Pre-operative Assessment
HPI: [text size="5"] yo [select value="M|F"] awaiting [text memo="specific surgery" memo_size="small" memo_color="yellow" size="50"]. Here for pre-operative assessment.[comment memo=" " memo_color="whitesmoke" memo_size="small"][checkbox name="preophxcomorbid" value="Has the following notable comorbidities: "][conditional field="preophxcomorbid" condition="(preophxcomorbid).is('Has the following notable comorbidities: ')"][textarea memo=" list significant cardiac, respiratory, neurologic, endocrine disease that affect patient's functional status and/or require additional recommendations and considerations regarding further risk assessment and perioperative medication management" memo_color="yellow" memo_size="small"][/conditional] -Functional Assessment - Patient able to perform - [checkbox name="Q1" value="Bicycling at a pace of 11 mph (6 METS)=1|Bowling (4 METS)=1|Dance, Slow Step (4 METS)=1|Dance, Square Dancing (5 METS)=1|Dance, Fast Step (Aerobic) (6 METS)=1|Exercise Equipment - Elliptical trainer, moderate effort (5 METS)=1|Exercise Equipment - Exercise bike bicycling, moderate to vigorous effort (6.8 METS)=1|Exercise Equipment - Exercise bike bicycling, spin class (8.5 METS)=1|Exercise Equipment - Rowing machine, moderate effort (4.8 METS)=1|Exercise Equipment - Ski machine (6.8 METS)=1|Fishing from river bank and walking (4 METS)=1|Golf without a cart, walking (4 METS)=1|Housework, perform *heavy* work around the house (4.3 METS)=1|Hunting deer, elk, large game (6 METS)=1|Jumping rope (12.3 METS)=1|Playing Sports - Baseball (5 METS)=1|Playing Sports - Basketball (6.5 METS)=1|Playing Sports - Football (touch or flag) (4 METS)=1|Playing Sports - Softball (5 METS)=1|Playing Sports - Tennis Singles (5 METS)=1|Playing Sports - Volleyball (4 METS)=1|Running/Jogging at 5 mph (8.7 METS)=1|Have sexual relations? (2.8 to 5.25 METS)=1|Shoveling (5 METS)=1|Skating at 10 MPH (5 METS)=1|Skiing, downhill snowskiing (8 METS)=1|Skiing, waterskiing (6 METS)=1|Swimming at 0.25 mph (4 METS)=1|Walk on level ground at 4 mph (4 METS)=1"] Total --> [calc memo="number of activities" value="score=(Q1)"] activities which require at least moderate (4 to 6 METS) functional capacity. -Cardiovascular Assessment - Fleisher-Eagle Algorithm for Preoperative Cardiac Risk Assessment [select value="NO=0|YES=1" name="ischemic"] <-- Ischemic heart disease (angina or prior MI)? [select value="NO=0|YES=1" name="chf"] <-- Heart failure? [select value="NO=0|YES=1" name="riskysurg"] <-- High-risk surgery (including intraperitoneal, intrathoracic, and suprainguinal vascular procedures)? [select value="NO=0|YES=1" name="diabetes"] <-- Diabetes mellitus (especially insulin-requiring)? [select value="NO=0|YES=1" name="renal"] <-- Renal insufficiency? [select value="NO=0|YES=1" name="poorfunc"] <-- Poor functional status (defined as the inability to walk four blocks or climb two flights of stairs)? [conditional field="ischemic|chf|riskysurg|diabetes|renal|poorfunc" condition="(ischemic).is('YES=1')||(chf).is('YES=1')||(riskysurg).is('YES=1')||(diabetes).is('YES=1')||(renal).is('YES=1')||(poorfunc).is('YES=1')"][select value="NO=0|YES=10" name="coronary"] <-- History consistent with coronary heart disease? [/conditional] [checkbox name="preopPE" value="PHYSICAL EXAM" memo="*" memo_color="blue" memo_size="small"][conditional field="preopPE" condition="(preopPE).is('PHYSICAL EXAM')"] [textarea rows="18"]-Vitals - reviewed, no remarkable abnormalities -General - well developed, well nourished, no apparent distress -HEENT - normocephalic, atraumatic, nares