Basic exam 2 Flashcards by Felicia Woodall

Lactic acidosis due to hypoperfusion should be treated with what before administering bicarbonate? CHOOSE 2

Fluid resuscitation

Oxygen

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A positive base excess indicates what acid base disturbance?

Metabolic alkalosis

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What happens to your CO and oxyhemoglobin curve in metabolic alkalosis

Decrease CO and Left shift in oxyhemoglobin dissociation curve

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Where is there high ventilation but no perfusion (dead space)?

Trachea

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What are the signs and symptoms of nerve damage in the lateral recumbent position?

Brachial plexus- burning sensation and weakness in arm and hand

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What physiological changes would you expect to see in a pt. who is in the lateral recumbent position? (think HR and MAP)

Increase in HR from 85 to 97 and Decrease in MAP

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How would you prepare a pt to prevent ulnar nerve damage in the supine position? (2 answers)

Avoid excessive pressure on the post condylar groove of the humerus

hand and forearm position will need to be either supinated and/or in the neutral position.

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What physiological change happens in your body at first when you are put in trendelenburg?

1 Min: 9% increase in Cardiac Output, 10 Min: C.O. returns to baseline

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Compression or stretch injury to the ____________is common in Trendelenburg positions

Brachial plexus

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When in prone position and your arms are up by their head, your shoulders should be?

less than 90 degrees

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While the patient is in the prone position, proper padding and rotation of the arms is essential for prevention of what major nerve complication?

ulnar nerve compression

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Invasive arterial blood pressure should be monitored at what level in the sitting position?

External auditory meatus to optimize cerebral perfusion pressure

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As a SRNA you are well aware of the risk factors associated with the sitting position, so when your patient develops a venous air embolism, you remain calm and do the following. Select all that apply

a. Discontinue N2O immediately and deliver 100% oxygen with anesthetic inhalation
b. Attempt to aspirate central venous catheter to retrieve entrained air
c. Implement Bilateral jugular vein compression

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Risk with sitting position?

Venous air embolism

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How much blood can a lap hold?

100-150ml

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How much blood can a 4 x 4 hold?

10ml

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Formula for Allowable Blood loss?

EBV x (starting Hct – Target Hct)/ Starting Hct

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Your pH is 7.21, CO2 47, HCO3 31, what is this blood gas?

Partially compensated respiratory acidosis

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What are the 2 most common physiological complications of Spinal?

bradycardia

hypotension

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Two causes of cardiac arrest during a spinal?

increased vagal response

decreased preload

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Metabolic Acidosis and an anion gap <12 (normal) may be indicative of what disorder?

HYPOaldosteronism

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Renal compensation during metabolic acidosis includes?

a. Increased reabsorption of filtered HCO3
b. Increased ammonia production
c. Increased excretion of acid

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PACO2 increases appx ____ hg for each ___ meqs increase in HCO3?

1 : 1

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Does Malignant hyperthermia cause respiratory alkalosis?

MH is a cause of respiratory ACIDOSIS

mixed respiratory and metabolic acidosis

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Patient with respiratory rate of 32. Complaining of dyspnea and has a K+ of 5.9 and a history of COPD. Without ABG, what would you expect?

Respiratory acidosis

Respiratory alkalosis can be controlled during neurosurgery to decrease ICP, but PaCO2 ____mmHg may produce cerebral ischemia

below 20

Hanging 12th bag of PRBCs on trauma patient. What acid base imbalance would you expect?

Metabolic acidosis

You are giving blood, what’s the proper identification?

Right patient, drug, dose, route, time. Check with a licensed provider. Check pt armband.

Pituitary gland tumor (pituitary adenoma) = Cushing’s syndrome, what does this tumor secrete and cause an increase in?

Secretes excess amount of ACTH Increased cortisol from adrenal glands

Most common type of Villous adenoma?

Tubular

Adrenal adenoma can produce what syndrome?

Cushing's

cushing's syndrome is caused by excessive levels of what?

Cortisol

Preoperative preparation of Cushing's syndrome includes the initial treatment of what three things?

treatment of hypertension DM and creating a normal fluid volume

Decrease in sodium reabsorption and the loss of potassium and hydrogen ions is characteristic of what?

Excessive secretion of aldosterone

What is the principle site of action of aldosterone?

distal nephrons

The principal regulators of aldosterone synthesis and secretion is what two things?

Renin-angiotensin system potassium ion concentration

Major circulating mineralocorticoid in the human body?

ALDOSTERONE

Made exclusively in the Zona glomerulosa?

