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Exam 2 (PACU Management) Flashcards

1
Q
  • What is PACU standard #1?
A

All Pt’s shall receive appropriate PACU care

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2
Q
  • What is PACU standard #2?
A

Pt must be monitored & transported by anesthesia member

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3
Q
  • What is PACU standard #3?
A

Pt must be reevaluated in PACU and verbal report must be given

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4
Q
  • What is PACU standard #4?
A

Pt’s status must be continuously evaluated in PACU

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5
Q
  • What is PACU standard #5?
A

An MD is responsible for discharge from PACU

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6
Q
  • How long does a Pt have to stay in PACU phase 1?
A
  • 30mins
  • q5min VS for first 15mins
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7
Q
  • What Aldrete score does a Pt need to pass on from PACU?
A

8-9

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8
Q
  • What are the parts of the Standard Aldrete Score?
A
  • Activity,
  • respirations
  • circulation,
  • consciousness,
  • O2 saturation
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9
Q
  • What are the parts of the PACU Discharge Score?
A
  • VS (BP & HR),
  • Activity
  • N/V
  • Pain
  • Surgical Bleeding
  • (Each category is on a 0 – 2 score)
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10
Q
  • What are the 2 biggest complications for anesthesia?
A

N/V & airway obstruction

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11
Q
  • What are the treatments for upper airway obstructions?
A
  • Jaw thrust,
  • CPAP,
  • oral/nasal airway
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12
Q
  • What happens in laryngospasms?
A

Vocal cords close and prevent any air movement

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13
Q
  • What causes negative pressure pulmonary edema?
A
  • Closed APL valve
  • Kinked ETT
  • Laryngospasm
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14
Q
  • What are the S/S of a laryngospasm?
A
  • Faint inspiratory stridor.
  • Increased diaphragmatic excursion.
  • Flailing of lower ribs
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15
Q
  • What is the treatment for laryngospasms?
A
  • Get help
  • Apply facemask
  • 100% FiO2 close APL & do NOT squeeze bag wait 1-5 sec for Pt to breath then release 5-10sec.
  • Suction.
  • Chin lift.
  • Oral/nasal airway.
  • Pressure on the laryngospasm notch(Larson’s point)
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16
Q
  • How much gas is on board for a deep extubation?
A

1 MAC

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17
Q
  • What meds & actions are taken if unable to break laryngospasm?
A
  • Atropine,
  • Propofol,
  • Succinylcholine (1/10th dose) &
  • re-intubate.
18
Q
  • What is the treatment for airway hematoma?
A
  • Decompress the airway by releasing clips or sutures (will bleed a lot more now).
  • Re-intubate.
  • Tracheostomy as last resort
19
Q
  • Can a Pt be asymptomatic with vocal cord palsy?
A

Yes, if unilateral

20
Q
  • Which nerve is damaged with vocal cord palsy?
A

External branch of the Superior Laryngeal Nerve

21
Q
  • What are the risks after thyroid surgery?
A
  • Hypocalcemia (24-48hrs)
  • Hematoma (within 24hrs).
  • recurrent laryngeal nerve damage
22
Q
  • What does Stop-Bang stand for?
A
  • Snore
  • Tired
  • Observed
  • Pressure
  • BMI
  • Age
  • Neck
  • Gender
23
Q
  • What score Stop-Bang score indicates a high risk of OSA?
24
Q
  • What are the treatments of arterial hypoxemia?
A
  • Apply O2
  • Reverse opioids or benzos.
  • Continue to stimulate Pt
25
Q
  • What happens in diffusion hypoxia?
A

Nitrous oxide rapidly diffuses into alveoli at the end of NO2 use → decreased PaO2 & PaCO2

26
Q
  • What are the meds & doses to treat systemic hypertension?
A
  • Labetalol 5-25mg
  • Hydralazine 5-10mg
  • Metoprolol 1-5mg
27
Q
  • What are the causes of Distributive hypotension?
A
  • Sepsis
  • Allergic reactions
  • Critical illness
  • Latrogenic sympathectomy
28
Q
  • What is the IV dose for Epi in allergic reactions?
A

10 – 20 mcg

29
Q
  • What are the symptoms with NMBD allergic reaction?
A
  • Histamine release → vasodilation, erythema, edema, hypotension, GI constriction, tachycardia, pruritis.
  • Bronchoconstriction → increased airway pressures
30
Q
  • What surgeries are at high risk for sepsis?
A
  • Urinary tract manipulation &
  • biliary tract procedures
31
Q
  • What leads do you want to monitor for Pts at risk for MI?
A

Lead II & V5

32
Q
  • What are risk factors for atrial dysrhythmias?
A
  • Positive fluid balance
  • Electrolyte abnormality
  • O2 desaturation
  • Preexisting cardiac risk factors
33
Q

What med classifications can be given intraop for A-fib?

A

Beta-blockers or CCB if stable

34
Q
  • What do you do when seeing ventricular dysrhythmias?
A

Investigate H’s & T’s

35
Q
  • Where are the cardiac accelerator fibers?
36
Q
  • What are the intra-op factors associated with delirium?
A
  • Hypotension
  • Blood loss (Hct <30)
  • NO2 use
  • General anesthesia
37
Q
  • What is the adult Narcan dose to treat opioid-induced delayed awakening?
A

20 – 40mcg

38
Q
  • How is scopolamine-induced delayed awakening treated?
A

Physostigmine 0.5 – 2mg IV

39
Q
  • What are some causes of delayed awakening?
A
  • Hypothermia <33℃
  • Hypoglycemia
  • Increased ICP
  • Residual NMBD
40
Q

What Sx is likely to cause atrial arrhythmias?

A

Thoracotomy

Principles 2 (10 decks)

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