Last updated on 18 Apr 2015 at 9:42 AM (Abdo19)

Pre-admission and surgical risk assessment
A 69 year old Māori woman attends her appointment at the Surgical Pre-admission Clinic. She is due to have her gallbladder removed. She has had a lot of health problems in the past, including heart and lung disease. However, she has had recurrent bouts of biliary colic and is keen to have the operation.

 

Applied Science for Medicine
Anatomy and physiology of the heart and lungs
Physiology of body fluid compartments
Microbiology of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), extended-spectrum beta-lactamases (ESBLs)
Pharmacology of low molecular weight heparin, clopidogrel, aspirin

Clinical and Communication Skills
History from a patient in a surgical pre-admission clinic; take a medication history
Perform a full systems examination
Recognise adverse factors that increase the risk of perioperative complications
Classify patients using American Society of Anaesthesiologists (ASA) criteria and undertake a risk vs benefit assessment
Perform venepuncture, arterial blood gas
Indications for echocardiogram
Interpret full blood count, renal function, liver function tests, coagulation screen, ECG, chest X-ray, pulmonary function tests/spirometry, HbA1c, blood group and antibody screen
Management in the perioperative period of thromboembolic disease, anticoagulation and antiplatelet agents, fluid and electrolyte balance, glucose control, antibiotics, decolonisation of resistant organisms
Outline management of perioperative checklist (eg. marking surgical site, consent form), high-risk surgical patient
Provide instructions for pre operative medication regimen and prescribe on in-patient prescription chart
Role of anaesthetist, cardiologist, surgeon, transfusion medicine specialist
Anaesthetic and common post-surgical complications

Personal and Professional Skills
Empathise with the patient who has experienced pain for a long period of time
Undertake full informed consent process, allowing the patient to fully voice concerns and ask questions
Discuss prescribing decisions with colleagues

Hauora Māori
Appropriate engagement and consultation with whānau
Ability to cater for differential health literacy needs of Māori patients and whānau
Awareness of differing risk profiles for Māori (and other disadvantaged populations) requiring surgery compared with non-Māori in NZ
Inequities in medical/surgical error/adverse events between Māori and non-Māori
Consideration of access to cultural/spiritual support for patient and whānau

Population Health
Epidemiology in New Zealand of MRSA, VRE, ESBL
Standardised pre-admission forms and protocols

 

Conditions to be considered relating to this scenario

Common

gallstones, ischaemic heart disease, valvular heart disease, atelectasis, pneumonia, asthma, COPD, peripheral vascular disease, cardiac arrhythmias, pulmonary embolism, deep vein thrombosis, malnutrition, diabetes mellitus, obesity

Less common but 'important not to miss'

pulmonary fibrosis, pulmonary hypertension