Total Joints
The acceptable HBA1C for patients going for elective Joint replacements
what is < or = to 8
Surgical Risk Calculator that estimates the chance of an unfavorable outcome (such as a complication or death) after surgery. The risk is estimated based upon information the patient gives to the healthcare provider about prior health history. The estimates are calculated using data from a large number of patients who had a surgical procedure similar to the one the patient may have
ACS NSQIP surgical risk calculator
Last dose of Low molecular weight Heparin preop
What is 24 hours before surgery
These lifestyle choices put your patient at risk for respiratory complications post operatively.
What are smoking, obesity, decreased activity
This type of surgery is done to confirm or rule out a diagnosis. Examples include a biopsy, fine needle aspiration, invasive testing such as cardiac catheterization.
What is Diagnostic(Exploratory)surgery
Side effects of this type of anesthesia include hypotension, nausea, vomiting, urinary retention or a headache from leakage of CSF.
What is Spinal Anesthesia
The kind of anesthesia that should not be given during or within 14 days after a URI which has involved a bronchial cough
What is General anesthesia
A patient takes more than 20 mg prednisone daily for more than 5 days, what is the dose for steroids perioperatively?
What is stress dose
Major surgeries(cardiac, vascular, Trauma, hepaticojejunostomy, Esophagectomy)- Daily Dose+Hydrocortisone 100 mg IV before incision,
50 mg Hydrocortisone IV Q 8 hours X24 hrs
Taper dose by half per day until usual daily dose is reached
Moderate surgeries(Total joint replacement)- usual daily dose ,Decadron immediate preop and postop , then usual daily dose
This stimulates intestinal motility, enhances lung expansion, mobilizes secretions, promotes venous return, prevents joint rigidity and relieves pressure.
What is Early ambulation
This class of medications increase the risk for hypotension during surgery, may interact with anesthetic agents to cause bradycardia and impaired circulation.
What is Antihypertensives
Periop And Intraop Managment of patients with Deep Brain stimulator/ Vagal Nerve Stimulator/spinal cord stimulator/ Sacral nerve stimulator
What is turn off Device before surgery(By patient or Neurology)
Postop Device interrogation recommended
Have Manufacturer numbers handy(Medtronics/Boston scientific etc)
Routine CXR has been controversial as to its utility in assessing preoperative risk. What history element is more predictive of complications.
What is functional status. (Although CXR in women over 50 has been routine, many belive that it rarely changes the plan and more often confirms a specific diagnosis).
Diagnosis made by: prolonged PTT, ristocetin cofactor activity and factor VIII activity
What is von Willebrand disease
This drug is administered when a patient is unresponsive with lowered respiratory rate with impending respiratory distress/arrest.
What is Narcan.
A rare life-threatening complication that may be triggered by drugs commonly used in anesthesia.
What is Malignant Hyperthermia
The nurse has inserted an IV catheter and an indwelling urinary catheter. The pre-op client begins to complain of itchy eyes and nasal drainage. The nurse considers that the client might be experiencing this.
What is a latex allergy?
Preoperative diagnosis and treatment of ___________ will improve heart function, reduces pulmonary artery pressure and normalizes blood pressure in the introperative and postoperative periods.
What is OSA- obstructive sleep apnea. (Obesity and diabetes is major risk factor).
Duration of hold of Hormone replacement therapy for high risk surgeries for VTE
What is 1-2 weeks before surgery
This activity helps to expand the lungs and maintain adequate air exchange.
What are breathing exercises and incentive spirometry
These types of medications can increase the risk for cardiac dysrhythmias secondary to K+ loss, interfere with metabolism of anesthetics because of their effects on the liver, increase potential for excessive bleeding, decrease cerebral blood flow, cause HTN, increase the effects of opioids and sympathetic nervous system stimulants.
What is Herbal and Alternative medications
Perioperative suboxone managment
Review case with prescribing addiction medicine (CDRP) or pain physician.
In some cases, continue therapy up to and including day of surgery.
In surgeries causing mod-severe pain: 3-7 days prior to surgery, consider reducing the dose to < 8 mg/day, sometimes as low as 1-2 mg/day.
In surgeries causing minimal pain: increasing doses of buprenorphine may be helpful in the perioperative period and may be used as the main pain control.
Use standard opioid agonists for anesthesia and post-operative analgesia. Once acute pain subsided, stop opioid agonists and resume previous or higher buprenorphine dosing. Collaborate with CDRP.
In the acute hospital setting, higher doses of full agonists may be needed in patients on partial agonists. Dilaudid and Fentanyl are more effective because of higher affinity. Collaborate with CDRP.
Of the following, which provides a patient with a 50-fold to 80-fold increase in risk for thromboembolism,factor V Leiden mutation, prothrombin gene mutation, antithrombin III, protein C, protein S, MTHFR variant...
What is homozygous for factor V Leiden mutation (heterozygotes: 3-fold to 8-fold increase)
Valvular heart diseases which needs Bridging therapy with Heparin/Lovenox for patients on Warfarin
Hyperthermia, tachycardia, confusion in the post-op period...
What is thyroid storm (most feared complication of untreated hyperthyroidism, can occur commonly at induction of anesthesia or postop, can be confused with malignant hyperthermia, must be treated with a beta blocker and an antithyroid treatment like iodine, PTU or methimazole).
A rare life-threatening complication that may be triggered by drugs commonly used in anesthesia.
What is Prolonged QT interval