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CNOR > CNOR > Flashcards

CNOR Flashcards

1
Q

What is the first sign of Malignant Hyperthermia?

A

↑ ETCO2 & tachycardia

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2
Q

What is the treatment for Malignant Hyperthermia?

A

dantrolene (2-3mg/kg IV every 5min) w/ sterile water

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3
Q

What are the nursing interventions when a patient shows signs of Malignant Hyperthermia?

A

Stop anesthetic
Start central line
Bring down body temp

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4
Q

How do you bring down body temp for Malignant Hyperthermia?

A

Chilled Water
Ice Packs
Bladder instillation

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5
Q

What is the most common trigger of Malignant Hyperthermia?

A

Halothane

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6
Q

What is Halothane?

A

General anesthetic for induction / maintenence

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7
Q

What are the symptoms of Malignant Hyperthermia?

A

skeletal muscle contractions
↑ body temp
hypoxia
desaturated blood
mottled skin
cola colored urine

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8
Q

What is the main complication of Malignant Hyperthermia?

A

Rhabdomyolosis

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9
Q

What is Rhabdomyolosis?

A

damaged muscle tissue releases proteins and electrolytes into the blood - can lead to death

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10
Q

When can signs of Malignant Hyperthermia appear?

A

Up to 1-3 days post op

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11
Q

What anesthetics are safe to use in patient with Malignant Hyperthermia?

A

Nitrous oxide and sodium panthenol

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12
Q

What are the risk factors of Malignant Hyperthermia?

A

Muscular dystrophy
halothane use
first time under anesthesia
younger patient

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13
Q

Where should the safety strap be placed during positioning?

A

2” above the knees over the blanket

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14
Q

What position should the patient’s arms be in to prevent brachial plexus injury during surgery?

A

The patient’s arms should be at a 90° angle when supine.

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15
Q

How many people should be used to move an incapacitated patient during surgery positioning

A

4+

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16
Q

Who calls the count when moving a patient?

A

The person at the head

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17
Q

What is the shearing force?

A

dragging the skin across the sheet
Avoid

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18
Q

What is the recommended hand position for a patient in the supine position when arms are tucked?

A

Arms should be tucked with thumbs up (palms towards the body) to prevent ulnar injury

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19
Q

What are the pressure areas to be monitored in supine positioning?

A

scapula, elbows, sacrum, coccyx, heels, and occiput

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20
Q

What is the positioning for a patient undergoing perineal prostatectomy?

A

high lithotomy

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21
Q

What precautions should be taken during positioning for a pregnant patient?

A

positioner should be placed under the right side (left lateral decubitus) to relieve pressure off the inferior vena cava (IVC) and aorta

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22
Q

Where does the kidney rest?

A

12th rib

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23
Q

What is Trendelenberg?

A

feet higher than head

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24
Q

What should be monitored in Tredelenberg?

A

Intrathoracic and intracranial pressure

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25
Q

What are the effects of Low Trendelenburg?

A

cerebral edema and ischemic pressure on optic nerve

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26
Q

What are the effects of Steep Trendelenburg?

A

optic nerve neuropathy

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27
Q

What is reverse Trendelenberg?

A

Head higher than feet

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28
Q

What are the effects of low reverse Trendelenburg?

A

venous pooling to lower body

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29
Q

Where does the safety strap go in lithotomy?

A

Off the patient

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30
Q

What should be monitored in hemilithotomy positioning?

A

compartment syndrome

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31
Q

Where do candy canes put pressure?

A

plantar nerve / ankles & feet

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32
Q

How should legs be managed during positioning changes (ex: lithotomy)?

A

Elevate and lower them together for hemodynamic stability

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33
Q

Which nerve can become damaged in lithotomy?

A

Obturator nerve (hip)

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34
Q

Which nerve can become damaged in obese patients in lithotomy?

A

Peroneal nerve

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35
Q

How to avoid peroneal nerve damage?

A

pad the lateral aspect of the knee

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36
Q

What is seated position?

A

knees flexed at 30°

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37
Q

What effects does seated positioning have?

A

bradycardia and hypotension

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38
Q

What are the risks of beach chair positioning?

A

DVT, VTE, or air embolism

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39
Q

How do you treat an air embolus?

A

Remove air with CVC from right atrium, put the patient in steep trendelenburg with right side up to prevent air embolus from going into lungs

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40
Q

Which pressure points should be monitored in seated positioning?

A

Scapula, heels, ischial tuberosities

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41
Q

Which pressure points should be monitored in lateral positioning (>4hr)?

A

Ear, acromion, olecranon, iliac crest, trochanter, lateral leg, and malleolus

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42
Q

What positioning tools are needed for wide axillary positioning?

A

chest roll/support under ribs
No rolled towels/blankets

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43
Q

How should the upper arm be positioned in lateral positioning?

A

Level with the shoulder

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44
Q

Where should the safety strap be placed in lateral positioning?

A

at the hip

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45
Q

What pressure points should be monitored in lateral positioning?

A

ear, iliac crest, dependent knee, acromion process, greater trochanter of femur, malleolus

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46
Q

How should the chest rolls be positioned in the prone position?

A

laterally from clavicle to iliac crest

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47
Q

What should be done to ensure proper foot positioning in the prone position?

A

pillow or ankle roll should be placed so that the feet are off the OR table

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48
Q

Where does the safety strap go in prone position?

A

over the thighs

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49
Q

What should be monitored for when the patient is in the prone position?

A

facial edema and ocular pressure

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50
Q

Where are the pressure points in prone position?

A

face, breasts, iliac crest, patella, male genitalia, and dorsum of feet

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51
Q

How should cervical alignment be maintained during surgery in the prone position?

A

Keep cervical neck aligned with rest of spine

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52
Q

What potential issues can the jack-knife position cause?

A

circulatory changes and compromise respirations

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53
Q

When should hand hygiene be performed?

A

Before/after patient contact, touching surroundings, wearing gloves, eating/bathroom, touching bodily fluids, aseptic procedures, and handling medications

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54
Q

How long should hand hygiene be performed for C-Diff patients?

A

15 seconds with soap and water

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55
Q

What can hot water cause in hand hygeine?

A

dermatitis

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56
Q

What should be done after using hand sanitizer?

A

Let it dry naturally, avoid waving hands

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57
Q

How long should surgical scrub last?

A

2-5 minutes

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58
Q

When do bean bags cause injury?

A

When they are left on suction

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59
Q

What are the characteristics of iodine as a prep solution?

A

Intermediate acting, oxidizes bacteria, minimal residual effect

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60
Q

What are the effects of iodism?

A

burns, thyroid issues

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61
Q

What is iodism?

A

Too much iodine

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62
Q

What is contraindicated when using iodine?

A

pregnancy / lactation

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63
Q

What should be avoided when using iodine?

A

Mucous membranes

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64
Q

Where can iodine be safely used?

A

Perineum, eyes, ears

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65
Q

What alternatives can be used for iodine if allergic?

A

PCMX or undiluted 3% H2O2

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66
Q

What should be considered regarding iodine use and pregnancy?

A

iodine can cross placenta

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67
Q

What is the recommended eye prep solution?

A

Ophthalmic betadine

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68
Q

What are the characteristics of chlorhexidine gluconate?

A

Intermediate acting, disrupts cell membrane, long residual effect (up to 6 hours)

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69
Q

What inactivates iodine?

A

blood or mucus

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70
Q

What should be avoided when using chlorhexidine gluconate?

A

mucus membranes

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71
Q

What types of bacteria can ethyl/isopropyl alcohol effectively combat?

A

gram -/+

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72
Q

What is the residual effect of ethyl/isopropyl alcohol?

A

none

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73
Q

What types of bacteria is Chloroxylenol Parachlorometaxylenol effective against?

A

gram -/+, disrupts cell wall

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74
Q

Is Triclosan used as prep?

A

No, banned due to environmental impact and is antibiotic resistant

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75
Q

Where do you start prepping the abdomen?

A

at the incision line and it is not passed over

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76
Q

What does wearing a jacket during prep do?

A

prevents skin shedding

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77
Q

What action should be avoided during surgery regarding drapes?

A

Avoid repositioning

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78
Q

When can chlorhexidine gluconate be used?

A

in patients with VRE

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79
Q

Which areas are prepped first?

A

areas considered contaminated and umbilicus

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80
Q

What happens if hair is removed during surgical prep?

A

There are higher rates of post-op infection

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81
Q

What is the main source of transmission for microorganisms?

A

person to person contact

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82
Q

Where do bacteria commonly form biofilms?

A

warm, moist areas

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83
Q

What do Bacillus and Clostridium bacteria form?

A

endospores, which are hard to kill

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84
Q

What is the first line of defense against microorganisms?

A

skin

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85
Q

What type of bacteria is commonly found on the skin and body hair?

A

staphylococcus aureus

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86
Q

What does MRSA stand for, and how does it spread?

A

MRSA stands for Methicillin-resistant Staphylococcus aureus. It spreads through skin contact.

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87
Q

Name some diseases transmitted via droplet transmission.

A

common cold, chickenpox, flu, bacterial meningitis, strep throat, tuberculosis, measles, mumps, whooping cough, diphtheria, and pertussis.

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88
Q

When should a mask be worn to prevent droplet transmission?

A

within 3 feet of talking

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89
Q

What type of mask should be worn to prevent TB transmission?

A

N95

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90
Q

What are some ways to prevent airborne transmission in the operating room?

A

damp dusting, surgical plume (smoke), drapes, and minimal in/out traffic

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91
Q

How is prion disease characterized?

A

nonliving protein-based helical structure without DNA/RNA that forms a sponge-like protein in the brain

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92
Q

What is Creutzfeldt-Jakob Disease (CJD) commonly known as?

A

mad cow disease

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93
Q

How is Creutzfeldt-Jakob Disease diagnosed?

A

brain biospy

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94
Q

How can Creutzfeldt-Jakob Disease be transmitted?

A

blood, instruments, growth hormone, brain tissue, dual grafts, infected cattle, and can be inherited or spontaneous

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95
Q

How is prion disease inactivated?

A

heat, drying, freezing, most chemical radiation

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96
Q

What is Spongiform Encephalopathy (TSE)?

A

rare family of prions that causes fatal neuro disorders (ex: CJD)

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97
Q

What parts of the body does Creutzfeldt-Jakob Disease affect?

A

brain, spinal cord, CSF, cornea, present in low concentrations in other tissues

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98
Q

What are the long term effects of Creutzfeldt-Jakob Disease?

A

dementia and death

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99
Q

What is the recommended size for a tourniquet cuff?

A

Wide cuff (> 1/2 diameter of extremity)

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100
Q

What should be applied under the tourniquet cuff?

A

Wrinkle-free padding

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101
Q

How much higher should the tourniquet pressure be compared to SBP when placed on upper extremity, calf, and ankle?

A

30-70mmHg higher, typically at 200-250mmHg

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102
Q

When should antibiotics be given when using a tourniquet?

A

20 min before tourniquet goes up

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103
Q

What should the tourniquet pressure be when placed on thigh?

A

250-300mmHg or 400mmHg if patient is larger

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104
Q

How does limb occlusion pressure (LOP) affect tourniquet pressure settings?

A

Adjust pressure based on LOP or systolic pressure & limb circumference.

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105
Q

When is limb occlusion pressure checked?

A

Prior to inflation

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106
Q

How is limb occlusion pressure checked?

A

Use doppler to locate artery distal to cuff, slowly increase pressure until pulse stops

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107
Q

What is the recommended tourniquet pressure adjustment for LOP < 130 mmHg?

A

Increase the tourniquet pressure by 40 mmHg

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108
Q

What is the recommended tourniquet pressure adjustment for LOP between 130-190 mmHg?

A

Increase the tourniquet pressure by 60 mmHg

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109
Q

What is the recommended tourniquet pressure adjustment for LOP > 190 mmHg?

A

Increase the tourniquet pressure by 80 mmHg

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110
Q

How is pediatric tourniquet pressure adjusted in relation to LOP?

A

set 50 mmHg greater than LOP

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111
Q

How long can the tourniquet be inflated for upper extremity surgeries?

A

1 hr

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112
Q

What complication can arise from rapid deflation of a tourniquet?

A

Rush of metabolic waste and medications

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113
Q

What are the signs and symptoms of rapid deflation of a tourniquet?

