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24 Cards in this Set
- Front
- Back
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What are the four questions to ask asthamtics
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What are there precipitating factors?
Frequency and severity of attacks? Medications taking? Response to treatment? |
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How do you manage an asthamtic
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-assure optimal disease control
-manage anxiety (avoid barbiturates and meperidine) -consider preoperative inhaler use -have bronchodilator available -may need to avoid NSAIDs |
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COPD questions to ask
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What is their exercise tolerance?
Do they have dyspnea or cough? Taking medications/O2? Response to treatment? |
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How to treat a COPD patient
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-assure optimal disease control
-manage anxiety but use caution with sedation (nitrous or light IV) -avoid barbiturates, opioids, anticholinergics and histamine blockers -low flow oxygen -semiupright position -vitals -bronchodilator available |
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Angina - questions to ask
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What are the precipitating events?
What is the frequency, duration and severity? What is their response to treatment? |
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Management of a patient with angina
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-identify angina as stable or unstable
-assure optimal management -anxiety management (BZDP, nitrous) -supplemental oxygen -consider NG pre-treatment -monitor vital signs -have NG available |
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Post MI - questions to ask
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How long since MI?
Any treatment - surgery or angioplasty? Meds you are taking? Current symptoms? |
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What are the recurrence rates of MI?
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36% in first 3 months
16% at 5 months 5% at 6 months |
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Treating a patient after MI
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less than 6 months & w/o surgery to correct arteries - emergency treatment only in a hospital
After surgery to open arteries - consult cardiologist After 6 months, same protocol as for angina (light oral sedation, nitrous inhalation, light IV, NOT GA) |
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Questions to ask w/arrhythmias
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What type of arrythmia?
Medications? Pacemaker? Are they anticoagulated |
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How to treat patients with an arrythmia
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Ventricular - limit epinephrine
-manage coagulation -avoid use of cautery w/pacemaker -consider ischemic heart disease protocol (avoid hypoxia and hypotension) |
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Questions to ask CHF?
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Do they get peripheral edema?
Do they have dyspnea, orthopnea? What is their exercise tolerance? Are there other systems involved? Are they on medications? How do they respond to treatment? |
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Treatment of a patient with CHF
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-assure optimal treatment
-manage anxiety (BZDP, nitrous, light IV, not GA) -supplemental oxygen -semiupright position -prevent postural hypotension |
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Questions to ask seizure disorder
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What type of seizures?
How frequent? Controlled? What precipitates them? |
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How to treat a seizure patient
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-assure optimal control
-manage anxiety (oral sedation, nitrous, IV - BZDP or barbiturates) |
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CVA questions to ask
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When did it occur?
Medications - anticoagulation? Contributing factors like HTN, DM, supraventricular arrhythmias? |
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Treatment of a stroke patient
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-monitor vital signs
-oxygen -manage anxiety (nitrous, light oral after consult, IV after consult, GA in OR only) -manage anticoagulation |
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Questions to ask DM
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Medications used?
Frequency of insulin reactions? Home monitoring of blood sugar? Recent HbA1c? Systemic complications? |
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Treating patient on insulin
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-determine if patient can follow normal diet after surgery
-determine if patient can modify insulin regimen -avoid hypoglycemia -decrease insulin dose and avoid shortacting insulin -AM appointments |
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What is typical insulin adjusting protocol
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-have an AM appointment
-halve the insulin dose the night before (for the long-acting) -don't take ANY short-acting in the morning |
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Treating patients on oral hypoglycemics
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-do NOT take any oral hypoglycemic on day of surgery
-AM appointment |
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Treatment of patient with liver failure
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-consult MD
-use local hemostatic measures (gelfoam, avitene**, sutures) -consider abx -monitor vital signs -sedation - oral BZDP, nitrous, IV |
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Anticoagulation questions
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What meds?
Reason for anticoagulants? How often are labs done? What are their values? |
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Management of anticoagulation
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-check INR day of procedure
-consult MD -low risk surgery proceed w/INR < 3-3.5, use local hemostasis measures -platelet inhibitors, aspirin - no change in dosage |
