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Anesthesia Flashcards

1
Q

What does anesthesia mean?

A

no sensation

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2
Q

Anesthesia providers include?

A
  1. Anesthesiologist
  2. Certified Registered Nurse
  3. Anesthesia Assistance (Tech)
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3
Q

What is considered clear liquids preoperatively?

A
  1. Water
  2. Sugar water
  3. Apple Juice
  4. Tea
  5. pedialyte
  6. black coffee
    Stop 2 hours before surgery
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4
Q

When do you stop Human Milk before surgery?

A

Stop 4 hours before surgery

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5
Q

Infant milk or non human milk

A

stop 6 hours

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6
Q

When do you stop Light meal toast and liquids?

A

6 hours before surgery

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7
Q

When do you stop eating before surgery Heavy meals, fatty food, meat and alcohol, large volume?

A

8 hours before surgery

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8
Q

Types of pt with delayed gastric emptying

A

Diabetic
obese
opioid use

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9
Q

When do you stop Gastric tube feeding before surgery?

A

clear liquid- 2 hours

other liquids- 6 hours before surgery

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10
Q

When do you stop Jejunal tube feeds?

A

may continue until time of surgery

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11
Q

What are types of Regional anesthesias?

A
  • Epidural
  • Spinal
  • axillary
  • interscalene
  • femoral
  • sciatic
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12
Q

What are common inhalation anesthetics?

A 
FLUs
nitrous oxide
isoflurane
sevoflurane
desflurane
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13
Q

Common IV anesthetics

A

propofol ( contains egg yolk pain on injection)
ketamine
etomidate
thiopental

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14
Q

What is a depolarizing muscle relaxant?

A

succinylcholine

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15
Q

non depolarizing muscle relaxant

A 
URIUMs
Cistracurium
Rocuronium
pancuronium
vecuronium
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16
Q

What are types of Benzodiazepine muscle relaxant?

A

produces, sedation and amnesia
Midazolam-Versed
Diazepam-Valium
Lorazepam- Ativan

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17
Q

Narcotic muscle relaxant

A

Fentanyl rapid onset short duration
Morphine Sulfate
Meperidine (demerol) decreases shivering

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18
Q
  • Phases of General Anesthesia
A
  1. Induction
  2. Maintenence
  3. Emergence
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19
Q

What occurs during the Excitement period of induction?

A

increase HR
High blood pressure
RN should remain at pt side(keep noise low)

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20
Q

minimal sedation (anxiolysis)

A

pt respond normally to verbal command

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21
Q

moderate sedation- conscious sedation

A

pt respond purposefully to verbal command

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22
Q

deep sedation

A

pt cannot be easily aroused but responds purposefully following repeated painful stimulus

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23
Q

*reflex withdrawal

A

from a painful stimulus is not considered a purposeful response

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24
Q

infant, children preference for anesthesia

A

general

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25
Q

adults preference for anesthesia

A

regional and local for less invasive procedure

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26
Q

What physiological factors influence the choice of anesthesia

A
  1. coexisting diseases( neuromuscular impairment, prefer no muscle relaxants when possible
  2. High risk Intubation: prefer regional, spinal or local anesthesia
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27
Q

What psychological factors influence the choice of anesthesia

A

mentally and emotionally uncooperative pt prefer general anesthesia

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28
Q

What is the ASA classification influence on the choice of anesthesia?

A

Type and duration of surgical procedure

long procedure: general

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29
Q

What type of anesthesia should you consider in prone position?

A

prone: ensure good airway and ventilation
prefer: general

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30
Q

Other factors influencing the determination of anesthetic technique includes

A
  1. postop pain management
  2. pt understanding and wish
  3. expertise of anesthesia provider
  4. surgeon preference
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31
Q

Intraoperative monitoring includes?

A
  1. Airway
  2. Ventilation
  3. oxygenation
  4. circulation
  5. depth of anesthesia
  6. muscle relaxation
  7. temperature
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32
Q

What are types of Airway support?

