Medically Compromised Patient

Most important presurgical evaluation?

Accurate medical history

• Updated every visit

Six vital signs for surgery patients?

• BP

• Pulse

• Temperature

• Respirations

• Height

• Weight

Dyspnea vs Orthopnea?

• Dyspnea = shortness of breathe

• Orthopnea = shortness of breathe lying down

Supine

lying down

Orthostatic hypotension

Postural hypotension

Purpose of anxiety-reduction protocol?

Reduce stress & oxygen demand during treatment

Nonpharmacologic vs Pharmacologic anxiety control?

• Nonpharmacologic = reassurance, tell-show-do, music, distraction

• Pharmacologic = profound anesthesia, nitrous oxide, IV anxiolytics

What is angina?

Chest pain from heart muscle not getting enough oxygen

• Anxiety increases oxygen demand

Nitroglycerin

Vasodilator commonly carried by angina patients

Angina management?

• Anxiety reduction

• Oxygen

• Nitroglycerin

• Profound anesthesia

• Nitrous oxide

• Monitor vitals

What is MI and ow long is surgery deferred?

Heart attack with ischemia/death of heart muscle

• Defer 6 months

What is CVA/stroke and how long is treatment deferred?

Death of brain cells from decreased blood flow

• Defer 6 months

CHF definition, signs, and positioning?

Heart cannot pump enough blood

• Pulmonary + ankle edema

• Breathe easier upright

CHF management?

• Physician consult

• Possible antibiotic prophylaxis

• Upright position

• Anxiety reduction

Asthma

Episodic airway narrowing

• Nitrous okay

• Bronchodilator accessible

• Avoid NSAIDs/respiratory depressants

COPD

Loss of airway elasticity causing breathing difficulty

• TX: upright position, avoid oxygen/respiratory depressants, bronchodilator available

Renal dialysis

Mechanical blood filtration

• Best treated day after dialysis

What two organs increase drug toxicity if diseased?

Kidneys and liver

Hypertension management?

• Monitor BP/vitals

• Avoid rapid posture changes

• Severe HTN = defer treatment

Liver disease management?

• Reduce liver-metabolized drugs

• Evaluate bleeding disorders

Type I vs Type II diabetes?

• Type I = insulin dependent

• Type II diabetes= insulin resistant/ ineffective

Diabetes management?

• Morning appointments

• Avoid long appointments

• Monitor vitals

• Watch for hypoglycemia

• Give sugar if unsure hypo vs hyperglycemia

Bacteremia

Bacteria in bloodstream

Prophylactic antibiotic coverage?

Antibiotics given before procedure to prevent serious infection

Which patients commonly need prophylactic antibiotics and what condition is prevented?

Artificial heart valve patients

• Prevents ineffective endocarditis

Common prophylactic antibiotic for non-penicillin-allergic patients?

Amoxicillin