NRNP 6560 Midterm Exam

NRNP 6560 Midterm Exam Surgery risk classes (ANS-

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

(ANS- 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 (ANS-

• 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 (ANS-

• 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 1 / 4

• determine functional capacity (need to be more than 4 METS, more than 10

METs makes low risk)

Low risk surgeries (ANS- catarcts breast biopsy cystoscopy, vasectomy laporascopic procedures Plastic surgery

intermediate risk surgeries (ANS- Head/ neck surgery thyroidectomy Intraperitoneal Prostate Laminectomy Hip/ knee Hysterectomy cholecystectomy nephrectomy non majot intrathoracic

High risk surgeries (ANS- aortic/ cabg transplants spinal reconstruction peripheral vascular surgery

Lee's revised cardiac risk index (ANS-

6 points:

High risk surgery = 1 2 / 4

CAD = 1

CHF = 1

Cerebrovascular disease = 1 DM 1 on insulin = 1 Creat greater than 2 = 1

• = low risk
• = moderate risk
• = high risk

SCIP pre-operative infection measures (ANS-

• 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 (ANS-

• 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

(ANS- 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 3 / 4

• prior trauma (sprains/ dislocations)
• diabetic neuropathy
• genetic

Osteoarthritis findings and diagnostics (ANS-

• 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 treatment (ANS- Goal 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
• / 4