NRNP 6560 Midterm exam/NRNP 6560 Midterm
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Class 1: benefits outweigh risk, should be done
Class 2a: reasonable to perform
Surgery risk classes
Class 2b: should be considered
Class 3: rarely appropriate
ECG before surgery only if coronary disease, except
General rules for surgery: when low risk surgery
testing Stress test not indicated before surgery
Do not do prophylactic coronary revascularization
- Diabetic agents: Use insulin therapy to maintain
glycemic goals(iii) Discontinue biguanides, alpha
glucosidase inhibitors, thiazolidinediones,
sulfonylureas, and GLP-1 agonists
- Do not start aspirin before surgery
Meds before surgery
- Stop Warfarin 5 days before surgery. May be
bridged with Lovenox.
- Do not stop statin before surgery
- Do not start beta-blocker on day of surgery, but
may continue
- Unstable cardiac condition (recent MI, active
angina, active HF, uncontrolled HTN, severe valvular
disease), concern with CAD, CHF. arrhythmia, CVD
- patient stable or unstable?
- urgency of the procedure (oncology will be time
Assessment of surgical
sensitive)
risk
- risk of procedure
- nutritional status
- immune competence
- determine functional capacity (need to be more
than 4 METS, more than 10 METs makes low risk)
catarcts
breast biopsy
Low risk surgeries cystoscopy, vasectomy
laporascopic procedures
Plastic surgery
Head/ neck surgery
thyroidectomy
Intraperitoneal
Prostate
intermediate risk Laminectomy
surgeries Hip/ knee
Hysterectomy
cholecystectomy
nephrectomy
non majot intrathoracic
aortic/ cabg
transplants
High risk surgeries
spinal reconstruction
peripheral vascular surgery
6 points:
High risk surgery = 1
CAD = 1
CHF = 1
Cerebrovascular disease = 1
Lee's revised cardiac risk
DM 1 on insulin = 1
index
Creat greater than 2 = 1
1 = low risk
2 = moderate risk
3 = high risk
- Prophylactic antibiotics should be received within
1 h prior to surgical incision
SCIP pre-operative - be selected for activity against the most probable
infection measures antimicrobial contaminants
- be discontinued within 24 h after the surgery end-
time
- pre-op hair removal (clippers)
- wash hands
Postoperative infection - normothermia
reduction methods - maintain euglycemia
- urinary catheters are to be removed within the first
two postoperative days
Slow destruction of bones/ joint followed by
production of replacement collagen which causes
inflammatory changes
- older than 60
- more female after 55
Osteoarthritis: what,
- more black than white women
incidence
- men and women equal risk between 45 - 55
- abnormal height or weight (obesity)
- repetitive movement
- prior trauma (sprains/ dislocations)
- diabetic neuropathy
- genetic
- Pain in weight bearing joints
- stiffness after sitting, gets better when arising
- feeling of instability on stairs
- fine motor skills deficit
- larger affected joints
- Heberden nodules (bony bumps on the finger joint
Osteoarthritis findings closest to the fingernail)
and diagnostics - Bouchard's nodules (bony bumps on the middle
joint of the finger)
- limited ROM with crepitus
- xr shows narrowing of joint space (need
anteroposterior and lateral knee films bilaterally)
- synovial fluid is clear and without WBC
Goal is to relieve symptoms, maintain/ improve
function, and avoid drug toxicity
Hand OA:
- rest/ joint protection, with splinting
- heat/ cold therapy
- topical capsaicin
- topical NSAID (trolamine salicylate) (especially for
older than 75)
- Oral NSAIDS, incl COX2 inhibitors such as
Osteoarthritis treatment celecoxib (Celebrex) (may cause cardiac problems)
- tramadol
- no opioids
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