A
  1. spontaneous ventilation
  2. blow by O2
  3. Nasal canula
  4. Face mask
  5. Mask ventilation with or without
    laryngeal mask airway
    Et tube
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33
Q

What is the definition of General anesthesia?

A

is the reversible state of unconsciousness

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34
Q

What is Balanced anesthesia ?

A

A combination of drugs that is used together for the purpose of its beneficial effects

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35
Q

What technique is used for General Anesthesia: induction method?

A

Inhalation

Iv method

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36
Q

What is the phase of Induction?

A

awake state to anesthetized state (unconscious)

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37
Q

General Anesthesia: Before Induction

RN responsibilities

A
  • Be immediately available for assistance
  • Check that suction is operational and within reach
  • Know the location of emergency equipment, tracheostomy supply
  • provide comfort and safety measures
  • stay with the pt
  • secure safety straps
  • Keep pt covered for warmth and privacy
  • Inform the pt when applying cold monitor leads and safety strap
  • Be prepared to handle ET tube because anesthesia agent will result in rapid loss of consciousness
  • Focus on pt and be at their side
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38
Q

What type of general anesthesia is used in children?

A

Inhalation agents are mostly used in children and masks are flavored for them

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39
Q

Methods of ET tube intubation

A
  • Direct laryngoscopy
  • Light wand
  • Fiberoptic intubation
  • Fast track laryngeal mask airway
  • retrograde intubation
  • blind nasal intubation
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40
Q

What can cause adverse events during intubation?

A
  • reactive airway

- aspiration

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41
Q

What pts are at risk for reactive airway?

A
  • smoking, asthma, and other respirator conditions

- at higher risk for bronchospasm or laryngospasm

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42
Q

What is the treatment for reactive airway?

A

administration of inhalants or bronchodilators before induction

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43
Q

What are risk factors for Aspiration?

A
  • full stomach
  • hx of gerd
  • hiatal hernia
  • obesity
  • pregnancy
  • ET tube of conscious pt
  • tumor or polyp on vocal cord( may cause pt to aspirate blood)
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44
Q

What are preoperative measures to prevent aspiration?

A
  • perform a thorough pre-sedation evaluation
  • provide appropriate instruction and compliance with preoperative fasting guidelines
  • -Neutralize stomach content pre-op (reglan, pepsid, bicitra)
  • administer antiemetics such as ondansetron, zofran, droperidol, metoclopromide
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45
Q

What is rapid sequence intubation

A
  • Another way to prevent aspiration
  • perioperative RN are often requested to assist by applying cricoid pressure
    ( the cricoid cartilage is the only complete ring in the trachea)
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46
Q

What is applying cricoid pressure known as?

A

Sellicks maneuver

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47
Q

What fingers are used to apply cricoid pressure?

A

thumb and index

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48
Q

*When do you remove pressure from the cricoid?

A

Not until the ET tube placement is confirmed by anesthesia and the cuff is inflated and anesthesia provider says to let go, DO NOT let anyone take over

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49
Q

How is ET placement confirmed?

A
  • Lack of breath sounds over stomach
    -presence of bilateral and equal breath sounds over the chest
  • symmetric movement of thorax with positive ventilation
  • presence of condensation of moisture
    from expired air in ET tube
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50
Q

When does the maintenance phase of general anesthesia begin?

A
    • starts with skin incision and proceeds throughout the surgery
  • surgery is performed and medications are titrated to keep pt at a safe plateau
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51
Q

When is the emergence phase of general anesthesia?

A
  • during the emergence phase, the pt exhibits spontaneous, regular breathing
  • regain consciousness
  • is extubated
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52
Q

What are possible adverse events during emergence?

A
  1. Hypoxia
  2. hypoventilation
  3. Laryngospasms
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53
Q

What are causes of hypoventilation?

A
  • pt tongue obstructing the airway ( reposition head)
  • muscle relaxant not being fully reversed
  • CNS depressants to help prevent hypoventilation
    ( encourage DB and check muscle strength by asking to lift their heads > 5 seconds
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54
Q

What causes laryngospasms?

