preoperative health status Medical Assignment Help

preoperative health status

BOX 1-19
Management of Patient with Diabetes

Insulin-Dependent Diabetes
1. Defer surgery until diabetes is well controlled; consult
physician.
2. Schedule an early morning appointment; avoid
lengthy appointments.
3. Use anxiety reduction protocol, but avoid deep
sedation techniques in outpatients.
4. Monitor pulse, respiration, and blood pressure
before, during, and after surgery.
5. Maintatn verbal contact with patient during
,surgery.
6. If patient must not eat or drink before oral surgery
and will have difficulty eating after surgery, instruct
patient to not take the usual dose of regular or NPH,
insulin; start an IVwith an DsW drip at 150 ml/hr.,
. 7. If allowed; have the patient eat a normal breakfast
before surgery and take the usual dose of regular
insulin, but only half the dose of NPH insulin.
, 8. Advise patients not to resume normal insu’lin doses
until they are able to return to usual level of caloric
intake and activity level.
9. Consult physician if any questions concerning modification
of the insulin regimen arise.
10. Watch for signs of hypoglycemia.
11. Treat infections aggressively. ,
Non-Insulin-Dependent Diabetes
1. Deter surgery until diabetes is well controlled.
2. Schedule an early-morning appointment; avoid
lengthy appointments.
3. Use an anxiety reduction protocol.
4. Monitor pulse, respiration, and blood pressure
before, during, and after surgery.
5. Maintain verbal contact with the-patient during
surgery.
6. If patient must not eat or drink before oral surgery
and will have difficulty eating after surgery, instruct
patient to skip any oral hypoglycemic medications
~~d~ . ,
7. If patient can eat before and after surgery, instruct
patient to eat a normal breakfast and to take the
usual dose of hypoglycemic agent.
8, Watch for signs of hypoglycemia,
9. Treat infections aggressively.
Iv, Intravenous; NPH, neutral protamine hagedorn,

lar goiter, or a thyroid adenoma. The early manifestations of excessive thyroid hormone production include fine, brittle hair, hyperpigrnentatlon of skin, excessive sweating, tachycardia, palpitations, weight loss, and emotional liability. Patients frequently, although not invariably, develop exophthalmos (a bulging of the globes caused by increases of fat in the orbits). If hyperthyroidism is not recognized early, the patient may develop heart failure. The diaghasis is made by the demonstration of elevated circulating thyroid hormones, using direct or indirect laboratory techniues.

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