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DH: Principles I > Exam 2 Positioning (6/13/24) > Flashcards

Exam 2 Positioning (6/13/24) Flashcards

1
Q

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

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

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

These are initial changes and are transient.

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2
Q

Safety belts/straps must be used in the ___ and ___ area to secure the patient in addition to the securing of extremities

A

Abdominal and Pelvic

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3
Q

What is the most common surgical position?

A

Supine

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4
Q

Describe Abduction of the arms for surgery:

A
  • 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)
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5
Q

Describe Adduction of the arms for surgery:

A
  • 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)
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6
Q

Complications of Supine positioning for surgery:

A
  • Stretch Injury (Brachial Plexus)
  • Ulnar Nerve Injury (if pronated)
  • Pressure Alopecia
  • Backache (Loss of tone from paraspinal muscles)
  • Brachial Plexus or Axillary nerve injury (if arms abducted > 90 degrees)
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7
Q

What position is this patient in?

A

Trendelenburg

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8
Q

True or False:

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

A

FALSE

Avoid using bean bags or shoulder braces

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9
Q

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

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

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10
Q

This pathophysiologic consideration for the trendelenburg position can increase with surgical time and in presence of fluid overload.

A

Edema of face, conjunctiva, larynx, and tongue

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11
Q

Why does the patient’s FRC and pulmonary compliance decrease in the trendelenburg position?

A

Because the diaphragm shifts cephalad

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12
Q

What is one consideration regarding vent management for the trendelenburg position?

A

May need higher pressures in ventilated patients for adequate ventilation

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13
Q

There is an increased risk of ___ because abdominal contents push the carina cephalad in the trendelenburg position.

A

Endobronchial intubation

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14
Q

What position is this?

A

Reverse Trendelenburg

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15
Q

Pathophysiologic considerations for the Reverse Trendelenburg Position for surgery:

A
  • Hypotension risk (Decreased Venous Return)
  • Downward displacement of abdominal contents and diaphragm
  • Decreased perfusion to brain
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16
Q

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?

A

Tragus

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17
Q

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

A

2

18
Q

In the sitting position, how should the hips be positioned?
What does this help reduce?

A

Hips should be flexed < 90 degrees.

This helps to reduce stretching of the sciatic nerve.

19
Q

The use of Compression stockings/wraps helps maintain ___ in the sitting position.

A

Venous Return

20
Q

Frequent Positon for Shoulder cases?

A

Beach Chair Position

Less severe hip flexion and slight leg flexion

21
Q

Risks of the Sitting position for surgery:

A
  • Cerebral hypoperfusion and air embolism
  • Pneumocephalus
  • Quadriplegia and spinal cord infarction
  • Cerebral ischemia
  • Peripheral nerve injuries
  • Sciatic Nerve Injury
22
Q

True or False:

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

A

TRUE

23
Q

There is no information on this card…

A

This is straight out of a horror movie… wtf

24
Q

Three places, specifically mentioned in lecture, in which we should avoid compression while in the prone position.

A
  1. Breasts
  2. Abdomen
  3. Genitalia
25
Q

Risks from prone position for surgery:

A
  • Facial/Airway Edema
  • Ulnar/Brachial plexus Nerve injury
  • Post-op vision loss secondary to decreased perfusion/ischemia
  • ETT Dislodgement
  • Loss of monitors and IV Lines
26
Q

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

A

D. Cardiac Output
E. Venous Return

There is actually improved ventilation in the prone position.

27
Q

Compression of this structure can cause a decrease in venous return in the prone position.

A

Inferior Vena Cava

28
Q

Describe the Lithotomy position:

A
  • 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)
29
Q

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

A

Periodically Lower the Legs

30
Q

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

A
  • Brachial Plexus
  • Ulnar Nerve
  • Common Peroneal
  • Lateral Femoral Cutaneous
31
Q

Aside from the various nerve injuries, there are 2 other risks while in the lithotomy position:

A

Back Pain
Compartment Syndrome

32
Q

Pathophysiological Considerations in the lithotomy position:

A
  • Increase VR, CO, ICP, Abdominal Pressure
  • Decreased lung compliance and Tidal Volume
33
Q

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

Operative vs. Non-Operative
Dependent vs. Independent

A

Non-Operative
Dependent

34
Q

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

A

Right

35
Q

Describe the placement and use of an axillary roll while in the lateral decubitus position:

A

Placed between chest wall and bed, caudal to axilla.
Used to prevent brachial plexus compression.

36
Q

Lateral Decubitus

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

A

Iliac Crest

37
Q

Lateral Decubitus Pathophysiological Considerations:

A
  • Venous Pooling in lower extremities
  • V/Q Mismatching (inadequate ventilation to dependent lung and decreased blood flow to the nondependent lung)
38
Q

Peripheral Nerve injuries are usually a result of ___.

A

Stretch, Pressure and/or ischemia

39
Q

Peripheral Nerve injuries can occur in as little as___.

A

30 minutes.

40
Q

True or False:

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

A

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

41
Q

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

A

Prone
Lateral Decubitus

42
Q

For which position should we be cautious with using an LMA due to dislodgement risk?

A

Lateral Decubitus

DH: Principles I (50 decks)

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