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Justin Lyle Cards > AP Exam 4 part II > Flashcards

AP Exam 4 part II Flashcards

1
Q

preventing PE

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

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

A

1.5-2

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3
Q

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

A

gastric contents; chemical pneumonitis

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4
Q

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

A

prevention

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5
Q

prevention of aspiration

A
  1. identify who is at risk (obesity, full belly, trauma, prego) 2. prophylactic pharmacology 3. appropriate airway technique (RSI)
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6
Q

tx of gastric aspiration

A
  1. correct hypoxemia/respiratory support 2. hemodynamic stability 3. antibiotics (only if have s/sx of infection)
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7
Q

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

A

FALSE

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8
Q

perioperative pharmacology to decrease aspiration risk

A
  1. non-particulate antacids (Bictra/sodium citrate) 2. H2 receptor antagonists & PPIs 3. gastric prokinetics (reglan) 4. antiemetics to moderate nausea and vomiting
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9
Q

non-particulate antacids MOA for aspiration prevention?

A

they increase gastric pH

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10
Q

H2 receptor antagonists & PPIs MOA for aspiration prevention

A

reduce gastric volume and acidity

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11
Q

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

A

FALSE

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12
Q

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

A

few hours

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13
Q

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

A

as 2 successive doses

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14
Q

what is teh best induction technique for prevention of aspiration

A

RSI

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15
Q

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

A

cuffed ETT

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16
Q

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

A

bronchospasm

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17
Q

what can cause a bronchospasm

A
  1. aspiration 2. secretions 3. ET intubation 4. pharyngeal or tracheal suction 5. histamine release 2/2 medicatinos or allergic response
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18
Q

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

A

asthma; COPD

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19
Q

s/sx of bronchospasm

A
  1. wheezing 2. dyspnea 3. use of accessory muscles 4. tachypnea 5. increased PIP with MV
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20
Q

tx of bronchospasm

A
  1. B2 agonist 2. anticholinergics 3. corticosteroids 4. IV lidocaine 5. inhalation anesthetics
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21
Q

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

A

RR; alveolar ventilation; paCO2

22
Q

hypoventilation may occur because of?

A
  1. decrease in central respiratory drive (2/2 IV and inhaled anesthetics) 2. poor respiratory muscle function 3. combination of both
23
Q

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

A
  1. inadequate reversal of NMB 2. surgery involving upper abdomen 3. positioning 4. obesity and OSA 5. DZ of neuromuscular system
24
Q

PACU management of hypoventilation

A
  1. verbal and tactile stimuli 2. turn, cough, deep breathe 3. reposition 4. CPAP
25
Q

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

A

spO2; etCO2

26
Q

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

A

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

27
Q

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

A

20; 90; 60

28
Q

clinical signs of hypoperfusion

A
  1. altered MS 2. hypotension 3. tachycardia 4. tachypnea 5. cool & clammy skin 6. decreased capillary refill 7. peripheral cyanosis and mottling 8. oliguria
29
Q

in the PACU what is the most common cause of hypotension

A

hypovolemia

30
Q

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?

A

myocardial dysfunction

31
Q

what should be the initial tx of hypotension in the PACU

A
  1. assess for active bleeding 2. give 300 - 500 mL fluid bolus of NS or LR
32
Q

respiratory cause of hypotension in PACU

A

tension pneumothorax

33
Q

differential dx for hypotension in the PACU

A
  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
34
Q

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

A

pain

35
Q

what is defined as hypertension

A

BP > 20% of baseline

36
Q

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

A

somatosympathetic

37
Q

where should planning for postop pain control begin?

A

in the holding room

38
Q

multimodal approach to pain control

A
  1. tylenol and NSAIDs 2. ketamine 3. alpha agonists 4. gabapentin 5. regional/local anesthetics 6. corticosteroids 7. opioids 8. repositioning and reassurance
39
Q

differential dx for htn in the PACU

A
  1. pain 2. hypoxemia and hypercarbia 3. distension of the bladder 4. hypothermia + shivering 5. preexisting HTN 6. medications
40
Q

medications that cause htn in the PACU

A
  1. vasopressors used intraoperatively 2. withdrawal from opioids 3. narcan administration 4. ketamine 5. rebound effects of clonidine and/or BB
41
Q

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

A
  1. compromised cough 2. obstruction 3. loss of airway patency 4. hypoventilation
42
Q

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

A

elderly

43
Q

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

A

TOF and double burst

44
Q

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

A

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

45
Q

what medications potentiate NMB

A
  1. aminoglycosides 2. lasix 3. inderal 4. dilantin
46
Q

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

A

MG, eaton lambert, muscular dystrophies

47
Q

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

A

delirium

48
Q

delirium is MOST commonly accompanied by __________ & _____________

A

fear; agitation

49
Q

what are the four categories of postoperative delirium

A
  1. withdrawal psychosis 2. toxic psychosis 3. circulatory and respiratory origin 4. funtional psychosis
50
Q

what is withdrawal psychosis

A

withdrawal of various substances such as alcohol and illcit drugs

Justin Lyle Cards (27 decks)

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