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Perioperative Nursing > Exam # 1 Intra-Operative & Post Anesthesia Phases > Flashcards

Exam # 1 Intra-Operative & Post Anesthesia Phases Flashcards

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0
Q

(T/F) Laryngospasms can occur from intubation?

A

True

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1
Q

What are the 4 important points to remember about the “Surgical Suite”?

A

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

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2
Q

What the difference between Induction and Immersion?

A

1) Induction - Sedation for surgery

2) Immersion - Waking up from surgery

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3
Q

List the 7 different roles generally involved in the OR room.

A

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

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4
Q

In which 4 surgical situations is general anesthesia typically used?

A

Procedures requiring:

1) Significant skeletal muscle relaxation
2) Long periods of time
3) Awkward positions
4) Procedures with extremely anxious patients

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5
Q

What are the 3 phases of general anesthesia?

A

1) Induction
2) Maintenance
3) Immersion

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6
Q

What are the 5 general purposes of general anesthesia?

A

1) Loss of sensation
2) Analgesia
3) Amnesia
4) LOC
5) Muscle relaxation

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7
Q

What are the characteristics of Local Anesthesia?

A

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

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8
Q

What are the effects of Local Anesthesia?

A

1) Autonomic Nervous System blockade
2) Skeletal muscle paralysis
3) Discomfort, hypotension and seizures

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9
Q

What is Regional Anesthesia? Give 2 examples.

A

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

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10
Q

What is the difference between a Spinal and an Epidural?

A

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).

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11
Q

Why does Spinal Anesthesia carry a risk of headache (especially when you sit up)?

A

Because of the loss of CSF

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12
Q

How is the type of anesthesia used in a surgery determined?

A

By the type of procedure and the patient’s complexity (how sick is the patient)

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13
Q

Spinal Anesthesia is usually injected in between which two lumbar vertebrae?

A

Between L4 and L5

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14
Q

Define Moderate Sedation

A

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).

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15
Q

What are the 3 characteristics of Moderate Sedation?

A

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

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16
Q

Describe Malignant Hyperthermia. What are the characteristics of this disorder?

A

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

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17
Q

Explain the physiology of Malignant Hyperthermia

A

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.

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18
Q

Besides the anesthetic gases halothane and succinylcholine, what 3 other things could cause Malignant Hyperthermia?

A

1) Trauma
2) Heat
3) Stress

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19
Q

What are the 6 SxS of Malignant Hyperthermia?

A

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)

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20
Q

What is the function of myoglobin?

A

Myoglobin stores/carries oxygen in the muscle (same as what hemoglobin does in the blood).

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21
Q

What 6 methods are used to treat and manage Malignant Hyperthermia in the PACU?

A

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

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22
Q

What are the steps for treating Malignant Hyperthermia treated on the floor?

A

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

23
Q

What are the methods used to promote a “Bloodless Surgery”?

A

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

24
Q

What are the 3 important goals of the post-operative period?

A

1) Maintain oxygenation and pain control
2) Preventing complications while the body repairs
3) Protecting the patient

25
Q

What are the 6 impending and imperative tasks to be performed by the PACU nurse when receiving a patient from surgery?

A

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

26
Q

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?

A

1) It aids in the elimination of the anesthetic agent

2) It meets ⬆ O2 demands from blood loss or increased metabolism

27
Q

(T/F) A neuro assessment in the PACU begins with LOC even though most patients will be asleep.

A

True

28
Q

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?

A

No, (4.5 x 30 = 135) the patient should have had a minimum of at least 135 mL by now.

29
Q

Which of the senses is the first to return to the patient post-op?

A

Hearing

30
Q

Give 6 examples of patients who are at particular risk for potential alterations in respiration post-op.

A

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

31
Q

What are the 6 potential problems in the post-op period that can occur in the respiratory system?

A

1) Airway obstruction
2) Hypoventilation
3) Aspiration of vomitus
4) Atelectasis
5) Pneumonia
6) Hypoxemia

32
Q

Airway obstruction in a post-op patient can be caused by which 6 factors?

A

1) Blockage of airway by patient’s tongue
2) Supine position
3) Extremely sleepy patient
4) Laryngospasms
5) Retained secretions
6) Larygeal edema

33
Q

When a patient’s tongue is occluding his or her airway, what is the proper intervention?

