AP Exam 4 part IV

Question 1

GI/GU consequences of pain

Answer 1

1. decreased gastric emptying/intestinal motility 2. increased urinary sphincter tone

Question 2

coagulation consequences of pain

Answer 2

1. increased plt aggregation 2. venous stasis

Question 3

immunologic consequences of pain

Answer 3

decreased immune fx

Question 4

psychologic consequences of pain

Answer 4

1. fear 2. anxiety 3. hopelessness 4. anger

Question 5

poorly controlled pain contributes to increased ______________ & ____________

Answer 5

morbidity and mortality

Question 6

hypothermia is defined as body temp < ____________C

Answer 6

36

Question 7

causes of hypothermia

Answer 7

1. 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

Question 8

majority of heat loss occurs through

Answer 8

radiation

Question 9

___________ = transfer (loss) of body heat to a cooler environment

Answer 9

radiation

Question 10

Evaporation causes:

Answer 10

1. sweating (rare with anesthesia) 2. surgical wounds and cleansing 3. respiratory losses 4. transcutaneous evaporation

Question 11

___________________ is a mechanism of heat loss, esp in peds, where they may lose 1/5 of body heat

Answer 11

transcutaneous evaporation

Question 12

the 2nd most common mechanism of heat loss in the OR = _________________

Answer 12

convection

Question 13

________________ = heat loss to cool air/”wind chill” factor

Answer 13

convection

Question 14

________________ is heat loss from direct contact with surfaces, but is negligible during surgery

Answer 14

conduction

Question 15

how can you prevent redistrubition hypothermia

Answer 15

warming before induction

Question 16

what is redistribution hypothermia

Answer 16

initial rapid decrease in core temp followed by slow reduction in core temp 2/2 anesthetic induced vasodilation (core heat to flow peripherally)

Question 17

physiologic consequences of hypothermia

Answer 17

1. 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

Question 18

T/F: prevention of hypothermia is far superior to active rewarming

Answer 18

TRUE

Question 19

hypothermia prevention

Answer 19

1. 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

Question 20

1 UPRBC or 1 L of crystalloid can decrease temp by ________C

Answer 20

0.25

Question 21

pt related factors for increased risk of PONV

Answer 21

1. female 2. non-smoker 3. hx of PONV/motion sickness 4. childhood/young adult

Question 22

surgery related risk factors for PONV

Answer 22

1. increased duration (>3 hrs) 2. type of surgery: breast, abdominal, laproscopic, GYN, strabismus 3. NPO status

Question 23

anesthesia related risk factors for PONV

Answer 23

1. volatile anesthetis 2. N2O 3. intra/postop opioids

Question 24

1 - 2 risk factors for PONV = ____________ risk

Answer 24

mod-severe

Question 25

how do you prevent mod-to-severe (1-2 RF) risk of PONV

Answer 25

2-3 drugs from different classes

Question 26

3-4 risk factors for PONV = ______________ risk

Answer 26

severe

Question 27

how do you manage someone at severe risk for PONV (3-4 RF)

Answer 27

1. consider avoiding GA or use propofol based anesthetic 2. minimize opioids 3. prevention with 3 drugs from different classes

Question 28

medications for PONV prophylaxis

Answer 28

1. Zofran 2. reglan 3. Droperidol 4. Decadron 5. Scopolamine transdermal 6. pregabalin

Question 29

_______________ is a 5-HT3 antagonists, that works to prevent PONV at peripheral and CNS sites.

Answer 29

zofran

Question 30

_________________ & ___________ are D2 antagonists that works to prevent PONV by working in the CTZ

Answer 30

reglan; droperidol

Question 31

goal of fluid management during perioperative period

Answer 31

1. maintain intravascular fluid volume 2. maintain LV filling pressure 3. maintain CO, BP, and O2 delivery to tissues

Question 32

________________ may mask low intravascular volume

Answer 32

hypothermia

Question 33

T/F: using urine output in the postoperative period as an index of volume status is a reliable measure

Answer 33

false; can be misleading.

Question 34

olguria is defined as, UOP of < __________ mL/kg/hr

Answer 34

0.5

Question 35

what meds can cause an increased risk of urinary retention in the postoperative period

Answer 35

1. opioids 2. ketamine 3. G.A 4. NSAIDs

Question 36

what surgeries is urinary retention in the postoperative period usually common with?

Answer 36

1. urologic 2. inguinal 3. genital

Question 37

polyuria is defined as UOP > _________ ml/kg/hr

Answer 37

5-Apr

Question 38

what is the leading cause of AKI in hospitalized pts

Answer 38

surgery

Question 39

triggers of tubular dysfunction

Answer 39

1. hypotension and hypovolemia 2. cardiac dysfunction 3. cardiac overload 4. abnormal HTN 5. tissue edema 6. microvascular dyfx 7. nephrotoxic

Question 40

systemic inflammation associated with surgery often leads to _________________

Answer 40

progressive tubular injury

Question 41

patient risk factors for AKI

Answer 41

1. CKD 2. obesity/metabolic syndrome 3. DM 4. CV dz 5. hepatobiliary dz 6. anemia 7. foley catheter fx (position, kink, obstruction)

Question 42

what provides the greatest protective benefit to the kidney ?

Answer 42

maintain MAP within renal autoregulation and administration of appropriate fluid therapy

Question 43

anesthetic implications of oliguria

Answer 43

1. maintain MAP within autoreg 2. purposeful intravascular fluid expansion 3. maintaining optimal blood volume, Hgb level and CO 4. optimize comorbidities

Question 44

_________________ solutions improve renal perfusion and dilutes nephrotoxins

Answer 44

isotonic crystalloid

Question 45

renal protective strategies (with evidence)

Answer 45

1. 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

Question 46

what fluid should be avoided to protect the kidney

Answer 46

0.9% NS and HES solutions

Question 47

what medications should be held prior to surgery, to protect the kidneys

Answer 47

1. ACE 2. ARB 3. Diuretics 4. NSAIDs

Question 48

PACU orders will typically consist of/include

Answer 48

1. 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

Question 49

Discharge from PACU

Answer 49

1. patient focuesed outcome indicators 2. discharge disposition 3. aldrete score 4. ideally evaluated for d/c by qualified anesthesia provider

Question 50

PPE protect who?

Answer 50

the patient and the healthcare provider