Exam 2 Positioning (6/13/24) Flashcards
Increase or decrease in the following when laying supine for surgery?
Tidal Volume
Preload
Stroke Volume
Cardiac Output
Venous Return
Functional Residual Capacity
- Tidal Volume: Decreased
- Preload: Increased
- Stroke Volume: Increased
- Cardiac Output: Increased
- Venous Return: Increased
- FRC: Decreased
What is the most common surgical position?
Supine
Describe Abduction of the arms for surgery:
- Out to the side, < 90 degrees
- Padded arm boards secured to the table and patient at the axilla
- The arms should be supine (palms up)
Describe Adduction of the arms for surgery:
- Tucked alongside the body
- Arms held along the side of body via draw sheet under the body and over the arm
- Hand and forearm are supine (palms up) or neutral position (palms toward body)
Complications of Supine positioning for surgery:
- Stretch Injury (Brachial Plexus)
- Ulnar Nerve Injury
- Pressure Alopecia
- Backache (Loss of tone from paraspinal muscles)
- Brachial Plexus or Axillary nerve injury (if arms abducted > 90 degrees)
What position is this patient in?
Trendelenburg
True or False:
In trendelenburg position, it is preferred to use bean bags and shoulder braces to prevent patient from sliding cephalad.
FALSE
Avoid using bean bags or shoulder braces
Pathophysiologic Considerations in the trendelenburg position:
Select All That Apply:
Which of the following are increased while in the trendelenburg position for surgery?
A. Intra-abdominal Pressure
B. Venous Return
C. Cardiac Output
D. FRC
E. Intra-Ocular Pressure
F. Pulmonary Compliance
A. Intra-abdominal Pressure
B. Venous Return
C. Cardiac Output
E. Intra-Ocular Pressure
What dis is?
Reverse Trendelenburg
Pathophysiologic considerations for the Reverse Trendelenburg Position for surgery:
- Hypotension risk (Decreased Venous Return)
- Downward displacement of abdominal contents and diaphragm
- Decreased perfusion to brain
For a patient in the reverse trendelenburg and sitting positions, where should place the transducer level of an arterial line to ensure accurate blood pressures and accurate cerebral perfusion pressures?
Tragus
While in the sitting position for surgery, you want to ensure at least ___ fingers distance between the chin and the sternum.
2
Frequent Positon for Shoulder cases?
Beach Chair Position
Less severe hip flexion and slight leg flexion
Risks of the Sitting position for surgery:
- Cerebral hypoperfusion and air embolism
- Pneumocephalus
- Quadriplegia and spinal cord infarction
- Cerebral ischemia
- Peripheral nerve injuries
- Sciatic Nerve Injury
True or False:
Hypotension, decreased cardiac index, and decreased cerebral perfusion pressure are common pathophysiologic changes in the sitting position for surgery.
TRUE
There is no information on this card…
This is straight out of a horror movie… wtf
Risks from prone position for surgery:
- Facial/Airway Edema
- Ulnar/Brachial Nerve injury
- Post-op vision loss secondary to decreased perfusion/ischemia
- ETT Dislodgement
- Loss of monitors and IV Lines
Select All that Apply:
Which of the following are decreased while the patient is in the prone position for surgery?
A. Ventilation
B. Facial Edema
C. Abdominal Pressure
D. Cardiac Output
E. Venous Return
D. Cardiac Output
E. Venous Return
Describe the Lithotomy position:
- Patient laying supine with legs up in padded or “candy cane” stirrups
- Hips flexed 80 -100 degrees and legs abducted 30 - 45 degrees from midline, knees flexed
- Lower extremities MUST be raised and lowered in synchrony together (Prevents lumbar injury)
If the patient is undergoing a surgery that is > 2-3 hrs in the lithotomy position, what should we do?
Periodically Lower the Legs
Various nerves that are at a high risk of injury in the lithotomy position.
- Brachial Plexus
- Ulnar Nerve
- Common Peroneal
- Lateral Femoral Cutaneous
In the lateral decubitus position, which side of the patient is down?
Operative vs. Non-Operative
Dependent vs. Independent
Non-Operative
Dependent
If the patient is in the Left lateral Decubitus postion, what side of the body is the operation occuring on?
Right
Lithotomy Position
If bed flexed or kidney rest used, the break in the bed needs to be placed under the ____.
Iliac Crest
Lateral Decubitus Pathophysiological Considerations:
- Venous Pooling in lower extremities
- V/Q Mismatching
Peripheral Nerve injuries are usually a result of ___.
Stretch, Pressure and/or ischemia
Peripheral Nerve injuries can occur in as little as___.
30 minutes.
True or False:
So long as optimal positioning is performed peripheral nerve injuries will not occur.
FALSE:
Overall, cases of nerve injuries have decreased, but are still a major legal cause to professional liability claims and can still occur even when optimal positioning is performed
Which two positions does compression of the inferior vena cava occur?
Prone
Lateral Decubitus
What Standard of AANA Requirements is Positioning?
Standard 8
