Pre-Anesthesia Assessment (including CV) Flashcards Preview

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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

How to treat MH

diagnose early
stop the trigger
call staff
dantrolene
IV fluids
ice
treat dysrythmias