AP Exam 4 part II

Question 1

preventing PE

Answer 1

1. antiembolic stockings 2. compression devices 3. anticoagulants (heparin therapy)

Question 2

the goal of heparin therapy for PE prophylaxis is to have an aptt that is __________x the control

Answer 2

1.5-2

Question 3

aspiration of ________________ is the most severe form of aspiration, and is called _________________

Answer 3

gastric contents; chemical pneumonitis

Question 4

what is the goal with aspiration? (prevention or tx?)

Answer 4

prevention

Question 5

prevention of aspiration

Answer 5

1. identify who is at risk (obesity, full belly, trauma, prego) 2. prophylactic pharmacology 3. appropriate airway technique (RSI)

Question 6

tx of gastric aspiration

Answer 6

1. correct hypoxemia/respiratory support 2. hemodynamic stability 3. antibiotics (only if have s/sx of infection)

Question 7

T/F: corticosteroids are very beneficial in the tx of gastric aspiration

Answer 7

FALSE

Question 8

perioperative pharmacology to decrease aspiration risk

Answer 8

1. non-particulate antacids (Bictra/sodium citrate) 2. H2 receptor antagonists & PPIs 3. gastric prokinetics (reglan) 4. antiemetics to moderate nausea and vomiting

Question 9

non-particulate antacids MOA for aspiration prevention?

Answer 9

they increase gastric pH

Question 10

H2 receptor antagonists & PPIs MOA for aspiration prevention

Answer 10

reduce gastric volume and acidity

Question 11

T/F: use of anticholinergics like atropine and glycopyrolate are recommended for aspiration prevention

Answer 11

FALSE

Question 12

H2 receptor antagonists must be given ______________ prior to surgery for aspiration prevention

Answer 12

few hours

Question 13

PPIs for aspiration prevention work best when they are given how?

Answer 13

as 2 successive doses

Question 14

what is teh best induction technique for prevention of aspiration

Answer 14

RSI

Question 15

what type of airway securement device is recommended in those at high risk for aspiration

Answer 15

cuffed ETT

Question 16

_______________ results from increase in bronchial smM tone, with resultant small airway closure

Answer 16

bronchospasm

Question 17

what can cause a bronchospasm

Answer 17

1. aspiration 2. secretions 3. ET intubation 4. pharyngeal or tracheal suction 5. histamine release 2/2 medicatinos or allergic response

Question 18

there is an increased incidence of bronchospasm in PACU in pts with ______________ & _____________

Answer 18

asthma; COPD

Question 19

s/sx of bronchospasm

Answer 19

1. wheezing 2. dyspnea 3. use of accessory muscles 4. tachypnea 5. increased PIP with MV

Question 20

tx of bronchospasm

Answer 20

1. B2 agonist 2. anticholinergics 3. corticosteroids 4. IV lidocaine 5. inhalation anesthetics

Question 21

hypoventilation is manifested clinically with a decreased ______________ and ____________ –> increased _________________

Answer 21

RR; alveolar ventilation; paCO2

Question 22

hypoventilation may occur because of?

Answer 22

1. decrease in central respiratory drive (2/2 IV and inhaled anesthetics) 2. poor respiratory muscle function 3. combination of both

Question 23

most common reasons for poor respiratory muscle function –> hypoventilation in the PACU?

Answer 23

1. inadequate reversal of NMB 2. surgery involving upper abdomen 3. positioning 4. obesity and OSA 5. DZ of neuromuscular system

Question 24

PACU management of hypoventilation

Answer 24

1. verbal and tactile stimuli 2. turn, cough, deep breathe 3. reposition 4. CPAP

Question 25

for hypoventilation ______________ monitoring reflect oxygenation, but not adequacy of ventilation; however __________________ is of use in patients at risk of hypoventilation

Answer 25

spO2; etCO2

Question 26

for a patient with dz of NM system, to mitigate risk of hypoventilation in PACU, what could you do?