A
  • protective mechanism caused by spasm of vocal cord
  • may experience d/t secretions, anesthetic agents, that act as irritants or trauma to vocal cord
  • Most common after extubation
  • exhibit stridor crowing
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55
Q

What is emergence delirium?

A
  • responsive or unresponsive agitation or hyperexcitability state after emerging from anesthesia
  • may need to reanesthesize and reawaken
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56
Q

possible cause of emergence delirium?

A

r/o hypoxia

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57
Q

General Anesthesia: Lost airway

A

THIS IS AN EMERGENCY

  • pediatric tubes can be uncuffed which places a higher risk of dislodgement of ET tube
  • Malignant hyperthermia is another true emergency
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58
Q

What is croup caused by ?

A
  1. glottis

2. tracheal edema

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59
Q

What is Regional Anesthesia?

A

Anesthesia to a designated area of the body

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60
Q

*What are some nursing considerations for regional anesthesia?

A
  • correct site
  • monitor for toxic reaction
  • Monitor for complications of blocks
  • monitor for sensation and movement of pt extremity
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61
Q

How does toxic reaction occur?

A
  • when concentration of drug in the blood affects the CNS or when local or regional anesthesia is injected inadvertently into the intravascular space
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62
Q

What are classic toxic signs of the CNS?

A
  • Slurred speech
  • numbness of tongue
  • blurred vision
  • tinnitus
  • lightheadedness
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63
Q

What are classic toxic signs of cardiovascular system?

A
  • ecg change
  • cardiac output
  • blood pressure change
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64
Q

What are severe symptoms of toxic reaction?

A
  • asystole
  • sinus bradycardia
  • hypotension
  • muscle twitching
  • tremors
  • seizure
  • cardiovascular collapse
  • LAST) local anesthetic toxicity can cause cardiac arrest
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65
Q

Local Anesthetic System Toxicity (LAST)

A

Uncommon potentially fatal toxic reaction that occurs when the threshold blood levels of a local anesthetic are exceeded by inadvertent, intravascular injection or slow systemic absorption of large volume of local anesthetic

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66
Q

What are complications of blocks?

A
  • pneumothorax
  • atelectasis
  • air embolism
  • laryngeal nerve paralysis
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67
Q

What considerations should be monitored for sensation and movement of patient’s extremity?

A
  • position limb to ensure no pressure on nerves or bony prominences and the limb is secure
  • CMS checks
  • Motor functions returns first after anesthesia followed by sensory function
  • additional pain med if short acting is used
  • remind pt of limited control of extremity and importance of immobilizer device to prevent injury
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68
Q

What are contraindications for epidural and spinal techniques?

A

pt who are:

  • experiencing bleeding
  • on anticoagulation drugs
  • experiencing increase intracranial pressure
  • experiencing septicemia
  • experience skin infection at the insertion site
  • experiencing systemic disease with neurological sequelae
  • hypotension
  • refusing these techniques
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69
Q

What pt factors should be taken into consideration before epidural or spinal technique ?

A
  • hx of spinal deformities
  • previous spinal surgery
  • psychological status of the pt
  • age( these techniques are contraindicated in children
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70
Q

Spinal HA- (spinal and epidural adverse reaction and complication)

A
  • incidence(rare event)
  • size of catheter to percent of pts who get postop headaches
    -Cause: loss of CSF from dura leak
  • duration: up to 3 days
  • Tx: HOB flat; Hydration: Analgesics
    Severe cases require epidural blood patch
    Anesthesia will obtain 5-10 ml autologous blood and inject at puncture site
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71
Q

Hypotension (spinal and epidural adverse reaction and complication)

A
  • Technique blocks the vagus nerve causing vasodilation and stasis of blood
  • Caution when moving pt may cause sudden drop in BP
  • May exhibit bradycardia
  • Tx elevate HOB; Increase IV rate, administer Vasopressors, oxygen, administer atropine for bradycardia
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72
Q

