Primary care

CXR

EKG

LAB

UA

PTS WITH PULMONARY COMPLICATIONS IF RESULTS WOULD CHANGE PERIOPERATIVE MGT

FOR INVASIVE UROLOGIC PROCEDURES, AND THOSE HAVING IMPLANTATION OF FOREIGN MATERIAL ( PROSTHETIC JOINT,HART VALVE

UNDERLIYING RENAL DX

ON MEDS THAT CAUSE ELECTROLYTE IMBALANCE/RENALFAILURE

HI RISK OF DM, DO GLUCOSE TESTING

DM

HGB A1C IF RESULT WOULD CHANGE PERIOPERATIVE MGT

CBC

-IF AT RISK FOR ANEMIA

EXPECTED SIGNIFICANT PERIOP BLOOD LOSS

COAG STUDIES

TAKING A/C

HIGH RISK FOR BLEED-MEDICAL CONDITION-VON WILLEBRANDS

Table 1. Risk of Cardiac Death and Nonfatal Myocardial Infarction for Noncardiac Surgical Procedures

Risk of procedure Examples

High (> 5%) Aortic and major vascular surgery, peripheral vascular surgery

Intermediate (1 to 5%) Intraperitoneal or intrathoracic surgery, carotid endarterectomy, head and neck surgery, orthopedic surgery, prostate surgery

Low (< 1%) Ambulatory surgery, breast surgery, endoscopic procedures, superficial procedures, cataract surgery

Source: Fleisher LA, Beckman JA, Brown KA, et al.; American College of Cardiology; American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery); j of Coll Cardiol.society vascular surgery2008;

risk factor points

cerebrovacular dx 1

chf 1

creatinine >2.0 1

IDDM 1

ischemic heart dx 1

lumped together: suprainguinal vascular sx, intrathoracic sx, intra abdominal sx 1

RIsk by points

0 0.4%

1 0.9%

2 6.6%

3or more 11%

ONLY IF PT HAS NEW OR UNSTABLE CARDIOPULMONARY COMPLICATIONS-

TO POSTPONE SURGERY OR INFORM DECISIONS

EKG

CXR

LABS

UA

USU MORE PROTOCOL THAN ACTUAL NECESSITY

EKG-ONLY FOR

HIGH RISK SX

INTERMEDIATE RISK SX + PT HAS ADDITIONAL RISK FACTORS

EXAMPLE:

CATARACT SX

OVERACTIVITY OF PROTO ONCOGENES

UNDERACTIVITY OF TUMOR SUPPRESSOR GENES

EPIGENETIC- PATTERNS OF GENE EXPRESSION WITH NO DNA CHANGE

DEFECTS IN MOLECULAR AND CELLULAR PATHWAYS

CARCINOGENIC AGENETS

HEREDITY:

BRCA 1 ANDBRCA 2 MUTATIONS GERM LINE -BREAST OVARIAN PROSTATE PANCREATIC CANCERS

AUTOSOMAL DOMINANT-FAP RETINOBLASTOMAS

HORMONAL FACTORS W-BREAST OVARY ENDOMETRIUM

M-PROSTAT TESTICULAR

OBESITY

RADX/CHEMICAL CARCINOGENS

VIRAL AND MICROBIAL AGENTS

Check HIV Ab/P24 Ag with reflex

Check RPR, rfx qn RPR/confirm TP

Check chlamydiA/GC amplification-183194-P

Check HCV antibody-140659-U

Check HBsAg screen

Check nuswab vaginitis plus (vg+)

Check hsv 1 and 2 Ab, IgG

Check CBC with differential/platelet

Check comp. metabolic panel (14)-322000-P

Check igp, aptima HPV, rfx 16/18,45-199305-P

Check Pap lb, aptima HPV

mammography script

TUMOR STAGE TYPE

TREATMENT

DATE OF DIAGNOSIS & RX

DATE OF LAST DIAGNOSTIC AND SURVEILLANCE VISIT

YEARS OF SURVIVAL

PRESENCE OF LONG TERM S/E

PAIN LEVEL

NEUROPATHY

HAND-FOOT SYNDROME

ALOPECIA

MYELOSUPPRESSION : ALL THE PENIAS

EDEMA

SKIN CHANGES

DRY MOUTH

LOOK FOR NEW CANCER SIGNS

PYSCHOSOCIAL: ANX & DEP

REPRODUCTIV

FERTILIITY, MENSTRUAL DISTURBANCES

ERECTILE DYSFUNCTION

QOL

WORK ABILITY

GLUCOSE INTOLERANCE

MUSCLE ATROPHY

OP

• Focus on modifiable risk factors: diet and physical activity

• Cancer support groups

• Progressive muscle relaxation

• Biofeedback

• Guided imagery

• Systematic desensitization

• Acupuncture and acupressure

• Music therapy

• Genetic testing and counseling

• Surgery

Q 3-6 MONTHS FOR FIRST 3 YEARS, 6-12 FOR NEXT 2

1.

HISTORY

ALL MEDS INCL OTC

FAM HISTORY OF CARD, RESP, ENDOCRINE, GI OR HEMATOLOGICA DX

DIFF DX OR POSSIBLE CAUSES

ANEMIA-LMP

THYROID DISORDER-LOW

ADRENAL- ADDISONS OR CUSHINGS

MENTAL HEALTH/STRESSORS

DEPRESSION

DM

CHRONIC RENAL FAILURE

ARRHYTHMIAS

CHF

COPD

PREGNANCY

MONO

FIBROMYALGIA

OSA

PRIMARY INSOMNIA

RESTLESS LEG SYNDROME

PAIN SYNDROME

SUBSTANCE ABUSE

CHF

ASTHMA

STRESS ANXIETY DEPRSSION DYSTHYMIA

FIBROMYALGIA

MS

MUSCULAR DYSTROPHIES’

MYASTHENIA GRAVIS

(POLYMYOSITIS-SYSTEMIC DX UNKNOWN ETIOLOGY , WHEN RASH PRESENT ITS CALLED:

DERMATOMYOSITIS-

WEAKNESS OF LEGS, PROGRESSES UP TO NECK

RASH BUTTERFLY ON FACE, REDNESS TELANGIECTASIS OF HANDS AND NAILS

RAYNAUDS TOO-DX BIOPSY , INCREASED CPK,SGOT,SGPT,LDH )

LOU GEHRIGS DX

GUILLAN BARRE

HIGH THYROID -WEKANESS IN MUSCLES-LO TSH, HIGH T4, HIGH ESR, CA K AND GLUCOSE -R/O ADDISONS AND PHEOCHROMOCYTOMA

CUSHINGS

MALIGNANCY

ASK ABOUT TRAVEL ABROAD

HIV- BURKITT LYMPHOMA

LYMPHOMA

LEUKEMIA

PERI OR ENDOCARDITISD

INFECTION

VIRAL

CHEMO DRUGS

CANCER

DM

DIGESTIVE DX

THYROID DX

DEPRESSION

EATING DISORDERS

MALABSORPTION-SPRUE, CELIAC, BARISX, ZOLLINGER ELLISON SYNDROME, ETOH

PQRST OF PAIN

PALLIATIVE/PROVOLING

QUALITY

RADIATION

SEVERITY

TIMING