Aldosterone

What are the five body buffer systems when talking about acid base balance?

``` Bicarbonate Hemoglobin Intracellular proteins Phosphates Ammonia ```

Most important NONCarbonic buffer in the extracellular fluid?

Hemoglobin

What line of defense describes the kidneys ability to retain and excrete bicarbonate, synthesize ammonia and eliminate potassium ions?

3rd line defense

Which line of defense acts within minutes has max effect in 12-24 hours. H2CO3 produced and converted to CO2 for elimination?

2nd line defense

H2CO3 produced and converted to CO2 for elimination. Increase in alveolar ventilation describes what line of defense?

2nd line defense

An increase in H+ ions or more acidity would result in an increase or decrease in pH?

Decrease in pH

Sick patient using a Wilson table for surgery, what is a postoperative complication for this patient?

Postoperative vision loss

How do you position a patient having a Laminectomy?

Place patient with their arms close to their side while in the prone position.

What drug could distinguish between MH and NMS?

Rocuronium

What Respiratory changes would you see with hyperthermia in an anesthetized patient (choose 2)?

Increased minute ventilation Increased CO2 ``` also: Tachycardia Hypertension Increased drug metabolism Dehydration (decreased U/O) Increased O2 consumption ```

40% of heat loss in the OR is due to?

Radiation

Hypothermia does what to the dissociation curve, and what to O2 consumption?

Left shift of the hemoglobin- dissociation saturation curve increases O2 consumption up to 300%

Shivering? (tell me two things)

May increase oxygen consumption up to fivefold associated with myocardial ischemia

Patients at risk for hypothermia?

May be as frequent as 65% with GA male gender

85 y/o uroseptic patient getting 11th unit of blood, what would you expect could happen?

Citrate intoxication from blood administration

Ratio of crystalloids to blood loss?

3x the crystalloid to the blood loss | 1:3

How do you calculate adequate urine output?

0.5-1 ml/kg/hr

Universal blood donor?

O-

Rarest blood type?

AB-

Most malignant hyperthermia deaths are due to? (2)

Organ failure Delay in dantrolene treatment

What order of malignant hyperthermia indications would you expect to see in the clinical setting?

Masseter muscle rigidity, Increased end tidal co2, Increased temperature

8 year old child, what would be their tubes size and cut length?

tube size = 5.5, 6, 6.5 (mm) cut length = 18cm

A 28 year old woman undergoing surgery and is anesthetized with an inhalant and she is also given iv succ. She develops a HR of 129, increased co2 and a rising temp. This is due to?

Interferes with the release of calcium from the sarcoplasmic reticulum (Malignant hyperthermia)

After receiving a spinal, nausea would be due to? (Choose 2)

Systemic hypotension that would be sufficient enough to produce cerebral ischemia Predominance of the parasympathetic activity due to the sympathetic nervous system being selectively blocked

What things about the needle used could lower the incidence of post procedure HA? (2)

25 gauge needle (small) A pencil pointed needle

t4 t6 t10 dermatome levels?

nipple xyphoid umbilicus

What is a drug we use with paralytics that causes N&V?

Neuromuscular-blockage reversal (neostigmine)

68kg person, what size LMA?

Pseudocholinesterase deficiency, what drug do you take out of your induction line up?

Succinylcholine

Blood volume of ... infant full term preterm (what is the ml you x the kg by)

``` 80ml = infant 85ml = full term 95ml = preterm ```

How do you calculate adjusted body weight?

ABW = (IBW + Actual Body Weight) / 2

MOA of Dantrolene?

interferes with release of calcium from SR at ryanodine receptor

Elevated anion gap is most likely caused by?

ketoacidosis

How much does a patient’s temperature decrease in the first hour when you do not attempt to warm an anesthetized patient?

1-2 degrees C during the first hour

Dantrolene dosing?

2-10mg/kg half life is 6 hours thus q6hr give 1mg/kg for 24 hours

What blood gas would you see when minute ventilation is insufficient to eliminate CO2 production without an increased capillary-alveolar CO2 gradient

Respiratory Acidosis

common reasons for a patient to be in respiratory acidosis? (2) (one is the patient, one is the machine)

A patient with COPD Exhausted soda lime

Why is Neo preferred when you want to keep HR the same and increase BP?

Pure alpha agonist (alpha 1)

earliest sign of MH, and MOST sensitive sign of MH?

MMR CO2 doubling or tripling

Lab (blood gas) you would expect to see with MH?

TYPICALLY HAVE MIXED METABOLIC AND RESPIRATORY ACIDOSIS WITH MARKED BASE DEFICIT. MAY HAVE EARLY ISOLATED RESPIRATORY ACIDOSIS