Nausea( spinal and epidural adverse reaction and complication)

A
  • Cause: hypotension and motion changes
  • NAUSEA is the first sign of hypotension
  • Treatment: increase fluids, change position slowly and administer antimetic
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73
Q

Respiratory Depression (spinal and epidural adverse reaction and complication)

A
  • Difficultly breathing
  • Causes : sedative medication paralysis of PHRENIC NERVE
  • Tx: treat underlying cause of respiratory depression
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74
Q

Bladder Distention (spinal and epidural adverse reaction and complication)

A

-Cause: sacral autonomic fibers are last to recover; pt lacks sensation of full bladder
Tx: assess bladder distension offer urinal or bedpan and obtain order to catheterize bladder

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75
Q

Falls (spinal and epidural adverse reaction and complication)

A
  • Prevention of falls is a key concern for pt who have received an epidural or spinal anesthetic
76
Q

Skin Breakdown

A
  • Pt are at risk on their heels, sacrum and other bony prominences while recovering from spinal or epidural anesthesia
77
Q

What are complications of spinal and epidural anesthesia?

A
  1. Neurogenic Shock or Total spinal anesthesia
    Cause: high levels of anesthesia which causes partial paralysis of the respiratory muscle, myocardial depression and hypotension

THIS IS AN EMERGENCY!!!!!!
2. CNS disturbance
Causes: Accidental injection of medication into the epidural vein
local anesthetic toxicity can cause CARDIAC ARREST

78
Q

What are s/s of Neurogenic shock

A
  • Tachycardia
  • Hypotension
  • Pallor
  • Clammy Skin
  • Sweating
  • Dysrhythmia
79
Q

What is the treatment for Neurogenic Shock

A

immediate ventilation and prepare for intubation and administration of vasopressors and IV fluids

80
Q

S/S of CNS Disturbances

A
  • Slurred speech
  • Numbness of tongue
  • blurred vision
  • tinnitus
  • talkative euphoria
  • restlessness
  • muscle twitching
  • convulsion
  • coma
81
Q

Treatment for CNS disturbances

A
  • Diazepam
  • barbiturates
  • mechanical ventilation
  • vasopressors
82
Q

Complications of general and regional anesthesia Postoperatively?

A
  • Ineffective breathing
  • Fluid volume deficit( hypovolemia)
  • Hypertension
  • Cardiac output decrease or arrhythmia
  • Injury to extremity
  • Alteration in body temperature
  • Shivering
  • n/v
  • pain and discomfort cause by ineffective comfort and pain management
  • GI status
  • DVT or Emboli
  • Corneal abrasion
83
Q

S/S of alteration in breathing patterns

A
  • Oxygen sats less than 90
  • Restlessness/agitation
  • Confusion/delirium
  • Anxiety
  • Crowing
  • Difficulty breathing
84
Q

Alteration in breathing patterns include

A
  • airway obstruction
  • respiratory depression
  • aspiration
85
Q

What is pharyngeal obstruction?

A
  • sagging tongue
86
Q

How do you treat pharyngeal obstruction?

A

Stimulate the pt and reposition airway

87
Q

Pharyngeal obstruction cause?

A

hypoxia caused by PE and Pneumothorax

intrapulmonary shunts and DECREASED cardiac output

88
Q

How do you assess for airway obstruction?

A

by auscultation of the lungs
observing chest movement
feeling for flow of expired breath with the hand

89
Q

Alteration in breathing pattern: Laryngospasm

A
  • Irritable airway
  • Can become hypoxic
  • RN should present calm demeanor
    and reassure the pt
    Tx: positive pressure ventilation by mask/bag medication for muscle relaxants or reintubation.
90
Q

Alteration in breathing pattern: Respiratory Depression?

