AP Exam 4 part I Flashcards
when does postoperative planning begin?
when patient scheduled for surgery
what is the goal in postoperative planning?
provide best care/outcomes while not utilizing unnecessary resources
what are the three levels of PACU care?
Phase I, II (outpatient), and Extended care
the PACU assess and manages:
- respiratory and HD status 2. analgesics and antiemetics 3. preparedness for rapid/optimal recovery 4. common post anesthesia complications (which can be prevented and detected with specialized care)
________________ PACU care focus is on recovery from anesthesia nd the return of baseline VS
Phase I
_____________ PACU care focuses on continued recovery based on facility policy and patient need
phase II
_______________ PACU care, is when the pt meets criteria to leave phase I, but there due to unavailability, the patient is unable to go to another location
extended care
what is PACU “fast track”
when you bypass phase I care and move directly from OR/procedure suite to phase II
AANA standards for Post-anesthesia transfer of care
- evaluate the patients status and determine when it is appropriate to transfer the responsiblity of care 2. communicate the patients condition and essential information for continuity of care
what is the immediate priority of the CRNA and the PACU RN upon admission to the PACU?
evaluation of respiratory and circulatory adequacy
what must be included in the anesthesia verbal handoff to the PACU RN
- pt demographic and hx 2. surgical and anesthetic course 3. PACU tx plan/interventions/and endpoints 4. opportunity for RN to ask questions and for CRNA to respond.
what is the purpose of the anesthesia report to the PACU RN
to ensure pt safety and continuity of care.
components of the initial PACU assessment
- determine pts physiologic status at time of admission 2. est pts baseline 3. allow periodic reexamination 4. assess status of surgical site, its effect on preexisting conditions and recovery 5. assess the recovery from anesthesia/residual effects 6. prevent/manage complications 7. provide a safe environment for recovery 8. allow data and trend analysis for discharge or transfer critieria
what is the most widely used PACU scoring system
aldrete scoring system
aldrete score of ________________ is required for discharge
9-10
what is the most common cause of airway obstruction in the immediate postoperative period
loss of pharyngeal muscle tone in the sedated or obtunded pt
________________ is the most common cause of upper airway obstructions
tongue
s/s of upper airway obstruction
- snoring 2. use of accessory muscles 3. retractions 4. somnolence/difficulty to arouse
goal in management of upper airway obstruction
obtaining a patent airway
management of upper airway obstruction
- stimulate pt to take deep breaths 2. repositioning the airway (chin lift, jaw thrust) 3. placement of OPA/Nasal airway 4. reintubation with or without mechanical ventilation
__________________ may obstruct the airway as a result of complete or partial spasm of muscles
laryngeal obstruction
irritants that may cause/predispose pt to laryngospasm
- laryngoscopy 2. secretions 3. vomitus 4. blood 5. artificial airway placement 6. coughing 7. bronchospasm 8. frequent suctioning
sx of incomplete laryngospasm
stridor
sx of complete laryngospasm
- agitation 2. decreased SaO2 3. absent breath sounds 4. acute respiratory distress
tx of laryngospasm?
must be immediate!! 1. 100% fiO2 2. suction/remove stimulus 3. jaw thrust with CPAP 4. subparalytic dose of succ (0.15-.5 mg/kg IV or 4mg/kg IM) 5. may require reintubation 6. consider sedation
PACU management for pt with OSA
- planning begins in preop 2. use of regional with minimal sedation (if approp) 3. should have CPAP to use postop
concerns in PACU for pt with OSA
- anaglesia 2. positioning 3. oxygenation 4. monitoring
hypoxemia is defined as a paO2 of < _____________
60 mmHg
nonspecific signs to hypoxemia
- agitation to somnelance 2. HTN - HoTN 3. Tachycardia - Bradycardia
hypoxemia, if left untreated, results in _________________________
organ ischemia
most common causes of hypoxemia in the PACU
- atelectasis 2. pulmonary edema 3. PE 4. aspiration & bronchospasm 5. hypoventilation
what is the MOST common cause of postoperative hypoxemia
atelectasis
atelectasis post-operatively can lead to an increase in a ______to_______ shunt
right to left
atelectasis causes in postop
- secretions 2. decreased lung volumes 3. hypotension 4. low CO
how do you manage hypoxemia in the PACU?
- supplemental humidified O2 2. turn, cough, deep breath 3. postural drainage position 4. mobility 5. incentive spirometry 6. intermittent PPV
_________________ is fluid accumulation within the alveoli
pulmonary edema
pulmonary edema can occur 2/2 ?
- increase hydrostatic pressure 2/2 fluid overload and cardiac dysfunction 2. increase in capillary permeability 2/2 sepsis, aspiration, transfustion rxn, trauma, DIC 3. decrease in interstitial pressure 2/2 laryngospasm and prolonged airway obstruction
what is it called when you have acute pulmonary edema that occurs shortly after relief of severe upper airway obstruction?
postobstruction (aka negative pressure) pulmonary edema
what are some causes of noncardiogenic pulmonary edema
- incomplete reversal of NMB 2. naloxone bolus 3. significant period of hypoxia
what is a common cause of post-obstruction (negative pressure) pulmonary edema? (esp in young males)
biting on the ETT
s/s of pulmonary edema
- hypoxemia 2. cough 3. frothy sputum 4. rales with auscultation 5. decreased lung compliance 6. pulmonary infiltrates on CXR
management of pulmonary edema
- maintain oxygenation (most impt) 2. supplemental O2 via Fm, CPAP, ETT with MV + PEEP 3. diuretics + fluid resuscitation
T/F: noncardiogenic pulmonary edema usually recover quickly with no permanent sequelae
TRUE
etiology of PE
- venous stasis 2. hypercoagulability 3. vascular trauma aka virchows triad
risk factors for PE
- obesity 2. varicose veins 3. immobiity 4. CHF 5. age 6. pelvic/long bone fracture/surgery
90% of PEs arise from what?
DVT in the leg
thrombosis in the postoperative period seems to be related to what?
surgical tissue trauma and liberation of tissue factor that –> thrombin formation
S/Sx of PE
- dyspnea 2. chest pain 3. tachycardia 4. shock
s/sx of DVT
painful swelling of extremity that also has a fever
management of PE
- correction of hypoxemia 2. HD support
