Quiz 6 Flashcards
(26 cards)
No age limit in outpatient with the exception of premature babies
.
1st and second most common surgery center procedures
- Opthalmologic
- 2nd are gynecological surgeries
Healthy former premature infants should be greater than ______ weeks postconceptual age
50-60
Infants displaying ___________________________ should NOT be considered for surgery
bronchopulmonary dysplasia
Increased risk of SIDS
- Children with history of apnea/bradycardic events
- Siblings with SIDS (4-5X greater risk)
- Should not be considered until 6mo. – 1yr
Children with prior history should be free of apnea/bradycardia for ____ prior to surgery
6 months
Healthy full-term infant: If free of any complications can be considered case by case at _______ weeks of age
2 to 4
Those aged ___ years or greater are at greater risk for hospital admission and death within the week following surgery
85
Convulsive disorders
-If Controlled: Schedule procedures very early in the day to provide for optimal observation, minimum of 4 to 8 hours postoperatively
Malignant HyperthermiaSusceptibility
Must have at least 1 of the following criteria:
- Previous MH episode
- Masseter rigidity with previous anesthesia
- Relative (1st degree) with MH episode or positive muscle biopsy
Can do in outpatient, must watch 4 hours post-op.
Have a minimum of ____ vials of dantrolene available
36
Morbid obesity
- ASA class I, II only
- Co-morbidities such as cardiac, endocrine, hepatic, renal or pulmonary should be inpatient
- Bring CPAP
BMI greater than ___ considered very high risk/unacceptable
50
Sickle Cell Criteria for outpatient:
- No major organ disease (as a result)
- No sickle crisis for minimum of 1 year
- Compliant medical care
UNACCEPTABLEPatient Conditions for SDS
- Unstable ASA III or IV
- Newly diagnosed or untreated OSA
- Uncontrolled diabetes
- Isolation necessary (sepsis/infectious dz)
- Post-op pain not controlled with oral meds
H & P: For stable patient should be within __ days or within __ hours for the high risk patient
30
72
Lab values good within __ days of surgery if patient status is stable
60
unless on diuretic, digitalis - K+ within 7 days
If coumadin held, should be held for
4-5 days
Symptoms of URTI
- WBCs >12-15,000
- Mucopurulent nasal secretions
- Inflamed/reddened mucosa
- Positive chest findings
- Temperature 38C or>
- Tonsilitis
- Viral ulcers in oropharynx
- Conjunctivitis
- Coughing (nonproductive)
- Fatigue
- Itching
- Laryngitis
- Malaise/myalgias
- Sneezing
- Sore throat
- *throat/nasal cultures
URTI: Asymptomatic can be done if following are met
- Child older than 1yr, otherwise healthy and surgery is not on thorax or abdomen
- ETT intubation is not planned (11-fold increase risk of adverse respiratory complications)
Risk factors for increased respiratory airway problems with URTI:
- ETT
- <5yrs
- hx of prematurity
- hx RAD(reactive airway dz)
- 2nd hand smoke
- copious secretions
- nasal congestion
- ENT sx
Fluid Management
- Surgical procedure greater than 30 min.
- Increased hypothermia, increased analgesics, prolonged resumption of normal diet
- Procedures with increased PONV
- Procedures with increased post-op pain
- Prolonged fasting, particularly children
- Intra- or post-op bleeding
- Need for antibiotics
Top 2 reasons for inpatient admission
- N/V
- uncontrolled pain
Contributors to PONV
- Ambulation
- postural hypotension
- uncontrolled pain
- post-op pain meds
- oral intake
- low inspired O2 concentration
- reversal agents