A

Opioids can lead to respiratory depression

91
Q

Alteration in breathing pattern: Bronchospasm

A

-Lower airway obstruction spasm of the bronchiole tubes

92
Q

S/s of bronchospasm

A
  • wheeze

- dyspneic can suffer total airway closure

93
Q

Treatment for bronchospasm

A
  • inhaled bronchodilators
  • IV aminophylline
  • Steroids
  • Life threatening is treated with epinephrine
94
Q

Fluid volume deficit

A
  • Blood loss can manifest as hypotension

- Tachycardia may indicate hypovolemia, hypoxia, pain, or anxiety

95
Q

Hypovolemia

A

-Hemorrhage
-Inadequate fluid replacement
- Anesthetic or other medication
- Anaphylactic reactions
Tx: epinephrine, antihistamine, additional, IV fluids

96
Q

Hypotension

A
  • Fluid volume loss
  • cardiac dysfunction
  • anesthetic medication
97
Q

Clinical signs of hypotension

A
  • Rapid thready pulse
  • disorientation
  • restlessness
  • Oliguria
  • Cold pale skin
98
Q

Treatment for hypotension

A
  • IV saline
  • LR at max rate
  • Oxygen
  • Cardiac Stimulants
  • Hemodynamic monitor
99
Q

Arrhythmia

A
  • disorders of the heart rhythm d/t electrical problems
100
Q

Causes of Arrhythmia?

A
  • Abnormal levels of blood levels of potassium
  • MI or damage to heart muscle from pa MI
  • Congenital heart diseases, heart failure, cardiomyopathy
  • An overactive thyroid gland
  • Medication, ETOH, Caffeine, Cigarette smoking
101
Q

S/s of arrhythmia?

A

CP
Diaphoresis
Dyspnea
Dizziness

102
Q

Treatment of arrhythmia?

A

Medication
Oxygen administration
IV solution
Cardioversion

103
Q

Types of arrhythmia

A
  1. Bradycardia
  2. Tachycardia
  3. PVC
  4. Atrial Fibrillation
104
Q

Bradycardia causes

A
  • Vagal stimulation or pressure on internal organs

- Administration of opioid and reversal agents

105
Q

Tachycardia

A
  • Inadequate blood volume
  • hypoxia and fever
  • pain
106
Q

PVC

A
  • Hypoxia
  • Low potassium
  • Low magnesium
  • Cardiac ischemia
107
Q

Atrial fibrillation

A
  • A flutter
  • multifocal atrial tachycardia
  • paoxysmal superaventricular tachycardia
  • sick sinus syndrome
  • ventricular fibrillation
  • Vtach
  • wloft- parkinson white syndrome
108
Q

Types Positioning injury: - Brachial Plexus Injury

A
  • Arm placed greater than 90 degree
  • Obturator nerve
  • Saphenous Nerve
    -Femoral Nerve
    Skin burn by prep and ESU pad
109
Q

During regional anesthesia position pt

A

in a natural body alignment

move pt slowly

110
Q

Standard discharge criteria for spinal, epidural anesthesia from PACU is?

A

pt must stand, walk and void

111
Q

Hypothermia

A
  • Core body temp less than 96.8
    • vulnerable pt include ELDERLY and PT UNDER 2 yrs
  • High risk pt: BURN and NEONATES, pt going under general with NEUROAXIAL anesthesia
112
Q

Contributing factors for hypothermia?

A
  • general anesthesia depresses the hypothalamus preventing pt from compensating for the temperature in the OR
113
Q

Treatment of hypothermia

A

full body active warming device and fluid blood warmers

114
Q

Shivering

A

can raise the pt OXYGEN CONSUMPTION by 300-400% resulting in HYPOXIA, HYPERCARBIA, and ACIDOSIS
this is dangerous for a pt with cardiac hx

115
Q

Treatment for shivering?

A

Demerol 25-50 mg IV

116
Q

N/V

A

increase to 30% experience postop

117
Q

Preoperative risk factors for N/V?

A
  • FEMALE gender
  • Non smoker
  • Motion sickness
  • Obesity
  • Hx of N/V
  • Young
  • Pain
  • Middle ear and endoscopic surgery
118
Q

Treatment for N/V

A
  • protect AIRWAY
  • Antiemetic, zofran, anapsine, reglan
  • Prevent rapid movement
  • Head elevation for awake pt
  • Place sedated/ non reactive pt on side
119
Q

SEDATION and RELAXATION put a pt at risk for ?

