AP Exam 4 part IV Flashcards
GI/GU consequences of pain
- decreased gastric emptying/intestinal motility 2. increased urinary sphincter tone
coagulation consequences of pain
- increased plt aggregation 2. venous stasis
immunologic consequences of pain
decreased immune fx
psychologic consequences of pain
- fear 2. anxiety 3. hopelessness 4. anger
poorly controlled pain contributes to increased ______________ & ____________
morbidity and mortality
hypothermia is defined as body temp < ____________C
36
causes of hypothermia
- ambient room temperature 2. methods of heat transfer (radiation, evaporation, convection, conduction) 3. redistribution of blood from periphery to core 4. general, regional(neuraxial), and MAC anesthesia
majority of heat loss occurs through
radiation
___________ = transfer (loss) of body heat to a cooler environment
radiation
Evaporation causes:
- sweating (rare with anesthesia) 2. surgical wounds and cleansing 3. respiratory losses 4. transcutaneous evaporation
___________________ is a mechanism of heat loss, esp in peds, where they may lose 1/5 of body heat
transcutaneous evaporation
the 2nd most common mechanism of heat loss in the OR = _________________
convection
________________ = heat loss to cool air/”wind chill” factor
convection
________________ is heat loss from direct contact with surfaces, but is negligible during surgery
conduction
how can you prevent redistrubition hypothermia
warming before induction
what is redistribution hypothermia
initial rapid decrease in core temp followed by slow reduction in core temp 2/2 anesthetic induced vasodilation (core heat to flow peripherally)
physiologic consequences of hypothermia
- increased O2 consumption (400-500% via shivering) 2. increased CV events: MI, CVA 3. increased sickling with sickle cell pts 4. imparied coagulation and cold induced defect in plt function (increases surgical blood loss) 5. decrease in drug metabolism and elimination 6. CNS depression 7. decreased pt satisfaction 8. impaired wound healing/surgical site infection 9. prolonged PACU stay and increase in hospital costs
T/F: prevention of hypothermia is far superior to active rewarming
TRUE
hypothermia prevention
- preop cutaneous warmin: forced air warming blanket 2. airway heating and humidification (HME) 3. warm IV fluids 4. warm ambient OR temp (>23 C) 5. cutaneous heating: warm blankets, forced air warming systems
1 UPRBC or 1 L of crystalloid can decrease temp by ________C
0.25
pt related factors for increased risk of PONV
- female 2. non-smoker 3. hx of PONV/motion sickness 4. childhood/young adult
surgery related risk factors for PONV
- increased duration (>3 hrs) 2. type of surgery: breast, abdominal, laproscopic, GYN, strabismus 3. NPO status
anesthesia related risk factors for PONV
- volatile anesthetis 2. N2O 3. intra/postop opioids
1 - 2 risk factors for PONV = ____________ risk
mod-severe
how do you prevent mod-to-severe (1-2 RF) risk of PONV
2-3 drugs from different classes
3-4 risk factors for PONV = ______________ risk
severe
how do you manage someone at severe risk for PONV (3-4 RF)
- consider avoiding GA or use propofol based anesthetic 2. minimize opioids 3. prevention with 3 drugs from different classes
medications for PONV prophylaxis
- Zofran 2. reglan 3. Droperidol 4. Decadron 5. Scopolamine transdermal 6. pregabalin
_______________ is a 5-HT3 antagonists, that works to prevent PONV at peripheral and CNS sites.
zofran
_________________ & ___________ are D2 antagonists that works to prevent PONV by working in the CTZ
reglan; droperidol
goal of fluid management during perioperative period
- maintain intravascular fluid volume 2. maintain LV filling pressure 3. maintain CO, BP, and O2 delivery to tissues
________________ may mask low intravascular volume
hypothermia
T/F: using urine output in the postoperative period as an index of volume status is a reliable measure
false; can be misleading.
olguria is defined as, UOP of < __________ mL/kg/hr
0.5
what meds can cause an increased risk of urinary retention in the postoperative period
- opioids 2. ketamine 3. G.A 4. NSAIDs
what surgeries is urinary retention in the postoperative period usually common with?
- urologic 2. inguinal 3. genital
polyuria is defined as UOP > _________ ml/kg/hr
5-Apr
what is the leading cause of AKI in hospitalized pts
surgery
triggers of tubular dysfunction
- hypotension and hypovolemia 2. cardiac dysfunction 3. cardiac overload 4. abnormal HTN 5. tissue edema 6. microvascular dyfx 7. nephrotoxic
systemic inflammation associated with surgery often leads to _________________
progressive tubular injury
patient risk factors for AKI
- CKD 2. obesity/metabolic syndrome 3. DM 4. CV dz 5. hepatobiliary dz 6. anemia 7. foley catheter fx (position, kink, obstruction)
what provides the greatest protective benefit to the kidney ?
maintain MAP within renal autoregulation and administration of appropriate fluid therapy
anesthetic implications of oliguria
- maintain MAP within autoreg 2. purposeful intravascular fluid expansion 3. maintaining optimal blood volume, Hgb level and CO 4. optimize comorbidities
_________________ solutions improve renal perfusion and dilutes nephrotoxins
isotonic crystalloid
renal protective strategies (with evidence)
- correct anemia and min blood transfusion 2. maintain perfusion: MAP 80-160 (autoreg) 3. avoid nephrotoxins 4. use balanced crystalloid solutions 5. avoid diuretics 6. continue statins 7. maintain normoglycemia 8. consider low dose precedex and NaHCO3 9. dexmethasone 10. early initiation of renal replacement therapy
what fluid should be avoided to protect the kidney
0.9% NS and HES solutions
what medications should be held prior to surgery, to protect the kidneys
- ACE 2. ARB 3. Diuretics 4. NSAIDs
PACU orders will typically consist of/include
- VS and parameters 2. respiratory support 3. fluids 4. analgesics, anxiolytics, antiemetics 5. other PRN meds: antihtn, respiratory, insulin 6. lab and dx tests 7. d/c criteria
Discharge from PACU
- patient focuesed outcome indicators 2. discharge disposition 3. aldrete score 4. ideally evaluated for d/c by qualified anesthesia provider
PPE protect who?
the patient and the healthcare provider
