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Flashcards in Health History Deck (20)
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Who mandates that a pre-op assessment be completed?

JCAHO, ASA, AANA

1

Where do you collect data from during the pre-op assessment?

patient's medical record
patient interview
diagnostic tests (labs, xrays, etc.)
specialist consultation/report
physical exam

2

What is the benefit of having the preop assessment completed a week prior at a clinic?

reduced patient anxiety
consents signed then
allows time to schedule consults and get results of diagnostic tests
promotes patient teaching
allows time to develop anesthetic plan

3

Who requires an early pre-op assessment?

uncontrolled CV disease patients
Home O2
COPD or reactive airway disease
IDDM
adrenal disease
thyroid disease
liver disease
ESRD
massive obesity
symptomatic GERD
spinal cord injury/problems

4

What are the 6 purpose of the pre-op interview?

obtain medical history
obtain informed consent
formulate anesthetic plan of care
patient education
improved efficiency
motivate patients towards better health

5

What are some factors to consider when interviewing the patient?

organized and systematic
use lay-person terminology
use open ended questions
progress from general to specific questions
make it individualized
make attempts to control the environment (quiet, family presence, etc.)

6

What are the goals of pre-operative lab tests?

improve intra-op quality
decrease intra-op costs
return patient to desirable functioning
reduce anesthetic morbidity

7

What is sensitivity?

It will be positive in a patient who does actually have the disease

8

What is specificity?

it will be negative in a patient without the disease

9

For what type of procedures might you consider doing pre-op blood tests?

moderately or highly invasive surgeries

10

What is an ASA Class 1?

healthy patient with no systemic disease
(excludes neonates and very old patients)

11

What is an ASA Class 2?

mild to moderate systemic disease, well controlled, no functional limitation

12

What is an ASA Class 3?

mild to moderate systemic disease with functional limitation

13

What is an ASA Class 4?

Severe systemic disease that is a constant threat to life

14

What is an ASA Class 5?

moribund patient, not expected to survive with or without the procedure

15

What is an ASA Class 6?

patient who has been declared brain dead whose organs are being harvested for transplant

16

What are the current ASA guidelines for NPO status?

2 hours for clear liquids on all patients
4 hours for breast milk
6 hours formula or solids; light meal
8 hours heavy meal of fried or fatty food, candy, etc.

17

What are some examples of patients who are considered an aspiration risk?

neonates 70
ascites (ESLD)
GERD, hiatal hernia
pyloric stenosis or other mechanical obstruction
prematurity
pregnancy
neurologic disease
metabolic disorders (DM, obesity, ESRD, hypothyroid)

18

What is the "reasonable practitioner standard"?

what a normal practitioner would consider important for consent

19

What is the "reasonable patient standard"?

what a prudent patient would need to know to make an intelligent decision