A

Manual elevation of the mandible (as in CPR) will clear the tongue from the airway.

34
Q

What is the difference between Hypoxemia and Hypoxia?

A

1) Hypoxemia - ⬇ Oxygen in the blood

2) Hypoxia - ⬇ Oxygen in the tissues

35
Q

What is the best diagnosis of Hypoxemia?

A

Arterial Blood Gas levels

36
Q

What is the most common cause of postoperative Atelectasis and what is the appropriate intervention to prevent it?

A

Atelectasis, which may result from bronchial obstruction from retained secretions or decreased respiratory excursion.
Tell patient to breathe deeply to prevent alveolar collapse

37
Q

What are the 3 characteristics of post-op pulmonary edema?

A

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)

38
Q

What are 6 symptoms of a patient aspirating from gastric contents?

A

1) Bronchospasms
2) Atelectasis
3) Alveolar hemorrhage
4) Hypoxemia
5) Interstitial edema
6) Respiratory failure

39
Q

Explain the physiology of Bronchospasms

A

Bronchospasms result from an increase in bronchial smooth muscle tone with resultant closure of the small airways. Edema develops, causing secretions to build up.

40
Q

What are the 5 SxS of Bronchospasms?

A

1) Wheezing
2) Dyspnea
3) Use of accessory muscles
4) Hypoxemia
5) Tachypnea

41
Q

What can cause post-op Hypoventilation and what are the 3 SxS?

A

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

42
Q

How should breath sounds be properly auscultation.

A

Anteriorly, laterally, and posteriorly

43
Q

How will you evaluate airway patency in your patient?

A

1) Check chest symmetry

2) Check depth, rate, and character of or respirations

44
Q

What are the 6 SxS of Hypoxemia?

A

1) Tachypnea
2) Gasping
3) Apprehension
4) Restlessness, agitation, and confusion
5) Rapid/thready pulse
6) PaO2 less than 60mm Hg

45
Q

Describe the difference between trachea sputum and lung sputum.

A

1) Trachea Sputum - Clear and thin

2) Lung Sputum - Green/yellow and thick

46
Q

In what position should you place a conscious patient? An unconscious patient?

A

1) Conscious Patient - Low Fowler’s (30-45 degrees)

2) Unconscious Patient - Side laying

47
Q

What are the 5 most common causes of post-op Hypotension?

A

1) Blood loss from surgery
2) Drugs administered
3) Dysrhythmias
4) ⬇ Low systemic vascular resistance
5) Incorrect cuff

48
Q

What are the 3 most common causes of post-op Hypertension?

A

1) Urinary retention & bladder distention
2) Pain, stress and anxiety
3) Respiratory compromise

49
Q

What are the 5 most common causes of post-op Dysrhythmias?

A

1) Potassium imbalance
2) pH change
3) Hypoxemia
4) Hypercapnia
5) Circulatory imbalance

50
Q

What 4 assessment will you perform to check for post-op cardiovascular complications?

A

1) Labs
2) O2
3) Vitals
4) Skin color, temperature and moisture

51
Q

What are the 3 Adrenal surgical responses to stress?

A

1) ⬆ Aldosterone - ⬆K and ⬆ Na
2) ⬆ Cortisol - ⬆ Glucose and ⬆ anti-inflammatory
3) ⬆ Norepinephrine and Epinephrine - Vasoconstriction

52
Q

What is the Brain’s surgical responses to stress?

A

⬆ ADH - ⬆ H2O

53
Q

What are the Pancreatic and GI surgical responses to stress?

A

1) Pancreas - ⬆ Glucagon leading to ⬆ glucose

2) GI - ⬆ Gastric acid and ⬇ peristalsis

54
Q

What is the significance of a narrowing pulse pressure?

A

1) A narrowing pulse pressure is a sign of hemorrhage or blood loss and can lead to shock.

55
Q

What are the 5 components of an Aldrete Score?

A

1) Circulation
2) Consciousness
3) Color
4) Respiration
5) Activity

56
Q

What Aldrete score qualifies a patient for discharge?

A

A score of 8-10

Perioperative Nursing (5 decks)

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