To Hold or Not to Hold- Meds
A 67-year-old patient who is scheduled for a kyphoplasty in 2 weeks mentions they take 81mg of Aspirin Daily during their tele visit. This is the only medication they are taking currently.
What medication instructions should be given?
Instructions: Hold Aspirin for 6 days before surgery and resume taking 24 hours following surgery.
What kind of appointment would you schedule for a 65-year-old patient scores a 7 on STOP-BANG?
Follow up with NP for appointment vs Sleep Med referral
45 year old patient is scheduled for a Laparoscopic Cholecystectomy.
True or False: this patient meets Preop bag/ERAS protocol.
False
A 58-year-old patient is scheduled for a total knee replacement. Medical history includes hypertension and type 2 diabetes.
A BMP that was completed 4 months ago showed these results: Na 129, K 5.1
No additional labs have been ordered.
What labs are indicated for this patient?
EKG, A1C
Repeat BMP within 1 month of scheduled surgery.
A 52-year-old patient is scheduled for a laparoscopic cholecystectomy. History includes well-controlled Type II Diabetes treated with Metformin and GERD controlled with daily famotidine. His last A1C was 5.12. The patient is independent in all activities and has no functional limitations.
What ASA classification is most appropriate?
ASA II
A 54-year-old patient is scheduled for an outpatient hernia repair. During the PAT phone call, they report taking Lisinopril every morning for hypertension. You give these instructions:
Hold Lisinopril 24 hours prior to surgery
You are on a Tele visit with a 36-year old female patient who is scheduled for an elective C4-C5 Posterior Athrodesis in 2 weeks. Medical History includes: endometriosis, scoliosis, fibromyalgia, chronic back pain and alcoholism. She has listed the following daily meds: Metformin, Escitalopram , Buprenorphine and Famotidine.
What appointment/referral would you consider for this patient?
NP visit and Referral to the Pain Pharmacist, Jessie Whitten
An 80-year-old patient with a history of pulmonary hypertension is scheduled for elective lumbar spinal fusion.
True or False: this patient meets Preop bag/ERAS protocol.
True
An 80-year-old patient is scheduled for elective abdominal myomectomy. History includes severe pulmonary hypertension, oxygen-dependent COPD, chronic kidney disease, and poorly controlled diabetes. She reports some shortness of breath with walking. There is no previous lab data/history available.
What preop tests should be considered?
EKG, BMP, CBC, Antibody Screen, A1C, BNP, Chest Xray
A 25-year-old patient is scheduled for a knee arthroscopy. They are healthy, exercise regularly, and take no medications other than a daily multivitamin. BMI is 23 and all pre-op testing is normal.
What ASA classification is most appropriate?
ASA I
A patient 44 year old patient scheduled for surgery in 9 days reports taking the following daily medications: Metformin, Semaglutide, Oxycodone, and Digoxin. What medication instructions do you give?
Hold Semaglutide 7 days prior to surgery
Continue Oxycodone and Digoxin (can be taken on day of surgery with sip of water)
87-year-old patient is scheduled for an elective, right phacoemulsification cataract removal in 4 weeks. He was previously scheduled to have this procedure done last week but it was cancelled due to a preop glucose of 450. He has not been to his PCP in over 6 months.
What kind of appointment would you schedule for this patient?
NP clinic appointment
A 42-year-old patient is scheduled for a Hyerteroscopy D&C. She has a history of obstructive sleep apnea and a seizure disorder. She is an ASA III.
True or False: this patient meets Preop bag/ERAS protocol.
False
An 55-year-old patient with a history of pulmonary hypertension, diabetes, and atrial fibrillation is scheduled for elective lumbar laminectomy surgery. During the PAT medication review, the patient reports taking Humulin R U-500, Methocarbamol, Warfarin, and Cetirizine daily.
What labs are indicated for this patient?
EKG, A1C, PT/ INR, CBC, BMP, T&S and BNP
A 74-year-old patient presents for emergent surgery following a bowel perforation. The patient is septic, hypotensive on vasopressors, and has acute kidney injury. Past medical history includes CHF and chronic atrial fibrillation.
What ASA classification is most appropriate?
ASA IV
A 76-year-old patient is scheduled for a total hip replacement. During chart review, you note the patient takes Warfarin for atrial fibrillation. Their INR today is 2.7.
1 What instructions do you anticipate giving to the patient?
2. Who should be contacted?
2. There should be a discussion between anesthesia, the prescribing provider and/or surgeon for specific holding/bridging instructions.
A 27-year-old patient with a history of Crohn's disease is scheduled for a partial colectomy with ileostomy in 3 weeks. Her medications include Remicade infusion every 8 weeks, daily cetirizine, pregabalin and spironolactone.
What kind of appointment would you schedule for this patient?
NP clinic appointment
A 64-year-patient is scheduled for a Thoracoscopy.
True or False: this patient meets Preop bag/ERAS protocol.
True
A 36-year-old patient is scheduled for a breast reduction. Their medical history includes stage 3 CKD, endometriosis and asthma.
What labs are indicated for this patient?
EKG, BMP and CBC
A 68-year-old patient is scheduled for total hip replacement. Medical history includes insulin-dependent diabetes, COPD requiring daily inhalers, and obstructive sleep apnea treated with CPAP. The patient becomes short of breath climbing one flight of stairs.
What ASA classification is most appropriate?
ASA III