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Chapter 4 Flashcards

special populations

1
Q

definition of geriatric patient

A

over the age of 65

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2
Q

what does the surgical team need to watch out for when dealing with geriatrics

A

chronic debilitation

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3
Q

how can you ensure a proper outcome with geriatric cases

A

preoperative assessment and planning

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4
Q

which type of procedure has the higher mortality rates for geriatric PT

A

emergent

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5
Q

how many geriatric patients have one or more conditions

A

80%

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6
Q

what are the most common disabilities geriatric patients come into the OR with

A

hearing and/or visual impairment

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7
Q

what do you do if a geriatric patient has hearing or visual impairment

A

discuss it previously

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8
Q

how can you ensure physiological security with geriatric patients

A

return things such as glasses and dentures as soon as you can post op

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9
Q

what do you do to accommodate geriatric fragile skin and bones

A

delicate transportation + positioning

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10
Q

what are the most delicate parts of a geriatric patient

A

skin and bones

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11
Q

what can you do to accommodate geriatric patients in the OR

A

provide them with a blanket

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12
Q

why do you provide geriatric patients in the OR with a blanket

A

they are easily prone to hypothermia

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13
Q

what do you do to prevent problems with hypotension and low circulation for geriatric PT

A

anti embolism stockings + sequential compression device

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14
Q

critical factors for the surgical team to remember for the best outcomes:
(7)

A

careful surgical technique

optimization of function level

appropriate anesthesia

prevention of alterations in BP + heart rate

avoide changes to fluid, electrolyte + acid based status

minimize stresses of postop
hyperthermia, hypoxemia, and pain

careful periop precautions

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15
Q

surgical needs of a pregnant patiently births a year

A

4.31 million

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16
Q

how many births need surgery (other than C-s)

A

1-2%

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17
Q

when do we do pregnancy surgeries

A

delay first trimester- increase chance of abortion

abd procedures best done in second trimester

third trimester surgeries:
- 40% increase in premature labor
- organs become displaced

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18
Q

altered vital signs with pregnancy

A

increase pulse
low arterial BP

signs not immediately displayed
- lose 30% of blood before signs of shock
- fetus may be hypoxic before you notice

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19
Q

anesthesia 3 main worries

A
  • premature
    fetal death
    low birth weight *
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20
Q

anesthesia medications for pregnancy

A

bupivacain
lidocaine

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21
Q

what to do to carry out best pregnancy surgeries

A

be fast!

raise OR temp to avoid maternal hypothermia

  • be ready for C section*
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22
Q

patient positioning with pregnancy

A

slight trendelenburg 30 degrees
- to help with venous return

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23
Q

hearing impairments combats

A

interpreter ASL
speaking with writing
nonverbal communication goes long way
preop visit patient w/ hearing aids

