11points)
(next is MI in past months with 10)
29
brisk walking 3-5 mph or walking up stairs is what METS
4 or >
30
what are 3 pre-operative risk factors for CV related problems while under anesthesia
Smoking
DM
HTN
31
Characteristics of TRUE angina
retrosternal diffuse pain
Lt arm, Jaw, Back
aching dull pressure or squeezing
32
what are thought to be but are probally not true angina signs
Lt inframam localized pain
Rt arm pain
sharp, cutting, shooting
seconds, hours, days
increase with respiration, motion
very nonspecific
33
Cardiac causes of chest pain
CAD
Aortic valve disease
pulm htn
MVP
pericarditis
IHSS
34
Pulmonary causes of chest pain
PE
PNE
pleuritis
pneumothorax
35
musculoskeletal causes of chest pain
costochondritis
arthritis
muscular spasm
Bone tumor
36
GI causes of chest pain
ulcer disease
bowel disease
hiatial hernia
pancreatitis
cholecystitis
37
Vascular causes of chest pain
aortic dissection
38
Emotional causes of chest pain
anxiety
depression
39
what is the most reliable indicator of how a pt will tolerate GA
their description of exercise tolerance (METS)
40
what is HTN criteria
normal 160 or >100
41
what extracts the largest amt of 02 in the body
Heart
42
Myocardial demand consumption is affected most by what
contractility
43
The heart uses this ______ for energy to produce a contraction?
ATP
44
what is the most important factor in maintaining balance between supply and demand
HR
45
what affects supple in the heart
hr
O2 content in blood
Coronary perfusion
46
What affects demand in the heart
HR
contractility
Afterload
Preload
47
Why do we monitor lead II
rate/rhythm/ PVCs
48
why do we monitor lead V5
ST elevation
49
where is lead V5 supose to be placed
slightly lateral and under left breast
50
***** who needs endocarditis prophylaxis
Artificial heart valves
Hx on endocarditis with valve dysfunction
Hx of partial or total repair of VSD
51
***** who no longer needs endocarditis prophylaxis
MVP
Hypertrophic cardio myopathy
rhumatic fever
52
****myocardial DEMAND O2 comsumption is most affected by what
contractility
53
STOP BANG for sleep apnea
Snoring (do you)
Tired (feel tired)
Observed (seen stop breathing)
BP (HTN)
Age (>50)
Neck circumference (> 40cm)
Gender (male)
54
with the STOP BANG what score indicates a high risk? and what indicates a low risk
high- yes to 3 or more
low- yes to < 3
55
how much wood could a wood chuck chuck if a wood chuck could chuck wood?
a wood chuck could chuck as much wood as a wood chuck could chuck if a wood chuck could chuck wood
56
