Pre-Op Visit

*** PRE-OP  MEDICAL  H&P ***

Name: ***
Age:  ***

PLANNED PROCEDURE:

PROCEDURE DATE:

ALLERGY: Patient has answered NKA

 
MEDICAL HISTORY:


====================================================================

 FUNCTIONAL STATUS:
CARDIOVASCULAR
   PAD:     No
   Cerebrovascular: No
   CAD:     No
   Angina:  NoNo
   MI:      No
   CHF:     No  Most recent LVEF:
   CABG/Stents: No
   Aortic Stenosis: No,
   Pacemaker: No
   Implanted defibrillator: No
   A-FIB:   No
   Cerebrovascular Accident: No
   DVT/PE:  No

 RESPIRATORY
   Asthma: No
   COPD:   No
   Sleep Apnea: No
     CPAP: No

 BLEEDING RISK/ANTICOAGULATION
   ASPRIN:   No
   NSAID:    NoNo
   Warfarin: No

 
 ENDOCRINE
   Diabetes: No
   Thyroid disorder uncontrolled: No
   Steroid use: No
   Adrenal insufficiency Risk: No

 GASTROINTESTINAL
   Hiatal Hernia: No
   GERD: No
   Liver Disease: Hepatitis: No
   Cirrhosis: No

 RENAL
   Chronic Renal Failure: No

 HABITS
   Tobacco: Never smoked
   ETOH:   Not drinking now

 INFECTION RISK
   Endocarditis Risk: No
   Hepatitis:         No
   HIV:               No

 SURGICAL HISTORY
   List Previous Surgeries:
   History Of Complications:         No
   Family Hx Of Anesthetic Problems: No

 NEURO/PSYCH
   Dementia, Delirium, Encephalopathy: No
   Seizure disorder:                   No

EXAM: General
Height: 
 Weight: 
 Resp:   
 Temp:   
 HR:     
 BP:     
 Mental Status:
Oropharynx:
Teeth:
Neck ROM:
Lungs:
Heart: Rhythm[  ] Murmur[ ] S3[ ] JVP[ ]
LE edema:

LABs:

EKG
  Date:
  Rhythm:
  Rate:

CXR: 
 
ASSESSMENT:
  *** is a *** yr old, with Med Hx as outlined above.
I have reviewed the records, Interviewed & Examined the patient, and
reviewed pertinent studies. Patient has:
No significant (relevant) active medical issue(s) for planned procedure

RECOMMENDATIONS
  CARDIAC/VASCULAR:
    Monitor Vitals and Rhythm Peri-Procedure PRN NTG SL 0.4 mg PRN Angina. 
Not
Applicable

  PULMONARY:
    Keep Head Of Bed Elevated Peri-Procedure. Not Applicable

  DM-II: Not applicable

  DVT PROPHYLAXIS:
    Early Post-Op Ambulation
    +/- Pneumoboots
    +/- SQ Heparin If Bed Bound Post-Procedure and
    If/When Safe To Do So From Procedure Bleeding Risk

  ALLERGY: Note Allergies As Listed Above

Perioperative Medication Recommendations: