NRNP 6560 Midterm exam
Surgery risk classesANSWERClass 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: testingANSWERECG 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 surgeryANSWER- 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 riskANSWER- 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 surgeriesANSWERcatarcts
breast biopsy
cystoscopy, vasectomy
,laporascopic procedures
Plastic surgery
intermediate risk surgeriesANSWERHead/ neck surgery
thyroidectomy
Intraperitoneal
Prostate
Laminectomy
Hip/ knee
Hysterectomy
cholecystectomy
nephrectomy
non majot intrathoracic
High risk surgeriesANSWERaortic/ cabg
transplants
spinal reconstruction
peripheral vascular surgery
Lee's revised cardiac risk indexANSWER6 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 measuresANSWER- 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 methodsANSWER- pre-op hair removal (clippers)
- wash hands
- normothermia
- maintain euglycemia
- urinary catheters are to be removed within the first two postoperative days
Osteoarthritis: what, incidenceANSWERSlow destruction of bones/ joint followed by production 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
Osteoarthritis findings and diagnosticsANSWER- 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 joint closest to the fingernail)
- Bouchard's nodules (bony bumps on the middle joint of the finger)
- limited ROM with crepitus
, - xr shows narrowing of joint space (need anteroposterior and lateral knee films bilaterally)
- synovial fluid is clear and without WBC
Osteoarthritis treatmentANSWERGoal is to relieve symptoms, maintain/ improve function, and avoid
drug toxicity
Hand OA:
- rest/ joint protection, with splinting
- heat/ cold therapy
- topical capsaicin
- topical NSAID (trolamine salicylate) (especially for older than 75)
- Oral NSAIDS, incl COX2 inhibitors such as celecoxib (Celebrex) (may cause cardiac problems)
- tramadol
- no opioids
Hip/ knee OA:
- weight reduction, cardiovascular exercises
- transcutanous external nerve stimulator
- acetaminophen
- Topical NSAIDS (knee)
- intraarticular corticosteroid injections
- surgery (joint replacement)
Rheumatoid arthritis: what, whoANSWERchronic, systemic autoimmune disease that causes
inflammation of connective tissue, first that of jionts them other soft tissues (renal, cardiovascular,
pulm). TNF-alpha plays a big role
- more women than men
- unknown cause
- Epstein Barr virus
Surgery risk classesANSWERClass 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: testingANSWERECG 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 surgeryANSWER- 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 riskANSWER- 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 surgeriesANSWERcatarcts
breast biopsy
cystoscopy, vasectomy
,laporascopic procedures
Plastic surgery
intermediate risk surgeriesANSWERHead/ neck surgery
thyroidectomy
Intraperitoneal
Prostate
Laminectomy
Hip/ knee
Hysterectomy
cholecystectomy
nephrectomy
non majot intrathoracic
High risk surgeriesANSWERaortic/ cabg
transplants
spinal reconstruction
peripheral vascular surgery
Lee's revised cardiac risk indexANSWER6 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 measuresANSWER- 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 methodsANSWER- pre-op hair removal (clippers)
- wash hands
- normothermia
- maintain euglycemia
- urinary catheters are to be removed within the first two postoperative days
Osteoarthritis: what, incidenceANSWERSlow destruction of bones/ joint followed by production 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
Osteoarthritis findings and diagnosticsANSWER- 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 joint closest to the fingernail)
- Bouchard's nodules (bony bumps on the middle joint of the finger)
- limited ROM with crepitus
, - xr shows narrowing of joint space (need anteroposterior and lateral knee films bilaterally)
- synovial fluid is clear and without WBC
Osteoarthritis treatmentANSWERGoal is to relieve symptoms, maintain/ improve function, and avoid
drug toxicity
Hand OA:
- rest/ joint protection, with splinting
- heat/ cold therapy
- topical capsaicin
- topical NSAID (trolamine salicylate) (especially for older than 75)
- Oral NSAIDS, incl COX2 inhibitors such as celecoxib (Celebrex) (may cause cardiac problems)
- tramadol
- no opioids
Hip/ knee OA:
- weight reduction, cardiovascular exercises
- transcutanous external nerve stimulator
- acetaminophen
- Topical NSAIDS (knee)
- intraarticular corticosteroid injections
- surgery (joint replacement)
Rheumatoid arthritis: what, whoANSWERchronic, systemic autoimmune disease that causes
inflammation of connective tissue, first that of jionts them other soft tissues (renal, cardiovascular,
pulm). TNF-alpha plays a big role
- more women than men
- unknown cause
- Epstein Barr virus