A

Ringing ears, numbness/tingling in lips/fingers, loss of consciousness, seizures, arrhythmias.

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114
Q

How can you facilitate proper tourniquet application in obese patients?

A

Gentle traction of adipose tissue distal to the cuff

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115
Q

What should be documented regarding tourniquet use?

A

Location of cuff, cuff pressure, time of inflation and deflation, distal pulses before and after, person who applied cuff, skin protection measures, limb occlusion pressure, skin integrity before and after, and ID# of tourniquet used.

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116
Q

What are the contraindications for esmark use?

A

Risk of DVT, thrombus, infection, dislocated fractures, malignancy.

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117
Q

How long can the tourniquet be inflated for lower extremity surgeries?

A

90 min

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118
Q

How long can the tourniquet be inflated for pediatric surgeries?

A

75 min

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119
Q

What do you do if you go over the time limit for tourniquet?

A

deflate and allow for reperfusion for at least 10-15 minutes then reinflate

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120
Q

What are the potential complications of using a tourniquet?

A

hyperthermia (inflation), hypothermia (deflation), emboli (1 min after deflation), increased ICP, overpressurization (nerve damage, pain at site), ischemic injury, underpressurization (bleeding, venous congestion)

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121
Q

What overlap should be maintained when applying a tourniquet?

A

3-6 inches

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122
Q

Where should the tubing of a tourniquet be positioned on the extremity?

A

On the lateral aspect of the extremity.

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123
Q

What is the purpose of using an esmark bandage before inflating a tourniquet?

A

exsanguinate the limb

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124
Q

What should be done if you can’t use esmark to exsanguinate the limb?

A

Exsanguinate by elevation

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125
Q

What may cause rhabdomyolysis when using a tourniquet?

A

Compartment syndrome

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126
Q

What should be done if there is rapid delfation when using a tourniquet?

A

lactic acid bolus

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127
Q

What complications come from nerve damage from tourniquets?

A

permanent motor / sensory deficits

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128
Q

How should a timeout be performed when using a tourniquet?

A

mention placement of tourniquet

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129
Q

What are the 7 rights of medication administration?

A

Patient, drug, time, route, dose, reason, documentation

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130
Q

What precaution should be taken with medications regarding the rubber stopper?

A

Do not remove the rubber stopper from medications.

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131
Q

What are characteristics of Absorbable Gelatin?

A

Used for capillary bleeding, can soak up to 45x its weight, can be used on infected tissue

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132
Q

What are examples of Absorbable Gelatin?

A

Gelfoam, Surgiflo

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133
Q

What are characteristics of Oxidized Cellulose?

A

Cotton or rayon based, soak 10x its weight, not for long term use

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134
Q

Where can you place Oxidized Cellulose?

A

On sutures or wrap around oozing areas

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135
Q

What is Microfibrillar Collagen made from?

A

Bovine

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136
Q

How does Microfibrillar Collagen work?

A

swells to form a clot when dry and pressure is applied.

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137
Q

What are characteristics of Absorbable Collagen?

A

used for oozing / bleeding, not for infected wounds, 8-10 weeks to absorb

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138
Q

What does Thrombin do?

A

accelerates the clotting process

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139
Q

What is an example of Thrombin?

A

Tisseel

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140
Q

What is Magnesium Sulfate used for in pregnancy?

A

lower blood pressure and an anticonvulsant in preeclampsia

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141
Q

What should be avoided in patients with a PCN allergy?

A

Cefixime, Rocephin

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142
Q

Example of Oxidized Cellulose?

A

surgicel

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143
Q

What are the parameters to monitor during local anesthesia administration?

A

BP, HR/pulse, SpO2, pain, anxiety, LOC

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144
Q

What is the role of the monitoring RN during local anesthesia administration?

A

The monitoring RN can also serve as a circulator

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145
Q

How are esters metabolized?

A

pseudocholinesterase.

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146
Q

What is released during the metabolism of esters?

A

para-aminobenzoic acid (PABA)

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147
Q

What response can an allergy to esters cause?

A

histamine response

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148
Q

Name some examples of esters used in local anesthesia.

A

cocaine, procaine, and tetracaine

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149
Q

How are amides metabolized?

A

liver

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150
Q

Give examples of commonly used amides in local anesthesia.

A

bupivacaine, lidocaine, and mepivacaine

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151
Q

What is Local Anesthetic Systemic Toxicity (LAST)?

A

High serum levels of local anesthetics causing CNS and cardiovascular complications

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152
Q

When can signs of LAST appear?

A

Within 1 minute to 30 minutes after injection

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153
Q

How often should patients be assessed for LAST?

A

Frequently

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154
Q

What are the risk factors for LAST?

A

advanced age, liver disease, decreased albumin levels, CHF, ischemic heart disease, acidosis, meds that inhibit sodium channel, low EF, conduction abnormalities, BIER block

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155
Q

What are the initial signs of LAST?

A

Dizziness, numbness in the tongue, metallic taste, LOC, anxiety, agitation

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156
Q

What are the intermediate signs of LAST?

A

Shivering, slurred speech, confusion, seizures

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157
Q

What are the severe signs of LAST?

A

Coma, decreased heart rate, cardiac arrest

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158
Q

What is the first intervention step for LAST?

A

Call anesthesia

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159
Q

How should the airway be maintained in LAST?

A

100% oxygen and hyperventilation

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160
Q

What medication (and how) should be administered in LAST?

A

20% lipid emulsion 1.5 mL/kg bolus, repeat up to 3 times, then 0.25 mL/kg/min infusion IV

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161
Q

How can you prevent LAST when using local anesthetics?

A

Know and calculate the maximum dose

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162
Q

What should be done before injecting local anesthetics to prevent LAST?

A

Aspirate at the site

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163
Q

What should you ask the patient to help prevent LAST?

A

If they are experiencing symptoms

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164
Q

How should large or multiple wounds be repaired to prevent LAST?

A

Serial repairs

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165
Q

What is used to monitor moderate sedation?

A

Capnography, depth of sedation scale (ETCO2), BIS monitoring, and audible alarms.

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166
Q

What should be considered when adjusting medication doses for older adults during moderate sedation?

A

Dose adjustments are necessary, be aware of individual patient needs.

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167
Q

Why should airway obstruction be considered during the discharge of infants and toddlers?

A

Their heads may fall forward, causing airway obstruction.

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168
Q

Who provides guidelines for the scope of practice of the RN?

A

Nurse Practice Act (SBON, AORN)

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169
Q

Which ASA physical status classifications can an RN administer moderate sedation to?

A

ASA 1, 2, & 3

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170
Q

What patient characteristics should be avoided in moderate sedation?

A

Beards, dentures, and sleep apnea

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171
Q

What is required for the monitoring RN during moderate sedation?

A

No competing responsibilities and 2 RNs in the room at all times, with brief interruptible tasks allowed.

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172
Q

What areas should education and competency cover for moderate sedation?

A

Pharmacology, expected sequence of events, completing pain assessments, and patient teaching.

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173
Q

What are examples of regional anesthesia?

A

Topical (drops or ointment) and local infiltration.

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174
Q

How is local infiltration administered?

A

Injected into the incision site

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175
Q

How does epinephrine affect local infiltration?

A

delay absorption for post-op pain

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176
Q

What is the maximum dose of 1% lidocaine without epinephrine?

A

5 mg/kg/day

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177
Q

What is the maximum dose of 1% lidocaine with epinephrine?

A

7 mg/kg/day

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178
Q

Which herbal supplements are associated with liver damage?

A

Echinacea and kava.

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179
Q

What unusual effect can kava have when used with propofol?

A

Turns urine green

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180
Q

Which herbal supplements can increase the risk of bleeding?

A

Ginger, gingko, garlic, feverfew, saw palmetto, biloba, and omega-3

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181
Q

Which herbal supplements can cause arrhythmias or affect blood pressure?

A

Goldenseal, milk thistle, licorice, and ginseng with ephedra (with atropine)

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182
Q

Which herbal supplements can prolong emergence from anesthesia?

A

Gingko, St. John’s wort, and valerian

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183
Q

Which herbal supplement is associated with hypertension?

A

Ginseng

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184
Q

What is the function of mydriatics in eye medications?

A

Mydriatics dilate the pupil and reduce the effect of trauma by paralyzing the sphincter muscle of the iris.

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185
Q

Give two examples of mydriatics.

A

Neo-synephrine and atropine.

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186
Q

What is the function of miotic eye medications?

A

Miotics constrict the pupil and decrease intraocular pressure (IOP)

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187
Q

Which disease are myotic medications usually used in?

A

Glaucoma

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188
Q

Give two examples of miotic eye medications.

A

Miochol and miostat

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189
Q

What is the function of tropicamide in eye medications?

A

Tropicamide dilates the eyes and causes inability to focus due to its anticholinergic properties.

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190
Q

What type of eye medication is pilocarpine and when should it not be used?

A

Pilocarpine is a miotic and should not be used with cataracts.

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191
Q

How are aminoesters metabolized?

A

By plasma by liver enzymes

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192
Q

What can aminoesters stimulate?

A

Allergies

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193
Q

Give three examples of aminoesters.

A

Cocaine, tetracaine, and novocaine

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194
Q

How are aminoamides metabolized?

A

Liver

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195
Q

Give two examples of aminoamides.

A

Lidocaine and bupivacaine

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196
Q

What cardiac symptoms is lidocaine used for?

A

arrhythmias and pulseless ventricular tachycardia

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197
Q

How does bupivacaine compare to lidocaine in strength?

A

4x stronger

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198
Q

What areas are targeted by a femoral nerve block?

A

anterior thigh and knee, including the quadriceps and tendon repairs

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199
Q

What are the primary effects of benzodiazepines?

A

Reduce anxiety and provide sedation

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200
Q

What is Versed (Midazolam) primarily used for?

A

Amnesic and anti-anxiety effects

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201
Q

What is a key contraindication for Versed (Midazolam)?

A

Narrow-angle glaucoma

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202
Q

How is Versed (Midazolam) administered?

A

IV only

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203
Q

What is the duration of action for Versed (Midazolam)?

A

Short acting

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204
Q

How can Valium (Diazepam) be administered?

A

Orally or IV

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205
Q

What is a notable side effect of Valium (Diazepam) when given IV?

A

Can burn

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206
Q

What respiratory effect is associated with Valium (Diazepam)?

A

potent respiratory depressant

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207
Q

How long does it take for Valium (Diazepam) to be eliminated from the body?

A

Approximately 2 days

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208
Q

What is Romazicon (Flumazenil) used for?

A

As a reversal agent for benzodiazepines

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209
Q

What are the contraindications for Romazicon (Flumazenil)?

A

Seizures and tricyclic antidepressant (TCA) use.

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210
Q

How do our bodies control pain naturally?

A

Through natural endorphins.

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211
Q

What natural ability do humans have concerning pain?

A

The natural ability to ignore pain.

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212
Q

What is an endorphin?

A

Endogenous morphine

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213
Q

What effect can synthetic opioids have on the body?

A

Histamine release

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214
Q

What are high-risk factors associated with narcotic use?

A

Respiratory depression, head injuries, breathing problems, obesity, age over 60.

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215
Q

What are the key characteristics of Morphine/Duramorph?

A

Fast-acting, used for moderate to severe pain

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216
Q

What is the onset time for Morphine/Duramorph?

A

1-3 minutes

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217
Q

What are common side effects of Morphine/Duramorph?

A

Constipation and urinary retention

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218
Q

What is a notable complication of Morphine/Duramorph?

A

Nausea / vomiting

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219
Q

How long does Morphine/Duramorph last during conscious sedation or epidurals?

A

3-4 hours

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220
Q

What is the recommended dose of Morphine/Duramorph for conscious sedation or epidurals?

A

1-2 mg

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221
Q

How does Fentanyl/Sublimaze compare in potency to Morphine?

A

100x more potent

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222
Q

What is the onset time for Fentanyl/Sublimaze?

A

1-3 minutes

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223
Q

How long does a 25 mcg dose of Fentanyl/Sublimaze last?

A

30-60 min

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224
Q

What are potential side effects of Fentanyl/Sublimaze?

A

Delayed respiratory depression

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225
Q

What drug interaction should be considered with Fentanyl/Sublimaze?

A

MAOIs

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226
Q

How should IV Fentanyl/Sublimaze be administered?

A

Push slowly

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227
Q

What is the potency of Meperidine/Demerol compared to Morphine?

