W2 (1) Flashcards
(40 cards)
What should be included in the patient assessment
- patient Identification
- patient History
- Signalment
- Physical exam
- Diagnostics
Why is body condition scoring important to Anesthesia?
Very thin patients:
- Underlying disease
- Prone to hypothermia
- Drugs may act quicker or stronger on these patients
Overweight patients:
- Underlying disease
- Dose to lean body weight
- Brain is the same size even if body isn’t
- Cardio-pulmonary may be compromised
Why is TPR important to Anesthesia?
Know what “normal values” are for dog, cat, horse, cow
Hyperthermia/hypothemia
Tachycardia/bradycardia
Panting”
Why is hydration important to Anesthesia?
- In general we want to anesthetize hydrated patients
- Exceptions in emergencies
- Dehydration will impair tissue perfusion -> Hypotension
How do you assess hydration?
skin turgor, postition of the eye in the orbit, mucous membrane moisture level, heart rate, pulse strength, and level of consciousness
What words are used to describe the level of consciousnes and temperament
Consciousness : BAR, QAR, Lethargic, Obtunded, Stuporous, Comatose
Temperament : Anxious, Friendly, calm, Aggressive, Excitable, Scared
What are the different values for Mucous membrane color?
Pink - normal color
White/pale - decreased perfusion from shock, vasoconstriction, hypotension, or a variety of other condictions, anemia
Blue - “cyanotic”, reduced oxygen saturation
Yellow - Iceteric
Red
What is a pain score?
- Affects how you interact with animal
- pain management plan
What is involved in a preanesthetic Diagnostic workup?
Test and Diagnostic Procedures: PCV/TP or Plasma Protein, CBC/Profile (Panel), Urinalysis, Serologic or Chemistry Panels, Coagulation Screen, ECG/EKG, Radiographs, Contrast studies, Ultrasound
- All completed tests must be reviewed by the veterinarian, record in the patient’s permanent record before the anesthesia plan/protocol is formed.
What factors influence the diagnostic tests chosen?
Different tests may be ordered based on:
- Facility standard policies
- Different patient groups: Pediatric, Geriatric, Trauma, Elective, Disease states
Other considerations: Financing
Diagnostic : CBC
Evaluation of blood cell numbers and morphology
- Packed cell volume (PCV), plasma protein (PP), hemoglobin,
- Total red blood cell (RBC), white blood cell (WBC), platelet, and absolute leukocyte counts.
Diagnostic : Elevated PCV or RBC
- Dehydration (associated fluid lost leads to decrease in blood volume)
- Decreased Blood volume lead to: Affecting cardiac output, Blood pressure, Tissue perfusion
Diagnostic : Decreased PVC/RBC
Anemia
- Decrease capacity to supply oxygen to the tissues
- Anesthesia increase risk: Tissue hypoxia
- PCV less than 25% in dog and 20% in cat, horse, cow should be reported immediately
Diagnostic : TP
(Proteins-albumin, gobulins, and fibrinogen)
- Hypoproteinemia
- Decreased protein production by the liver
- Protein loss in the GI tract, kidneys
- Blood loss
- Most anesthetics are partially protein bound and the other portion is unbound and free in the blood : Patients with low protein, less protein the anesthetic can bound to resulting in increasing drug potency.
- Less 4.0 g/dL in any patient should be reported immediately
Diagnostic : Total WBC and Leukocyte counts
- Measure the total number of leukocytes
- Measure the number of each type of leukocyte (neutrophils, lymphocytes, monocytes, eosinophils, basophils)
- Changes in counts and morphology may be associated with infection, parasitism, and other diseases
- These changes may influence preanesthetic patient management
Diagnostic : Platelet count
- Evaluate blood coagulation
- Patients with thrombocytopenia are at greater risk of intraoperative and postoperative bleeding
- May have to stabilize condition before surgery
- These changes May influence preanesthetic patient management
Diagnostic : Blood chemistries (panel/profile)
- Assess organ health and function
Kidney – which values Assess Kidney function?
Liver – which values Assess Liver function? - Screen For any diseases or conditions that May increase the patient risk under anesthesia
- Results of These test will aid to formulate an anesthetic plan
Diagnostic : urinalysis
- Information of urinary and non urinary systems
- Kidney function is important in regulating electrolyte and water balance, blood pressure, and elimination of anesthetic agents
- Protein in urine or specific gravity is less than: 1.030 in canine, 1.035 in feline
(Further test needed to assess kidney function) - Macroscopic exam finding (color, clarity odor, biochemical analysis) and Microscopic findings : May reveal diabetes, liver or kidney disease, other systemic disorder
Diagnostic : Blood coagulation tests/screens
- Blood coagulation screens evaluate the chemical, and sometimes mechanical, components of blood coagulation.
- Various disorders may adversely affect blood coagulation and put surgery patients at high risk for intraoperative and postoperative hemorrhage
- A coagulation panel: prothrombin time (PT), activated partial thromboplastin time (APTT)
- Should be performed on any patient that may have a preexisting coagulation disorder (end stage liver disease, hereditary disorders – e.g. Von Willebrand’s)(Doberman, Rottweilers, Scottish terriers)
- In house screen tests : Buccal mucosal bleed time (see page 26 in the textbook)
Diagnostic : EKG/ECG
- Records the electrical activity of the heart
- Assess heat rhythm
-Recommended in patients with known or suspected:
Heart disease (Patent ductus arteriosus (PDA)), Chest trauma, Gastric dilation volvulus (GDV), Splenic disease, Electrolyte disturbances, Medications that may affect heart rhythm
- Because most anesthetic agents alter heart rate, cardiac output, and oxygen consumption to some degree, patients with heart disease are at much greater risk for anesthetic complications.
Diagnostic : Radiography
Thoracic and abdominal radiographs (heart disease, traumas, suspected foreign bodies, diaphragmatic hernia, pneumothorax, pleural effusion, etc.)
Diagnostic : Ultrasound
Masses, heart blood flow, foreign bodies, bladder stones, etc.
TPR Normal Values (dog, cat, horse, cow
Dog -
Cat -
Horse -
Cow -
What are the physiological needs of Fluid administration?
- We all need a constant source of oxygen delivered to all body tissues! (Necessary to perform basic metabolic functions)
- Absence of oxygen will damage any tissue resulting in cell death in the brain and heart muscle
- This can happen within minutes
