Exam 2 Positioning (6/13/24)

Question 1

Increase or decrease in the following when laying supine for surgery?

Tidal Volume
Preload
Stroke Volume
Cardiac Output
Venous Return
Functional Residual Capacity

Answer 1

• Tidal Volume: Decreased
• Preload: Increased
• Stroke Volume: Increased
• Cardiac Output: Increased
• Venous Return: Increased
• FRC: Decreased

Question 2

What is the most common surgical position?

Answer 2

Supine

Question 3

Describe Abduction of the arms for surgery:

Answer 3

• 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)

Question 4

Describe Adduction of the arms for surgery:

Answer 4

• 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)

Question 5

Complications of Supine positioning for surgery:

Answer 5

• 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)

Question 6

What position is this patient in?

Answer 6

Trendelenburg

Question 7

True or False:

In trendelenburg position, it is preferred to use bean bags and shoulder braces to prevent patient from sliding cephalad.

Answer 7

FALSE

Avoid using bean bags or shoulder braces

Question 8

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

Answer 8

A. Intra-abdominal Pressure
B. Venous Return
C. Cardiac Output
E. Intra-Ocular Pressure

Question 9

What dis is?

Answer 9

Reverse Trendelenburg

Question 10

Pathophysiologic considerations for the Reverse Trendelenburg Position for surgery:

Answer 10

• Hypotension risk (Decreased Venous Return)
• Downward displacement of abdominal contents and diaphragm
• Decreased perfusion to brain

Question 11

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?

Answer 11

Tragus

Question 12

While in the sitting position for surgery, you want to ensure at least ___ fingers distance between the chin and the sternum.

Answer 12

2

Question 13

Frequent Positon for Shoulder cases?

Answer 13

Beach Chair Position

Less severe hip flexion and slight leg flexion

Question 14

Risks of the Sitting position for surgery:

Answer 14

• Cerebral hypoperfusion and air embolism
• Pneumocephalus
• Quadriplegia and spinal cord infarction
• Cerebral ischemia
• Peripheral nerve injuries
• Sciatic Nerve Injury

Question 15

True or False:

Hypotension, decreased cardiac index, and decreased cerebral perfusion pressure are common pathophysiologic changes in the sitting position for surgery.

Answer 15

TRUE

Question 16

There is no information on this card…

Answer 16

This is straight out of a horror movie… wtf

Question 17

Risks from prone position for surgery:

Answer 17

• Facial/Airway Edema
• Ulnar/Brachial Nerve injury
• Post-op vision loss secondary to decreased perfusion/ischemia
• ETT Dislodgement
• Loss of monitors and IV Lines

Question 18

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

Answer 18

D. Cardiac Output
E. Venous Return

Question 19

Describe the Lithotomy position:

Answer 19

• 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)

Question 20

If the patient is undergoing a surgery that is > 2-3 hrs in the lithotomy position, what should we do?

Answer 20

Periodically Lower the Legs

Question 21

Various nerves that are at a high risk of injury in the lithotomy position.

Answer 21

• Brachial Plexus
• Ulnar Nerve
• Common Peroneal
• Lateral Femoral Cutaneous

Question 22

In the lateral decubitus position, which side of the patient is down?

Operative vs. Non-Operative
Dependent vs. Independent

Answer 22

Non-Operative
Dependent

Question 23

If the patient is in the Left lateral Decubitus postion, what side of the body is the operation occuring on?

Answer 23

Right

Question 24

Lithotomy Position

If bed flexed or kidney rest used, the break in the bed needs to be placed under the ____.

Answer 24

Iliac Crest

Question 25

Lateral Decubitus Pathophysiological Considerations:

Answer 25

• Venous Pooling in lower extremities
• V/Q Mismatching

Question 26

Peripheral Nerve injuries are usually a result of ___.

Answer 26

Stretch, Pressure and/or ischemia

Question 27

Peripheral Nerve injuries can occur in as little as___.

Answer 27

30 minutes.

Question 28

True or False:

So long as optimal positioning is performed peripheral nerve injuries will not occur.

Answer 28

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

Question 29

Which two positions does compression of the inferior vena cava occur?

Answer 29

Prone
Lateral Decubitus

Question 30

What Standard of AANA Requirements is Positioning?

Answer 30

Standard 8