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P&P Fall 2019 > Ex3 Positioning > Flashcards

Ex3 Positioning Flashcards

1
Q

Biggest problem with position changes

A

Hypotension

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2
Q

What must be checked after head, neck, whole body is moved?

A

Breath sounds
- also document
if breath sounds in R>L, pull tube back (it is in mainstem)

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3
Q

Before prone, what should always be checked?

A

PIP, shape of ETCO2, breath sounds

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4
Q

Supine - where should focus be on arms?

A

Olecranon - must be padded

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5
Q

Supine - how should arms be positioned

A

Supinated (back of hand down, arm with hand up)

NOT proned

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6
Q

Physiologic changes with supine position

A

Decreased FRC (20%), pulm compliance
Gravity increases to zone III
Compression of IVC

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7
Q

What should never be used in trendelenberg position?

A

Shoulder brace (d/t brachial plexus injury)

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8
Q

Who should never be placed in trendelenberg?

A

Increased ICP patients

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9
Q

Prone position - head monitoring

A

Maintain cervical spine in neutral position

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10
Q

Prone - arm positioning

A

Avoid extending above shoulders (brachial plexus injury)

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11
Q

Physiologic changes - lateral decubitus (ventilated, anesthetized patient)

A

Perfusion - gravity dependent

Ventilation - favors non dependent lung

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12
Q

What is always going to occur in lateral decubitus position (ventilated patient)?

A

V/Q mismatch = decreased PaO2

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13
Q

Awake, spontaneous patient in lateral decubitus

A

Only change = blood flow/ventilation in dependent lung are greater than non dependent lung
NO V/Q MISMATCH

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14
Q

Mnemonic for nerve damage in lithotomy position

A

FOPSS

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15
Q

FOPSS

A 
Femoral
Obturator 
Peroneal 
Saphenous 
Sciatic

(nerves at risk for damage in lithotomy position)

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16
Q

F in FOPSS

A

Femoral nerve: stretched by excessive angulation of thigh

—> FRONT

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17
Q

O in FOPSS

A

Obturator Nerve - stretched by excessive flexion of thigh to groin
*** confirm position????

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18
Q

P in FOPSS

A

Peroneal (common) nerve: compression of LATERAL aspect of legs at head of fibula against stirrup

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19
Q

S in FOPSS

A

Saphenous Nerve - compression of MEDIAL aspect of legs against stirrup supports

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20
Q

2nd S in FOPSS

A

Sciatic nerve - stretched by excessive external rotation of leg when placing pt in lithotomy position
(In the BACK)

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21
Q

Biggest risk of sitting position

A

VAE (venous air embolism)

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22
Q

How to counteract risks in sitting

A

Venodynes, TEDS

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23
Q

Radial nerve - how is it injured?

A

Compression against underlying humerus when lateral upper arm is compressed on table

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24
Q

Result of radial nerve injury

A
  • inability to extend wrist, abduct thumb
  • wrist drop
  • decreased sensation over dorsal surface of later 3.5 fingers (thumb->half ring finger)
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25
Q

Cause of ulnar nerve injury

A

Compression between medial epicondyle of humerus —> sharp edge of bed/head frame

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26
Q

Result of ulnar nerve injury

A

Sensory loss in 5th digit (pinky)

“Claw hand”

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27
Q

Where would claw hand be seen?

A

Ulnar nerve injury

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28
Q

Cause of median nerve injury

A

Indiscriminate probing (fishing) in AC fossa during IV placement

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29
Q

Result of median nerve injury

A
  • loss of sensation of finger tips from thumb to mid-point of ring finger
  • inability to oppose 1st/5th digits
  • decreased sensation on palmar surface of lateral 3.5 fingers
30
Q

Cause of sciatic nerve injury

A
  • sitting: pressure on ischial tuberosity
  • lithotomy: thigh/nerves externally rotated, knees extended
  • excessive hip flexion =nerve stretch
  • IM injection
31
Q

Result of sciatic nerve injury

A
  • weakness of all muscles below knee/diminished sensation over lateral 1/2 of leg/all of foot
  • foot drop
  • pain/numbness of lower leg/thigh/foot
32
Q

Candy Cane Stirrups cause damage from what?

