Pre-Op Assessment

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Pre-Op Assessment
2012-07-26 22:18:24
Obtaining history pre op chemistries PE

Obtaining history, pre-op chemistries, PE
Show Answers:

  1. What are the roles of the VT in anesthesia?
    • Preparing, operating, and maintaining anesthetic equip
    • Admin of anesthetic agents
    • ET intubation
    • Patient monitoring
    • Understanding of physical parameters and machine data
    • Perform quick and effective corrective interventions
    • High standard anesthetic monitoring and understanding of interventions
  2. What are important pre-op procedures are performed to determine a patients health status?
    Obtaining patient history, performing PE and diagnostic tests
  3. What is included in patient care?
    IV catheter, med admin, etc
  4. What may be done to prep for an upcoming procedure?
    Maintaining anesthesia machine and sx room, preping surgical equipment (packs, sutures, blades, heating beds, towels, etc) required for the procedure
  5. When may a VT induce anesthesia?
    Upon DVM instruction
  6. What is a scrub nurse?
    Sterile nurse who assists the vet in retraction, stabilization, hemostasis and so on
  7. What does the non-sterile assistant do in sx?
    Includes monitoring anesthesia and the patient, opening surgical packs, drapes, sutures, etc in sterile manners; lavage & suction; admin of medication
  8. What are the post-op roles of the VT?
    • Cleaning patient of blood, feces, urine
    • Placing bandages
    • Recovering patient thru extubating and waiting until patient calms
    • Keeping patient calm & admin of any Rx meds until discharge
    • Discharging patient & informing owner of instruction for care
    • Cleaning sx room & equipment, making sx packs & autoclaving them
  9. What is the minimal information that should be retrieve from the client upon arrival?
    • Hx
    • Complete PE
    • Diagnostic testing ordered by DVM
    • Confirmation of sx procedure to be done
    • Determination of physical status & anesthetic risk
  10. What type of questions should be asked when gaining a hx on a patient?
    Open ended
  11. Give examples of questions to ask a client if a problem is indicated.
    • How long has the problem been occuring?
    • How often does the problem occur?
    • What is the patients stool character?
    • Have they tried intervening the problem?
    • Did they get any results from the intervention?
  12. What might be confirmed before a procedure?
    • Confirm all procedures to be performed
    • Confirmation of limb 
    • Confirm location of masses & if histopathology will be performed after removal
    • Receive current contact information before client leaves
  13. It is important to receive signalment.  What does signalment entail?
    • Age
    • Sex
    • Breed
    • Repro status (know if intact or used for breeding)
    • Species
  14. Why is it important to know about any medications that the pet is on?
    Drug interactions may occur and may cause increased bleeding of profound sedation
  15. What type of drug should always be asked about when talking to a client about current medications?
  16. Why is it important to ask a client about patient allergies?
    • Anaphylaxis may occur (penicillins)
    • Previous adverse interactions with anesthetics
  17. What might be asked about preventative measures the client uses for the patient?
    • When and what were previous vaccines given?
    • Are they on HW &/or flea & tick prevention?
  18. Why is it important to know about previous medical problems?
    Anesthetic protocol may need to be altered
  19. What may need to be done in signs of illness?
    • Additional diagnostic testing
    • Delay in anesthesia
  20. What actions are performed with the written consent form?
    • Provided the client with estimates for expected charges
    • Thoroughly review w/ owner & describe procedures
    • Explain why mandatory procedures are required (IVC, bldwk)
    • Discuss optional procedures (microchips, gastropexy, etc)
    • Confirm owners understanding that anesthesia is NEVER w/o risk
    • Answer last minute questions
  21. The PE is the responsibility of the _______, but the VT can use PE findings to _________________, _________________, and ___________________________.
    Veterinarian; provide effective patient care, respond to patient needs, alert vet to changes in patient condition