A

1/10th times the strength

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228
Q

What is the onset time for Meperidine/Demerol?

A

1-5 min

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229
Q

How long does a 10-20 mg dose of Meperidine/Demerol last?

A

1-2 hr

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230
Q

What additional condition is Meperidine/Demerol used for?

A

Shivering

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231
Q

What are the risks associated with Meperidine/Demerol?

A

Head injuries/increased ICP (increase in CSF pressure), liver or kidney damage.

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232
Q

How does Hydromorphone/Dilaudid compare in strength to Morphine?

A

7x stronger

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233
Q

How should IV Hydromorphone/Dilaudid be administered?

A

Push slowly

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234
Q

What is the function of Narcan/Naloxone?

A

It is a reversal agent that competes for opiate receptors.

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235
Q

What is the initial dose range for Narcan/Naloxone?

A

0.4-2 mg

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236
Q

How is Narcan administered?

A

IV, IM, subcutaneously, or nasally

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237
Q

How long does Narcan/Naloxone last?

A

30-45 min

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238
Q

What is the recommended redosing interval for Narcan/Naloxone?

A

0.1-0.2 mg at 2-3 minute intervals, redose every 2 minutes up to 10 mg.

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239
Q

What are potential side effects of Narcan/Naloxone?

A

Increased heart rate, stroke, hypertension, respiratory depression

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240
Q

How is Narcan/Naloxone metabolized?

A

Liver

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241
Q

How is Narcan/Naloxone excreted?

A

Kidneys

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242
Q

What is the primary use of neuromuscular blockers in surgery?

A

abdominal surgery and work on muscles

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243
Q

What do nondepolarizing neuromuscular blockers do?

A

Prevent muscle contraction by binding to cholinergic receptors

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244
Q

What are some characteristics of neuromuscular blockers?

A

do not cause fasciculation and are not MH triggers.

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245
Q

What type of agents are acetylcholine competitive antagonists?

A

Blocking agents that block acetylcholine and do not interact with the receptor (slower than succinylcholine)

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246
Q

What is Atracurium/Tracrium used for?

A

Intubation

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247
Q

How long does Atracurium/Tracrium last?

A

30-60 min

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248
Q

What are the effects of Atracurium/Tracrium?

A

Decreased blood pressure, vasodilation, and histamine release.

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249
Q

What is the intubation dose for Atracurium/Tracrium?

A

0.3-0.5 mg/kg

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250
Q

How long does Vecuronium/Norcuron last?

A

30 min

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251
Q

What is the intubation dose for Vecuronium/Norcuron?

A

0.6 mg/kg

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252
Q

What are the storage requirements for Vecuronium/Norcuron?

A

Must be refrigerated

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253
Q

Are there any notable effects of Vecuronium/Norcuron?

A

No notable effects

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254
Q

How long does Rocuronium/Zemuron last?

A

30-90 min

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255
Q

What is the intubation dose for Rocuronium/Zemuron?

A

0.6-1.2 mg/kg

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256
Q

What are the effects of Rocuronium/Zemuron?

A

Increased heart rate and possible reactions with antibiotics; patients recover quickly.

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257
Q

How long does Pancuronium/Pavulon last?

A

Over 1 hr

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258
Q

What are the effects of Pancuronium/Pavulon?

A

Decreased blood pressure, increased heart rate, and bronchospasm.

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259
Q

What are the contraindications for Pancuronium/Pavulon?

A

Neonates and children (contains benzyl alcohol)

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260
Q

What is Neostigmine/Prostigmine used for?

A

reversal agent that inhibits the destruction of acetylcholine

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261
Q

What are the contraindications for Neostigmine/Prostigmine?

A

Asthma

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262
Q

What are the side effects of Neostigmine/Prostigmine?

A

seizures, coronary artery disease, arrhythmias, bowel obstruction, and urine retention

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263
Q

What do anticholinesterases do?

A

Block acetylcholinesterase, increase acetylcholine concentration in the neuromuscular junction, and displace muscle relaxants from acetylcholine receptors.

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264
Q

What are the unwanted side effects of anticholinesterases?

A

Decreased heart rate, bronchospasm, and enhanced GI peristalsis.

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265
Q

Why are anticholinesterases combined with muscarinic antagonists?

A

counteract unwanted side effects

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266
Q

Examples of muscarinic antagonists.

A

glycopyrrolate / atropine

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267
Q

Examples of Anticholinersterases

A

Neostigmine, Edrophonium, Sugammadex

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268
Q

How is Neostigmine typically administered?

A

Mixed with glycopyrrolate

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269
Q

What occurs first when Neostigmine is mixed with atropine?

A

Atropine effects

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270
Q

How is Edrophonium prepared?

A

Mixed with atropine

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271
Q

What is Sugammadex used for?

A

reverse any level of paralysis from rocuronium or vecuronium

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272
Q

How do depolarizing neuromuscular blockers work?

A

They stimulate the ANS and act like acetylcholine.

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273
Q

What are the contraindications for depolarizing neuromuscular blockers?

A

Involuntary muscle contractions (fasciculations) that result in flaccidity and triggering malignant hyperthermia (MH)

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274
Q

What is Succinylcholine/Anectine used for?

A

Intubation and induction

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275
Q

What is the duration of Succinylcholine/Anectine?

A

4-10 min

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276
Q

How is Succinylcholine metabolized?

A

By pseudocholinesterase (longer than acetylcholinesterase)

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277
Q

Is there a reversal agent for Succinylcholine?

A

No

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278
Q

What are the adverse reactions to Succinylcholine?

A

Decreased heart rate, increased intracranial pressure, increased potassium, oxygen depletion.

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279
Q

What are the contraindications for Succinylcholine?

A

Family history of malignant hyperthermia, glaucoma, and degenerative neuromuscular disorders.

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280
Q

How is induction achieved in children?

A

Inhalation

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281
Q

What are barbiturates used for induction?

A

Brevital, which is a short-acting anesthetic

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282
Q

What sedatives/hypnotics are used for induction?

A

Propofol and etomidate

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283
Q

What is the nurse’s responsibility during induction?

A

Remain with the patient, manage stress response (increased BP & HR), limit sensory stimulation, and know the location of the emergency/difficult intubation cart/trach tray

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284
Q

How should asthmatic patients be managed during induction?

A

Induce deeper anesthesia and use a bronchodilator prior to induction

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285
Q

Why is malignant hyperthermia (MH) a concern during induction?

A

Signs and symptoms appear from anesthesia gases

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286
Q

Who are at risk for aspiration during induction?

A

Patients with GERD, trauma, pregnancy, obesity, and those requiring awake intubation

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287
Q

What technique is used to reduce aspiration risk during induction?

A

Applying cricoid pressure

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288
Q

What is the narrowest part of a child’s airway?

A

cricoid cartilage

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289
Q

How is inhalation anesthesia administered?

A

face mask, endotracheal tube (ET), or laryngeal mask airway (LMA) mixed with CO2

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290
Q

What are the risks associated with Halothane?

A

Triggers MH

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291
Q

What can Halothane cause if combined with epinephrine?

A

arrhythmias

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292
Q

What is the strongest inhalation agent?

A

Halothane

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293
Q

What are the characteristics of Nitrous Oxide (N2O)?

A

It’s nonflammable, nonhalogenated, provides rapid induction and quick recovery, and is safe in MH patients

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294
Q

What are the potential effects of Nitrous Oxide (N2O)?

A

poor muscle relaxation, hypoxia, and support combustion like oxygen

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295
Q

What effects does nitrous oxide have on the cardiovascular system?

A

None

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296
Q

What is the purpose of Desflurane/Suprane?

A

used for patients with increased intracranial pressure (ICP)

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297
Q

What are the potential effects of Desflurane/Suprane?

A

glycosuria and proteinuria

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298
Q

What are the characteristics of Desflurane/Suprane in terms of onset and offset?

A

Fastest onset / offset of inhalation drugs

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299
Q

What are common side effects of Desflurane/Suprane?

A

Coughing and a smell resembling rubber

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300
Q

How does Isoflurane/Forane affect heart rate?

A

Slows

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301
Q

How is Isoflurane/Forane metabolized?

A

Liver

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302
Q

Is Isoflurane/Forane safe in patients with renal disease?

A

Yes, not metabolized by kidney

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303
Q

What are the potential effects of Isoflurane/Forane?

A

Respiratory depression and vasodilation

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304
Q

What happens if Isoflurane/Forane is used with a pneumatic tourniquet?

A

Increased ICP

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305
Q

What is the significance of Sevoflurane in pedatrics?

A

Agent of choice due to rapid onset / offset

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306
Q

When is Ethrane contraindicated?

A

Seizures

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307
Q

What is the composition of Propofol/Diprivan?

A

Contains soybean oil and lecithin

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308
Q

What is the dosage range for Propofol/Diprivan?

A

1.0-2.5 mg/kg

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309
Q

What are the effects of Propofol/Diprivan?

A

Respiratory and cardiac depression

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310
Q

What is the onset of action for Propofol/Diprivan?

A

rapid

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311
Q

What type of anesthesia does Ketamine/Ketalar provide?

A

dissociative anesthesia (patient is awake but unaware)

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312
Q

What are the effects of low-dose Ketamine/Ketalar?

A

does not cause respiratory depression, hallucinations, or delirium

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313
Q

What is the onset of action for Ketamine/Ketalar?

A

rapid

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314
Q

What are the contraindications for Pentothal/Thiopental Sodium?

A

chronic renal or hepatic disease

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315
Q

What are the effects of Pentothal/Thiopental Sodium?

A

decreased arterial pressure and cardiac output

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316
Q

What is the mechanism by which Pentothal/Thiopental Sodium protects the brain?

A

sedative-hypnotic properties

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317
Q

How long does Zofran/Ondansetron last?

A

12-24 hr

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318
Q

How long does Reglan/Metoclopramide last?

A

6 hr

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319
Q

What is the purpose of Scopolamine/Hyoscine before surgery?

A

placed behind the ear as a sedative

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320
Q

What is the mechanism of action of Prilosec/Omeprazole?

A

proton pump inhibitor that prevents the release of gastric acid

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321
Q

What is the dosage of Prilosec/Omeprazole?

A

60mg

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322
Q

How quickly does Protonix/Pantoprazole work?

A

20min

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323
Q

What is the concentration of IV Protonix/Pantoprazole?

A

4mg/mL

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324
Q

What is the indication for Adenosine/Adenocard?

A

increasing heart rate and restoring normal sinus rhythm (NSR) by causing brief asystole

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325
Q

What is the dosage of Adenosine/Adenocard?

A

6mg bolus every 1-2 min

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326
Q

What is the action of Amiodarone/Cordarone?

A

class II antiarrhythmic used for life-threatening ventricular arrhythmias

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327
Q

How is Amiodarone/Cordarone administered?

A

intravenously (IVP) as 300mg in 20-30mL of normal saline (NS) or D5W, followed by a repeat dose of 150mg every 3-5 min.

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328
Q

What is the purpose of Atropine/Atropen?

A

anticholinergic agent used for bradycardia, asystole, and AV node block

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329
Q

What is the dosage of Atropine/Atropen?

A

1mg every 3-5 min

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330
Q

When is Epinephrine/Adrenaline administered?

A

adrenergic emergency, asystole, pulseless ventricular tachycardia, asthma/allergic reactions

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331
Q

What are the routes of administration for Epinephrine/Adrenaline?

A

endotracheal (ET) inhalation, subcutaneous (subq), intramuscular (IM), or intravenous (IV) routes

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332
Q

What is the dosage of Epinephrine/Adrenaline?

A

1mg every 3-5 min

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333
Q

What is the action of Vasopressin/Vasostrict?

A

increases blood pressure by constricting blood vessels and restricts renal excretion while increasing peristalsis (ADH)

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334
Q

What is the dosage of Vasopressin/Vasostrict?

A

40 units intravenously (IVP)

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335
Q

How does Nitroglycerin/Nitrostat work?

A

increases coronary blood flow by dilating arteries, thereby reducing blood pressure and relieving angina

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336
Q

What is the purpose of Lasix/Furosemide intraoperatively?

A

reduce intracranial pressure (ICP)

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337
Q

What is the indication for Mannitol/Osmitrol?

A

increased intracranial pressure (ICP) and intraocular pressure (IOP)

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338
Q

What is the action of Dilantin/Phenytoin?

