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,
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
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
Intraperitoneal
Prostate
Laminectomy
Hip/ knee
Hysterectomy
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)
- diabetic neuropathy
- genetic
12.Osteoarthritis findings and diagnostics: - Pain in weight bearing joints
- stiffness after sitting, gets better when arising
- feeling of instability on stairs
- fine motor skills deficit
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,
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
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
Intraperitoneal
Prostate
Laminectomy
Hip/ knee
Hysterectomy
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)
- diabetic neuropathy
- genetic
12.Osteoarthritis findings and diagnostics: - Pain in weight bearing joints
- stiffness after sitting, gets better when arising
- feeling of instability on stairs
- fine motor skills deficit
