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    Anesthesiology Pre-Op Evaluation: Exovsrts

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    sabbo mors
    This document summarizes a patient's pre-operative evaluation for anesthesia. It includes medical history, current medications, prior anesthesia complications, physical exam findings, lab results, and anesthesia plan. Key details include a history of hypertension, hyperlipidemia, and back pain, as well as normal exam findings. The planned anesthesia is general anesthesia. The pre-op evaluation was reviewed and approved by a CRNA and supervising anesthesiologist.

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    Anesthesiology Pre-Op Evaluation: Exovsrts

    Uploaded by

    sabbo mors
    192 views1 page
    This document summarizes a patient's pre-operative evaluation for anesthesia. It includes medical history, current medications, prior anesthesia complications, physical exam findings, lab results, and anesthesia plan. Key details include a history of hypertension, hyperlipidemia, and back pain, as well as normal exam findings. The planned anesthesia is general anesthesia. The pre-op evaluation was reviewed and approved by a CRNA and supervising anesthesiologist.

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    pre-op sheet

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    This document summarizes a patient's pre-operative evaluation for anesthesia. It includes medical history, current medications, prior anesthesia complications, physical exam findings, lab results, and anesthesia plan. Key details include a history of hypertension, hyperlipidemia, and back pain, as well as normal exam findings. The planned anesthesia is general anesthesia. The pre-op evaluation was reviewed and approved by a CRNA and supervising anesthesiologist.

    Copyright:

    © All Rights Reserved
    Download as RTF, PDF, TXT or read online from Scribd
    Download as rtf, pdf, or txt
    192 views1 page

    Anesthesiology Pre-Op Evaluation: Exovsrts

    Uploaded by

    sabbo mors
    This document summarizes a patient's pre-operative evaluation for anesthesia. It includes medical history, current medications, prior anesthesia complications, physical exam findings, lab results, and anesthesia plan. Key details include a history of hypertension, hyperlipidemia, and back pain, as well as normal exam findings. The planned anesthesia is general anesthesia. The pre-op evaluation was reviewed and approved by a CRNA and supervising anesthesiologist.

    Copyright:

    © All Rights Reserved
    Download as RTF, PDF, TXT or read online from Scribd
    Download as rtf, pdf, or txt
    of 1

    ANESTHESIOLOGY PRE-OP EVALUATION

    & exovsrts
    Covenant Mtdiml tamer
    Heighl

    Medlcaiions: (Ctrcle Rx Givefi Today)

    |**] Note(s) reviewed

    Prior Anesthesia Complications: O No O Yes 1s] HD MH O PONV Family Hirforj/ Of Anes. Problems:
    @ DTFF Aiway Hx
    Q Asthma Q Pneumonia Q Home O, @ Rhinins
    Labc WHC HfH f PLT Antitxxly screen + •-
    COPD @ Recenl URIQ Sleep Apnea @ CPAP
    Na K BUN Cr Glu BTLfTAH LMP
    PTfPTT / INR HCG NEG
    Q Hiatai Hernia Q Jaundice GI Bleed
    @ GERO'PUO Q Ascites Q Cirrhosis
    Bridges U / L Neck ROM
    @ Diverilcidosls @ Crohn’s Ds @ Appendicitis
    OK Limited
    HepaHtis [°*) Choiecysfitis
    Airway Class: TMD
    Exam of Heart Q Regular Q Irregular Q Munnur ONC {°°) WNL Mastectomy R f L Radialion
    Exam of Lungs CTA Q Wheeze Q Crackles Q Oiher {**j Chetno {**j Cancer

    CAD M1 HX HX CABG @ Hx UTI Q stones Q Acute Reaal Failure CKD


    {°°) MVP/MiUAifAS [°°) High Chol [**} AICD/Pacer Henao-Dialysis
    @ PVD @ Murmur @ Rh. reset @ BPH @ Peritoneal malysis
    @ Arrhythmias (A-Fib/A-Stutter) @ CaldionJyopathy
    UNDO, WNL @ NIDDM @ ADDM @ Neuropallty
    @ CHh (Systo1ic / DiastoJic) (Acufe / Clzzonic)
    @ Obesity @ Hypoglycenzia
    Q Thyroid (Hypo/Hyper) O tlierine Dysfurirtlun
    EKG:
    {_) Bleeding Dysfunction j Hx DVT / PE
    CNS (°°] WNL {°°) Dementia {°°) Seizure/Epilepsy ETOH
    @ Anemia Chronic @ H1V/A1HS
    Q Hx CVA/TlA @ Headaches/Migraines Q Orug Ahuse.
    (**} Acute Blood lms Anemia (°°} Sickle Ceil
    @ Anxiety @ Depression @ Mentally Impaired
    DS fi Eaxy bruisirig/frcq. No ebleeds
    Q Residual Heinipa •iiWeinlplegia Q Bipolar
    Othal O MalnuDition Q Glaucoma
    {**| Decubirris LfJcer Sire
    O Back paiii/kower extremity nutnbnexs/wealuitss
    @ Transplant stahis (KJdztey/Liva/Heart/Luztg)

    Mimcnhiskeietal:
    Prenulure V / N hy weeks
    (°°} WNL [°°) RA (°°} OA DID [°°) SLE
    Hx of apnea Y f N Immunization up-to-date Y N
    Gout Arthritis Fihmn1y *8 ia
    Hx of intu6ation/respiratory distress Y / N
    Preop evaluatlon Signatures: CRNA Anesthesiologist

    Plan Of Care: ASA 1 2 3 4 5 E


    @ GA @ Combined @ Epiduml @ SAB @ Bier Birk @ Mac @ defused Egidumt/Spinal
    Invasive I mcedures DiscuiW.
    Q A-Line @ CVC Q PAC TEE @ Bl‹xxl Transfusion
    Patil CattroJ Discussed:
    @ Epidural @ ISB @ FNB @ @ Refused
    CRNA providing anesthesia Signature DaiefTime
    Anesthesia plans discussed with CRNA Supervising Anesthesiologist Signature Datemrrie

    If pre anesthesia evaluation is completed greater then 48 hours prior to surgery, I


    have reviewed and agree with the pre-op evaluation with the following changes:
    Patient Identlficadon
    Signature

    Form 0: 0018 Originated 5f 1/08 Revised 6fl0/IO

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