Italiano Farmacia on line: comprare cialis senza ricetta, acquistare viagra internet.

Microsoft word - pre-anesthetic questionnaire.doc

Pre-Anesthetic Questionnaire: DATE:__________________ 1 of 4
CHIEF COMPLAINT”:________________________________________________
PROPOSED OPERATION:_________________________________________________HT:_____WT:______
CELL PHONE #:_______________ NO ___ YES___ DISCLOSURE ALERT
Primary Care Physician:
1_______________________________/_______ 5 _______________________________/_______ ______________________ 2_______________________________/_______ 6 _______________________________/_______ Cardiologist:( Date of last visit) 3_______________________________/_______ 7 _______________________________/_______
4_______________________________/_______ 8 _______________________________/_______ Approximate date of last Anesthetic/Surgery__________________ Have you had any problems with anesthesia? NO_______ YES_______ _______________________________ Have you been told you are difficult to intubate (insert breathing tube)? NO_______ YES_______ _____________________________ Have any blood relatives had a serious problem with anesthesia? NO_______ YES_______ ______________________________ Have you taken steroids (Cortisone, Prednisone, Hydrocortisone, or Decadron )within the past 12 months? NO_______ YES_______ ______________________________ REVIEW OF SYSTEMS:
_____ _____ Any Heart Studies (EKG, Stress Tests, Angiogram) _____ _____ Chest Pain, Shortness of Breath If yes, Fasting Blood Sugar ________________Range ______ _____ Anemia, Easy Bruising, Free Bleeding _____ _____ Heart Murmur/Irregular Heartbeat ______ _____ Sickle Cell, Other Blood Disease _____ _____ Elevated Cholesterol, Triglycerides _____ _____ Varicose Veins, Vascular Disorders ______ _____ Stroke, Paralysis, Other Neuro Disorder _____ _____ Prev. DVT (blood clot in legs or lungs) ______ _____ Depression, Anxiety, Psych Disorder _____ _____ Asthma, Bronchitis, Emphysema, Other Lung Disease ______ _____ Back Problems, Arthritis, Swelling _____ _____ Limited Neck Motion, Pain, or Injury _____ _____ Jaw Clicking, Pain or Stiffness _____ _____ Ulcerative Colitis, Crohn’s Disease, IBS _______ _____ History of Multi Drug Resistant Organism _____ _____ Previous colonoscopy, hx colon polyps (MRSA, VRE, etc.) _____ _____ Family history colon cancer ______ _____ Headaches or Recent Visual Changes _____ _____ Nausea, Vomiting (Persistent) ______ _____ Cancer, Immunosuppression, Chemotherapy Indigestion, Ulcers, Reflux, Hiatal Hernia ______ _____ Breathing difficulties when lying flat _____ _____ Facial Plastic or Reconstructive Surgery ______ _____ Sleep Apnea. If yes, CPAP machine used?__ ______ _____ Family History of Heart Disease
Do you frequently awaken with numbness in an arm or leg? NO_____ YES_____ Are you Pregnant? NO_____ YES_____ Not Sure_____ Not Applicable_____ Date of last menstrual period________________ Are you Right handed?_____ Left handed?______ Do you wear contact lenses? NO_____ YES_____ NOTE: If yes, please remove them before surgery. Do you have Capped Teeth / Crowns__________ Loose Teeth___________ Bridges___________ Dentures/Partials_____________ Do you have Advance Directives/ Living Will? NO _________ YES _________ (If YES, please have patient bring copy, if possible) SOCIAL HISTORY
Occupation:_______________________________ What type of exercise do you get?__________________________________________ Do/Did you smoke? NO_____ YES_____ Packs Per Day______ How many Years?___________ Quit when?____________________ What is your alcohol consumption?_________________________________________________________________________________ Do/Did you have a problem with drug or alcohol dependence/addiction?____________________________________________________ Do you have a religious objection to blood transfusion? NO_____ YES_____

____________ VERIFIED BY:_________________________RN TIME:__________


Course document

AMITY GLOBAL BUSINESS SCHOOL Module Syllabus Tourism is often claimed to be the biggest industry in the world, yet tourism is not really an industry, more a gathering together of disparate forms of production and consumptive activities. The distribution of this tourism is highly unequal geographically in terms of where tourists come from and where they travel to, though this is changing w

The following information is about passivation of lithium thionyl chloride battery for thereference. 1, General Introduction About Passivation. Passivation is a chemical term and it refers to phenomena that a kind of chemical film appears onthe surface of the metal and prevents the further corrupt from happening on the surface of themetal. In lithium thionyl chloride battery, thionyl chloride

Copyright © 2010-2014 Drugstore Pdf Search