Exam # 1 Intra-Operative & Post Anesthesia Phases Flashcards
(T/F) Laryngospasms can occur from intubation?
True
What are the 4 important points to remember about the “Surgical Suite”?
1) It includes various restricted areas
2) It flows to prevent cross contamination
3) It has a positive air pressure
4) It has restricted inflow and outflow of personnel
What the difference between Induction and Immersion?
1) Induction - Sedation for surgery
2) Immersion - Waking up from surgery
List the 7 different roles generally involved in the OR room.
1) Circulating Nurse - Masked but not sterile like the scrub nurse
2) Scrub Nurse - Counts surgical sponges and equipment
3) Perioperative Nurse
4) Anesthesiologist/CRNA
5) Surgeon
6) Patient
7) First Assistant - Usually a RNFA or PA
In which 4 surgical situations is general anesthesia typically used?
Procedures requiring:
1) Significant skeletal muscle relaxation
2) Long periods of time
3) Awkward positions
4) Procedures with extremely anxious patients
What are the 3 phases of general anesthesia?
1) Induction
2) Maintenance
3) Immersion
What are the 5 general purposes of general anesthesia?
1) Loss of sensation
2) Analgesia
3) Amnesia
4) LOC
5) Muscle relaxation
What are the characteristics of Local Anesthesia?
1) Produces loss of sensation without LOC
2) Can be administered topically, SQ, or intracutaneously (Intradermal)
3) Little systemic absorption leading to rapid recovery and little hangover
What are the effects of Local Anesthesia?
1) Autonomic Nervous System blockade
2) Skeletal muscle paralysis
3) Discomfort, hypotension and seizures
What is Regional Anesthesia? Give 2 examples.
Regional Anesthesia - Anesthesia where the patient remains awake but loses sensation and has an absence of pain in a particular body region. I.e.,
1) Spinal
2) Epidural
What is the difference between a Spinal and an Epidural?
1) Spinal - Includes sensation loss and paralysis from umbilicus to the toes. It is injected into the subarachnoid space (CSF) below the L2 and HOB must be flattened as a spinal precaution.
2) Epidural - Includes a sensation loss from the waist to the thighs. It is injected into the epidural space (does not enter CSF).
Why does Spinal Anesthesia carry a risk of headache (especially when you sit up)?
Because of the loss of CSF
How is the type of anesthesia used in a surgery determined?
By the type of procedure and the patient’s complexity (how sick is the patient)
Spinal Anesthesia is usually injected in between which two lumbar vertebrae?
Between L4 and L5
Define Moderate Sedation
Moderate Sedation is also known as “Conscious” or “MAC Sedation. It is a state of drug-induced depression of consciousness caused by administering a combination of anxiolytics (i.e.,versed) and opioids (i.e., fentanyl).
What are the 3 characteristics of Moderate Sedation?
1) The patient maintains their own airway but still achieves pain control
2) Provides analgesia, relieves anxiety, and/or amnesia
3) Patient can still respond to physical or verbal stimuli
Describe Malignant Hyperthermia. What are the characteristics of this disorder?
Malignant Hyperthermia is a rare metabolic disease characterized by extreme hyperthermia and rigidity of the muscles when anesthetic gases (especially halothane & succinylcholine) are administered. Characteristics include:
1) Affects genetically susceptible patients
2) Occurs anytime from anesthesia induction up to 24 hrs post-op
3) Can result in death
Explain the physiology of Malignant Hyperthermia
A spike in Calcium leads ⬆ metabolism which leads to ⬆ temperature which leads to ⬆ lactic acid which leads to ⬆ metabolic acidosis which leads to death if not treated.
Besides the anesthetic gases halothane and succinylcholine, what 3 other things could cause Malignant Hyperthermia?
1) Trauma
2) Heat
3) Stress
What are the 6 SxS of Malignant Hyperthermia?
1) Rapid onset on a high temperature (110 F and can rise 1-2 degrees every 5 mins).
2) Muscle rigidity (Jaw tightening)
3) ⬆ CO2 and ⬇ CO
4) Tachypnea & Tachycardia
5) Oliguria
6) Dark brown urine (myoglobinuria)
What is the function of myoglobin?
Myoglobin stores/carries oxygen in the muscle (same as what hemoglobin does in the blood).
What 6 methods are used to treat and manage Malignant Hyperthermia in the PACU?
1) Reconstitute an administer Dantrolene in large doses (20 vials given by 2 RNs via 2 IV lines).
2) Treat arrhythmias with IV meds
3) Obtain ABGs and serum potassium
4) Give 100% oxygen
5) ⬇ Temperature using ice bags the groin and armpits
6) Maintain urinary output
What are the steps for treating Malignant Hyperthermia treated on the floor?
1) Call for help (code situation)
2) Start icing the patient
3) Start second IV line
4) Administer O2 with non-rebreather mask
5) Transfer patient to ICU
What are the methods used to promote a “Bloodless Surgery”?
1) Hemodilution
2) ⬇ temperature (cold temp causes ⬆ platelet aggregation)
3) Cell saver - Reuse patients blood
4) Maximize blood production using FeSO4, EPO, and Vitamin K
5) Use other blood components such as plasma proteins and fibrinogen
What are the 3 important goals of the post-operative period?
1) Maintain oxygenation and pain control
2) Preventing complications while the body repairs
3) Protecting the patient
What are the 6 impending and imperative tasks to be performed by the PACU nurse when receiving a patient from surgery?
1) Assess the patients airway and apply O2
2) Connect to a cardiac monitor
3) Take VS
4) Attach to SaO2 monitor
5) Receive report from the OR nurse and Anesthesiologist
6) Assess drains, dressings, lines and tubings
When a patient is newly admitted to the PACU, a full head-to-toe assessment is performed and oxygen therapy (if general Anesthesia was used or if the Anesthegiologist orders) is administered. What is the benefit of the oxygen therapy to a post surgical patient?
