NRNP 6560 Midterm exam
Surgery risk classes
Correct answer- 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: testing
Correct answer- ECG before surgery only if coronary disease, except when low
risk surgery
Stress test not indicated before surgery
Do not do prophylactic coronary revascularization
Meds before surgery
Correct answer- - Diabetic agents: Use insulin therapy to maintain glycemic
goals(iii) Discontinue biguanides, alpha glucosidase inhibitors,
thiazolidinediones, sulfonylureas, and GLP-1 agonists
- Do not start aspirin before surgery
- Stop Warfarin 5 days before surgery. May be bridged with Lovenox.
- Do not stop statin before surgery
- Do not start beta-blocker on day of surgery, but may continue
Assessment of surgical risk
Correct answer- - 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 time sensitive)
- risk of procedure
- nutritional status
- immune competence
- determine functional capacity (need to be more than 4 METS, more than 10
METs makes low risk)
Low risk surgeries
Correct answer-
catarcts breast biopsy
cystoscopy, vasectomy
laporascopic
procedures Plastic
surgery
,intermediate risk surgeries
Correct answer- Head/ neck surgery
,thyroidectomy
Intraperitonea
l Prostate
Laminectomy
Hip/ knee
Hysterectomy
cholecystectom
y nephrectomy
non majot intrathoracic
High risk surgeries
Correct answer- aortic/
cabg transplants
spinal reconstruction
peripheral vascular
surgery
Lee's revised cardiac risk
index Correct answer- 6
points:
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 infection measures
Correct answer- - Prophylactic antibiotics should be received within 1 h prior
to surgical incision
- be selected for activity against the most probable antimicrobial contaminants
- be discontinued within 24 h after the surgery end-time
Postoperative infection reduction methods
Correct answer- - pre-op hair removal
(clippers)
- wash hands
- normothermia
- maintain euglycemia
- urinary catheters are to be removed within the first two postoperative days
, Osteoarthritis: what, incidence
Correct answer- Slow destruction of bones/ joint followed by production of
replacement collagen which causes inflammatory changes
Surgery risk classes
Correct answer- 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: testing
Correct answer- ECG before surgery only if coronary disease, except when low
risk surgery
Stress test not indicated before surgery
Do not do prophylactic coronary revascularization
Meds before surgery
Correct answer- - Diabetic agents: Use insulin therapy to maintain glycemic
goals(iii) Discontinue biguanides, alpha glucosidase inhibitors,
thiazolidinediones, sulfonylureas, and GLP-1 agonists
- Do not start aspirin before surgery
- Stop Warfarin 5 days before surgery. May be bridged with Lovenox.
- Do not stop statin before surgery
- Do not start beta-blocker on day of surgery, but may continue
Assessment of surgical risk
Correct answer- - 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 time sensitive)
- risk of procedure
- nutritional status
- immune competence
- determine functional capacity (need to be more than 4 METS, more than 10
METs makes low risk)
Low risk surgeries
Correct answer-
catarcts breast biopsy
cystoscopy, vasectomy
laporascopic
procedures Plastic
surgery
,intermediate risk surgeries
Correct answer- Head/ neck surgery
,thyroidectomy
Intraperitonea
l Prostate
Laminectomy
Hip/ knee
Hysterectomy
cholecystectom
y nephrectomy
non majot intrathoracic
High risk surgeries
Correct answer- aortic/
cabg transplants
spinal reconstruction
peripheral vascular
surgery
Lee's revised cardiac risk
index Correct answer- 6
points:
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 infection measures
Correct answer- - Prophylactic antibiotics should be received within 1 h prior
to surgical incision
- be selected for activity against the most probable antimicrobial contaminants
- be discontinued within 24 h after the surgery end-time
Postoperative infection reduction methods
Correct answer- - pre-op hair removal
(clippers)
- wash hands
- normothermia
- maintain euglycemia
- urinary catheters are to be removed within the first two postoperative days
, Osteoarthritis: what, incidence
Correct answer- Slow destruction of bones/ joint followed by production of
replacement collagen which causes inflammatory changes
