NURS 572 midterm Questions & answers Latest
Update 2026.
Stepwise approach to determine if patient is candidate for noncardiac surgery
1. urgency: emergency?
2. any active cardiac conditions? (major risk)*
3. Is patient undergoing low risk procedure? (M&M <1%)
4. Evaluate patient's functional capacity
5. if functional capacity poor: clinical risk factors may need further testing before surgery
clearance
ASA classification of surgical risk
1- healthy patient
2- patient with mild systemic disease, no ADL limitation
3- patient with severe systemic disease, mild ADL limitation but not incapacitating
4- patient with incapacitating systemic disease with constant threat to life
5- patient not expected to survive 24 hours with or without the operation
6- brain dead
E- emergency class
Surgeries considered high/moderate/low risk for M&M
high (>5%): aortic and other major vascular surgery, peripheral vascular surgery
intermediate (1-5%): intraperitoneal, intrathoracic, CEA, Head/neck, orthopedic, prostate
low (<1%): endoscopic, superficial, cataracts, breast surgery, ambulatory surgery
Surgeries considered high risk for bleeding
,high: major surgery, cancer surgery, orthopedic, reconstructive, thoracic, urologic/GI, TURP,
nephrectomy, colonic polyp resection, bowel, PEG tube, vascular, neuroaxial anesthesia,
epidural injections
Surgeries considered low/moderate risk for bleeding
Low to moderate bleed risk - arthroscopy, biopsies, foot/hand surgery, cardiac cath,
endoscopy/colonoscopy with biopsy, abdominal hysterectomy, lap choly, hernia repair,
bronchoscopy, hemorrhoid
Surgeries considered minimal risk for bleeding
Minimal bleeding risk - derm procedures, ophthalmologic, dental, pacemaker, ICD implantation
Relative cardiac risk index (RCRI)
score 0-3+, higher score = higher risk of cardiac event intra-op
ACS NSQIP Surgical Risk Calculator
uses patient demographics, disease and risk factors to predict probability of post-op
complications
POSSUM Operative Morbidity and Mortality Risk
uses patient demographics, disease and risk factors (includes labs) to predict probability of post-
op complications
Preop labs
hgb, platelets, creatinine, lytes, PT/INR, type & screen (all for major surgery)
Preop diagnostics
,EKG: cardiac history OR at RISK for CAD, history of arrythmias, CVA
chest xray: only if patient has pulmonary disease
COVID testing: yes to everyone
preop history taking: anesthesia
-separate consult/consent
-will need cardiac clearance if cardiac disease present
-pre medications/post medications? adjusted to individual patient risk
-egg allergy? (propofol)
-NPO?
preop history taking: bleeding
-on anticoagulation?
-unprovoked bleeding on trunk >5 cm
-nose/gum bleeding? mennorhea?
-splenomegaly, hepatomegaly
-prior excessive blood loss in surgery
-family history of bleeding
-bleeding disorders
-prescence of severe kidney or liver disease
preop history taking: genetic bleeding disorders
-hemophilia B9 deficiency
-hemophilia A8 deficiency
-Von Williebrand's: low vWF, low unbound factor 8
, preop history taking: acquired bleeding disorders
-liver disease
-anticoagulation therapy
-acquired thrombocytopenia
-platelet function disorders
-uremia/kidney function disorders
-HIT: type 1 (nonimmune, direct heparin effect on platelets) and type 2 (autoimmune, PF4
antibodies causing clots)
-TTP (acquired autoimmune or genetic)
-hemolytic uremic syndrome (E. coli) causing thrombocytopenia
-drug induced thrombocytopenia
preop history taking: bleeding and liver disease
-decreased synthesis of factors 5, 7, 10 result in prolonged PT/PTT
-acute alcohol abuse can cause acute thrombocytopenia
-hypersplenism Prescence from platelet sequestration
-obstructive jaundice can lead to vitamin K factor deficiency
bleeding risk: anticoagulants
-oral anticoagulants (Xa agents) typically held 24-48 hours before surgery
-dabigatran (pradaxa): hold 1-4 days
-hold SQ heparin morning of procedure
-consider heparin IV drip bridging only if off anticoagulant >2-3 days
-DO NOT administer spinal/epidural if patient on DOAC: bleeding risk too high
Update 2026.
