Preoperative Evaluation of Patient

Question 1

What are the six key factors that are looked at in determining the operative risk?

Answer 1

Age  
Benefits vs Outcome of surgery 
Urgency 
Nature of problem 
Duration of procedure 
Concurrent medical problems

Question 2

For a smaller patient, like on going under for a PDA repair, what are four things that should be set aside or used?

Answer 2

Warmed fluids
Glucose
Atropine
Nerve block

Question 3

What are the five levels of anesthetic risk?

Answer 3

Excellent - Good - Fair - Poor - Guarded

Question 4

What does a classification of risk of Good mean?

Answer 4

Slight chance for complications but highly likely there will be a good outcome

Question 5

What does a classification of risk of Fair mean?

Answer 5

Serious complications are possible but uncommon
Prolonged recovery possible
May not return to pre surgical function

Question 6

What does a classification of risk of Poor mean?

Answer 6

Underlying disease/Procedure itself is associated with severe complications
Recovery will be prolonged
Unlikely to return to pre surgical function

Question 7

What does a classification of risk of Guarded mean?

Answer 7

Outcome unknown

Question 8

What three things should you ask when focusing in on a complaint?

Answer 8

When
What did it look like when it first began
Better or Worse

Question 9

What is the most important part of a pre surgical work up?

Answer 9

PE

Question 10

What are the levels in rating the physical status of a surgical patient?

Answer 10

I to V

Question 11

What is a physical status of II mean?

Answer 11

Localized disease or mild systemic disease but otherwise healthy

Question 12

What is a physical status of III mean?

Answer 12

Severe systemic disease

Question 13

What is a physical status of IV mean?

Answer 13

Severe systemic disease that is life threatening

Question 14

What is a physical status of V mean?

Answer 14

Moribund, not expected to live 24 hours with or without surgery

Question 15

What is part of the intraoperative plan?

Answer 15

Surgical approach
Material/Equipment needed
Personnel you will need on staff
(How - Who - What)

Question 16

What are the examples of a postoperative plan?

Answer 16

Further testing
Wound care
Support (nutritional, fluid, oxygen, etc)

Question 17

What is the normal blood volume for a dog?

Answer 17

90 ml/kg

Question 18

What is the normal blood volume for a cat?

Answer 18

70 ml/kg

Question 19

What is the rate for the shock dosage of fluids?

Answer 19

30 ml/lb

Question 20

What do you have to be careful of when giving shock rate of fluids?

Answer 20

Can cause more problems then good if patient has:

Pulmonary + Cardio + Renal issues

Question 21

When do you know if you need to treat ventricular arrhythmias?

Answer 21

Interfere with CO
Multiform
R on T
Ventricular rate is > 160 rpm

Question 22

What are the two methods of suppling nutrition?

Answer 22

Enteral + Parenteral

Question 23

What are the possible complications/problems with total parenteral nutrition?

Answer 23

Expensive formulas

Sepsis

Question 24

What are the four types of tubes you can place for enteral feeding?

Answer 24

Nasogastric
Pharyngostomy
Gastrostomy
Enterostomy

Question 25

What are the three clinical methods of using antibiotics?

Answer 25

Therapeutic Prophylactic Nosocomial

Question 26

What is prophylactic antibiotic administration responsible for?

Answer 26

Antibiotic resistance in bacteria

Question 27

What are the four major reasons given for resistant bacteria?

Answer 27

Prolonged, extensive surgical procedures Increased invasiveness of supportive measures Long hospital stays Inappropriate use of AB's Immunosuppressive drugs

Question 28

What is infection dependent on?

Answer 28

Number/Virulence of bacteria Competence of host defense Amount of tissue damage Dead space resulting from procedure

Question 29

What four things can be done to decrease infections?

Answer 29

Good wound lavage Closure of dead space Appropriate AB prophylaxis Meticulous surgical technique

Question 30

Where is the most common place that bacteria come from that cause infection?

Answer 30

Endogenous to patient

Question 31

How much does the risk increase per person in the surgical suite?

Answer 31

1.3 times

Question 32

What are the two most common nosocomial infections?

Answer 32

Urinary tract + Surgical site infection

Question 33

When would you need to use prophylactic AB's?

Answer 33

Surgery longer than 90 minutes Prothesis implantation Prothesis that was there pre-surgery Severely infected wounds

Question 34

What are the four types of surgery that need prophylactic AB's?

Answer 34

Orthopedic + Respiratory + Gastrointestinal + Urogenital