A

aspiration

120
Q

pain management?

A 
nsaid
cox-2 inhibitor
pca
epidural catheter placement and delivery
Single shot extended relieve
121
Q

Comfort measures for pain?

A
  • position for comfort
  • DB&C
  • talk quietly w pt
  • apply heat or cold at surgical site
  • distract wit music
122
Q

Physiological S/s of pain?

A
  • elevated BP
  • Perspiration
  • Dilated pupils
123
Q

What are complications from unrelieved post op pain?

A
  • Reduced lung compliance/thoracic movement
  • Decreased mobility
  • Delay in return of bowel function
124
Q

GI Status alteration: Postop Ileus

A
  • Normal pt returns several hours after surgery

-

125
Q

Stomach motility returns to normal

A

24-48 hours after surgery

126
Q

Large intestine returns to normal

A

48-72 hours after surgery

127
Q

Delay in normal peristalsis is caused by?

A
  • Mechanics of surgery ( manipulation of the instestine)
  • Medications
  • Hormones
128
Q

Neurogenic causes of delay peristalsis?

A
  • Inflammation
  • Open laparotomy
  • Mis cases peristalsis can be up to 3 to 5 days
129
Q

Postop ileus (paralytic Ileus)

A
  • gastromotility is delayed beyond 72 hours after surgery
    -Causes: bloating
    n/v
    pain
    discomfort can lead to bowel obstruction
130
Q

The presence of bowel sounds indicate

A

return of small intestine motility

131
Q

The presence of indicate peristalsis has returned

A

flatus and stool

132
Q

VTE

A
  • all pt at risk
  • occur in lower extremity
  • pe may result
  • tx combo of non pharmacologic/ pharmacologic factors
133
Q

VTE cause?

A
  • venous stasis
  • vessel wall injury
  • hyper-coagulability
134
Q

Corneal abrasion

A

pt undergoing general anesthesia have risk

135
Q

S/s of corneal abrasion

A
  • photosensitivity
  • tearing
  • pain
  • complaining of sand in the eye
136
Q

treatment of corneal abrasion

A
  • artificial tear drops to eyes as lubricant
  • taping eyelids
  • protecting pt from scratching their eyes
137
Q

Anesthesia awareness cause?

A

inadequate anesthesia , equipment failure, or misuse

  • High Risk Surgeries( using deep anesthetic may not be in the best interest of the pt
  • Lasting Impact ( Some pt may experience PTSD after anesthesia awareness event
138
Q

Preventing anesthesia awareness?

A
  • Performing ongoing research
  • using clinical judgement
  • brain monitoring device
139
Q

Local anesthesia: AMIDES

A
  • Bupivicaine
  • Mepivacaine
  • Lidocaine
  • Ropivacaine
  • Reduce doses in
    Young
    Geriatric
    Debilitated patients
140
Q

Ester

A
  • Cocaine
  • Procaine
  • Proparacaine
  • Tetracaine
  • Chloroprocaine
141
Q

Adverse reactions to local anesthetics ?

A
  • Urticaria
  • Tachycardia
  • Laryngeal edema
  • N/V
  • Increase temp
  • Low BP
    anaphylactic shock
142
Q

Local anesthetic toxicity?

A
  • Metallic taste
  • Syncope, lightheadedness, visual disturbances
  • numbness of tongues
  • confusion, tremors, shivering, seizure
  • heartrate changes
  • cardiac or respiratory arrest
143
Q

Berlin questionnaire

A

Tool to assess a pt for obstructive sleep apnea

144
Q

Bispectral Index

A

RN can assess pt level of consciousness

145
Q

Aldrete Scale

A

Assess pt readiness for discharge

146
Q

Naloxone

A

Reversal agent for opioids

onset 1-2 mins duration 30 mins

147
Q

Flumazenil

A

reversal agent for benzodiazepine

onset 1-2 mins duration 30-60 minutes

148
Q

Tools for assessing anxiety?