A

prevent and treat seizures after head trauma

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339
Q

What is the action of Dantrolene/Revonto?

A

blocks the accumulation of calcium in skeletal muscles, primarily used for malignant hyperthermia (MH)

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340
Q

What is the administration method for Dantrolene/Revonto?

A

via central line as a 2-3mg/kg IV bolus

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341
Q

How should Ryanodex be reconstituted?

A

5mL of non-bacteriostatic water, used within 6 hours

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342
Q

Why should you add epinephrine to local anesthesia?

A

delay absorption for post op pain

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343
Q

What is the effect of Dopamine/Intropin on blood pressure?

A

Decreases

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344
Q

What is the effect of Dopamine/Intropin on cardiac output?

A

increases

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345
Q

What is the therapeutic indication of Dopamine/Intropin?

A

renal failure

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346
Q

What is the purpose of including Mannitol with Dantrolene?

A

increase renal function

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347
Q

What are the four kinds of brachial plexus blocks?

A

Interscalene
Supraclavicular
Infraclavicular
Axillary

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348
Q

What is the complication of an interscalene block?

A

Horner’s syndrome

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349
Q

What is Horner’s syndrome?

A

Disrupted nerve pathway on one side from the brain to the face / eye

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350
Q

What are symptoms of Horner’s syndrome?

A

Drooping eyelid, little / no sweating on affected side, smaller pupil

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351
Q

What is the complication of a supraclavicular block?

A

pneumothorax

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352
Q

What is the complication of an infraclavicular block?

A

short duration

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353
Q

What is the complication of an axillary block?

A

hematoma
accidental vascular injection

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354
Q

What is a Bier Block or Intravenous Regional Anesthesia (IVRA)?

A

regional anesthesia technique used for hand procedures

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355
Q

What is the typical duration of cases for which Bier Block is used?

A

Cases lasting 20-60 min

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356
Q

What is the primary advantage of Bier Block?

A

provides a bloodless surgical field

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357
Q

How quickly does Bier Block typically onset?

A

less than 5 min

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358
Q

What is the sequence of steps for performing a Bier Block?

A
  1. Exsanguinate the extremity.
  2. Apply a tourniquet.
  3. Inflate the proximal cuff.
  4. Inject local anesthesia and remove the IV.
  5. Perform the procedure.
  6. Deflate the cuff.
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359
Q

What surgical areas are well suited for a Femoral Block?

A

anterior thigh or knee, such as quadriceps tendon repair

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360
Q

In addition to surgery, what other purpose can the Femoral Block serve?

A

postoperative pain management after femur or knee surgery

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361
Q

Why is aspiration before injection important in neuraxial anesthesia?

A

prevents accidental intravascular injection

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362
Q

Which medication commonly causes LAST?

A

bupivacaine used in epidural procedures

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363
Q

What should be monitored during neuraxial anesthesia?

A

Sensory block and autonomic function of nerve roots and spinal cord.

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364
Q

What precautions should be taken while positioning or transferring patients during neuraxial anesthesia?

A

Careful positioning for proper body alignment and avoiding rapid changes to prevent hypotension.

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365
Q

When does motor function typically return compared to sensory functions during neuraxial anesthesia?

A

Motor function returns before sensory function

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366
Q

What factors should be considered before administering neuraxial anesthesia?

A

History of spinal malformation, previous spinal surgery, psychological status, and high skill level required in pediatric patients

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367
Q

What are the contraindications for neuraxial anesthesia?

A

Anticoagulation, increased intracranial pressure (ICP), septicemia, skin infection at insertion site, pre-existing neurological disorders (such as MS), cancer of brain or spinal cord, and patient refusal

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368
Q

What complications are associated with neuraxial anesthesia?

A

Respiratory depression, bladder distention, hypotension, and post-dural puncture headache

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369
Q

What can cause respiratory depression in epidurals?

A

sedation used with regional anesthesia or high placement affecting phrenic nerve

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370
Q

How do you treat bladder distension during an epidural?

A

offer void or catheter

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371
Q

What kind of needles are used in spinal anesthesia and why?

A

pencil point (not beveled)
prevent accidental dural puncture

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372
Q

What are some noninvasive treatments for post-dural puncture headache?

A

HOB flat, fluids, analgesics, caffeine, sumatriptan

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373
Q

Where is medication injected in peridural/epidural/caudal anesthesia?

A

epidural space

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374
Q

For what purpose can peridural/epidural/caudal anesthesia be used?

A

postoperative pain relief

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375
Q

What is a characteristic of peridural/epidural/caudal anesthesia in terms of duration?

A

Longer duration is achievable

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376
Q

In which regions of the body is peridural/epidural/caudal anesthesia commonly administered?

A

Thoracic / lumbar

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377
Q

Why is peridural/epidural/caudal anesthesia preferred for obstetrics?

A

Pain relief during labor

378
Q

What is the typical onset time for peridural/epidural/caudal anesthesia?

A

15-30 min

379
Q

Where is subdural/spinal/saddle anesthesia injected?

A

below L2

380
Q

What is the duration of subdural/spinal/saddle anesthesia?

A

2 hr

381
Q

or what purpose is subdural/spinal/saddle anesthesia NOT typically used?

A

post operative pain relief

382
Q

What is the typical onset time for subdural/spinal/saddle anesthesia?

A

5 min

383
Q

What is the goal of general anesthesia?

A

Achieving a level of sedation adequate to prevent the patient from being awake

384
Q

What factor determines the amount of sedation required during general anesthesia?

A

Intensity of stimulation

385
Q

How can the effectiveness of general anesthesia be enhanced?

A

By combining various drugs, which often has a synergistic effect

386
Q

What is the potency comparison between a sedative and narcotic combination versus a larger dose of either alone during general anesthesia?

A

The sedative and narcotic combination is more potent

387
Q

What is compromised during general anesthesia regarding compensatory vasoconstriction?

A

Compensatory vasoconstriction

388
Q

What does ASA 1 denote in anesthesia classification?

A

relatively healthy patient with a localized pathologic process

389
Q

What does ASA 2 denote in anesthesia classification?

A

Mild systemic disease

390
Q

What does ASA 3 denote in anesthesia classification?

A

severe systemic disease that limits activity but are not totally incapacitated

391
Q

What does ASA 4 denote in anesthesia classification?

A

incapacitating disease that poses a constant threat to life

392
Q

What does ASA 5 denote in anesthesia classification?

A

moribund patient who is not expected to survive 24 hours with or without surgery

393
Q

What does ASA 6 denote in anesthesia classification?

A

brain dead and are considered for organ donation

394
Q

How is an emergency indicated in terms of ASA?

A

The number followed by “E”

395
Q

Give an example of ASA 2.

A

Diabetes mellitus

396
Q

Give an example of ASA 3.

A

HTN, COPD

397
Q

Give an example of ASA 4.

A

cardiovascular disease, renal disease

398
Q

What should be monitored during spinal anesthesia?

A

Hypotension, decreased temperature, hematoma formation, and postural headache

399
Q

What is a postural headache in spinal anesthesia?

A

headache caused by migration above 1-2 subarachnoid space

400
Q

What complications should be watched for during epidural anesthesia?

A

slow absorption when used with epinephrine

401
Q

Where is epidural anesthesia administered?

A

above and surrounding dura matter

402
Q

What characterizes Stage 1 of anesthesia?

A

Induction, oxygenation, vital signs monitoring, airway establishment, analgesia, amnesia, consciousness, and ability to follow commands

403
Q

What occurs during Stage 2 of anesthesia?

A

Excitement, stable vital signs, slight unconsciousness with retained reflexes, potential for delirium, risk of laryngospasm and cardiac arrest, and REM sleep

404
Q

What defines Stage 3 of anesthesia?

A

Maintenance, safe for positioning, and surgical intervention.

405
Q

What are the four planes of Stage 3 anesthesia and their respiratory patterns?

A

Plane 1: Regular respirations.
Plane 2: Regular respirations with cessation of movement.
Plane 3: Diaphragmatic respirations (ideal).
Plane 4: Irregular respirations.

406
Q

What characterizes Stage 4 of anesthesia?

A

Overdose, danger, reaction to medication, failure of cardiovascular and respiratory systems, medullary depression, and respiratory paralysis

407
Q

What constitutes as an emergency state during anesthesia?

A

Laryngeal reflexes remain intact

408
Q

What happens during the emergence phase of anesthesia?

A

Recovery from anesthesia

409
Q

How do you treat laryngospasm?

A

100% O2, sedation, and paralysis if needed

410
Q

What are potential concerns in emergence of anesthesia?

A

hypoventilation, incomplete reversal of muscle relaxation, CNS depression, and laryngospasm

411
Q

What are the guidelines for documentation requirements?

A

PNDS (perioperative nursing data sets)

412
Q

What is the status of DNR/AND (Do Not Resuscitate/Allow Natural Death) orders during perioperative care?

A

not automatically suspended

413
Q

How are DNR/AND orders addressed with the patient?

A

Conversation between MD and patient

414
Q

Who is not authorized to alter DNR/AND orders?

A

RN

415
Q

What is the process if a DNR/AND order needs to be suspended?

A

Written order by physician

416
Q

What are intentional torts in healthcare?

A

Violations of patient rights without requiring actual harm

417
Q

Define assault as an intentional tort.

A

Instilling fear of being touched without consent.

418
Q

Define battery as an intentional tort.

A

Touching a person without their permission

419
Q

Define false imprisonment as an intentional tort.

A

Unjustified detention of an individual

420
Q

What’s important regarding documentation when using restraints?

A

Thorough documentation is crucial

421
Q

What characterizes quasi-intentional torts in healthcare?

A

Actions without intent to harm or distress

422
Q

What are examples of quasi-intentional torts in healthcare?

A

Patient abandonment
invasion of privacy
defamation of character
breach of confidentiality

423
Q

What are the ethical principles that guide nursing practice?

A

autonomy
beneficence
nonmaleficence
justice
veracity
fidelity

424
Q

Define autonomy in nursing ethics.

A

individuals making decisions for themselves

425
Q

Define beneficence in nursing ethics.

A

act of doing good

426
Q

Define nonmaleficence in nursing ethics.

A

principle of doing no harm

427
Q

Define justice in nursing ethics.

A

ensuring fairness in treatment

428
Q

Define veracity in nursing ethics.

A

truthfulness in communication

429
Q

Define fidelity in nursing ethics.

A

faithfulness to commitment

430
Q

What must be completed before a procedure as part of the Preprocedural Verification?

A

H&P & anesthesia assessment

431
Q

What needs to be available before a procedure?

A

Blood, implants, special equipment

432
Q

How must the consent form be prepared?

A

Accurate, signed, and witnessed

433
Q

What should be done if a patient changes their mind after signing consent?

A

Notify the surgeon

434
Q

When is consent not required?

A

During an emergency

435
Q

Where is the site marking done?

A

Outside the OR

436
Q

How should the site mark be used across hospitals?

A

Consistent mark used throughout hospitals.

437
Q

What condition must the patient be in during site marking?

A

not sedated and participating

438
Q

Who marks the surgical site?

A

medical person participating in the procedure.

439
Q

How is site verification for a child performed?

A

With the parent

440
Q

When is the time out performed?

A

Prior to the procedure, ideally before anesthesia

441
Q

When is the time out performed?

A

Prior to the procedure, ideally before anesthesia

442
Q

Who performs the time out and how?

A

designated person in a standardized manner defined by the organization.

443
Q

How is the information exchanged during a time out?

A

Two way conversation

444
Q

What is the response during a time out?

A

Info given and acknowledged if correct or not

445
Q

How many times is a time out performed per procedure?

A

Once or whenever surgeon leaves room

446
Q

When should a second time out be performed?

A

For a different surgeon or if re-draping.

447
Q

What needs to be assessed preoperatively?

A

Age
Height, weight, BMI
Baseline VS, cardiac, and respiratory status
PMH
Allergies
NPO status
Medications
Skin
Neurological status
Educational needs
Diagnostic results (labs)
Communication barriers
Mobility / sensory impairments
Detrimental behavior
Cultural considerations
Ability to tolerated surgical position
Anxiety level
Pain level
Need for IV access
Preceptions of surgery
Physical acuity

448
Q

What is the purpose of the assessment in the nursing process?

A

To formulate a nursing diagnosis.

449
Q

What does one do in the assessment phase?