patent, mucous membranes moist -Neck - soft/supple, no JVD, no thyromegaly -Heart/CV - RRR/no ectopy, normal S1/S2, No M/R/G, No S3/S4 auscultated, no friction rub -Lungs/Pulm - CTAB, BSE b/l, no wheezes, no crackles, no rhonchi -Abdomen - soft, nontender, nondistended, no voluntary/involuntary guarding, no rigidity, no rebound, bowel sounds present in all 4 quadrants -Skin - warm, dry, intact, no edema/erythema/induration/ecchymosis -EXT - no cyanosis, no over/gross deformity -PSYCH - appropriate mood/affect -NEURO - appropriate balance, normal gait[/textarea] [/conditional][comment memo=" " memo_color="whitesmoke" memo_size="small"]A/P #Pre-operative assessment Z01.818 -OVERALL: [select value="no further risk assessment or chronic disease optimization prior to surgery recommended|recommend further risk assessment AND disease optimization described below prior to surgery|recommend further risk assessment described below prior to surgery|recommend further chronic disease optimization described below prior to surgery"] -Laboratory Assessment/Recommendations: [textarea memo="CBC/BMP/UA if indicated" memo_size="small" memo_color="blue" default="no additional labwork warranted"] -Cardiac Assessment/Recommendations: [calc value="score=(ischemic)+(chf)+(riskysurg)+(diabetes)+(renal)+(poorfunc)+(coronary); score>2?'Noninvasive testing should be performed, followed by cardiac catheterization if the results are positive.':score>0?'Perioperative beta blocker therapy may be recommended - see updated 2014 ACC/AHA perioperative guidelines - but no further testing is recommended.':'No further testing or treatment recommended.'" memo="score interpretation"] [textarea rows="2" cols="80" memo="add'l testing/EKG/cards eval if needed" memo_size="small" memo_color="blue" default="no additional testing warranted"] -Pulmonary Assessment: [textarea rows="2" cols="80" memo="PFT if needed" memo_size="small" memo_color="blue" default="no additional testing warranted"] -Nutritional Assessment/Recommendation: [textarea rows="2" cols="80" default="no severe malnourishment detected, no restrictions or additional considerations to being NPO"] -Chronic disease/medications assessment/recommendations: [checkbox value=" -DM2 - hold oral meds while NPO "][comment memo=" " memo_color="whitesmoke" memo_size="small"][checkbox value=" -HTN - hold oral meds except b-blocker while NPO "][comment memo=" " memo_color="whitesmoke" memo_size="small"][checkbox value=" -A-Fib - may hold anticoagulation or aspirin prior to surgery, and resume in post-operative period "][comment memo=" " memo_color="whitesmoke" memo_size="small"][checkbox value=" -Primary CAD prevention - may hold aspirin prior to surgery, and resume in post-operative period "][comment memo=" " memo_color="whitesmoke" memo_size="small"][checkbox value=" -Primary CAD prevention - recommend continuation of statin therapy pre-operatively, okay to hold morning of surgery then resume immediately post-operatively "][comment memo=" " memo_color="whitesmoke" memo_size="small"][checkbox value=" -no additional medication adjustments necessary "][comment memo=" " memo_color="whitesmoke" memo_size="small"] -Additional chronic disease management recommendations: [textarea rows="1" cols="80" default="none"]
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Sandbox Metrics: Structured Data Index 0.67, 40 form elements, 118 boilerplate words, 2 text boxes, 7 text areas, 9 checkboxes, 9 drop downs, 8 comments, 2 calculations, 3 conditionals, 55 total clicks
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