NRNP 6560 Midterm exam
1. 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
2. General rules for surgery: testing: ECG before surgery only if
coronary dis- ease, except when low risk surgery
Stress test not indicated before surgery
Do not do prophylactic coronary revascularization
3. Meds before surgery: - Diabetic agents: Use insulin therapy to
maintain glycemic goals(iii) Discontinue biguanides, alpha
glucosidase inhibitors, thiazo- lidinediones, 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
,4. 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 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)
5. Low risk surgeries:
catarcts breast biopsy
cystoscopy,
vasectomy
laporascopic
procedures Plastic
surgery
6. intermediate risk surgeries: Head/ neck
surgery thyroidectomy
Intraperiton
eal Prostate
Laminectom
y Hip/ knee
Hysterectom
y
,cholecystecto
my
nephrectomy
non majot intrathoracic
7. High risk surgeries: aortic/
cabg transplants
spinal reconstruction
peripheral vascular
surgery
8. Lee's revised cardiac risk index: 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
9. SCIP pre-operative infection measures: - 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
10.Postoperative infection reduction methods: - pre-op hair removal
(clippers)
- wash hands
- normothermia
- maintain euglycemia
- urinary catheters are to be removed within the first two postoperative
days
11.Osteoarthritis: what, incidence: Slow 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)
1. 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
2. General rules for surgery: testing: ECG before surgery only if
coronary dis- ease, except when low risk surgery
Stress test not indicated before surgery
Do not do prophylactic coronary revascularization
3. Meds before surgery: - Diabetic agents: Use insulin therapy to
maintain glycemic goals(iii) Discontinue biguanides, alpha
glucosidase inhibitors, thiazo- lidinediones, 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
,4. 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 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)
5. Low risk surgeries:
catarcts breast biopsy
cystoscopy,
vasectomy
laporascopic
procedures Plastic
surgery
6. intermediate risk surgeries: Head/ neck
surgery thyroidectomy
Intraperiton
eal Prostate
Laminectom
y Hip/ knee
Hysterectom
y
,cholecystecto
my
nephrectomy
non majot intrathoracic
7. High risk surgeries: aortic/
cabg transplants
spinal reconstruction
peripheral vascular
surgery
8. Lee's revised cardiac risk index: 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
9. SCIP pre-operative infection measures: - 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
10.Postoperative infection reduction methods: - pre-op hair removal
(clippers)
- wash hands
- normothermia
- maintain euglycemia
- urinary catheters are to be removed within the first two postoperative
days
11.Osteoarthritis: what, incidence: Slow 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)
