Surgery EOR: Preoperative/Postoperative Care Exam Questions and Answers
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Surgery EOR
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Surgery EOR
Surgery EOR: Preoperative/Postoperative
Care Exam Questions and Answers
When can a patient eat prior to a major surgery? - Answer- NPO after midnight or at
least 8 hours
What risks should be discussed with all patients and documented on the consent form
for a surgical procedure? - Answer- Risk...
Surgery EOR: Preoperative/Postoperative Care Exam Questions and Answers When can a patient eat prior to a major surgery? - Answer - NPO after midnight or at least 8 hours What risks should be discussed with all patients and documented on the consent form for a surgical procedure? - Answer - Risk: Bleeding, infection, anesthesia, scars If a patient is on anti -HTN meds should the patient take them on the day of the procedure? - Answer - Yes Should a patient who smokes cigarettes stop before an operation? - Answer - Yes - improvement is seen in just 2 -4 weeks of smoking cessation What lab test must all women of childbearing age have before entering the OR? - Answer - B-Hcg and CBC What is a preop colon surgery "bowel prep"? - Answer - Bowel prep with a colon cathartic (GoLYTELY), oral abx (neomycin, erythromycin), IV antibiotic before incidsion What must you always order preoperatively for you patient undergoing a major surgery? - Answer - 1. NPO/IVF 2. Preop abx 3. Type and cross blood (PRBCs) What electrolyte must you check preoperatively if a patient is on hemodialysis? - Answer - Potassium Who gets a preop EKG? - Answer - Patients over 40 or undergoing cardiac procedure What is the most important preoperative eval performed by the surgical team? - Answer - H&P - no documentation exists linking a reduction in mortality and morbidity to routine lab testing in otherwise healthy patients undergoing elective procedures Detailed H&P prior to surgery including special attention to... - Answer - Hx of CVA, heart dz, pulm dz, renal dz, liver dz, GI d/o, DM, prior surgeries, bleeding problems, clotting problems, difficulty w/ anesthesia, nutrition, etoh, illicit drugs What is an ASA score? - Answer - American Society of Anesthesiologists (ASA) classification system which stratifies the degree of perioperative risk for patients Describe the ASA classification system - Answer - ASA 1: Normal healthy patient ASA 2: Patient with mild systemic disease ASA 3: Patient with severe systemic disease ASA 4: Patient with severe systemic disease with a constant threat to life ASA 5: Moribound patient who are not expected to survive without an operation ASA 6: Brain dead patient Mouth PE important to note - Answer - Teeth - if loose worry about intubation Tongue - think sleep apnea if large Jaw - TMJ could be difficult intubation Mallampati score Airway concerns with surgery - Answer - Tracheal deviation - can be issue for maintaining airway during surgery Neck concerns with surgery - Answer - If >17in there is concern for sleep apnea, masses, deformities, ROM Mallampati score - Answer - Classifies how open the airway is 1 - Can see the uvula, no prob w/ intubation IV- No uvula, hard intubation Routine preop labs/tests for patients with cardiac disease/vascular disease? - Answer - CBC EKG What are major cardiac risk factors for surgery? - Answer - Unstable coronary syndromes Recent MI Severe valvular disease Ventricular arrhythmias What are minor cardiac risk factors for surgery? - Answer - Hx of CVA Uncontrolled HTN What is the Goldman Criteria for Cardiac Risk? - Answer - Assesses risk of perioperative fatal and nonfatal cardiac events. Another used is Detsky's What are moderate cardiac risk factors for surgery? - Answer - Asymptomatic MI DM Compensated CHF What is Lee's revised cardiac risk index? - Answer - Validated way to predict risk in patients who undergo elective noncardiac procedures. There are 6 predictors (each get one point): History of ischemic heart disease CHF Hx of CVA High-risk operation Preoperative treatment with insulin Preoperative SCr >2.0 mg/dL Goldman criteria points - Answer - 0-5 = Class I 6-12 = Class 2 13-25 = Class 3 >25 = Class 4 Preop lab assessment for cardiac disease? - Answer - Resting LV function Ambulatory EKG monitoring Exercise stress test or nuclear stress test Stress echo Patients with an EF <___% are at greatest risk for complications during surgery - Answer - <35% What are indications for preop coronary angiography? - Answer - Patients with suspected left main disease, triple vessel coronary occlusive disease, or unstable coronary syndromes (high risk patients) What is appropriate medical therapy for CAD prior to surgery? - Answer - BB, CCBs, nitrates to ensure myocardial oxygen demand does not exceed supply What do patients with a history of rheumatic heart disease require prior to surgery? - Answer - Prophylactic antibiotics to prevent endocarditis What should you do if you find your patient to have carotid artery disease? - Answer - Endorterectomy prior to surgery - wait 6 months before operation if possible
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