NRNP 6560 Midterm exam Questions with Certified
Solutions.
Terms in this set (196)
Surgery risk classes Class 1: benefits outweigh risk, should be done
Class 2a: reasonable to perform
Class 2b: should be considered
Class 3: rarely appropriate
General rules for surgery: ECG before surgery only if coronary disease, except when low
testing risk surgery
Stress test not indicated before surgery
Do not do prophylactic coronary revascularization
- Diabetic agents: Use insulin therapy to maintainglycemic
goals(iii) Discontinue biguanides, alpha glucosidase
inhibitors, thiazolidinediones, sulfonylureas, and GLP-1
agonists - Do not start aspirin before surgery
Meds before surgery - Stop Warfarin 5 days before surgery. May bebridged with
Lovenox.
- Do not stop statin before surgery
- Do not start beta-blocker on day of surgery, butmay
continue
,Assessment of surgical risk - Unstable cardiac condition (recent MI, active angina,active HF,
uncontrolled HTN, severe valvular disease), concern with CAD, CHF.
arrhythmia, CVD - patient stable or unstable?
- urgency of the procedure (oncology will be timesensitive)
- risk of procedure
- nutritional status
- immune competence
- determine functional capacity (need to be morethan 4 METS,
more than 10 METs makes low risk)
Low risk surgeries catarcts breast biopsy
cystoscopy, vasectomy
laporascopic procedures
Plastic surgery
intermediate risk surgeries Head/ neck surgery thyroidectomy
Intraperitoneal
Prostate
Laminectomy
Hip/ knee Hysterectomy
cholecystectomy
nephrectomy
non majot intrathoracic
aortic/ cabg transplants spinal
High risk surgeries reconstruction peripheral
vascular surgery
,Lee's revised cardiac risk 6 points:
index High risk surgery = 1
CAD = 1
CHF = 1
Cerebrovascular disease = 1
DM 1 on insulin = 1
Creat greater than 2 = 1
1 = low risk
2 = moderate risk
3 = high risk
SCIP pre-operative - Prophylactic antibiotics should be received within 1 h prior
infection measures to surgical incision
- be selected for activity against the most
probableantimicrobial contaminants
- be discontinued within 24 h after the surgery endtime
- pre-op hair removal (clippers)
- wash hands
Postoperative infection - normothermia
reduction methods - maintain euglycemia
- urinary catheters are to be removed within the firsttwo
postoperative days
, Osteoarthritis: what, Slow destruction of bones/ joint followed by production
incidence of replacement collagen which causes inflammatory
changes
- older than 60
- more female after 55
- more black than white women
- men and women equal risk between 45 - 55
- abnormal height or weight (obesity)
- repetitive movement
- prior trauma (sprains/ dislocations)
- diabetic neuropathy
- genetic
- Pain in weight bearing joints
- stiffness after sitting, gets better when arising
- feeling of instability on stairs
- fine motor skills deficit
- larger affected joints
- Heberden nodules (bony bumps on the finger jointclosest to the
Osteoarthritis findings and
fingernail)
diagnostics
- Bouchard's nodules (bony bumps on the middle jointof the finger)
- limited ROM with crepitus
- xr shows narrowing of joint space (needanteroposterior and
lateral knee films bilaterally)
- synovial fluid is clear and without WBC
Solutions.
Terms in this set (196)
Surgery risk classes Class 1: benefits outweigh risk, should be done
Class 2a: reasonable to perform
Class 2b: should be considered
Class 3: rarely appropriate
General rules for surgery: ECG before surgery only if coronary disease, except when low
testing risk surgery
Stress test not indicated before surgery
Do not do prophylactic coronary revascularization
- Diabetic agents: Use insulin therapy to maintainglycemic
goals(iii) Discontinue biguanides, alpha glucosidase
inhibitors, thiazolidinediones, sulfonylureas, and GLP-1
agonists - Do not start aspirin before surgery
Meds before surgery - Stop Warfarin 5 days before surgery. May bebridged with
Lovenox.
- Do not stop statin before surgery
- Do not start beta-blocker on day of surgery, butmay
continue
,Assessment of surgical risk - Unstable cardiac condition (recent MI, active angina,active HF,
uncontrolled HTN, severe valvular disease), concern with CAD, CHF.
arrhythmia, CVD - patient stable or unstable?
- urgency of the procedure (oncology will be timesensitive)
- risk of procedure
- nutritional status
- immune competence
- determine functional capacity (need to be morethan 4 METS,
more than 10 METs makes low risk)
Low risk surgeries catarcts breast biopsy
cystoscopy, vasectomy
laporascopic procedures
Plastic surgery
intermediate risk surgeries Head/ neck surgery thyroidectomy
Intraperitoneal
Prostate
Laminectomy
Hip/ knee Hysterectomy
cholecystectomy
nephrectomy
non majot intrathoracic
aortic/ cabg transplants spinal
High risk surgeries reconstruction peripheral
vascular surgery
,Lee's revised cardiac risk 6 points:
index High risk surgery = 1
CAD = 1
CHF = 1
Cerebrovascular disease = 1
DM 1 on insulin = 1
Creat greater than 2 = 1
1 = low risk
2 = moderate risk
3 = high risk
SCIP pre-operative - Prophylactic antibiotics should be received within 1 h prior
infection measures to surgical incision
- be selected for activity against the most
probableantimicrobial contaminants
- be discontinued within 24 h after the surgery endtime
- pre-op hair removal (clippers)
- wash hands
Postoperative infection - normothermia
reduction methods - maintain euglycemia
- urinary catheters are to be removed within the firsttwo
postoperative days
, Osteoarthritis: what, Slow destruction of bones/ joint followed by production
incidence of replacement collagen which causes inflammatory
changes
- older than 60
- more female after 55
- more black than white women
- men and women equal risk between 45 - 55
- abnormal height or weight (obesity)
- repetitive movement
- prior trauma (sprains/ dislocations)
- diabetic neuropathy
- genetic
- Pain in weight bearing joints
- stiffness after sitting, gets better when arising
- feeling of instability on stairs
- fine motor skills deficit
- larger affected joints
- Heberden nodules (bony bumps on the finger jointclosest to the
Osteoarthritis findings and
fingernail)
diagnostics
- Bouchard's nodules (bony bumps on the middle jointof the finger)
- limited ROM with crepitus
- xr shows narrowing of joint space (needanteroposterior and
lateral knee films bilaterally)
- synovial fluid is clear and without WBC