A

Collect data

450
Q

What is the purpose of the diagnosis in the nursing process?

A

identify and classify data collected

451
Q

What does the diagnosis phase focus on?

A

Human response

452
Q

What types of diagnoses & outcomes are considered in the diagnosis phase?

A

Actual vs. potential

453
Q

What is the capability of nursing treatment during the diagnosis phase?

A

Correcting the issue

454
Q

What classification system is used in the diagnosis phase?

A

NANDA

455
Q

What is the purpose of identifying outcomes in the nursing process?

A

describe the desired or expected condition achievable.

456
Q

How are nursing interventions measured?

A

Based on outcome

457
Q

How do we evaluate the outcome?

A

Goals

458
Q

What characteristics must goals have?

A

Specific and measurable

459
Q

What is the purpose of planning in the nursing process?

A

select interventions to meet desired outcomes

460
Q

What must be identified during the planning phase?

A

Measurable outcomes

461
Q

What type of goals and interventions should be created during the planning phase?

A

Individualized

462
Q

Who should be communicated with during the planning phase?

A

patient, family, interdisciplinary team, and during change of shift

463
Q

What should be prepared in advance during the planning phase?

A

what will/may happen and prioritize care

464
Q

What is the purpose of the implementation phase in the nursing process?

A

Carry out plan of care

465
Q

What are the nursing actions during the implementation phase?

A

Promote wellness, restore health, prevent disease, cope with altered functions

466
Q

How should nurses respond during the implementation phase?

A

Critical thinking

467
Q

What is the purpose of the evaluation phase in the nursing process?

A

Identify if goal was met

468
Q

What questions are addressed during the evaluation phase?

A

Was the goal met? Which factors were (not) met?

469
Q

What should be done if the goal was not met in the evaluation phase?

A

Modify plan accordingly

470
Q

What is the active electrode in electrosurgery?

A

Bovie pencil

471
Q

What is the function of the bovie pencil?

A

sends current to surgical tissue

472
Q

What is the dispersive electrode in electrosurgery?

A

The bovie pad

473
Q

Where should the bovie pad be kept away from?

A

Keep away from implants and tattoos

474
Q

What surfaces should be avoided when placing the bovie pad?

A

Avoid bony, scarred, or hairy surfaces

475
Q

Where should the bovie pad be placed for optimal effectiveness?

A

On a large muscle close to the surgical site.

476
Q

What should be done to an ICD or pacemaker before electrosurgery?

A

Turn it off

477
Q

What type of electrosurgery should be used if possible with an ICD or pacemaker?

A

Bipolar

478
Q

What type of electrosurgery should be used with nerve stimulators?

A

Bipolar

479
Q

What type of electrosurgery should be avoided with cochlear implants?

A

No monopolar

480
Q

What is needed for return current in monopolar electrosurgery?

A

Grounding pad

481
Q

What are the different modalities of monopolar electrosurgery?

A

Cut, coagulate, blend, fulgurate, and desiccate.

482
Q

How does current return to the generator in bipolar electrosurgery?

A

One side of the forceps returns current to the generator.

483
Q

What is a characteristic of bipolar electrosurgery?

A

uses lower voltage for smaller areas

484
Q

What does a lower score on the Braden Scale indicate?

A

Higher risk of pressure ulcers

485
Q

What score on the Braden Scale indicates severe risk?

A

Less than 10

486
Q

What score range on the Braden Scale indicates high risk?

A

10-12

487
Q

What score range on the Braden Scale indicates moderate risk?

A

12-14

488
Q

What score range on the Braden Scale indicates mild risk?

A

15-18

489
Q

What are the stages of healing?

A

Inflammation, proliferation, maturation

490
Q

What is the timeframe for the inflammatory phase of wound healing?

A

Day 0-3

491
Q

What are the key characteristics of the inflammatory phase of wound healing?

A

Redness, edema, phagocytosis

492
Q

What is the timeframe for the proliferation phase of wound healing?

A

Day 4-24

493
Q

What occurs during the proliferation phase of wound healing?

A

Granulation and epithelial tissue formation

494
Q

What is the timeframe for the maturation phase of wound healing?

A

Day 24 - 1 year

495
Q

What occurs during the maturation phase of wound healing?

A

Scar formation and contraction

496
Q

What is primary intention in wound healing?

A

Minimal tissue loss, no dead space, all layers approximated

497
Q

Which type of wounds typically heal by primary intention?

A

most surgical wounds

498
Q

What is secondary intention in wound healing?

A

Significant tissue loss, granulation, closes from bottom up

499
Q

Which type of wounds typically heal by secondary intention?

A

pressure ulcers

500
Q

What is tertiary intention in wound healing?

A

Delayed primary intention, left open and packed, closed day 3-5

501
Q

When is tertiary intention used?

A

High suspicion of contamination

502
Q

What effect do steroids and anti-inflammatory drugs have on wound healing?

A

delay wound healing

503
Q

What is wound separation?

A

wound edges come apart

504
Q

What is dehiscence?

A

Separation of the fascial layer with a new development of drainage

505
Q

What is evisceration?

A

Abdominal contents spilling out, surgical emergency

506
Q

What is the expected infection rate for Class I (Clean) wounds?

A

< 5%

507
Q

What are the characteristics of Class I (Clean) wounds?

A

primary closure, no break in technique

508
Q

What is the expected infection rate for Class II (Clean-Contaminated) wounds?

A

8-11%

509
Q

What constitutes a class II wound?

A

GI, GU, respiratory tract entered under controlled conditions without spillage

510
Q

What is the infection rate for Class III (Contaminated) wounds?

A

15-20%

511
Q

What constitutes a class III wound?

A

fresh traumatic injuries, break in technique, spillage

512
Q

What are examples of class II procedures?

A

bowel resection, hysterectomy, T&A

513
Q

What are examples of class III procedures?

A

appendectomy for appendicitis, cholecystectomy for cholecystitis

514
Q

What is the infection rate for Class IV (Infected) wounds?

A

27-40%

515
Q

What constitutes a class IV wound?

A

clinical infection, perforated viscera, necrotic tissue

516
Q

What are examples of class IV procedures?

A

I&D of abscess, ruptured appendix, GSW to abdomen

517
Q

What is the trauma triage order?

A
  1. Cervical Spine
  2. Airway obstruction
  3. Hemorrhage
  4. Cardiac tamponade
  5. Pneumothorax
  6. Increased ICP
  7. Massive burns
  8. Spinal Cord Injury
    9.Extremity Injury
518
Q

What is the first step in rapid sequence intubation?

A

pre-oxygenation

519
Q

What maneuver is used to prevent aspiration of stomach contents during rapid sequence intubation

A

Sellick’s maneuver
applying cricoid pressure

520
Q

What does applying cricoid pressure do?

A

Closes the esophagus

521
Q

What is the third step in rapid sequence intubation?

A

paralysis with induction

522
Q

What is the final step in rapid sequence intubation?

A

placement with proof

523
Q

What is another name for pneumatic antishock garments?

A

MAST trousers

524
Q

What do pneumatic antishock garments do?

A

Prevent hypovolemia in patients with hemorrhage

525
Q

What must be done prior to deflating the pneumatic antishock garment?

A

Fluid resuscitation

526
Q

How should the pneumatic antishock garment be deflated?

A

slowly

527
Q

What are the key signs of cardiac tamponade?

A

Jugular vein distention and narrowing pulse pressures

528
Q

What type of injury typically causes a tension pneumothorax?

A

Closed chest injury to lung

529
Q

What changes in vitals indicate increased ICP?

A

increased BP and decreased HR

530
Q

What does a higher score on Glasgow Coma Scale Indicate?

A

better neurological status

531
Q

What are signs of fluid overload?

A

Edema, dyspnea, rales, weight gain, neck vein distension, increased central venous pressure and BP

532
Q

What are the signs of hypovolemia?

A

Postural hypotension / decreased BP, increased HR, dry mucous membranes, decreased urine output, dizziness, fainting

533
Q

What is the function of the sodium potassium pump?

A

Moves sodium out of cell and potassium into cells

534
Q

What is the normal range of serum sodium?

A

135-145 mEq/L

535
Q

What occurs in hyponatremia?

A

Fluid shifts into tissues

536
Q

What are the signs/symptoms of hyponatremia?

A

N/V, irritability, decreased respirations, headache, blurred vision, edema, muscle twitching

537
Q

What is the treatment for hyponatremia?

A

Fluid restriction, diuretics, hypertonic saline (3% or 5%)

538
Q

What occurs in hypernatremia?

A

Fluid shifts out of tissues into vascular space

539
Q

What are the signs/symptoms of hypernatremia?

A

Hypovolemia, thirst, concentrated urine, muscle weakness, diaphoresis, increased temp, restlessness

540
Q

What is the treatment for hypernatremia?

A

fluid administration

541
Q

What is the normal range of serum potassium?

A

3.5-5.0 mEq/L

542
Q

What causes hypokalemia?

A

diuretics, bowel prep, V/D, laxative abuse, alkalosis

543
Q

What are the signs and symptoms of hypokalemia?

A

Abdominal distention, loss of bowel sounds, decreased BP, weakness, paralysis, loss of T wave

544
Q

What is the first sign of hypokalemia?

A

Hypotension

545
Q

What is the treatment for hypokalemia?

A

Potassium replacement

546
Q

What causes hyperkalemia?

A

Medical conditions, crushing trauma, DKA, burns, Addison’s disease

547
Q

What are the signs and symptoms of hyperkalemia?

A

Intestinal cramping, elevated T wave, increased BP, sporadic paralysis, cardiac standstill

548
Q

What is the treatment for hyperkalemia?

A

D50 with insulin, correction of acidosis, takes hours

549
Q

What is the normal range of serum calcium / ionized calcium?

A

8.5-10.5 mg/dL
4.5-5.6 mg/dL

550
Q

What causes hypocalcemia?

A

multiple blood transfusions, parathyroid disease, diuretics

551
Q

What are the signs and symptoms of hypocalcemia?

A

Twitching, laryngospasm, cramping, arrhythmias, Chvostek’s sign, Trousseau’s sign

552
Q

What is the treatment for hypocalcemia?

A

Calcium replacement

553
Q

What causes hypercalcemia?

A

medical conditions, bone cancer, multiple myeloma, sarcoidosis

554
Q

What are the signs and symptoms of hypercalcemia?

A

Neuromuscular depression, arrhythmias

555
Q

What is the treatment for hypercalcemia?

A

Mithramycin, phosphate replacement

556
Q

What is the relationship between calcium and phosphorus?

A

Inverse

557
Q

What is the normal range of serum phosphorus?

A

1-2 mEq/L

558
Q

What causes hypophosphatemia?

A

hyperparathyroidism, hypercalcemia, V/D, diuresis, burns

559
Q

What are the signs and symptoms of hypophosphatemia?

A

Decreased HR / BP, weakness, decreased DTR, decreased bowel sounds, decreased LOC

560
Q

What is the treatment for hypophosphatemia?

A

phosphate replacement

561
Q

What causes hyperphosphatemia?

A

Hypoparathyroidism, hypocalcemia

562
Q

What are the signs and symptoms of hyperphosphatemia?

A

Twitching, laryngospasm, cramping, prolonged ST/QT intervals, diarrhea, Chvostek’s sign, Trousseau’s sign

563
Q

What is the treatment for hyperphosphatemia?

A

Calcium replacement, dialysis

564
Q

What is the normal range of serum magnesium?

A

1.5-2.5 mEq/L

565
Q

What causes hypomagnesemia?

A

poor nutrition, alcoholism, pancreatitis, diuretics, muscle spasms

566
Q

What is a key effect of hypermagnesemia?

A

sedative effect of CNS

567
Q

What are the medical uses of magnesium?

A

premature labor, preeclampsia, v-fib, torsades de pointes

568
Q

What electrolyte imbalances appear in hypoparathyroidism?

A

decreased calcium, increased phosphorus

569
Q

What is the normal hemoglobin range for men?

A

13.2-17.5 g/dL

570
Q

What is the normal hemoglobin range for women?

A

11.5-16 g/dL

571
Q

When should hemoglobin levels be reported to anesthesia?

A

< 8

572
Q

Why is hematocrit monitored?

A

Watch for anemia

573
Q

What is the normal hematocrit range for men?

A

42-52%

574
Q

What is the normal hematocrit range for women?

