Comment the following classmate post in a way that demonstrates deeper or broade

Comment the following classmate post in a way that demonstrates deeper or broader thoughts about a topic, rather than just rephrasing what the textbook or classmate just wrote.
2nd classmate post
I currently work in a cardiology group practice and requests for patient perioperative risk stratification from surgeons and primary care providers are a common occurrence. Lobos and Fisher (2021) recommend utilizing the American College of Cardiology/American Heart Association algorithm which evaluate cardiac risk by evaluating both the patient’s condition, active cardiac conditions, extent of the surgery, functional capacity, and utilization of RCRI. This guideline follows a stepwise process.
A. Perioperative risk stratification of 60-year-old female scheduled for a total knee replacement with no previous cardiac history, new onset murmur, echocardiogram with ejection fraction of 60%, and severe aortic stenosis.
1. Urgency: Elective
2. Active cardiac condition: severe aortic stenosis. Severe aortic stenosis is an unstable cardiac condition and one clinical risk factor for a perioperative major adverse cardiac event (MACE) classifying this patient as high risk. According to the 2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery, because the patient has severe aortic stenosis, “For adults who meet standard indications for valvular intervention (replacement and repair) on the basis of symptoms and severity of stenosis or regurgitation, valvular intervention before elective noncardiac surgery is effective in reducing perioperative risk” (Fleisher, 2014, np).
3. Surgical Intervention: Based on the type of surgery, the patient is considered intermediate risk (between 1% to 5%) (Bonaccorsi & Burns, 2022).
Perioperative risk: High risk for MACE.
Recommendation: I would recommend postponing this patient’s surgery and order a referral to cardiology for further evaluation regarding the severity of her AS and if she is a candidate for valvular intervention prior to her total knee replacement. Active cardiac conditions warrant postponement (Lobos & Fischer, 2021). Because a recommendation was made to postpone this patient’s surgery, patient education must be completed regarding the reason for postponement. Should the patient and surgeon opt to proceed with the surgery, informed consent must include information regarding the patient’s perioperative risk (high for MACE).
B. Perioperative risk stratification of 25-year-old male scheduled for emergency cholecystectomy with no previous cardiac, medical, or surgical history.
1. Urgency: Emergent
2. Active cardiac condition: none
3. Based on type of surgery, this patient is considered intermediate-Risk (between 1% to 5%) (Bonaccorsi & Burns, 2022). 4. Functional Capacity: I would consider implementing the Duke Activity Status Index (DASI). The DASI is a clinical questionnaire utilized to thoroughly evaluate patients exercise and functional capacity (Canada et al, 2021). Because he reports being active and has no exertional symptoms playing basketball for over an hour 3 times weekly, he is considered to be able to achieving a METS >10. Perioperative risk: Low to intermediate risk for MACE. Although this patient’s risk stratification is low to intermediate risk, patient education and informed consent must be as thorough as other surgeries to include risk for adverse events.
C. Perioperative risk stratification of 75-year-old female with proposed surgery is hip replacement.
1. Urgency: Time-Sensitive
2. Active cardiac condition: She presents with history of coronary artery disease with previous CABG and PCI, hypertension, and hyperlipidemia.
3. Based on type of surgery, Intermediate-Risk (between 1% to 5%) (Bonaccorsi & Burns, 2022).
4. Unable to evaluate functional capacity due to pain.
5. This patient’s cardiac co-morbidities necessitated further cardiac evaluation with an echo. Although the echocardiogram demonstrated an ejection fraction of 55–60% with no wall motion abnormality and she reports no active anginal or exertional symptoms, I would evaluate the patient further and complete an RCRI. Revised Cardiac Risk Index (RCRI) is a risk calculator and tool that evaluates clinical markers to include ischemic heart disease, congestive heart failure, cerebrovascular disease, diabetes requiring preoperative insulin use, chronic kidney disease with creatinine greater than 2 mg/dL, and planned procedure that is by definition a high-risk surgery (‌Singh & Zeltser, 2020). The RCRI can be utilized to evaluate the need for perioperative beta blockade. Further, information regarding time of stent placement is needed to determine if the second antiplatelet agent could be stopped for surgery. Perioperative risk: Indeterminate until further information is attained. Patient education is extremely important for this patient scenario because further evaluation is required to complete an accurate perioperative risk assessment.