Quote from smoo
I need help........What exactly is an ASA rating and wound classification in the OR? I need to write a paper for my OR observation and it is asking me these question. Any help is appreciated.
I'm a new nurse and currently in AORN's peri-op 101 class. This is what i have in my notes according to Alexander's textbook and what i was told. "ASA ratings are Physical Status Classification of the American Society of Anesthesia to provide uniform guidelines. It is the evaluation of the severity of systemic diseases, physiologic dysfunction, and anatomic abnormalities." In my textbook there are P1, P2, P3, P4, P5, P6. At our hospital the circulating nurses do not fill this out on the OR record, the anesthesiologist does and instead of the P1, P2, etc we have I, II, III and IV. I is a normal healthy adult. II is a patient with mild systemic disease such as hypertension, asthma, diabetes mellitus, obesity, or tobacco abuse. III is a patient with severe systemic disease that limits activity but is not incapacitating. Like cardiovascular or pulmonary disease that limits activity. Severe diabetes with systemic complications. HX of MI, angina or poorly controlled hypertension.
IV is a patient with severe systemic disease that is a constant threat to life, severe cardiac (CHF), pulmonary, renal, hepatic or endocrine dysfunction. Now P5 which we don't have on our hospital's OR record, i'm not sure why but this is something i'm going to have to look into when i get to orient with an anesthesiologist. P5 is a patient who is not expected to survive 24 hours with or without operation. "Surgery is done as a last recourse, like cerebral trauma, ruptured aneurysm, or large pulmonary embolus. P6 is a patient declared brain dead whose organs are being removed for donor purposes."
Their are four surgical wound classifications according to CDC. Our hospital goes by A B C or D.
Class I (A)are clean wounds that are not infected, no inflammation, no breaks in sterile technique, no hollow viscus entered. The respiratory and the genitourinary tract has not been entered. Some examples would be a breast biopsy, thyroidectomy, mastectomy, laminectomy, total hip replacement, open-heart surgery.
Class II (B)are clean/contaminated wounds, no infection or inflammation, no breaks in sterile technique, hollow viscus entered and the respiratory, alimentary or genitourinary tract has been entered under controlled conditions. Some examples are hysterectomy, cholecystectomy, c-section, colon resection, tracheostomy, appendectomy.
Class III (C)are contaminated wounds that involve inflammation, gross spillage of bowel or products of the GI tract. Open or fresh traumatic wounds of less than 4 hours. Entrance into the genitourinary or biliary tracts with infection. Examples- Inflamed but ruptured appendix or gall bladder, emergency open cardiac massage, penetrating abdominal trauma involving bowel or a gunshot wound to abdomen.
Class IV (D)are dirty or infected wounds. Trauma from a contaminated source or gross spillage of infected materials. Old traumatic wounds of over 4 hours. Existing clinical infection. I remember this one because i got to watch an amputation and i was told that it would fall under this class because my patient had retained dead tissue. Other examples include drainage of abscesses and ruptured appendix.
Hope this helps and good luck with school.