pre operative testing
CXR
EKG
LAB
UA
WHEN NEEDED
PTS WITH PULMONARY COMPLICATIONS IF RESULTS WOULD CHANGE PERIOPERATIVE MGT
PRE OP UA
FOR INVASIVE UROLOGIC PROCEDURES, AND THOSE HAVING IMPLANTATION OF FOREIGN MATERIAL ( PROSTHETIC JOINT,HART VALVE
PRE OP LABBS
ELECTROLYTESP AND CREATININE
DM
CBC
COAGULATION STUDIES
UNDERLIYING RENAL DX
ON MEDS THAT CAUSE ELECTROLYTE IMBALANCE/RENALFAILURE
HI RISK OF DM, DO GLUCOSE TESTING
HGB A1C IF RESULT WOULD CHANGE PERIOPERATIVE MGT
-IF AT RISK FOR ANEMIA
EXPECTED SIGNIFICANT PERIOP BLOOD LOSS
COAG STUDIES
TAKING A/C
HIGH RISK FOR BLEED-MEDICAL CONDITION-VON WILLEBRANDS
GUIDELINES ARE MUDDLED-5 OF THEM
REVISED CARDIAC RISK INDEX ( RCRI)
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;
rcri
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%
cxr
AMERICAN COLLEGE OF PHYSICIANS
ONLY IF PT HAS NEW OR UNSTABLE CARDIOPULMONARY COMPLICATIONS-
TO POSTPONE SURGERY OR INFORM DECISIONS
MEDICAL CLEARANCE
PRE OPERATIVE TESTING
KEY RECOMMENDATIONS FOR PRACTICE
WHEN IS EKG NEEDED
EXAMPLE OF LO RISK PROCEDURE
LABS
USU MORE PROTOCOL THAN ACTUAL NECESSITY
EKG-ONLY FOR
HIGH RISK SX
INTERMEDIATE RISK SX + PT HAS ADDITIONAL RISK FACTORS
EXAMPLE:
CATARACT SX
physical exam cancer pt
CANCER ETIOLOGY
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
EIGHT DEADLY CANCER SITES
surprise card
testing with PAP and for STI -hsv at pt request
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
CANCER PHYSICAL
HISTORY TAKING
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
CANCER RX S/E
HISTORY
NEUROPATHY
HAND-FOOT SYNDROME
ALOPECIA
MYELOSUPPRESSION : ALL THE PENIAS
EDEMA
SKIN CHANGES
DRY MOUTH
CANCER
HISTORY TAKINNG
LOOK FOR NEW CANCER SIGNS
PYSCHOSOCIAL: ANX & DEP
REPRODUCTIV
FERTILIITY, MENSTRUAL DISTURBANCES
ERECTILE DYSFUNCTION
QOL
WORK ABILITY
GLUCOSE INTOLERANCE
MUSCLE ATROPHY
OP
PHYISCAL CANCER PT
non pharm
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
physical cancer pt
f/u
Q 3-6 MONTHS FOR FIRST 3 YEARS, 6-12 FOR NEXT 2
PRIMARY CARE VISITS
VAGUE ALL SYMPTOMS PTS
COMPLAINT AND DIFF DX
1 FATIGUE
1.
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
CHRONIC RENAL FAILURE
ARRHYTHMIAS
CHF
COPD
PREGNANCY
MONO
FIBROMYALGIA
INSOMNIA VAGUE COMPLAINTS
DIFF DX
OSA
PRIMARY INSOMNIA
RESTLESS LEG SYNDROME
PAIN SYNDROME
SUBSTANCE ABUSE
ASTHMA
STRESS ANXIETY DEPRSSION DYSTHYMIA
VAGUE SX
WEAKNESS
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
FEVER UNKNOWN ORIGIN
DIFFS
ASK ABOUT TRAVEL ABROAD
HIV- BURKITT LYMPHOMA
LYMPHOMA
LEUKEMIA
PERI OR ENDOCARDITISD
INFECTION
VIRAL
CHEMO DRUGS
UNEXPLAINED WT LOSS
DIGESTIVE DX
THYROID DX
EATING DISORDERS
MALABSORPTION-SPRUE, CELIAC, BARISX, ZOLLINGER ELLISON SYNDROME, ETOH
PAIN
PQRST OF PAIN
PALLIATIVE/PROVOLING
QUALITY
RADIATION
SEVERITY
TIMING
Zuletzt geändertvor 9 Monaten