Ppp-psq rev 01-06

361 Hospital Road, Suite 124 • Newport Beach, CA 92663 • (949) 631-0988 PRE-ANESTHESIA SURGERY QUESTIONNAIRE
1. Name of your regular family doctor _______________________________ Phone ___________ OR ❏ I do not have a regular family doctor 2. Have you ever had any problems with blood pressure, previous heart disease, palpitations or angina?____________________________________________ If yes, please explain: ___________________________________________________________________________________________________________ 3. Have you had an EKG in the past? If yes, where? when ___________________________________________________________________________________________________ 4. Have you had any ( Circle ) breathing problems, asthma, hay fever, chronic bronchitis, emphysema or shortness of breath? __________________________ 5. Have you had any ( Circle ) seizures, convulsions, migraine headaches, fainting spells or stroke? _________________________________________________ 6. Have you had ( Circle ) jaundice, hepatitis, liver disease or blood transfusion reactions? _______________________________________________________ 7. Do you have ( Circle ) diabetes, hypoglycemia or thyroid problems? _______________________________________________________________________ 8. Do you have kidney problems? ____________________________________________________________________________________________________ 9. Have you had ( Circle ) a cold, sore throat, or flu in the last two weeks? ____________________________________________________________________ 10. Any recent exposure to tuberculosis? ❏ Yes ❏ No Any of the following symptoms: night sweats, cough with bloody sputum? _______________________ 11. Within the last two weeks have you had any exposure to chicken pox, mumps, measles (rubeola), German measles (rubella)? ________________________ 12. Do you have any ( Circle ) physical disabilities, back pain, arthritis or bursitis? _______________________________________________________________ 13. Do you have sleep apnea? C-PAP? Sleeping disorders? Snoring?__________________________________________________________________________ 14. Any other medical conditions? List: __________________________________________________________________________________________________ 15. Do you have any implants? (Cardiac, Cosmetic, Orthopedic) List:____________________________________________________________________________ 16. Have you ever had motion sickness? ___________________________________________________________________________________________________ 17. Do you smoke? ______________________________ How much/day? ___________________________________________________________________ 18. Do you drink alcoholic beverages? _______________________ How much/week? __________________________________________________________ 19. Do you use recreational drugs? ___________ Please list_______________________________________________________________________________ 20. Do you have ( Circle ) any loose teeth, dentures, permanent or removable bridges or front capped teeth? _________________________________________ 21. Do you wear contacts? __________________________________________________________________________________________________________ 22. Do you have any difficulty opening your mouth? ______________________________________________________________________________________ 23. Have you or any blood relative had an unusual reaction to anesthesia or malignant hyperthermia? ______________________________________________ 24. Are you allergic to anything? List: __________________________________________________________________________________________________
25. Do you have a latex allergy? ______________________________________________________________________________________________________ 26. Within the last year have you had cortisone or steroids? ________________________________________________________________________________ 27. Within the last two weeks have you taken ( Circle ) a tranquilizer, diet pills or herbal medications? _______________________________________________ 28. Have you taken any medication today? List: __________________________________________________________________________________________ 29. Do you use aspirin, ibuprophen (Motrin), Advil, Aleve, Naproxen or Anaprox? _______________________________________________________________ Others ____________________________________________________________________Last date taken?_____________________________________ 30. Do you use blood thinners (Heparin, Lovenox, Coumadin, etc.)? ______________________________Last date taken?______________________________ 31. Do you have bleeding tendencies? _________________________________________________________________________________________________ 32. Could you be pregnant at this time? ___________________ Date of last menstrual period: ____________________________________________________ 33. Circle pain medications you have ever taken: ❑ Tylenol ❑ Percocet ❑ Codeine ❑ Aspirin ❑ Darvocet ❑ Vicodin ❑ Other ________________________ 34. Height: ______________________ Weight: ___________________________
(i.e. fever, nausea, vomiting, low blood pressure) COMPLETED BY: ___________________________________________________________________________________ RELATIONSHIP: ___________________________________________DATE: ___________________________________ REVIEWED BY: PRE-OP RN: _________________________________OR/GI R.N.:______________________________

Source: http://www.nbsc.cc/forms/PPP-PSQ%20REV%2004-07.pdf

Microsoft word - 115 - preparación de miralax - 6-15-10

Preparación de Miralax para colonoscopía y cirugía: Compras – en farmacia / no necesita receta Una semana antes de su procedimiento: DEJAR DE TOMAR medicinas que causan sangramiento : Plavix, Coumadin, Aspirina. DEJAR de tomar anti-inflamatorios: Empirin, Ecotrin, Exedrin, Bufferin, Ascriptin, Ibuprofen, Motrin, Advil, Medipren, Nuprin, Naprosyn, Naproxen, Sulindac, Piroxicam, Feld

Voor u gelezen januari 2003

VOOR U GELEZEN December 2012 Jef De Loof Wondreiniging met kraantjeswater is effectief Fernandez R. et al. gingen in een review van 11 onderzoeken met in totaal 3449 deelnemers na of er een verschil was in genezing van chronische wonden die regelmatig gereinigd werden met kraantjeswater of met fysiologisch serum (NaCl 9%) of met een ander desinfectans. Wondreiniging met kraantjeswater bl

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