Stepwise approach to determine if patient is candidate for noncardiac surgery
1. urgency: emergency?
2. any active cardiac conditions? (major risk)*
3. Is patient undergoing low risk procedure? (M&M <1%)
4. Evaluate patient's functional capacity
5. if functional capacity poor: clinical risk factors may need further testing before surgery
clearance
ASA classification of surgical risk
1- healthy patient
2- patient with mild systemic disease, no ADL limitation
3- patient with severe systemic disease, mild ADL limitation but not incapacitating
4- patient with incapacitating systemic disease with constant threat to life
5- patient not expected to survive 24 hours with or without the operation
6- brain dead
E- emergency class
Surgeries considered high/moderate/low risk for M&M
high (>5%): aortic and other major vascular surgery, peripheral vascular surgery
intermediate (1-5%): intraperitoneal, intrathoracic, CEA, Head/neck, orthopedic, prostate
low (<1%): endoscopic, superficial, cataracts, breast surgery, ambulatory surgery
Surgeries considered high risk for bleeding
,high: major surgery, cancer surgery, orthopedic, reconstructive, thoracic, urologic/GI, TURP,
nephrectomy, colonic polyp resection, bowel, PEG tube, vascular, neuroaxial anesthesia,
epidural injections
Surgeries considered low/moderate risk for bleeding
Low to moderate bleed risk - arthroscopy, biopsies, foot/hand surgery, cardiac cath,
endoscopy/colonoscopy with biopsy, abdominal hysterectomy, lap choly, hernia repair,
bronchoscopy, hemorrhoid
Surgeries considered minimal risk for bleeding
Minimal bleeding risk - derm procedures, ophthalmologic, dental, pacemaker, ICD implantation
Relative cardiac risk index (RCRI)
score 0-3+, higher score = higher risk of cardiac event intra-op
ACS NSQIP Surgical Risk Calculator
uses patient demographics, disease and risk factors to predict probability of post-op
complications
POSSUM Operative Morbidity and Mortality Risk
uses patient demographics, disease and risk factors (includes labs) to predict probability of post-
op complications
Preop labs
hgb, platelets, creatinine, lytes, PT/INR, type & screen (all for major surgery)
Preop diagnostics
,EKG: cardiac history OR at RISK for CAD, history of arrythmias, CVA
chest xray: only if patient has pulmonary disease
COVID testing: yes to everyone
preop history taking: anesthesia
-separate consult/consent
-will need cardiac clearance if cardiac disease present
-pre medications/post medications? adjusted to individual patient risk
-egg allergy? (propofol)
-NPO?
preop history taking: bleeding
-on anticoagulation?
-unprovoked bleeding on trunk >5 cm
-nose/gum bleeding? mennorhea?
-splenomegaly, hepatomegaly
-prior excessive blood loss in surgery
-family history of bleeding
-bleeding disorders
-prescence of severe kidney or liver disease
preop history taking: genetic bleeding disorders
-hemophilia B9 deficiency
-hemophilia A8 deficiency
-Von Williebrand's: low vWF, low unbound factor 8
, preop history taking: acquired bleeding disorders
-liver disease
-anticoagulation therapy
-acquired thrombocytopenia
-platelet function disorders
-uremia/kidney function disorders
-HIT: type 1 (nonimmune, direct heparin effect on platelets) and type 2 (autoimmune, PF4
antibodies causing clots)
-TTP (acquired autoimmune or genetic)
-hemolytic uremic syndrome (E. coli) causing thrombocytopenia
-drug induced thrombocytopenia
preop history taking: bleeding and liver disease
-decreased synthesis of factors 5, 7, 10 result in prolonged PT/PTT
-acute alcohol abuse can cause acute thrombocytopenia
-hypersplenism Prescence from platelet sequestration
-obstructive jaundice can lead to vitamin K factor deficiency
bleeding risk: anticoagulants
-oral anticoagulants (Xa agents) typically held 24-48 hours before surgery
-dabigatran (pradaxa): hold 1-4 days
-hold SQ heparin morning of procedure
-consider heparin IV drip bridging only if off anticoagulant >2-3 days
-DO NOT administer spinal/epidural if patient on DOAC: bleeding risk too high