A

37-47%

575
Q

What condition is indicated by low platelet count?

A

thrombocytopenia

576
Q

What is a normal range for platelets?

A

150,000-450,000

577
Q

What is the normal range of WBC?

A

4,000-10,000

578
Q

What is the normal prothrombin time?

A

11-12.5 seconds

579
Q

What coagulation factors does prothrombin time evaluate?

A

I, II, V, VII, X

580
Q

Wat conditions can prothrombin time help diagnose?

A

bleeding / clotting disorders

581
Q

What conditions and treatments can affect prothrombin time?

A

Liver disease, warfarin therapy

582
Q

What is the normal partial thromboplastin time?

A

30-40 seconds

583
Q

What coagulation factors does partial thromboplastin time evaluate?

A

II, V, VIII, IX, X, XI, XII

584
Q

Wat conditions can partial thromboplastin time help diagnose?

A

bleeding / clotting disorders

585
Q

What conditions and treatments can affect partial thromboplastin time?

A

heparin therapy, hemophilia, DIC

586
Q

What happens to partial thromboplastin time in DIC?

A

it shortens

587
Q

What is the universal blood donor?

A

O-

588
Q

What is a normal pH level?

A

7.35-7.45

589
Q

What does low pH indicate?

A

acidosis

590
Q

What does high pH indicate?

A

alkalosis

591
Q

What is a normal PaO2 level?

A

80-100

592
Q

What is a normal O2 saturation?

A

> 98%

593
Q

What is a normal PaCO2 level?

A

35-45

594
Q

What does low PaCO2 indicate?

A

alkalosis

595
Q

What does high PaCO2 indicate?

A

acidosis

596
Q

What is a normal level of HCO3?

A

22-26

597
Q

What does low HCO3 indicate?

A

acidosis

598
Q

What does high HCO3 indicate?

A

alkalosis

599
Q

What levels indicate respiratory acidosis?

A

low pH
high PaCO2

600
Q

What levels indicate respiratory alkalosis?

A

high pH
low PaCO2

601
Q

What levels indicate metabolic acidosis?

A

Low pH & HCO3

602
Q

What is the treatment for metabolic acidosis?

A

bicarb to counteract the production of acid

603
Q

What levels indicate metabolic alkalosis?

A

High pH & HCO3

604
Q

What is the treatment for metabolic alkalosis?

A

treat the cause

605
Q

What can cause metabolic acidosis?

A

acid loss, diuretics, upper GI loss

606
Q

How does hypoventilation affect blood gas levels?

A

increase in CO2 levels and decrease in pH

607
Q

What are the potential complications of alkalosis?

A

Seizures

608
Q

What can cause metabolic acidosis?

A

Hemorrhage

609
Q

What are the symptoms of metabolic acidosis?

A

Vasodilation, myocardial depression, hyperkalemia, shift of oxyhemoglobin dissociation curve to the right, confusion, and stupor

610
Q

What is the treatment for metabolic acidosis?

A

Warm patient to reverse coagulopathy, administer blood, fresh frozen plasma (FFP), and platelets

611
Q

What should you avoid using in the treatment of metabolic acidosis?

A

Bicarbonate

612
Q

How does an air embolism occur?

A

pressure in the right atrium is lower than atmospheric pressure

613
Q

What are the venous causes of air embolism?

A

neuro procedures with the patient in a sitting position, hysteroscopy, TUR procedures

614
Q

What are the arterial causes of air embolism?

A

bypass surgery and dialysis

615
Q

What are the signs and symptoms of air embolism?

A

decreased end-tidal carbon dioxide (ETCO2), decreased blood pressure, arrhythmia, decreased oxygen saturation (SPO2), pulmonary edema, and neurologic damage

616
Q

What is the first sign of an air embolism?

A

Decreased ETCO2

617
Q

How do you treat venous air embolism?

A

identifying and occluding entry sites, use sloppy wet sponges, using an irrigation syringe, and stopping nitrous oxide (N2O), aspirate right atrium catheter

618
Q

What position should the patient be during a venous air embolism?

A

Durant’s maneuver - left lateral

619
Q

How do you treat arterial air embolism?

A

Aspirate air from the circuit

620
Q

What position should the patient be during a arterial air embolism?

A

deep trendelenburg

621
Q

What is DIC?

A

disseminated intravascular coagulation

622
Q

What causes DIC?

A

trauma, sepsis, amniotic fluid in obstetrics, or release of procoagulants into the bloodstream (cancer)

623
Q

What complications are associated with DIC?

A

severe bleeding, stroke, decreased blood flow to organs, and kidney or liver overload

624
Q

How do you treat DIC?

A

addressing the underlying cause, administering fresh frozen plasma (FFP) and cryoprecipitates, initiating heparin initially, and replacing volume and blood as necessary

625
Q

What should be kept nearby in case of swelling during head and neck procedures?

A

tracheostomy (trach) tray

626
Q

Why should wire cutters be available during head and neck procedures?

A

in case the jaw is wired closed

627
Q

What should be sent with tracheostomy patients postoperatively?

A

obturator

628
Q

What postoperative symptoms should be anticipated after head and neck surgery?

A

dizziness and nausea/vomiting.

629
Q

What is the risk after long bone procedures?

A

fat emboli

630
Q

How can DVTs be prevented after orthopedic procedures?

A

sequential compression devices (SCDs), coumadin/heparin, and early ambulation

631
Q

What should be monitored for after orthopedic procedures?

A

pulmonary embolism using Virchow’s Triad

632
Q

What are the signs and symptoms of pulmonary embolism?

A

sudden onset of pain and shortness of breath

633
Q

How should casts be handled postoperatively?

A

Wet casts should be handled with palms only

634
Q

How should casts be positioned and cared for?

A

Elevate casts and keep them open to air

635
Q

What is the biggest concern regarding circulation in flap procedures?

A

Vasoconstriction in graft areas

636
Q

How should circulation be monitored post-flap procedure?

A

doppler

637
Q

From what should the site be protected after a flap procedure?

A

shearing / pressure

638
Q

What measures should be taken to regulate body temp after a flap procedure?

A

Keep patient warm

639
Q

What precautions should be taken for patients on renal dialysis?

A

Avoid using a blood pressure cuff or IV in the AV fistula arm

640
Q

What are common issues seen in renal dialysis patients?

A

Fluid & electrolyte imbalances

641
Q

How should medications be managed for renal dialysis patients?

A

avoid medications metabolized by kidneys

642
Q

What complication are burn patients prone to?

A

Hypothermia

643
Q

What are common issues seen in burn patients?

A

Fluid & electrolyte imbalances

644
Q

What complications are diabetic patients prone to?

A

HTN, GERD, delayed wound healing

645
Q

What equipment should be available for diabetic patients?

A

glucometer

646
Q

What types of surgeries should one be mindful of in diabetes insipidus?

A

pituitary/hypothalamus/head trauma-related surgeries

647
Q

How is diabetes insipidus treated?

A

fluids to match urinary output, vasopressin / DDAVP

648
Q

How long does it take for ciliary function to return in smokers?

A

7-8 weeks

649
Q

What is the recommendation for smokers preoperatively?

A

Stop smoking ASAP

650
Q

What is the goal for blood pressure management in patients with cardiac complications?

A

Maintain steady blood pressure on the low side of baseline

651
Q

What factor is deficient in hemophilia?

A

Factor VIII

652
Q

How is hemophilia managed during surgery?

A

synthetic factor VIII replacement

653
Q

What precautions should be taken for pregnant patients preoperatively?

A

Check for pregnancy and position off the vena cava to maintain fetal perfusion

654
Q

What monitoring is required for pregnant patients during surgery?

A

fetal heart monitor

655
Q

What is a characteristic of vasomotor tone in CHF patients?

A

poor vasomotor tone

656
Q

What is a risk for CHF patients regarding fluid?

A

fluid overload

657
Q

What preoperative precautions should be taken for CHF patients?

A

NPO status and avoiding diuretics preoperatively

658
Q

How do CHF patients respond under anesthesia?

A

They may dilate, requiring fluid management

659
Q

How is wound healing affected in morbidly obese patients?

A

compromised

660
Q

What should be considered during intubation for morbidly obese patients?

A

may be difficult, need glidescope

661
Q

What considerations should be made when positioning morbidly obese patients?

A

Positioning can make ventilation difficult

662
Q

What should asthmatic patients bring with them for surgery?

A

Own inhaler

663
Q

What special consideration should be taken during intubation for asthmatic patients?

A

Deeper sedation may be required

664
Q

How do COPD patients respond to oxygen levels?

A

Low oxygen levels stimulate breathing, not high oxygen

665
Q

What postoperative ventilation parameters are indicative of complications in COPD patients?

A

tidal volume lower than 500mL and PaCO2 > 45mmHg

666
Q

What special consideration should be taken regarding joint immobility in rheumatoid arthritis patients?

A

Creative positioning

667
Q

What is a common complication seen in rheumatoid arthritis patients?

A

Anemia

668
Q

What risk does steroid coverage pose for rheumatoid arthritis patients?

A

risk for impaired stress response, potentially leading to hypoadrenal crisis

669
Q

What specific considerations are necessary for anesthesia management in sickle cell anemia?

A

avoid triggers and use tools like bair huggers and fluid warmers

670
Q

What complications may arise during surgery for sickle cell anemia patients?

A

decreased temperature, decreased blood pressure, hypovolemia, decreased blood glucose, and decreased oxygen levels

671
Q

How should SPD be set up?

A

physical separation between decontamination and processing areas

672
Q

What is the workflow progression of SPD?

A

decontamination
preparation / packaging
sterilization processing
clean distribution . storage

673
Q

What is the most important step of decontaminating instruments?

A

cleaning - prevents infection

674
Q

What areas are targeted during cleaning to prevent infection?

A

Brush lumens, channels, crevices, and joints

675
Q

What is recommended before the decontamination of instruments?

A

pre-treatment

676
Q

What method can be used for automated cleaning during instrument decontamination?

A

Ultrasonic or washer

677
Q

What is sterilization?

A

Complete elimination/destruction of all forms of microbial life

678
Q

What does a Pre-Vacuum Autoclave do during sterilization?

A

Sucks air out of chamber

679
Q

What temperature is used in a Pre-Vacuum Autoclave?

A

270°F

680
Q

How long does it take to sterilize porous/lumenn (vs. non-porous) items in a Pre-Vacuum Autoclave?

A

4 min (vs. 3 min)

681
Q

What testing is recommended for Pre-Vacuum Autoclaves?

A

Geobacillus stearothermophilus spore testing at least weekly, preferably daily.

682
Q

What is the purpose of the Bowie Dick test?

A

to test air removal function in the autoclave’s empty chamber, done daily.

683
Q

What preconditioning techniques can be used in a Pre-Vacuum Autoclave?

A

vacuum pump, above atmospheric pressure process, steam-flush-pressure-pulse

684
Q

What is the purpose of a Gravity Displacement Autoclave?

A

focuses steam into the chamber

685
Q

What temperature is used in a Gravity Displacement Autoclave?

A

275°F

686
Q

When should consecutive air removal tests be done for new, renovated, or moved equipment in a Pre-Vacuum Autoclave?

A

Before the biological tests

687
Q

How does a Gravity Displacement Autoclave remove air from the chamber?

A

Steam displacing air

688
Q

How long does it take to sterilize porous/lumen items in a Gravity Displacement Autoclave?

A

10 min

689
Q

How long does it take to sterilize nonporous items in a Gravity Displacement Autoclave?

A

3 min

690
Q

What is the function of the thermometer in a Gravity Displacement Autoclave?

A

closes the drain

691
Q

What kind of items can be sterilized in a Gravity Displacement Autoclave?

A

Heat and moisture stable.

692
Q

What testing is recommended for a Gravity Displacement Autoclave?

A

Geobacillus stearothermophilus spore testing - At least weekly, preferably daily

693
Q

What is necessary for steam sterilization to be effective?

A

Steam must contact all surfaces of the item.

694
Q

What is the purpose of evacuating air from the chamber during steam sterilization?

A

To ensure steam reaches all surfaces by pushing air down.

695
Q

What should be avoided during steam sterilization?

A

condensation

696
Q

Why is it important to allow airflow between trays during steam sterilization?

A

To facilitate steam penetration.

697
Q

What should be done with sterilized loads immediately after the steam sterilization process?

