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46 Cards in this Set
- Front
- Back
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Objectives of the pre-op interview |
-ensure goals of assessment are met -provide peri-op education -obtain written informed consent -acquaint the patient with process of surgery -evaluate patient's social situation -motivate the pt to comply w/ preventative care strategies (i.e. smoking cessation) |
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Patients at high risk for latex sensitivity: |
chronic exposure, spina bifida, urology procedures, intolerance to latex based products (gloves, balloons, condoms), allergies to tropical fruits, healthcare professionals with history of contact dermatitis |
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Patients should be instructed to stop smoking at least ___ to ___ hours before surgery |
12-48 hours * short term pre-op abstinence from smoking reduces the deleterious effects of nicotine and carbon monoxide on cardiopulmonary function |
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clinical signs of alcohol withdrawal include: |
hand tremors autonomic hyperactivity (sweating, tachycardia, high SBP) insomnia anxiety, restlessness, N/V, hallucinations, psychomotor agitation or seizures |
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Garlic, Gingko and Ginseng all have what effects on the body? |
inhibit platelet aggregation |
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This herb has the potential to increase the sedative effect of anesthetics |
Valerian |
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This Herb causes an induction of C-P450s and must be stopped at least 5 days before surgery |
St. Johns Wort |
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Assessment of what should be completed in pre-op for every patient, regardless of the plan for anesthesia? |
Assessment of the airway |
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In adults, a thyromental distance of less than 7cm (3 finger breaths) is associated with what? |
difficult endotracheal intubation (b/c pharyngeal and laryngeal axis may not align) |
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What is the current "gold standard" for establishing a clinical diagnosis of obstructive sleep apnea? |
polysomnography |
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Unstable angina is associated with the highest risk for what? |
perioperative MI |
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When is the highest risk of period after an acute MI? |
within 30 days |
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most common cause of adult valvular disease? |
rheumatic fever |
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Severe aortic stenosis poses the greatest risk for non-cardiac surgery when the cross-sectional are is less than _____. |
1cm |
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_________ can mask the toxicity of anti-arthymic drugs, electrolyte disorders, and MI and irritability. |
Pacemakers |
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Definition of significant stenosis for a major coronary artery? For a the left main coronary artery? |
narrowing > 70% narrowing > 50% |
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Indications of poor LV function (4) |
CI of less than 2.2L/M^2 LVEDP > 18mmHg EF < 40% |
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If stable LV dysfunction is preset ______ therapy is recommended |
ACE inhibitor |
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What is the most important risk factor for the development of post-op pulmonary complications? |
surgical site (aortic and thoracic) |
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elective surgery is postponed whenever what 4 things are present: |
severe dyspnea wheezing pulmonary congestion hypercarbia (PaCO2>50mmHg) |
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FEV1/FVC of less than______ indicate the presence of obstructive process |
80% |
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______ is the hallmark of asthma |
inflammation of the airways |
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Any time there is _____ tract involvement in an active URI for a child, it is prudent to postpone surgery |
lower respiratory |
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What two things can you infuse to correct pre-op coagulopathies? |
phytonadione FFP and cryoprecipitate |
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Prolonged PT is a better indicator of ____ _____ than hypo-albuminemia. |
liver dysfunction |
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Clinical evidence of renal insufficiency may not appear until _____ of nephrons are non functional |
70% |
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the most accurate reflection of renal reserve or GFR is ___ ____ |
creatinine clearance; represents the ability of the glomeruli to excrete creatinine into the urine at given blood concentration |
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Pre-op measurement of K level is recommended within how many hours of surgery? |
6-8hours |
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orthostatic hypotension, resting tachycardia and lack lack of reap. variability in cardiac rhythm may reflect _____ _____. |
autonomic neuropathy |
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Does the ASA classification represent an estimate anesthesia risk? |
no |
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Triggering agents that may cause seizures and hypertensive crisis fir patients talking big MAOIs |
Meperidine, pentazocine, dextromethorphan, anti cholinergics, indirect acting sympathomimetics (ephedrine) |
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Houston should be dc'd within ____ hours of surgery |
6hrs, check ptt |
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Warfarin should be discontinued how early ? |
3-5 days, check inr |
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What happens with abrupt withdrawal of tricyclic antidepressants? |
Cholinergic symptoms - movement disorders, cardiac arrhythmias |
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What happens with abrupt withdrawal of tricyclic antidepressants? |
Cholinergic symptoms - movement disorders, cardiac arrhythmias |
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Lithium can cause bradycardia resistant to ______. |
Atropine |
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What happens with abrupt withdrawal of tricyclic antidepressants? |
Cholinergic symptoms - movement disorders, cardiac arrhythmias |
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Lithium can cause bradycardia resistant to ______. |
Atropine |
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2 tools for Assessing alcohol consumption/abuse? |
Audit and Cage questionnaires |
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What happens with abrupt withdrawal of tricyclic antidepressants? |
Cholinergic symptoms - movement disorders, cardiac arrhythmias |
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Lithium can cause bradycardia resistant to ______. |
Atropine |
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2 tools for Assessing alcohol consumption/abuse? |
Audit and Cage questionnaires |
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Anesthetic requirements of hypnotics, opioids, and inhalation drugs are increased or decreased in the chronic alcoholic? |
Increased. |
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Risks associated with long term androgen steroid supplementation include: |
Impaired liver function Jaundice Hepatic adenocarcinoma Peliosis hepatitis MI Atherosclerosis Hypercoagulopathies Stroke, HTNdyslipidemia Psych disturbances |
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3 herbs that increase bleeding risk and inhibit platelet aggregation |
Garlic, ginkgo, ginseng |
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This herb induces P450s |
St. John's wort |
