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During risk assessment for the pt, what is the best way to determine the severity, stability, and nature of the medical condition of your patient?
look at medical history
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What are the 2 basic techniques used to obtain a medical history?
- interview
- printed questionnaire
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What are 2 ways to determine the functional capacity of the patient?
- ASA classification
- MET (metabolic equivalent level)
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A widely used method of expressing medical risk, a system that was originally developed to classify patients according to their risk for general anesthesia, but is now used for outpatient medical and dental use for all types of procedures
ASA physical classification system
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normal healthy patient
ASA I
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Patient with mild systemic disease that does not interfere with daily activity, or patient with a significant health risk factor like smoking, alcohol abuse, or gross obesity
ASA II
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Patient with moderate to severe systemic disease that is incapacitating but that may alter daily activity
ASA III
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Patient with severe systemic disease that is incapacitating and is a constant threat to life
ASA IV
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A patients ability to perform common daily tasks can be expressed as what?
Metabolic equivalent levels
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What provides a way of quantifying a patient's general physical status?
metabolic equivalent level
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What is a MET?
- a unit of oxygen consumption
- the higher the MET, the more physically involved the activity
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A's in risk assessment
- antibiotic
- anesthesia
- anxiety
- allergy
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B's in risk assessment
bleeding
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C's in risk assessment
chair position
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-
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What are 8 effective ways to reduce stress?
- open communication about fear
- short appointments
- morning appointments
- preoperative
- intraoperative sedation
- profound local anesthesia
- adequate postoperative pain control
- patient contacted on evening of the procedure
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What 5 areas should we pay special attention to in a physical exam?
- skin and nails
- face
- eyes and nose
- ears
- neck
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Cyanosis can indicate what?
cardiac or pulmonary insufficiency
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yellowing of skin and nails can indicate what?
liver disease
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petechiae or ecchumoses can be signs of what?
bleeding disorder
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The following alterations in the fingernails indicate what?:
clubbing
white
yellow
splinter hemmorrhage
- cardiopulmonary insufficiency
- cirrhosis
- malignancy
- bacterial endocarditis
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The following abnormal varieties in the face can indicate what?
pale edematous
moon facies
dull puffy
unilateral paralysis
- nephrotic syndrome
- cushing's syndrome
- myxedema
- bell's palsey
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What are some of the most common sites for sctinic keratosis and basal cell carcinomas?
- bridge of nose
- infraorbital region
- ears
- back/dorsal of hands
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The following eye irregularities may indicate what?
lid retraction/wide eye stare
xanthomas
scleral yellowing
red conjunctiva
- hyperthyroidism
- hypercholesterolemia
- hepatitis
- sicca syndrome, allergy, or iritis
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An earlobe crease occurs more frequently in pts with what?
coronary artery disease
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What are the six things that vital signs consist of?
- blood pressure
- pulse
- respiratory rate
- temperature
- height
- weight
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A blood pressure cuff that is too small yields false ___________ results, a blood pressure cuff that is too large yields false ___________ results
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The best way to consult the patients physician and to prevent the pt from coming in and starting the appointment with a condition that will compromise the appointment is what?
a phone call
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What are three main types of treatment modifications?
- preoperative
- intraoperative
- postoperative
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What are three main aspects of the patient to evaluate in risk assessment?
- functional capacity - ASA
- emotional status
- planned procedure - type and magnitude
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