Pre-Anesthesia Assessment NGR 6421 Principles of Anesthesiology Nursing I

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Pre-Anesthesia AssessmentNGR 6421 Principles of
Anesthesiology Nursing I
Jeffrey Groom, PhD, CRNA, ARNPDirector and
Clinical Associate ProfessorNurse Anesthetist
Program College of Nursing and Health
SciencesFlorida International University
Miami, Florida
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Pre-Anesthesia Assessment

• Patient flow
• Surgical vs. Diagnostic procedures
• Assessment skills anesthetic
  considerations
• Anesthesia care plan Plan A Plan B
• PostOp Management

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Pre-Anesthesia Assessment
PATIENT PERSPECTIVE
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Scheduled Procedure

• Procedure Booking
• Admission Orders
• OR Schedule
• PreOp Evaluation
• PreSurgery Review
• Surgery
• PostOp Evaluation

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Pre-Anesthesia Assessment

• Point of Encounter
• Pre-Anesthesia Clinic
• Phone Interview
• Automated Interview

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Pre-Anesthesia Assessment
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Pre-Anesthesia Interview Goals

• Learn of the patients procedure and medical
  history
• Establish a Provider-Patient relationship
• Develop an anesthesia plan
• Provide patient education and direction
• Obtain an informed consent.

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Medical History

• Chart
• Old Medical Records
• Patient - Family
• Physician - Surgeon

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Patient Assessment

• Chief Complaint / Procedure
• Present Illness
• Medications
• Allergies Reactions
• Anesthesia/Surgical Hx
• Family Social Hx
• Review of Systems
• Physical Exam
• Lab Data

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Medical History

• Review of Systems
• Cardiac
• Respiratory
• Renal
• Hepatic
• Endocrine
• Neuro
• Ortho
• Infectious disease
• NPO status

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ASA Physical Status Classification
Class Criteria
I A normal healthy patient
II A patient with mild systemic disease that does not limit activity
III A patient with severe systemic disease that limits activity but is not incapacitating
IV A patient with severe systemic disease that limits activity and is a constant threat to life
V A moribund patient who is not expected to survive with or without the operation
VI A declared brain-dead patient whose organs are being removed for donor purposes
E Emergency case
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American Society of Anesthesiologists (ASA)
classification and predicated mortality 
ASA Class   Definition   Mortality ()  
I Normal healthy individual   0.05
II Mild systemic disease that does not limit activity   0.4
III Severe systemic disease that limits activity but is not incapacitating   4.5
IV Incapacitating systemic disease which is constantly life-threatening   25
V Moribund, not expected to survive 24 hours with or without surgery   50
50 of patients presenting for elective surgery
are ASA Class 1 Operative mortality for these
patients is less than 1 in 10,000.
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Patient Assessment

• Physical Exam
• Vital Signs
• Airway
• Chest
• Abdomen
• Extremities
• Neuro
• Back

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Airway Exam

• Mouth Opening
• Oropharyngeal Classification
• Teeth
• Jaw Subluxation
• TM Distance
• Neck
• Range of Motion
• Ease of Mask Seal

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Mallampati Classification

• Class I - hard palate, soft palate, uvula and
  tonsillar pillars
• Class II - hard palate, soft palate, uvula
• Class Ill - hard palate, soft palate
• Class IV - hard palate

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Mallampati Classification
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Laryngoscopy
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Cormack Lehane Grading
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Cormack Lehane Grading

• grade I - visualization of entire laryngeal
  aperture (95)
• grade II - visualization of posterior part of
  the laryngeal aperture (4)
• grade III - visualization of epiglottis only
  (1)
• grade IV - not even the epiglottis is visible
  (0.05)

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Cormack Lehane Grading
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Mallampati Classification

• Class I, then view is grade I 99 of the time.
• Class IV view is grade III or IV 100 of the
  time.
• Mallampati class alone,may fail to predict over
  50 of difficult intubations.

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Airway Exam
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• Mouth Opening
• Oropharyngeal Classification
• Teeth
• Jaw Subluxation
• TM Distance
• Neck
• Range of Motion
• Ease of Mask Seal

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Patient Assessment
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• Lab Data
• CBC / Chemistry / UA
• EKG
• Chest X-Ray
• PFTs
• LFTs
• Other Echo, Cath, CT, MRI

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Patient Assessment
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• Lab Data
• Na Cl BUN
• 
  Glucose
• K HCO3 Cr
• Hgb
• WBC Platelets
• Hct

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Patient Assessment
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• Provider Patient Relationship
• Medical History
• Anesthesia Plan
• Patient Education
• Informed Consent

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Informed Consent
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• Anesthesia options
• Anesthesia procedures
• Anesthesia risks
• Questions
• Consent

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Patient Assessment
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• Pre-Anesthesia Instructions
• Pre-Anesthesia Orders
• Medicine/Cardiac Consults
• Pre-Anesthesia Record
• Anesthesia Consent
• Progress Note
• HIPPA

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Peripheral Brain
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