A
  • Rapid assessment anxiety tool
  • State trait anxiety inventory
  • Visual analog
149
Q

before administering moderate sedation

A
  • baseline vs
  • o2 sats
  • inspect iv
  • o2 tank > 500
  • o2 pulse alarm on
  • communication process establish with pt
150
Q

Valium

A

-sedative
- titrate 1-2mg
-onset 30 seconds to 2 min
-duration 2-4 hours
kids
0.1-02mg/kg
*contraindicated in glaucoma

151
Q

Versed

A
  • Sedative
  • Titrate 0.5-1mg( 2 min in between dose)
  • Kids 0.02-1.0 mg/kg po nasally
152
Q

Morphine

A
  • Narcotic
  • 10 mg increment
  • onset 1-3 minutes
  • duration 4 hours
153
Q

Demerol

A
  • Narcotic
  • 10 mg increment
  • 1-2 mg
  • Onset 1-3
  • Duration 1-3 hr
154
Q

Fentanyl

A
  • Narcotic
  • kids 1-2 mcg/kg
  • Onset 1-3 mins
  • Duration 30-60
155
Q

Desirable Effects of sedation?

A
  • intact protective reflexes
  • relaxation
  • comfort
  • cooperation
  • appropriate level of verbal communication
  • patent airway with adequate ventilation
  • easily a rousable
156
Q

Undesirable effects of sedation?

A
  • Loss of reflexes
  • aspiration
  • slurred speech
  • difficult to arouse
  • agitation
  • hypo/hypertension
  • respiratory depression
  • airway obstruction
  • apnea
157
Q

Midazolam adverse reaction

A

hiccups

158
Q

Benzo adverse reaction

A

decrease reflex

159
Q

Narcotic adverse reaction

A

decrease respiration
hypotension
n/v

160
Q

Fentyl adverse reaction

A

itchy nose

chest wall rigidity

161
Q

Hemodynamic Monitoring

A 
Candidates
- Pt who suffer from 
r/l heart failure
-Cardiac valvular disease
-Cardiogenic shock
- Respiratory distress
- Trauma
- High risk surgery
-Cardiac surgery
-Surgery requiring controlled hypotension
162
Q

What measuring device is used to monitor circulating blood?

A
  • CVP central venous pressure
  • Left side heart pressure
  • Adequacy of blood flow to hand
163
Q

What is central venous pressure?

A
  • Measured in the right atrium
  • assesses cardiac preload
  • reading is the amount of venous blood flow returning to the heart
  • it is affected by blood volume, vascular tone (venous) right ventricular function and pulmonary tree pressure
  • used as indirect late index of Left ventricular function
164
Q

What is a Normal CVP readings?

A
  • spontaneous breathing pt: 5-10 cm/h2O

- ventilated pt increases 3-5 cm/H2O

165
Q

What causes decrease CVP?

A
  • Hemorrhage
  • Fluid loss
  • Venous pooling
166
Q

What causes increase in CVP?

A
  • Fluid volume overload
  • Right ventricular failure
  • Cardiac Tamponade
  • Pulmonary hypertension (COPD, PE)
  • Left ventricular failure( Pulmonary Edema)
167
Q

What are complications related to changes in CVP?

A
  • Pneumothorax
  • Arterial Puncture
  • Air embolism
  • Infection
168
Q

What is a pulmonary artery catheter (PAC)

A
  • Left sided heart pressure

- measures hearts ability to maintain its pumping efficiency

169
Q

PAC is performed in order to ?