A

remove immediately

698
Q

What can lead to condensation in steam sterilization?

A

leaving the door ajar to cool after sterilization is complete

699
Q

Where should hot items not be placed after steam sterilization?

A

cold surfaces / racks

700
Q

What happens if condensation is observed on items after steam sterilization?

A

They are unsterile

701
Q

What testing is recommended for a Steam Sterilizer?

A

Geobacillus stearothermophilus spore testing - At least weekly, preferably daily

702
Q

What is Immediate Use Steam Sterilization (IUSS) commonly known as?

A

Flash sterilization

703
Q

What is the purpose of Immediate Use Steam Sterilization (IUSS)?

A

Sterilization for immediate use.

704
Q

What should never be used in IUSS?

A

packaging, wrapped items, and textiles

705
Q

What is essential for lumens in the decontamination process for IUSS?

A

Brushing and flushing

706
Q

What type of chemical indicator must be used for IUSS?

A

Class 5

707
Q

What are the characteristics of Class 1 chemical indicators?

A

only react to heat and are represented by tape

708
Q

What type of containers are used for IUSS?

A

Rigid sterilization containers with a lid.

709
Q

What records must be maintained for IUSS?

A

Sterilization log

710
Q

What temperature and time are used for sterilizing implants in IUSS?

A

270°F for 10 minutes.

711
Q

What is the dry time requirement after IUSS?

A

Minimal or no dry time.

712
Q

When should items sterilized with IUSS be used?

A

ASAP

713
Q

What are the characteristics of Class 2 chemical indicators?

A

only reacts to pressure

714
Q

What are the characteristics of Class 3-4 chemical indicators?

A

reacts to time and temperature

715
Q

What are the characteristics of Class 5-6 chemical indicators?

A

reacts to time, temp, pressure, and steam

716
Q

What is the method of sterilization involving glutaraldehyde?

A

Cold sterilization

717
Q

Where is glutaraldehyde typically used?

A

point of care use only

718
Q

How long does it take for glutaraldehyde to sterilize items through immersion?

A

10 hr

719
Q

What types of materials are suitable for sterilization with glutaraldehyde?

A

plastic & rubber

720
Q

Why is glutaraldehyde considered suboptimal for sterilization?

A

poses environmental problems and is difficult to use

721
Q

What type of items is ethylene oxide used to sterilize?

A

Heat and moisture-sensitive items (cold and dry), specifically instruments

722
Q

How long is the typical exposure time for ethylene oxide sterilization?

A

2-5 hr

723
Q

How long does aeration typically take after ethylene oxide sterilization?

A

8-12 hr

724
Q

What risk is associated with ethylene oxide exposure?

A

human carcinogen

725
Q

What is required for lumens before ethylene oxide sterilization?

A

be completely dry and clean

726
Q

What are the parameters considered in ethylene oxide sterilization?

A

Pressure in the chamber (concentration), exposure time, humidity (moisture), and temperature

727
Q

What testing is recommended for ethylene oxide sterilization?

A

Bacillus atrophaeus spore testing with every load

728
Q

What is the exposure limit for ethylene oxide?

A

1 ppm over an 8-hour day, not exceeding 40 hours per work week

729
Q

Name some examples of items suitable for ethylene oxide sterilization.

A

GI scopes, lensed instruments, delicate instruments, and electrical devices

730
Q

What happens when ethylene oxide is mixed with water?

A

forms antifreeze

731
Q

What is another name for Low Temp Hydrogen Peroxide Plasma Sterilization?

A

Sterrad System

732
Q

For what type of items is Low Temp Hydrogen Peroxide Plasma Sterilization typically used?

A

Heat and moisture-sensitive items when indicated by the manufacturer’s instructions for use (IFU)

733
Q

How does the Sterrad System sterilize items?

A

A vacuum is created, and liquid peroxide is injected, which becomes vapor and kills pathogens

734
Q

Is aeration needed after Low Temp Hydrogen Peroxide Plasma Sterilization?

A

No, it is dry

735
Q

How long does Low Temp Hydrogen Peroxide Plasma Sterilization typically take?

A

75 min

736
Q

How does Low Temp Hydrogen Peroxide Plasma Sterilization impact the environment?

A

environmentally sound

737
Q

What testing is recommended for Low Temp Hydrogen Peroxide Plasma Sterilization?

A

Geobacillus stearothermophilus spore testing at the same interval as other sterilizers in facility (daily)

738
Q

What is another name for Peracetic Acid sterilization?

A

Steris System

739
Q

For what types of items is Peracetic Acid sterilization typically used?

A

Items that can be immersed, such as scopes.

740
Q

How does Peracetic Acid impact instruments and people?

A

It is corrosive

741
Q

What temperature range is typically used for Peracetic Acid sterilization?

A

120-130°F

742
Q

How long does Peracetic Acid sterilization typically take?

A

20-30 min

743
Q

What type of water rinse is typically used after Peracetic Acid sterilization?

A

Micron filtered tap water rinse

744
Q

Where is Peracetic Acid sterilization typically performed?

A

Point of care

745
Q

What testing is recommended for Peracetic Acid?

A

Geobacillus stearothermophilus spore testing daily

746
Q

What temperature should ozone sterilization be?

A

Low

747
Q

For what types of materials is ozone sterilization commonly used?

A

plastic and metal

748
Q

How many manufacturers of ozone sterilization systems are there in the USA?

A

one

749
Q

What regulatory clearance does ozone sterilization have from the FDA?

A

FDA cleared

750
Q

What process does the exhaust of ozone sterilization pass through?

A

Catalytic converter

751
Q

How does ozone impact the environment?

A

environmentally sound

752
Q

What is the aeration time for ozone?

A

none

753
Q

What are the restrictions on the types of devices that can be sterilized with ozone?

A

No sealed glass ampules

754
Q

What testing is recommended for ozone?

A

Geobacillus stearothermophilus spore testing daily

755
Q

Where is dry heat sterilization commonly found?

A

In doctor/dentist offices and tattoo parlors.

756
Q

What is a characteristic of the dry heat sterilization process in terms of duration?

A

Longer compared to others

757
Q

What temperature range is typically associated with dry heat sterilization?

A

high

758
Q

For what types of items is dry heat sterilization best suited?

A

Heat-stable powders and oils.

759
Q

Name some examples of items commonly sterilized using dry heat.

A

Dental instruments, burrs, reusable needles, glass, oil, and foil packages.

760
Q

What type of indicators are required upon installation and after any repair for dry heat sterilization?

A

Bacillus atrophaeus indicators

761
Q

Is tape used in dry heat sterilization?

A

No

762
Q

What is the purpose of disinfection?

A

kill all microorganisms except high numbers of bacterial spores on inanimate objects

762
Q

What testing is recommended for dry heat?

A

Bacillus atrophaeus weekly

763
Q

When is disinfection typically used?

A

non-critical items

764
Q

Name some examples of disinfectants.

A

Glutaraldehyde solutions, phthalaldehyde (ortho), peracetic acid, alcohols, chlorine compounds, hydrogen peroxide, iodine/iodophors, phenolics

765
Q

What is the purpose of pasteurization?

A

kill bacteria but not endospores

766
Q

When is pasteurization typically used?

A

reusable respiratory devices and anesthesia breathing circuits, but not metal instruments

767
Q

What is the objective of decontamination?

A

To remove, inactivate, or destroy bloodborne or other pathogens

768
Q

What is high-level disinfection?

A

process that destroys all microorganisms except spores

769
Q

What items is high-level disinfection used on?

A

Semi-critical

770
Q

What is low-level disinfection effective against?

A

It kills most vegetative bacteria, fungi, and viruses, targeting the least resistant organisms.

771
Q

Define sterility.

A

The absence of all living organisms

772
Q

What is cavitation?

A

process that uses sound waves traveling through water to create gas bubbles, producing a vacuum to rid instruments of debris.

773
Q

What type of medical equipment is considered the highest piece associated with Healthcare-Associated Infections (HAIs)?

A

Endoscopes

774
Q

What procedure is typically performed on endoscopes before cleaning?

A

Leak testing

775
Q

How is an endoscope cleaned?

A

water in the lumen, wiped on the outside

776
Q

What is the timeframe for cleaning an endoscope after use?

A

Within 1 hour or following delayed processing instructions.

777
Q

How should an endoscope be maintained during delay or transport to decontamination?

A

Kept damp/wet but not submerged - do not let dry out

778
Q

What are the storage options for endoscopes after cleaning?

A

In a drying cabinet or positive pressure cabinet with HEPA filter

779
Q

What is the purpose of a Biological Indicator (BI)?

A

To monitor the efficacy of the sterilizer, not the sterility of the item.

780
Q

What should be done with BI loads until results are known?

A

Quarantine

781
Q

What should all implant loads have?

A

Biological indicators

782
Q

What is the purpose of a Chemical Indicator?

A

To immediately verify if a package has been exposed to the sterilization process.

783
Q

What are the two classes of Chemical Indicators and how are they used?

A

Class 1 (tape) is placed externally, while Class 2 (Bowie Dick) is a specialty test.

784
Q

What documentation should be included to trace items from the method of sterilization?

A

Lot control number, load/cycle number, date, and time.

785
Q

What is sterile technique founded in?

A

An individual’s surgical conscience.

786
Q

What is the frequency of Biological Challenge (spore testing) for autoclaves?

A

Daily biological for gravity displacement, daily Bowie Dick for pre-vacuum, and with every implant.

787
Q

What is the purpose of the Bowie Dick test for pre-vacuum autoclaves?

A

To check function, not sterility

788
Q

What is the purpose of the Spaulding Classification?

A

To determine the correct processing method for preparing instruments and other items for use

789
Q

What are critical items?

A

Items introduced into the human body

790
Q

Give an example of a critical item.

A

acupuncture needles

791
Q

What are semi-critical items?

A

Items that come into contact but do not penetrate

792
Q

Give an example of a semi-critical item.

A

bronchoscope, laryngoscope blade

793
Q

What are non-critical items?

A

items that only come into contact with the outside of the skin

794
Q

Give an example of a non-critical item.

A

blood pressure cuff, tourniquet, stethoscope

795
Q

What is a requirement for packaging regarding compatibility with the type of sterilization?

A

It must work with the type of sterilization being used

796
Q

What kind of packaging must be used for items?

A

Packaging must allow for identification of contents

797
Q

Where should count sheets be placed in wrapped sets or rigid containers?

A

outside

798
Q

What should the packaging be free of?

A

Lint, holes, textiles, peel pouches, or rubber mats inside trays.

799
Q

What are the requirements for the storage area where sterile items are kept?

A

It must not exceed 78 degrees and 60% humidity.

800
Q

What should be the condition of instruments inside packaging?

A

Disassembled, open, and unlocked

801
Q

Where should the integrator be placed in the tray?

A

In the corner of the tray, both inside and outside

802
Q

Where should the count sheet be located in relation to the tray?

A

outside

803
Q

How should peel pouches be positioned inside the sterilization chamber?

A

do not stack

804
Q

Which part of the peel pouch should be written on?

A

plastic, not paper

805
Q

What type of items are peel pouches not suitable for?

A

heavy items (drills)

806
Q

What is the requirement for double pouching with peel pouches?

A

inner pouch cannot fold, face the same direction.

807
Q

What characteristics should sharp disposal containers have?

A

Puncture and leak resistant

808
Q

Where should sharp disposal containers be placed?

A

In a recognizable and visible location, in proximity to use

809
Q

When should sharps be removed from the area?

A

Before decontamination

810
Q

What role should perioperative RNs play in sharp disposal?

A

Serve as role models for other team members

811
Q

What practices should perioperative RNs follow regarding sharps precautions?

A

Follow regulations, use PPE, report and treat injuries timely, and adhere to universal precautions for Hepatitis C immunization

812
Q

When can patients with airborne precautions enter the OR?

A

Only in emergency cases

813
Q

What type of mask is worn for airborne precaution?

A

Fit tested N95

814
Q

Who should wear the N95?

A

Both the healthcare provider and the patient if possible

815
Q

Where should intubation take place for patients under airborne precautions?

A

In an isolation room

816
Q

What should be used on the endotracheal tube for patients with airborne precautions during intubation?

A

Bacterial filter

817
Q

What equipment should be used in the OR on a patient with airborne precautions who is not intubated?

A

HEPA filter and PAS-HEPA (antechamber)

818
Q

What should the air exchange be in the OR if a patient is on airborne precautions?

