Mgt of medically comp patient.

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mexident82
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83326
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Mgt of medically comp patient.
Updated:
2011-05-02 19:50:58
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systemic mgt
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mgt of medically comp patient
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  1. 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
  2. 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
  3. 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?
  4. 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
  5. CVD includes? (4)
    • 1. Ischmic heart disease (angina)
    • 2. Arrhythmias
    • 3. Congestive heart failure
    • 4. Risk of SBE
  6. 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?***
  7. 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 O2
    • 5. Consider NG prior to tx
    • 6. Monitor vitals
    • 7. Have NG available
  8. Questions for MI pt?
    • 1. How long since MI?
    • 2. Tx - surgery/angioplasty?
    • 3. Meds taking?
    • 4. Current symptoms
  9. % reinfarction rate in first 3 months?
    % at 5 months?
    % at 6 months?
    % for non-MI pt risk during surgery?
    • 36%
    • 16%
    • 5%
    • <.1%
  10. 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
  11. Questions for Arrhthmia pt? (4)
    • 1. What type of arrhythmia?
    • 2. Meds?
    • 3. Pacemaker?
    • 4. Are they anticoagulated
    • ***esp if Afib***
  12. 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)
  13. 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?
  14. 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 O2
    • 4. Semisupine position
    • 5. Prevent postural hypotension
  15. Questions to ask pt w/ seizure disorders? (5)
    • 1. What type of seizures
    • 2. frequent?
    • 3. Controlled?
    • 4. Meds? Changes?
    • 5. What precipitates seizures?
  16. Tx seizure pt?
    • 1. Assure optimal control
    • 2. Manage anxiety
    • - oral sedation
    • - N2O/O2
    • - IV sedation - esp BZDP or barbiturates
  17. Questions ask CVA pt? (3)
    • 1. When did it occur?
    • 2. Meds- anticoagluation?
    • 3. Are there continuing risk factors
    • - HTN
    • - DM
    • - supraventricular arrhythmias?
  18. Tx of stroke pt? (4)
    • 1. Monitor vitals
    • 2. Supplemental O2
    • 3. Manage anxiety
    • - N20-O2
    • - Light oral sedation after MD consult
    • - IV sedation after MD consult
    • - GA in OR ONLY
    • 4. Manage anticoagulation
  19. Questions for diabetes pt? (5)
    • 1. Meds?
    • 2. Freq of insulin reactions?
    • 3. Home monitoring of blood sugar?
    • 4. Recent HbA1c?
    • 5. Systemic complications?
  20. 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
  21. Tx pt on oral hypoglycemics. (2)
    • 1. DO NOT TAKE oral hypoglycemic on day of surgery!!!
    • 2. AM appt
  22. 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
  23. 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
  24. 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?
  25. 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

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