A
  • evaluate heart failure
  • determine if pulmonary edema is caused by a weak heart or leaky pulmonary capillaries
  • Monitor therapy after MI
  • Check fluid balance of pts in shock as well as those recovering from heart surgery, burns, or kidney disease
  • Monitor effects of medication on the heart
170
Q

PAC procedure

A

PAC catheter

  • has four lumens with ports for right atrium
  • pulmonary artery
  • balloon
  • cardiac output
171
Q

Inserting a PAC

A
  • Use sterile technique
  • Access to large central vein is obtained
  • Internal jugular is used also subclavian
  • Catheter is passed through the right atrium
  • and right ventricle out to the pulmonary artery
  • Highest risk of pneumothorax when subclavian is used*
  • Caution with internal jugular vein because artery is near by
  • If the carotid is inadvertently pierced the pt requires heparinization for the procedure ( case may be cancelled d/t possibility of formation of an expanding hematoma in the neck area
  • PAC is flushed and threaded through the introducer
  • The line is attached to the transducer that converts pressure into numerical value and gives continuous waveform indicating pressure at the tip of the catheter
  • Normal pressure reflect a normally functioning heart with no fluid accumulation
172
Q

PAC parameters

A

Rely on healthcare policy and procedures

  • cardiac output 4-8 liters
  • CVP 2-6 mm hg
  • Right ventricular Pressure20-30 mm hg systolic
  • Pulmonary Artery Pressure 20-30 mm hg systolic 8-12 diastolic
  • Pulmonary capillary wedge pressure 4-12 mm hg
173
Q

Causes of change in pulmonary artery DECREASE pressure

A
  • hypovolemia

- vasodilation

174
Q

Causes of change in pulmonary artery INCREASE

A
  • Hypervolemia
  • PE causing increase pulmonary resistance
  • Chronic Lung Disease
  • Left ventricular failure
  • Vasoconstrition
175
Q

PAC complications?

A
  • Arrhythmias
  • Knotting and misplacement
  • Cardiac valve treatment
  • Pulmonary infraction
  • Pulmonary artery rupture
  • Balloon rupture
  • Catheter thrombosis or embolism
176
Q

Arterial line

A
  • continuous BP monitoring
  • procedures ( adrenalectomy, cardiothoraic, major neurosurgery, major vascular surgery
  • Blood sampling
  • Arterial blood gas monitoring
  • Pt on dopamine or nipride
  • Most common site : Radial artery
177
Q

Allen’s test

A
  • Should be performed before insertion
  • done to assess adequacy of blood flow to hand through the ulnar artery because the radial artery will be partially occluded
178
Q

Performing Allen’s test what do you do?

A
  • elevate pt arm
  • *compress the ulnar/radial arteries until hand becomes blanch
    -Pressure on the ulnar artery is released while maintaining pressure on radial artery
    -Normal color to the hand should return to ulnar artery if patent
  • some pt may not left or right artery status post CABG
    -* Most frequent complication is accidental disconnection of catheter with subsequent blood loss
    it is important to check like connection
179
Q

Pain mangement

A
  • pain behavior
  • evaluation techniques
  • pharmacological/non pharmacological strategies
180
Q

Affects on pain

A
  • age
  • socioeconomic status
  • gender
  • ethnicity
  • culture
  • values
181
Q

Caring for pt with pain

A
  • consider all pain real to pt

- *be observant to non verbal behavior pt self report is most reliable measure of pain

182
Q

Types of pain

A
  1. Acute
    - sudden onset
    - short term
  2. Chronic
    - presents overtime
    - sudden leading to pain
    - duration of six months or more
    - due to unknown sources
    - signs of hopelessness or depression
    - complete relief of chronic pain is not possible
  3. Cancer pain
    - tumor involvement
    - pain associated with cancer treatment
183
Q

Theories associated with pain: Gate

A

– Pain occurs when a gate impulses

ascending to the brain opens the gate closes when impulses descend and pain is decreased

184
Q

Pattern theory r/t pain

A
  • a patter of noxious stimuli is coded by cns resulting in perception of pain
  • pain is produced by spatiotemperal patterns of neuronal impulses rather than by specific receptors
185
Q

Physiology of pain management

A
  • localize pain
  • cns controls emotional affect response to pain
  • thalamus
  • hypothalamus
  • medulla
  • cortex
  • reticular formation system
  • limbic system

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