Pre-Anesthesia Assessment NGR 6091 Principles of Anesthesiology Nursing I

1. Pre-Anesthesia AssessmentNGR 6091 Principles of Anesthesiology Nursing I

2. Pre-Anesthesia Assessment Patient flow Surgical vs. Diagnostic procedures Assessment skills & anesthetic considerations Anesthesia care plan Plan A Plan B PostOp Management

4. Scheduled Procedure Procedure Booking Admission Orders OR Schedule PreOp Evaluation PreSurgery Review Surgery PostOp Evaluation

5. Pre-Anesthesia Assessment Point of Encounter Pre-Anesthesia Clinic Phone Interview Automated Interview

6. Pre-Anesthesia Assessment

7. Pre-Anesthesia Interview Goals Learn of the patient’s procedure and medical history Establish a Provider-Patient relationship Develop an anesthesia plan Provide patient education and direction Obtain an informed consent.

8. Chart Old Medical Records Patient - Family Physician - Surgeon Medical History

9. Chief Complaint / Procedure Present Illness Medications Allergies & Reactions Anesthesia/Surgical Hx Family & Social Hx Review of Systems Physical Exam Lab Data Patient Assessment

10. Review of Systems Cardiac Respiratory Renal Hepatic Endocrine Neuro Ortho Infectious disease NPO status Medical History

11. ASA Physical Status Classification

13. Physical Exam Vital Signs Airway Chest Abdomen Extremities Neuro Back Patient Assessment

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

15. 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

16. Mallampati Classification

19. 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%) Cormack & Lehane Grading

21. 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. Mallampati Classification

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

25. Patient Assessment Lab Data CBC / Chemistry / UA EKG Chest X-Ray PFT’s LFT’s Other – Echo, Cath, CT, MRI

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

27. Provider – Patient Relationship Medical History Anesthesia Plan Patient Education Informed Consent Patient Assessment

28. Anesthesia options Anesthesia procedures Anesthesia risks Questions Consent Informed Consent

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

30. Peripheral Brain