5 Questions
Why is pre-operative care important?
Pre-operative care is important because it helps identify issues that require further evaluation, determines which medications should be taken or held, and assesses the patient's health status for surgery.
What are the components of a preoperative evaluation?
Components of a preoperative evaluation include history taking, physical examination, medication history, identifying allergies, family history, and social history. Vital signs and weight/height measurements are also important.
Why is obtaining a thorough medication history crucial before surgery?
Obtaining a thorough medication history is crucial before surgery to ensure proper management of medications like antihypertensives, insulin, aspirin, and other drugs that may need to be adjusted or stopped prior to the procedure.
What medications should be stopped before surgery?
Clopidogrel (Plavix)
Why is the perioperative assessment of diabetic patients important?
The perioperative assessment of diabetic patients is important because they are at higher risk of morbidity and mortality, likely to have hyperglycemia, and require close monitoring to maintain optimal glucose levels during surgery.
Study Notes
Peri-Operative Care
- Reviewing how to take a proper history and interview a patient in the peri-operative setting is crucial
- Performing a medication reconciliation and reviewing which medications may be taken pre-op/must be held is essential
Importance of Pre-Operative Care
- Pre-operative care is important due to the stress response caused by surgery and anesthesia
- The stress response is proportional to blood loss, activation of coagulation system, hemodynamic instability, catecholamine release, and activation of the inflammation cascade
History and Physical Examination
- A good history and physical examination are essential to identify issues that require further evaluation or perioperative modification
- A careful history and physical examination are effective screening tools to determine if further tests are indicated
- Specialized technology is no substitute for a careful history and physical examination
Conducting the Initial Interview
- The initial interview sets the tone for the entire course of care; the first impression is the most important
- It is essential to convey that nothing is more important than that moment; establish trust, confidence, and demonstrate interest
- Adjust to the patient's conversational style and vocabulary level, and use visual aids
Taking a Comprehensive History
- A comprehensive history should include CC, HPI, PMH, PSH, Meds, Allergies, FH, SH, and a complete physical exam
- In an ER/emergency situation, an AMPLE history works, with a focused exam and examination of key areas
Medication History and Reconciliation
- A thorough history of all medications, including vitamins and supplements, should be obtained
- Patients should be asked to bring all their medications to the pre-op appointment
- Certain medications, such as beta blockers, antihypertensives, and antilipids, should be continued until the day of surgery
- Insulin, oral diabetic medications, aspirin, and clopidogrel may need to be held or adjusted pre-operatively
Diabetic Peri-Operative Assessment
- Perioperative morbidity and mortality are greater in diabetic patients compared to non-diabetic patients
- Diabetic patients are more likely to have hyperglycemia
- Factors that can affect glucose levels, such as anesthesia, surgery, and medication, should be considered
Assess your knowledge of perioperative care, including taking patient history, medicine reconciliation, and pre-op preparations.
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