A

Proceed as usual

819
Q

How long should the OR remain empty after a patient with airborne precautions? 

A

28 min

820
Q

What kind of pressure should be in the room for airborne precautions?

A

Positive pressure

821
Q

How are droplets released?

A

Coughing, sneezing, talking

822
Q

What are the PPE guidelines for droplet precautions?

A

Wear PPE within 3 feet of talking

823
Q

What kind of PPE is used for contact precautions?

A

Gown, gloves

824
Q

How are contact precautions maintained during transport?

A

Reverse isolation (patient wears gown)

825
Q

How do you prevent spread of infection with contact precautions?

A

Adequate disinfection and cleaning

826
Q

What are prions?

A

Proteins that self-replicate and are usually fatal

827
Q

What disease is associated with prions?

A

Creutzfeldt-Jakob Disease (CJD)

828
Q

What type of instruments should be used for prion-contaminated procedures?

A

Disposable

829
Q

How should areas contaminated with prions be cleaned?

A

With bleach or lye (sodium hypochlorite, sodium hydroxide)

830
Q

What is the contact time for cleaning prion-contaminated areas with bleach or lye?

A

15 minutes contact time, soak for 1 hour

831
Q

What are the conditions for steam sterilization of prion-contaminated instruments using a pre-vacuum method?

A

18 minutes at 272°F

832
Q

What are the conditions for steam sterilization of prion-contaminated instruments using gravity displacement?

A

60 minutes at 272°F

833
Q

What areas are included in terminal cleaning?

A

restricted and semi-restricted areas in OR, preop, postop, SPD

834
Q

What is the temperature range for unrestricted areas?

A

70-75°F

835
Q

What is the temperature range for semi-restricted areas?

A

72-78°F

836
Q

What is the temperature range for restricted areas?

A

68-75°F

837
Q

What is the temperature range for decontamination areas?

A

60-73°F

838
Q

What is the acceptable humidity range?

A

20-60%

839
Q

Why is controlling humidity important?

A

controls growth of microorganisms and prevents electrostatic discharges

840
Q

What should be done with contaminated instruments and garbage?

A

remove from area

841
Q

What should be used to clean transport vehicles, equipment, and OR furniture?

A

hospital-grade germicidal agent

842
Q

What should be used for mopping the floors?

A

new / freshly laundered mop head

843
Q

What kind of water should be used for mopping the floors?

A

New water that has never been double dipped

844
Q

How should the floors be mopped?

A

OR table and equipment should be moved out of the way
clean to dirty

845
Q

Is there a specific time after which sterility is no longer maintained?

A

No, sterility is event related, not time related

846
Q

What should the air pressure in the OR be relative to the hallway?

A

Greater than in the hallway

847
Q

How should a dirty case be handled in terms of turnover?

A

regular turnover

848
Q

How much space should be between supplies and the ceiling?

A

18 inches

849
Q

Who are the members of the multidisciplinary team?

A

Perioperative RNs, SPD, EVS, infection prevention

850
Q

What are the main responsibilities of the multidisciplinary team?

A

Education and competence, developing / adhering to policies and procedures, quality improvement

851
Q

What should be done if an item touches the floor?

A

Disinfect it before patient use

852
Q

What should be done with items that are difficult to clean?

A

use a barrier / cover

853
Q

Why are insects / vermin a concern in clinical environments?

A

carry pathogens and antibiotic resistance

854
Q

What cleaning should be done prior to the first case of the day?

A

Damp dust horizontal surfaces

855
Q

What happens the longer MDROs stay in the environment?

A

Become more difficult to control, increased morbidity / mortality

856
Q

What are some common MDROs?

A

MRSA, VRE, VRSA, C-Diff, Klebsiella, ESBL, CRE

857
Q

Where is central venous pressure measured?

A

Right atrium

858
Q

What is the normal range of central venous pressure?

A

4-8 mmHg

859
Q

What conditions can cause low central venous pressure?

A

hemorrhage, venous pooling, dehydration

860
Q

What conditions can cause high central venous pressure?

A

pulmonary HTN, pulmonary edema, right ventricular failure

861
Q

What is the normal range for cardiac output measured by a Swan-Ganz catheter?

A

4-8 L/min

862
Q

What is the normal range for right atrial pressure measured by a Swan-Ganz catheter?

A

4-8mmHg

863
Q

What are normal pulmonary artery pressures?

A

1/3 of systemic pressures

864
Q

What is the normal range for pulmonary artery wedge pressure?

A

4-12 mmHg

865
Q

What additional measurement can a Swan-Ganz catheter provide?

A

Core temp

866
Q

What does a high pulmonary artery wedge pressure indicate?

A

left heart failure

867
Q

What are potential risks associated with using a Swan-Ganz catheter?

A

Microshock and arrhythmias

868
Q

What is the purpose of an arterial line?

A

continuous monitoring of BP

869
Q

What drugs is an arterial line needed for and why?

A

Hemodynamic drugs because they require tight control (nitroprusside)

870
Q

Which artery is most commonly used for arterial line insertion?

A

Radial

871
Q

What test should be performed before a-line insertion, and what does it assess?

A

Allen test ensures adequate hand perfusion

872
Q

Who is at an increased risk for a latex allergy?

A

Healthcare workers

873
Q

What are risks associated with latex allergies?

A

Prolonged exposure throughout career and cross-reactivity with allergies to banana & kiwi

874
Q

What are signs/symptoms of a latex allergy?

A

Nausea, abdominal pain, tachycardia, hives, shortness of breath, hypotension, fainting

875
Q

What is the Self-Determination Act?

A

Gives patient right to choose not to be treated for emergent event secondary to normal anesthesia during surgery

876
Q

What other rights are included in the Self-Determination Act?

A

informed consent, living will, POA, DNR, organ procurement

877
Q

What is a surgical conscience?

A

Willingness to be held liable for one’s own actions in providing care to a patient

878
Q

When should sensory items (eyeglasses, hearing aids) be taken from the patient?

A

Start of anesthesia

879
Q

What are signs of shock?

A

cool / clammy skin, anaphylaxis, pale / cyanotic skin, hypotension, tachycardia, tachypnea, N/V, hypovolemia

880
Q

What is an Andrew’s table used for?

A

modified knee/chest position in prone
Resembles letter “Z”

881
Q

What is counted in sets of 5?

A

laps, tonsil sponges, peanuts

882
Q

When are counts performed during a c-section?

A

Initial: beginning
Second: prior to uterine closure

883
Q

How much blood loss is considered minor?

A

500-700mL

884
Q

How much blood loss is considered moderate?

A

750-1500mL

885
Q

How much blood loss is considered major?

A

1500-2250mL

886
Q

How much blood loss is considered catastrophic?

A

> 2250mL

887
Q

What are the components of the fire triangle?

A

fuel, oxidizer, ignition source

888
Q

What should be done if the ETT catches fire?

A

ensure airway safety
extubate patient
turn off gas

889
Q

What are examples of laser precautions?

A

Safety glasses for staff and patient, laser safe ETT, smoke evacuator

890
Q

What is a sentinel event?

A

Unexpected event causing harm / risk of harm to patient

891
Q

What is an important characteristic of a surgical gown?

A

impervious to fluids

892
Q

How can patients be protected from radiation?

A

place lead shielding under patient

893
Q

Who regulates radiation exposure limits?

A

OSHA

894
Q

Give examples of ionizing radiation sources.

A

portable x-ray, portable c-arm

895
Q

Give an example of non-ionizing radiation sources.

A

laser

896
Q

What is the purpose of a vasovasostomy?

A

vasectomy reversal

897
Q

What equipment is needed for a vasovasostomy?

A

microscope

898
Q

What risk should be watched for during a long bone fracture/surgery?

A

fat embolism

899
Q

Why is continuous bladder irrigation used during a transurethral resection of the prostate?

A

prevent clots in bladder

900
Q

What is the treatment for narrow angle glaucoma?

A

peripheral iridotomy (laser) to decrease IOP

901
Q

What caution should be taken with a spica cast?

A

diminish pressure on the fibular head

902
Q

What is a complication of a spica cast?

A

peroneal nerve palsy

903
Q

What arteries are involved in a carotid endartectomy?

A

external carotid artery, internal carotid artery, and common carotid artery

904
Q

When do superficial infections typically occur post surgery?

A

within 30 days

905
Q

What causes conduction heat loss?

A

physical contact

906
Q

How can conduction heat loss be prevented or countered?

A

using a warming blanket on the patient

907
Q

What causes convection heat loss?

A

air currents

908
Q

How can convection heat loss be prevented or countered?

A

Minimizing drafts and maintaining a warm environment

909
Q

What causes radiation heat loss?

A

ambient temperature, no physical contact

910
Q

How can radiation heat loss be prevented or countered?

A

Turning up the room temperature to keep the environment warmer

911
Q

What is Root Cause Analysis (RCA)?

A

tool used to understand areas for improvement

912
Q

How does Root Cause Analysis (RCA) differentiate between issues?

A

distinguishes between patient safety issues and system-level concerns

913
Q

What nursing actions are included in a handoff?

A

patient information, diagnosis, treatment plan, patient condition, medications, ongoing needs

914
Q

What is excluded from a nursing handoff?

A

anesthesia related report

915
Q

What is Ventricular Bigeminy?

A

PVCs occurring every other beat

916
Q

What does PVC stand for?

A

Premature Ventricular Contractions

917
Q

What is the treatment for Ventricular Fibrillation (v-fib)?

A

Defibrillation

918
Q

What is Asystole characterized by?

A

Sudden cessation of cardiac activity

919
Q

What are the immediate interventions for asystole?

A

CPR, epinephrine, and vasopressin administration

920
Q

What is the management approach for 3rd Degree Heart Block?

A

Stabilization with temporary pacing

921
Q

What is the recommended first-line treatment for cardiac emergencies?

A

Amiodarone or lidocaine

922
Q

What is Virchow’s Triad?

A

set of factors contributing to the formation of deep vein thrombosis

923
Q

What are the components of Virchow’s triad?

A

hypercoagulation, blood stasis, and endothelial injury

924
Q

How far in advance should an inservice be provided before the introduction of new instrumentation?

A

2 weeks

925
Q

What is stress urinary incontinence characterized by?

A

Leakage of urine due to pressure on the bladder, such as during coughing, sneezing, or exercise

926
Q

What is urge urinary incontinence defined as?

A

Sudden and intense need to urinate, often resulting in involuntary urine loss

927
Q

What is overflow urinary incontinence characterized by?

A

Incomplete emptying of the bladder, leading to continual leakage or dribbling of urine

928
Q

Describe functional urinary incontinence

A

Incontinence resulting from physical or mental impairment, where the individual may have difficulty reaching the bathroom in time

929
Q

What is mixed urinary incontinence?

A

simultaneous occurrence of stress and urge urinary incontinence

930
Q

Where is the sterile field of a sterile gown?

A

chest to the level of the field, with sleeves from 2 inches above the elbows to the cuffs

931
Q

What does the Aldrete Score evaluate?

A

Recovery after anesthesia and readiness for discharge from the Post-Anesthesia Care Unit (PACU)

932
Q

Define malpractice

A

Negligence by a professional in the performance of a professional act that results in patient injury

933
Q

What are the elements of malpractice?

A

Duty, breach of duty, causation, and damages

934
Q

Which suture has the highest tensile strength?

A

2-0 vicryl

935
Q

What is the role of The Joint Commission?

A

regulatory agency responsible for surveying facilities’ compliance with the universal protocol

936
Q

What are the signs and symptoms of hypothermia?

A

Shivering, impaired speech, cyanosis, muscle rigidity, dizziness, and hypotension

937
Q

What methods test for Geobacillus Stearothermophilus?

A

steam (gravity displacement/dynamic air), plasma (hydrogen peroxide), ozone, and peracetic acid

938
Q

How is Bacillus Atrophaeus tested?

A

ethylene oxide and dry heat

939
Q

What action should be taken if BUN/Creatinine levels are elevated?

A

Avoid using aminoglycosides/glycopeptides due to their nephrotoxic effects

940
Q

What items are included in the WHO Checklist?

A

Patient identity, procedure, laterality/procedure, relevant images, implants, equipment concerns, anticipated critical events, antibiotics, and confirmed sterilization indicators

941
Q
A

CNOR (1 decks)

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