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24
Q

visual impairment

A

most important sense
fear
contacts not allows in surgery

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25
how can you help with visual impairment
describe words they can't see
26
examples of physical challenges
arthritis loss of limb deformaties paralysis stiffness tremors
27
hoe to deal with paralysis
careful positioning + transporting
28
cognitive impairment def.
condition that limits an individuals ability to learn and reason
29
challenges with cognitive impairment
hard cooperation requires team effort
30
Down syndrome patients characteristics
lower cognitive ability risk of heart defects GERD ear infections sleep apnea lose joints muscle hypotonia
31
other names for PTSD
shell shock combat fatigue
32
history of PTSD
first though physical condition then temporary medical condition military leaders doubted its existence
33
PTSD problems in the OR
difficulty trusting healthcares professionals triggered by sharps + new environment may have irrational fear of surgery
34
emotions of PTSD pt in OR
dissasocitated, unresponsive, poor concentration
35
how a CST should treat PTSD pt
avoid loud noises keep sharps out of view keep environment calm quite + peaceful
36
what separates kids from adults
different vital ranges
37
how to accommodate kids
let them bring toys into OR meet surgical staff explain everything + walk through
38
temperature for pediatrics
neonate can not shiver - incubators and overhead heaters -warm blankets -keep extremities covered
39
monitoring pediatric urine output
1-2 ml/kg/hr for neonates
40
monitoring cardiac function for pediatrics
ill peds w/ constant ECG infants children: radial artery neonate: umbilical artery non ill peds: older kids: internal jug vein neonate: external jugular
41
monitoring oxygenation fro peds
measuring arterial blood gases
42
shock in peds
septic shocks - negative bacteria hypovolemic shocks - bradycardia, from dehydration - battle with fluid replacement
43
fluid and electrolytes for peds
water is lost through skin and lungs during surgery cover neonates limbs + humidify gases
44
infection for neonates
GI + skin underdeveloped sign: fever, treat with antibiotics
45
pediatric treatment exceptions
sulfonamides cholarmphenicol tetracycline
46
metabolic + nutritional responses for peds
surgery increases caloric responses feeding tubes
47
trauma with peds
accidents leading cause of death ages 1- 15 best method is preventing
48
emergency treatment for peds
more likely to hyperventilate insert nasogastric tube iv in great sapphenous
49
most common birth trauma
fractured clavicle
50
2 main difficulties with substance abuse people
behavior + communication of pt
51
most substance abuse pt are
trauma
52
comorbid psychiatric disorder
causes substance abuse
53
30-80% of pt form
coexisting psychiatric illness
54
who provides assistance to team ant PT with substance abuse pt
counselor/ social worker
55
what does the counselor communicate to the surgical team about substance abuse pt
mood of pt know how to properly react
56
organs of immune system
has none of its own but uses from other strictures
57
factors that effect immunocompetence
old/ young drugs (immunosuppressants) chemotherapy
58
what should the CST be aware of with immunocompromised
be very diligent with sterility
59
HIV
retro virus may remain dormant disrupts t lymphocytes can be passed through birth
60
AIDS
most severe HIV associated with opportunistic infections - kaposi - PCP - fungal and parasitic infections
61
complications with AIDS pt
experience pain from multiple complications - lesions
62
type 1 diabetes
pancreas produces little to no insulin IDDM
63
type 2
non dependent NDDM pancreases requires different amounts of insulin
64
what must be prevented during surgery
ketonuria acetonuria keto acidosis hyperglycemia (shock)
65
what is performed prep for diabetes pt
EKG fasting CBC blood urea nitrogen
66
complications with diabetes PT
type 1 more at risk because no insulin effects caloric intake
67
how to prevent ulcers for diabetes pt
lots of padding because they have poor circulation
68
preop Strats for diabetes PT
blood test for blood sugar level insulin dose lowered prevent throwing up- hypoglycemia
69
intra op diabetes PT care
anesthesia monitors insulin+ electrolytes prevent metabolic crisis glucometer measure blood glucose anti embolic stockings
70
post op diabetes PT care
provided with proper nutrients after for control of glucose sequential compression device for DVT anti hyperglycemic meds
71
definition of bariatrics
body weight 100 lbs greater than ideal body weight
72
barriers bariatrics have in OR
lifting them/ getting them to OR Hoyer
73
what to do if peripheral veins not available in bariatrics
venous cutdown to put IV in place
74
intubation difficult due to lots of fat
anesthesia has multiple a airway carts
75
why does an obese pt take longer to wake up
adipose tissue absorbs anesthetic gasses
76
what to do when positioning obese pt
avoid skin wrinkles and tears on lots of skin
77
what position do you use for obese patients
reverse trendelenburg
78
three most common obese surgeries complications
abd catastrophes, internal hernia, and acute gastric distention
79
gallstones with obese
be prepared to remove gallbladder most common with every obese patient
80
degenerative osteoarthritis with obese
one of the most popular complications with weighing so much on joints
81
golden hour in trauma
difference between life and death
82
level 1 trauma center
operating room 24/7 trauma surgeon available 24/7 expensive for hospital -U + IMC
83
level 2 trauma center
seriously injured, but system doesn't have everything level 1 does - ogden regional
84
level 3 trauma center
community or rural hospitals - Riverton, Jordan valley
85
level 4 trauma center
just a little more than urgent care
86
kinematics/ MOI 3 factors
1- flexibility of tissue 2- shape of injuring force 3- velocity of injuring force
87
blunt trauma
compression, shearing, hitting MVA spleen most common injured (seatbelt)
88
3 causes of blunt trauma MVA
1. car into another car 2. person collides with object in car 3. internal body structure collide with rigid bone - seatbelt + airbag
89
penetrating trauma
foreign object passes through tissue velocity, distance, location m-16 bullet
90
what is it called when bullet goes all the way through
through and through
91
revised trauma score (RTS)
decides severity of trauma Glasgow coma score
92
considerations for Surg Tech in trauma
* keep spine alignment!!!* - often need multiple procedures performed (same time) - deal with life threatening first ---- head> chest> abdomen> limbs - challenging to prepare
93

SURG TESTS (24 decks)

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