Brianna’s CAPA Misc Notes Flashcards
Herbals that impair coagulation due to platelet inhibition
-chamomile
-Vit E
-Feverfew (clotting time)
-garlic
Herbals that prolong bleeding time
-Ginger
-Garlic
Herbals that inc risk of bleeding
-Gingko Biloba
-Black Cohosh
Herbal that reduces blood concentration of certain anesthesia agents
St Johns Wart
Desflurane
Highest incidence of laryngospasm
Sevoflurane
-lowest incidence of laryngospam
-choice for pediatrics
-sweet smelling
-fast emergence… may in risk for emergence delirium
Neostigmine
-last approx 75 minutes
Pediatric Pain Scales
-Wong Baker FACES 3+
-FLACC 2 mo-7 yrs (face, legs, activity, cry, consolability)
Hypocalcemia
<8.5-10.5 watch for laryngeal spasms or skeletal muscle spasms
Flumanezil
-benzo reversal
-0.2mg over 15 seconds, repeat Q 1 min, max 1 mg
-peds 0.01mg/kg
-duration 1-2 hrs
Narcan
-adults 0.2-0.4mg
-(duration 1-4 hrs)
-peds 0.1mg/kg
Medications okay to take day of surgery
Beta Blockers, clonidine, nitrates, digoxin, Ca Channel blockers (-ipine, cardizem), antidysrhythmics, statins, ACE (-pril), ARBs (-artan), seizure meds, antiparkinson, antidepressants, pain meds except NSAIDS
Medications to hold prior to surgery
Diuretics, MAO inhibitors , diabetic meds, MVIs, herbals 2 weeks. Anticoagulants:
-aspirin- 1 week
-NSAIDS 3-5 days
-Coumadin 4-5 days
-plavix/clopidrogrel 1 week
-ticlopidine (ticlid) 10-14 days
Hyper vs Hypokalemia
Hyperkalemia: peaked T waves, depressed ST seg
Hypokalemia: U waves, wide QRS, slow reflexes (ileus)
Fasting
-clears 2 hrs
-breast milk 4 hrs
-formula/light meal 6 hrs
-high fat/protein meal 8 hrs
Esophageal surgery
Airway concern
-HOB elevated
-low cont suction
Gastric surgery considerations
-pulm toilet, assess for hypovolemia, risk for aspiration
-do not manipulate ngt.
Small bowel surgery considerations
Assess for Na and Bicarbonate loss, electrolyte imbalances, stoma care
Rectum/Anus surgery considerations
Assess for retention
Thyroidectomy or parathyroidectomy considerations
Assess for hypocalcemia (muscle twitches, tingling, weakness)
-pharyngeal nerve damage- say “e”
ENT & Dental procedure considerations
Ice for swelling
-irritation can inc secretions 4x
Vocal cord surgery considerations
Provide materials for pt to write with
Fluid requirements
-Adult KG + 40 = ml/hr
-Pediatric 0-10kg. 4ml/kg/hr
-ped 10-20kg. 40+ 2ml/kg/hr for each kg over 10
-ped >20kg 60+ 1ml/kg/hr per kg over 20
Pediatric hypotension
SBP 70 + (age x 2)
Adequate UOP
Adults 1ml/kg/hr
Pediatrics 2-3ml/kg/hr
Pediatric ACLS medications
-epi 0.01mg/kg
-amio 5mg/kg
-adenosine 0.1mg/kg first, second 0.2mg/kg
-atropine 0.02mg/kg
More herbal supplement info
Epi anaphylaxis
1: 1,000
Tx for CPR 1:10,000
Halothane
Bronchodilating effects
Diuretics
Potassium Wasting: bumex, lasix, -thiazides
Potassium sparing: aldactone, spirinolactone
ICD implantable debfibrillator
-driving restricted 6 mo
-limited movement on affected side
-bed rest 6-18 hrs
-no MRIs
ESWL shock wave lithotripsy
-monitor for dec UOP from large calculi blocking ureter
-pain, bruising, hematuria common (2-3days)
-encourage fluids!
Von Willebrand disease
-common hematologic disorder- easily bruises, epistaxis
DDAVP desmopressin is synthetic vasopressin to help minimialize bleeding
Skin graft
Elevation promotes venous return
Posterior hip arthroplasty
-lower extremities in neurotransmitter alignment
-avoid hip flexi on >90
Avoid internal rotation
-if anterolateral approach- avoid external rotation
HELLP
LDH is first enzyme to inc
Pituitary procedure considerations
-monitor temp: hyper then hypothalamic issues. Hypo then Dec thyroid stem hormone levels
MH susceptible pts
1+ hrs phase 1
1.5+ hrs phase 2
Myasthenia gravis
-associated with prolonged blockade
-rapid fatigue of voluntary muscles
Ethmoidectomy (sinus surgery) considerations
-cocaine for vasoconstriction- CV effects
-change mustache dressing 2-3x in first 4 hrs is normal. Do not swallow secretions… leads to n/v. ice preferred. Assess vision
Ketamine
-bronchodilator effects
-inc HR, BP
-inc secretions
-inc ICP, inc cerebral flow
Blephartoplasty (eyelid surgery)
Avoid heavy lifting and bending
-ice ok, no hot liquids for 24 hrs
Sickle cell pt goal
Avoid acidosis, hypothermia, dehydration,