A

Lateral thighs hyperflexed

33
Q

Physiologic changes in Supine - obese/pregnant

A

compression of IVC

34
Q

Awake vs anesthetized pt in supine

A

Awake - SNS can compensate

Blood flow = gravity

35
Q

Physiologic changes in Supine position

A 
Decreased - FRC, pulm compliance
Increased - blood flow to Lung ZoneIII
Cephaled shift of abd
Minimal CVS changes 
Pressure on occiput
36
Q

If shoulder braces are used, where should they be placed?

A

NOT near neck (compression of brachial plexus)

37
Q

Physiologic changes in Trendelenberg Position

A

Same as supine except –> increased cerebral circulation
Increased: CBF, venous pressure
Decreased: FRC, pulm compliance

38
Q

Greatest decline in FRC is in which position?

A

Trendelenberg

39
Q

Jack Knife position

A

prone + kneeling

40
Q

Physiologic changes in prone position

A

Increased: ventilation, venous return
Decreased: intrathoracic/vena cava/abd pressure

41
Q

Best for Prone position

A
  1. Jackson Table
  2. Wilson Frame
  3. 2 padded chest rolls from shoulder –> hips
42
Q

Ideal face position in prone

A

face down in doughnut/Mayfield

43
Q

V/Q in proning

A

optimal matching

44
Q

Avoid what in proning?

A
  • pressure on facial nerve/any pendulous soft tissue
  • extending arms above shoulders
  • turning head to the side
45
Q

Turning head to the side in prone position - Risk

A

paralysis

obstruction of jugular venous/vert. artery flow

46
Q

Kidney rest position

A

lateral decub with flexion at iliac crest

47
Q

Lateral Decub - head injury presents as

A

Horner’s Syndrome – nerve damage

48
Q

Lateral Decub - monitor

A

distal circulation of dependent arm frequently to avoid compression of axillary artery

49
Q

Best for non-dependent arm in Lateral Decub

A

Mayo Stand

50
Q

V/Q effect in Lateral Decubitus Position

A

V/Q mismatch – decreased PaO2

*only in anesthetized/MV patients

51
Q

Lateral decub - effects on lungs

A

perfusion favors dependent lung
ventilation favors nondependent lung
(decreased compliance in dep lung)

52
Q

Compartment syndrome is most common in which position?

A

Lithotomy

53
Q

Increased risk of compartment syndrome if

A

time > 2-3h
Obesity
Hypoperfusion

54
Q

Trendelenberg +Lithotomy position can result in

A

atelectasis (dec lung volume 20% d/t abd pressure)

55
Q

Femoral nerve damage can be reduced by

A

avoiding hip flexion > 90d

excessive angulation of thigh

56
Q

Femoral nerve damage results in

A

absent knee jerk, decreased sensation in thigh

57
Q

Obturator nerve damage can be reduced by

A

avoiding excessive flexion of thigh

avoiding forceps delivery

58
Q

Obturator nerve damage results in

A

unable to adduct leg

decreased sensation in medial thigh

59
Q

most common nerve damage in lithotomy position

A

peroneal

60
Q

Peroneal nerve damage can be reduced by

A

avoid candy cane stirrups

padding lateral aspect of fibula

61
Q

Result of peroneal nerve damage

A

Foot drop, unable to evert foot/dorsal extend toes

62
Q

How to reduce saphenous nerve damage

A

pad medial side of knee

63
Q

result of saphenous nerve damage

A

decreased sensation of anteromedial leg

64
Q

how to reduce sciatic nerve damage

A

avoid excessive external rotation of leg/flex hip, pad butt

65
Q

result of sciatic nerve damage

A

weak below knee
dec. sensation in lateral leg/all foot
foot drop
pain/numb in lower leg/thigh, foot

66
Q

Nerves which damage causes foot drop

A

Sciatic

Peroneal

67
Q

Most common nerve injured

A

ulnar

68
Q

Nerve injury d/t IV AC attempt, carpal tunnel

A

Median

69
Q

Nerve damage results in wrist drop

A

Radial Nerve

70
Q

Weak arm function d/t _____ nerve injury

A

Brachial plexus

P&P Fall 2019 (17 decks)

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