1) It aids in the elimination of the anesthetic agent
2) It meets ⬆ O2 demands from blood loss or increased metabolism
(T/F) A neuro assessment in the PACU begins with LOC even though most patients will be asleep.
True
The patient should be outputting at least 30 mL/hr post-op. Is it ok if the patient has a total urinary output of 69 mL for the past 4 and a half hours since she has been out of surgery?
No, (4.5 x 30 = 135) the patient should have had a minimum of at least 135 mL by now.
Which of the senses is the first to return to the patient post-op?
Hearing
Give 6 examples of patients who are at particular risk for potential alterations in respiration post-op.
1) Patients who receive general anesthesia
2) Older patients
3) Smokers
4) Patients with lung disease
5) Obese patients
6) Patients undergoing thoracic, airway, or abdominal surgery
What are the 6 potential problems in the post-op period that can occur in the respiratory system?
1) Airway obstruction
2) Hypoventilation
3) Aspiration of vomitus
4) Atelectasis
5) Pneumonia
6) Hypoxemia
Airway obstruction in a post-op patient can be caused by which 6 factors?
1) Blockage of airway by patient’s tongue
2) Supine position
3) Extremely sleepy patient
4) Laryngospasms
5) Retained secretions
6) Larygeal edema
When a patient’s tongue is occluding his or her airway, what is the proper intervention?
Manual elevation of the mandible (as in CPR) will clear the tongue from the airway.
What is the difference between Hypoxemia and Hypoxia?
1) Hypoxemia - ⬇ Oxygen in the blood
2) Hypoxia - ⬇ Oxygen in the tissues
What is the best diagnosis of Hypoxemia?
Arterial Blood Gas levels
What is the most common cause of postoperative Atelectasis and what is the appropriate intervention to prevent it?
Atelectasis, which may result from bronchial obstruction from retained secretions or decreased respiratory excursion.
Tell patient to breathe deeply to prevent alveolar collapse
What are the 3 characteristics of post-op pulmonary edema?
1) Caused by an accumulation of fluid in the alveoli
2) Can result from fluid overload, left ventricular failure, prolonged airway obstruction, sepsis, or aspiration.
3) Characterized by crackles, infiltrates on x-ray, and ⬇ compliance (ability of lungs to expand and contract)
What are 6 symptoms of a patient aspirating from gastric contents?
1) Bronchospasms
2) Atelectasis
3) Alveolar hemorrhage
4) Hypoxemia
5) Interstitial edema
6) Respiratory failure
Explain the physiology of Bronchospasms
Bronchospasms result from an increase in bronchial smooth muscle tone with resultant closure of the small airways. Edema develops, causing secretions to build up.
What are the 5 SxS of Bronchospasms?
1) Wheezing
2) Dyspnea
3) Use of accessory muscles
4) Hypoxemia
5) Tachypnea
What can cause post-op Hypoventilation and what are the 3 SxS?
Post-op Hypoventilation may occur from depression of the central respiratory drive and/or poor respiratory muscle tone. SxS include:
1) ⬇ rate or effort of breathing
2) Hypoxemia
3) ⬆ PaCO2
How should breath sounds be properly auscultation.
Anteriorly, laterally, and posteriorly
How will you evaluate airway patency in your patient?
1) Check chest symmetry
2) Check depth, rate, and character of or respirations
What are the 6 SxS of Hypoxemia?
1) Tachypnea
2) Gasping
3) Apprehension
4) Restlessness, agitation, and confusion
5) Rapid/thready pulse
6) PaO2 less than 60mm Hg
Describe the difference between trachea sputum and lung sputum.
1) Trachea Sputum - Clear and thin
2) Lung Sputum - Green/yellow and thick
In what position should you place a conscious patient? An unconscious patient?
1) Conscious Patient - Low Fowler’s (30-45 degrees)
2) Unconscious Patient - Side laying
What are the 5 most common causes of post-op Hypotension?
1) Blood loss from surgery
2) Drugs administered
3) Dysrhythmias
4) ⬇ Low systemic vascular resistance
5) Incorrect cuff
What are the 3 most common causes of post-op Hypertension?
1) Urinary retention & bladder distention
2) Pain, stress and anxiety
3) Respiratory compromise
What are the 5 most common causes of post-op Dysrhythmias?
1) Potassium imbalance
2) pH change
3) Hypoxemia
4) Hypercapnia
5) Circulatory imbalance
What 4 assessment will you perform to check for post-op cardiovascular complications?
1) Labs
2) O2
3) Vitals
4) Skin color, temperature and moisture
What are the 3 Adrenal surgical responses to stress?
1) ⬆ Aldosterone - ⬆K and ⬆ Na
2) ⬆ Cortisol - ⬆ Glucose and ⬆ anti-inflammatory
3) ⬆ Norepinephrine and Epinephrine - Vasoconstriction
What is the Brain’s surgical responses to stress?
⬆ ADH - ⬆ H2O
What are the Pancreatic and GI surgical responses to stress?
1) Pancreas - ⬆ Glucagon leading to ⬆ glucose
2) GI - ⬆ Gastric acid and ⬇ peristalsis
What is the significance of a narrowing pulse pressure?
1) A narrowing pulse pressure is a sign of hemorrhage or blood loss and can lead to shock.
What are the 5 components of an Aldrete Score?
1) Circulation
2) Consciousness
3) Color
4) Respiration
5) Activity
What Aldrete score qualifies a patient for discharge?
A score of 8-10
