-
Questions to ask to an asthma pt? (4)
- 1. WHat are precipitating factors?
- 2. Freq and severity of attacks
- 3. Medications
- 4. Resp to tx
-
How to tx pt? (5)
- 1. Assure optimal disease control
- 2. manage anxiety
- - avoid barbiturates and meperidine
- 3. Consider preop inhaler use
- 4. have bronchodilator avail
- 5. may need to avoid NSAIDS
-
Questions to ask COPD pt? (4)
- 1. what is exercise tolerance?
- 2. do they have dyspnea or cough?
- 3. Taking meds/O2?
- 4. Resp to tx?
-
Tx of COPD (5)
- 1. Assure optimal disease control
- 2. Manage anxiety, but use caution w/ sedation
- - Inhalation - N2O-O2 - IV - use light sedation
- x-avoid barbiturates, opioids (resp. depression)
- x - avoid anticholinergics and histamine blockers (hydroxyzine - increase viscosisty of resp secretions)
- 3. Use low flow 02 (2-3L/min) and monitor vitals
- 4. semisupine position
- 5. Have bronchodilator avail
-
CVD includes? (4)
- 1. Ischmic heart disease (angina)
- 2. Arrhythmias
- 3. Congestive heart failure
- 4. Risk of SBE
-
Questions to ask Angina Pt? (5)
- 1. Precepitating events?
- 2. Frequency
- 3. Duration?
- 4. Severity?
- 5. resp to tx?
- ***Do you have to use NG pills?***
-
How do you manage surgery with Angina? (7)
- 1. ID angina type (stable/unstable)
- 2. Assure optimal mgt
- 3. Anxiety mgt
- -Oral - light sedation w/ BZDP
- - Inhalation - N2O -O2 - IV - light sedation w/ BZDP
- - Elective GA NOT RECOMMENDED
- 4. Give supplemental O25. Consider NG prior to tx
- 6. Monitor vitals
- 7. Have NG available
-
-
Questions for MI pt?
- 1. How long since MI?
- 2. Tx - surgery/angioplasty?
- 3. Meds taking?
- 4. Current symptoms
-
% reinfarction rate in first 3 months?
% at 5 months?
% at 6 months?
% for non-MI pt risk during surgery?
-
Tx of pt after MI?
- 1. <6 mos., w/o surg to correct arteries - EMERGENCY TX ONLY in hospital setting
- 2. After surg to open arteries - consult cardiologist
- 3. >6 mos, same protocol for angina
- - Oral - light sedation ok
- - Inhalation - N2O-O2 - IV - only light sedation
- - Elective GA NOT RECOMMENDED
-
Questions for Arrhthmia pt? (4)
- 1. What type of arrhythmia?
- 2. Meds?
- 3. Pacemaker?
- 4. Are they anticoagulated
- ***esp if Afib***
-
Tx of pt with arrhythmia (4)
- 1. If ventricular - limit epi
- 2. Manage anticoag
- 3. Avoid use of cautery w/ pacemaker
- 4. Consider ischemic heart disease protocol
- - Avoid hypoxia and hypotension
- *****(put on O2) ****(no Proprofol)
-
Questions to ask CHF pt? (6)
- 1. Do you get periph edema?
- 2. Do they have dyspnea, othopnea? (trouble breathing)
- 3. What is exercise tolerance?
- 4. Are there other systems involved?
- 5. Meds?
- 6. Respond to tx?
-
How to manage surg on a CHF pt?
- 1. assure optimal tx
- 2. manage anxiety
- - Oral sed w/ BZDP
- - N2O
- - Light IV sedation
- - Outpatient GA NOT RECOMMENDED
- 3. Use supplemental O24. Semisupine position
- 5. Prevent postural hypotension
-
Questions to ask pt w/ seizure disorders? (5)
- 1. What type of seizures
- 2. frequent?
- 3. Controlled?
- 4. Meds? Changes?
- 5. What precipitates seizures?
-
Tx seizure pt?
- 1. Assure optimal control
- 2. Manage anxiety
- - oral sedation
- - N2O/O2 - IV sedation - esp BZDP or barbiturates
-
Questions ask CVA pt? (3)
- 1. When did it occur?
- 2. Meds- anticoagluation?
- 3. Are there continuing risk factors
- - HTN
- - DM
- - supraventricular arrhythmias?
-
Tx of stroke pt? (4)
- 1. Monitor vitals
- 2. Supplemental O23. Manage anxiety
- - N20-O2
- - Light oral sedation after MD consult
- - IV sedation after MD consult
- - GA in OR ONLY
- 4. Manage anticoagulation
-
Questions for diabetes pt? (5)
- 1. Meds?
- 2. Freq of insulin reactions?
- 3. Home monitoring of blood sugar?
- 4. Recent HbA1c?
- 5. Systemic complications?
-
Tx of pt using insulin. (5)
- 1. Determin if pt can follow normal diet after surg.
- 2. Determine if pt can modify insulin regimen
- 3. Avoid hypoglycemia
- 4. Decrease insulin dose and avoid shortacting insulin (consult MD)
- 5. AM appointments
-
Tx pt on oral hypoglycemics. (2)
- 1. DO NOT TAKE oral hypoglycemic on day of surgery!!!
- 2. AM appt
-
Someone says they have liver disease. What do you need to know?
- 1. Hepititis? - btwn jaundice as a baby vs. actual hepititis A,B,C,D
- 2. Alcoholism? Hx- how much/ how long
- 3. May have bleeding disorder
-
Tx of pt with liver failure. (5)
- 1. Consult w/ physician
- 2. Use local hemostatic measures
- - gelfoam
- - avitene
- - sutures
- 3. consider Abx
- 4. monitor vitals
- 5. Sedation - can use oral BZDP, N2O, IV BZDP
-
If someone is anticoagulated what do you need to know? (4)
- 1. What meds?
- 2. Reason for anticoag
- 3. how often do they get labs drawn?
- 4. most recent value?
-
Mgt of anticoag. (5)
- 1. Need to check INR day of procedure
- 2. If procedure is high risk for blood loss - consult LMD
- 3. If low risk for blood loss (simple TE or non-impacted surgical extraction), can usually proceed w/ INR<3-3.5, and use local hemostatic measures
- 4. platelet inhibiors, aspirin - no change in dosage needed
- 5. Want to minimize pt going off of anticoags
|
|