Answer 26

keep the pt intubated until fx returns and residual anesthetic effects are absent

Question 27

hypotension is defined as a fall in arterial BP > __________% below baseline, or an absolute value of <_______mmHg systolic or MAP < ______ mmHg

Answer 27

20; 90; 60

Question 28

clinical signs of hypoperfusion

Answer 28

1. altered MS 2. hypotension 3. tachycardia 4. tachypnea 5. cool & clammy skin 6. decreased capillary refill 7. peripheral cyanosis and mottling 8. oliguria

Question 29

in the PACU what is the most common cause of hypotension

Answer 29

hypovolemia

Question 30

in the PACU your patient has hypotension, and you fluid resuscitate the patient, but there is no response, what should be considered the cause of hypotension?

Answer 30

myocardial dysfunction

Question 31

what should be the initial tx of hypotension in the PACU

Answer 31

1. assess for active bleeding 2. give 300 - 500 mL fluid bolus of NS or LR

Question 32

respiratory cause of hypotension in PACU

Answer 32

tension pneumothorax

Question 33

differential dx for hypotension in the PACU

Answer 33

1. hypovolemia 2. MI, tamponade, PE 3. dysrhythmia 4. CHF exacerbation 5. tension pneumothorax 6. anaphylaxis/histamine release 7. anesthetic agents 8. vasodilators 9. sepsis

Question 34

____________ is the leading cause of HTN and tachycardia in the PACU

Answer 34

pain

Question 35

what is defined as hypertension

Answer 35

BP > 20% of baseline

Question 36

htn and tachycardia 2/2 pain is known as the __________________ reflex

Answer 36

somatosympathetic

Question 37

where should planning for postop pain control begin?

Answer 37

in the holding room

Question 38

multimodal approach to pain control

Answer 38

1. tylenol and NSAIDs 2. ketamine 3. alpha agonists 4. gabapentin 5. regional/local anesthetics 6. corticosteroids 7. opioids 8. repositioning and reassurance

Question 39

differential dx for htn in the PACU

Answer 39

1. pain 2. hypoxemia and hypercarbia 3. distension of the bladder 4. hypothermia + shivering 5. preexisting HTN 6. medications

Question 40

medications that cause htn in the PACU

Answer 40

1. vasopressors used intraoperatively 2. withdrawal from opioids 3. narcan administration 4. ketamine 5. rebound effects of clonidine and/or BB

Question 41

incomplete reversal of neuromuscular blockade can lead to what postoperative pulmonary complications?

Answer 41

1. compromised cough 2. obstruction 3. loss of airway patency 4. hypoventilation

Question 42

who would you expect to be the most at risk for having residual NMB effects (after reversal) in the PACU

Answer 42

elderly

Question 43

what objective measurement tools should be used in early postop to assess for depth of residual block

Answer 43

TOF and double burst

Question 44

why is marginal NMB reversal more dangerous than near total paralysis?

Answer 44

bc an agitated pt exhibiting uncoordinated movements and airway obstruction is more easily identified with near total than marginal

Question 45

what medications potentiate NMB

Answer 45

1. aminoglycosides 2. lasix 3. inderal 4. dilantin

Question 46

what NM dz's will have a prolonged response to NMBA?

Answer 46

MG, eaton lambert, muscular dystrophies

Question 47

______________ is defined as a condition characterized by extreme distrubances of arousal, attention, orientation, perception, intellectual fucntion, and affect

Answer 47

delirium

Question 48

delirium is MOST commonly accompanied by __________ & _____________

Answer 48

fear; agitation

Question 49

what are the four categories of postoperative delirium

Answer 49

1. withdrawal psychosis 2. toxic psychosis 3. circulatory and respiratory origin 4. funtional psychosis

Question 50

what is withdrawal psychosis

Answer 50

withdrawal of various substances such as alcohol and illcit drugs