AP Exam 4 part I

Question 1

when does postoperative planning begin?

Answer 1

when patient scheduled for surgery

Question 2

what is the goal in postoperative planning?

Answer 2

provide best care/outcomes while not utilizing unnecessary resources

Question 3

what are the three levels of PACU care?

Answer 3

Phase I, II (outpatient), and Extended care

Question 4

the PACU assess and manages:

Answer 4

1. 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)

Question 5

________________ PACU care focus is on recovery from anesthesia nd the return of baseline VS

Answer 5

Phase I

Question 6

_____________ PACU care focuses on continued recovery based on facility policy and patient need

Answer 6

phase II

Question 7

_______________ 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

Answer 7

extended care

Question 8

what is PACU “fast track”

Answer 8

when you bypass phase I care and move directly from OR/procedure suite to phase II

Question 9

AANA standards for Post-anesthesia transfer of care

Answer 9

1. 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

Question 10

what is the immediate priority of the CRNA and the PACU RN upon admission to the PACU?

Answer 10

evaluation of respiratory and circulatory adequacy

Question 11

what must be included in the anesthesia verbal handoff to the PACU RN

Answer 11

1. 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.

Question 12

what is the purpose of the anesthesia report to the PACU RN

Answer 12

to ensure pt safety and continuity of care.

Question 13

components of the initial PACU assessment

Answer 13

1. 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

Question 14

what is the most widely used PACU scoring system

Answer 14

aldrete scoring system

Question 15

aldrete score of ________________ is required for discharge

Answer 15

9-10

Question 16

what is the most common cause of airway obstruction in the immediate postoperative period

Answer 16

loss of pharyngeal muscle tone in the sedated or obtunded pt

Question 17

________________ is the most common cause of upper airway obstructions

Answer 17

tongue

Question 18

s/s of upper airway obstruction

Answer 18

1. snoring 2. use of accessory muscles 3. retractions 4. somnolence/difficulty to arouse

Question 19

goal in management of upper airway obstruction

Answer 19

obtaining a patent airway

Question 20

management of upper airway obstruction

Answer 20

1. 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

Question 21

__________________ may obstruct the airway as a result of complete or partial spasm of muscles

Answer 21

laryngeal obstruction

Question 22

irritants that may cause/predispose pt to laryngospasm

Answer 22

1. laryngoscopy 2. secretions 3. vomitus 4. blood 5. artificial airway placement 6. coughing 7. bronchospasm 8. frequent suctioning

Question 23

sx of incomplete laryngospasm

Answer 23

stridor

Question 24

sx of complete laryngospasm

Answer 24

1. agitation 2. decreased SaO2 3. absent breath sounds 4. acute respiratory distress

Question 25

tx of laryngospasm?

Answer 25

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

Question 26

PACU management for pt with OSA

Answer 26

1. planning begins in preop 2. use of regional with minimal sedation (if approp) 3. should have CPAP to use postop

Question 27

concerns in PACU for pt with OSA

Answer 27

1. anaglesia 2. positioning 3. oxygenation 4. monitoring

Question 28

hypoxemia is defined as a paO2 of < _____________

Answer 28

60 mmHg

Question 29

nonspecific signs to hypoxemia

Answer 29

1. agitation to somnelance 2. HTN - HoTN 3. Tachycardia - Bradycardia

Question 30

hypoxemia, if left untreated, results in _________________________

Answer 30

organ ischemia

Question 31

most common causes of hypoxemia in the PACU

Answer 31

1. atelectasis 2. pulmonary edema 3. PE 4. aspiration & bronchospasm 5. hypoventilation

Question 32

what is the MOST common cause of postoperative hypoxemia

Answer 32

atelectasis

Question 33

atelectasis post-operatively can lead to an increase in a ______to_______ shunt

Answer 33

right to left

Question 34

atelectasis causes in postop

Answer 34

1. secretions 2. decreased lung volumes 3. hypotension 4. low CO

Question 35

how do you manage hypoxemia in the PACU?

Answer 35

1. supplemental humidified O2 2. turn, cough, deep breath 3. postural drainage position 4. mobility 5. incentive spirometry 6. intermittent PPV

Question 36

_________________ is fluid accumulation within the alveoli

Answer 36

pulmonary edema

Question 37

pulmonary edema can occur 2/2 ?

Answer 37

1. 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

Question 38

what is it called when you have acute pulmonary edema that occurs shortly after relief of severe upper airway obstruction?

Answer 38

postobstruction (aka negative pressure) pulmonary edema

Question 39

what are some causes of noncardiogenic pulmonary edema

Answer 39

1. incomplete reversal of NMB 2. naloxone bolus 3. significant period of hypoxia

Question 40

what is a common cause of post-obstruction (negative pressure) pulmonary edema? (esp in young males)

Answer 40

biting on the ETT

Question 41

s/s of pulmonary edema

Answer 41

1. hypoxemia 2. cough 3. frothy sputum 4. rales with auscultation 5. decreased lung compliance 6. pulmonary infiltrates on CXR

Question 42

management of pulmonary edema

Answer 42

1. maintain oxygenation (most impt) 2. supplemental O2 via Fm, CPAP, ETT with MV + PEEP 3. diuretics + fluid resuscitation

Question 43

T/F: noncardiogenic pulmonary edema usually recover quickly with no permanent sequelae

Answer 43

TRUE

Question 44

etiology of PE

Answer 44

1. venous stasis 2. hypercoagulability 3. vascular trauma aka virchows triad

Question 45

risk factors for PE

Answer 45

1. obesity 2. varicose veins 3. immobiity 4. CHF 5. age 6. pelvic/long bone fracture/surgery

Question 46

90% of PEs arise from what?

Answer 46

DVT in the leg

Question 47

thrombosis in the postoperative period seems to be related to what?

Answer 47

surgical tissue trauma and liberation of tissue factor that –> thrombin formation

Question 48

S/Sx of PE

Answer 48

1. dyspnea 2. chest pain 3. tachycardia 4. shock

Question 49

s/sx of DVT

Answer 49

painful swelling of extremity that also has a fever

Question 50

management of PE

Answer 50

1. correction of hypoxemia 2. HD support