  22. What would be examined during a routine PE?
    • EENT (ears, eyes, nose, mouth)
    • H/L (cardiovascular/pulmonary)
    • Abd (GI & abd)
    • MSI (musculoskeletal/integ)
    • Neuro (neurologic)
    • U/G (Urogenital)
  23. What is always to be received before any procedure is performed, and typically is done before the patient enters the exam room?
    Body weight
  24. What is the BCS?  What are the two scales used and how do the ranges work?
    • Body condition score is a numeric assessment of the patient's body composition compared to the ideal body weight
    • 1-5 & 1-9; 1 being cachexia, 5 or 9 being morbidly obese
  25. How can hydration be assessed?
    • Skin turgor
    • MM color/moisture
    • CRT
    • Heart rate
    • Pulse rate
  26. What diagnostic tests can assess hydration?
    • BUN
    • USG
    • TP/PCV
    • Creatinine
  27. What are the levels of consciousness?
    • BAR
    • QAR
    • Quiet/subdued
    • Lethargic
    • Obtunded (dull mental state requiring vigorous stimulation to react)
    • Stuporous (low consciousness)
    • Comatose
  28. When should body temperature be taken?
    After all other vital signs
  29. When examining a patients gait, what are you looking for?
    • Manner in which they walk
    • Equal weight bearing on all four limbs
    • Ataxia
    • Circling
    • Stiffness
  30. When examining the skin, what are you looking for?
    • Alopecia
    • External parasites
    • Thickening/discoloration
    • Redness, flaking, parasite debris, wounds
    • Odor
    • Masses
  31. What lymph nodes are palpated in PLS?
    • Submandibular
    • Prescapular
    • Axillary
    • Inguinal
    • Popliteal
  32. What is the ratio of benign cancers to malignant cancers in dogs and cats?
    • 50:50 in dogs
    • 5:95 in cats
  33. What does it mean for anisocoria to occur?
    Different sized pupils
  34. What is normal rxn when testing PLR?
    Direct and consensual constriction
  35. Yeast smells _________, while bacteria smells ____________
    Sweaty; sweet
  36. What is a bacteria commonly found in the ear?
    Pseudomonas aeruginosa
  37. What do pale MM indicate?  Cyanotic MM?
    • Anemia or poor perfusion
    • Hypoxia or poor perfusion
  38. What causes methemoglobinemia and muddy gums?  What is it treated with?
    Acetominophen; Mucomyst® (Acetylcysteine)
  39. What is a sinus arrhythmia?  Is it normal?
    • HR increases with inspiration and decreases with expiration
    • Yes
  40. What is a pulse deficit?
    When there is a difference in HR and pulse
  41. What is the Flehmen response?
    When the cat breathes open mouth due to a smell in urine or pheromones
  42. What format is used when writing in the medical record?  What does each letter stand for?  Give examples.
    • Subjective: things open to interpretation (CC, BCS, lvl of consciousness)
    • Objective: more concrete facts (HR, RR, temp, etc)
    • Assessment: determined by vet (anesthetic risk categories, DDx, etc)
    • Plan: what is being done (diagnostic testing, sx, etc)
  43. What does PAP stand for?  What does it consist of?
    Preanesthetic panel consists of BUN, Cr, Alk Phos, ALT, Gluc, TP
  44. What is the GHP?  What does it consist of?
    General health panel consists of BUN, Cr, Alk Phos, Gluc, ALT, TP, Amyl, T-bili, Phos, Alb, Ca, Chol
  45. What is involoved in a CBC?
    • PCV
    • TP
    • Hemoglobin
    • RBC
    • WBC differential
    • Platelet count
  46. What do blood chemistries assess?
    Enzymes, electrolytes, proteins and metablolites
  47. What are some indications of kidney fxn?
    • USG
    • Proteinuria
  48. What causes glucosuria?
    Stress, renal dz, diabetes mellitus
  49. Urobilinogen is indicative of what?
    Kidney fxn
  50. What might be seen with a urinary tract infection?
    • Hematuria
    • Pyuria
  51. Describe classes I - V when talking about anesthetic risk.
    • Class I: minimal risk, normal & healthy (OVH & neuter)
    • Class II: slight risk, minor dz present (neonates, geriatrics, obese, local infection)
    • Class III: moderate risk, obvious dz (anemia, fever, low grade heart dz)
    • Class IV: high risk, significant dz (shock, uremia, toxemia, uncompensated heart dz)
    • Class V: extreme risk, moribund (HBC, KBH, blocked tom, advanced metabolic dz)
  52. What sx may be performed on a blocked tom?
    Perineal urethrostomy (PU sx)
  53. Fasting prior to anesthesia can help prevent what?
    Aspiration pneumonia or esophageal inflam.