Lecture 16 - Pre-Op Patient Assessment & Prep

Product w/antimicrobial activity that formerly may have been referred to as an antimicrobial agent.

Food withheld no longer than 4-6 hours because hypoglycemia may occur.

Discuss the sterile skin prep.

Evaluating cardiac disease includes thoracic radiographs, a cardiac ultrasound scan, & and an electrocardiogram.

When positioning a patient with restraints for a surgical procedure, what must we be careful to avoid?

Considered normal or resident organisms living in the skin's superficial cornified layers & outer hair follicles?

Endogenous microbial flora are the most common source of SSI (s. aureus & Strep spp)

Young, healthy animals undergoing elective procedures (ex. OHE) should have which lab data done? Select all that apply

Emergencies may allow only a cursory examination until the animal has been stabilized.

What must be true to be considered an SSI infection?

Our PE includes a systemic evaluation including the general condition and tailored exams for traumatized animals.

In abdominal incision extends to the pubis in male dogs, clamp the prepuce to 1 side w/ sterile towel clamp & 4x4 gauze.

Use a circular scrubbing motion, moving from the center to the periphery.

For an OHE, generally clip just above the xyphoid to the pubis & laterally beyond the nipple line.

In a hanging-leg preparation, the limb is hung from IV pole and drapes placed around limb secured w/towel clamps.

Diet, exercise, environment, past med prob, recent treatments, & evidence consistent with infection are topics of a P HX

Prevention of sepsis by preventing or inhibiting the growth of resident & transient microbes.

Food intake is generally restricted 6-12 hrs before induction & water is generally not withheld.

Which prognosis is associated w/serious complications possible, recovery prolonged, & may not return to pre-SX funct?

What is the purpose of a sterile skin prep?

Select all that apply - "III Severe systemic disease"

Professional communication skill with owners is critical!

Which prognosis is associated with some potential for complications & high probability of a good outcome?

Select all that apply - "II healthy w/localized dx or mild systemic dx"

Owner should sign an estimate form, outlining anticipated costs of diagnostics, pre-op care, surgery, & post-op.

SSI in humans is associated with increased incidence of morbidity & mortality, length of hospitalization, & $.

Eliminating exposure to flora is important during surgery. It is impossible to sterilize skin w/out impairing skin.

Which prognosis is seen w/severe complication, prolonged recovery, likelihood of death, & unlikely to return to func?

Owner should sign a waiver, authorizing surgery & accepting anesthetic & surgical risks.

While cost can't always be predicted, owners should be kept apprised of the animal's status & procedures that affect $$$

Identification of associated or underlying disease influences pre-op managment, procedure, prognosis, & post-op care.

Which incisional infection involves deep soft tissue layers such as incisional fascia & muscle?

Select all that apply - "IV severe systemic disease that is life threatening"

For limb procedure, place glove over distal extremity & secure with tape or Vetrap.

S. aureus, S. intermedius, E. coli, Streptococcus spp, Enterobacter spp, & Clostridium spp are transient pathogens.

Discuss clipping and prepping your patient.

The initial shave is done in which direction? Which direction is subsequent shaving done?

Replacing fluid loss & correcting acid-base & lytes abnormalities before induction of anesthesia are usually justified

Backhaus towel clamps on the outside drape should be clamped around the neck of underlying towel clamp.

Discuss some determinations of surgical risk.

Which prognosis is associated w/the potential for complications being min & high probability the P will return to normal

What are some items we would want to check for when collecting a patient's history?

The current literature strongly suggests that ____ for preoperative antisepsis for patients.

A general guideline is to clip 20 cm on each side of the incision with a #40 blade nearly parallel to the skin.

Evaluation of preanesthetic physical status is one of the best determinants of the likelihood of what kind of emergency?

Select all that apply - American Society of Anesthesiologist' physical status scale for "I healthy w/no discernable dx"

What are some items we might ask when gathering the patient's history?

An incisional infection is at the site of the surgical incision. Which involves the skin & SQ tissue?

Edges of the drape can be secured to the field drapes w/allis tissue forceps to avoid putting holes through outer drape.

A patient should always receive a complete PE, followed by the appropriate lab work-up. Why is this recommended?

Animals < 5 -7 y/o or have systemic signs (ex. hrt murmur) should have which of the following lab data done?

Flush the prepuce of male dogs with antiseptic soln before performing the sterile preparation.

Organ/space infection is of an anatomic part that was manipulated during the operation.

Select all that is true.

The tips of the towel clamps are considered nonsterile once they have been placed through the skin.

The risk of the surgical procedure may outweigh its potential benefits.

Select all that apply - "V Moribund: Patient not expected to live more than 24 hours w/or w/out surgery"

What should owners be informed about before surgery?

A guarded prognosis is given when the outcome is highly variable or unknown.

In neoplasia cases evaluating for metastasis what would be recommended to perform?

Which of the following is listed under a preoperative assessment? Select all that apply.