Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Physical Science in Nursing Anesthesia > Intro to Anesthesia > Flashcards

Intro to Anesthesia Flashcards

You may prefer our related Brainscape-certified flashcards:
Nursing Pharmacology flashcards NCLEX-RN® flashcards Nursing Mental Health flashcards Nursing Fundamentals flashcards Nursing Safety & Infection flashcards Nursing Adult Health flashcards NCLEX-PN® flashcards Nursing Management of Care flashcards Nursing Pediatrics flashcards Nursing Maternity flashcards
1
Q

Types of anesthesia

A

General anesthesia
Monitored anesthesia Care “MAC”
Regional anesthesia
Local anesthesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Ideal anesthetic Techniques

A

oOptimal patient safety
oPatient satisfaction
oExcellent operating condition for surgeon
oAllows rapid recovery
oAvoid postoperative side effects
oLow cost
oEarly transfer or discharge from PACU (cost)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Considerations that influence the choice of anesthetic/technique

A 
oPatient safety
oPatient comfort
oPreference 
oCoexisting disease
oSurgical site
oPositioning 
oElective vs emergency airway
oDuration of surgery
oPatient age
oRecovery time
oPost anesthesia care unit discharge criteria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

drug-induced depression of the CNS resulting in the loss of response to and perception of all external stimuli
SA continuum of sedation: a drug-induced loss of consciousness during which patients are not arousable, even by painful stimulation

A

General anesthesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Components of anesthetic

A 
oUnconsciousness
oAmnesia
oAnalgesia
oImmobility
oAttenuation of autonomic response to noxious stimuli
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Phases of General Anesthesia

A

Induction
Maintenance
Emergent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Candidate for total IV anesthetics

A

patient with severe refractory postop nasuea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Induction sequence

A 
Room set up
"SAM TIDE" - suction, airway, machine, tape, IV, drugs, equipment
Apply monitors
Position patient
Baseline vitals
Preoxygenate
Administer induction agents (eyelid reflex)
Mask ventilation 
\+/- NM blocking agent
Airway instrumentation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

ASA standard 5 minimum monitors include…

A

Pulse ox continuously - audible pulse and tone threshold along with clinical observaition and ABG analysis if needed

Ventilation - verification of trachea placement of artifical airway through auscultation, chest excursion, and confirmation of expired CO2 (3 breaths), capnography

EKG continuously, HR and BP at least every 5 minutes

Thermoregulation
NM (if NM blockade adminstered assess depth of blockade and degree of recovery)

Positioning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Pre-induction preoxygenation is doen in order to …

A

Denitrogenate patient’s FRC in order to increase safety margin for periods of apnea giving the provider more time before they desaturate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Methods for pre-induction pre-oxygenation

A

Breath 100% O2 via face mask with normal tidal volume for 3-5 min OR
Eight vital capacity breaths with 100% O2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

oAdministering anesthetic drugs (inhaled or IV) to induce a state of anesthesia
oInducing a state of unconsciousness

A

Induction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Desirable properties for induction agents

A

Rapid and smooth onset of recovery
Analgesia
Minimal cardiac and respiratory depression
Antiemetic actions
Lack of toxicity or histamine release
Advantages pharmacokinets and pharmaceutics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Intravenous injection of an anesthetic to produce unconsciousness followed immediately by a neuromuscular blocking drug that produces a rapid onset of skeletal muscle paralysis

A

Rapid sequence induction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Situations that warrant a rapid sequence induction

A

Full stomach or risk of aspiration such as trauma patients, those with comorbidities such as DM and gastroparesis or achalasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Main difference between standard induction and RSI

A

NO VENTILATION

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Perform induction and ventilation, use standard induction without paralytics with this type of airway

A

Laryngeal mask airway (LMA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Where does LMA sit

A

posterior pharynx and larynx and creates a seal around laryngeal opening, DOES NOT go past vocal cords

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Most common method for inducing children in North America, scheduled for elective case

A

Inhalation induction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Agents used in inhalation induction

A

+/- 70% nitrous and 30% oxygen
Can have oxygen + nitrous +sevo
OR can have just sevo + oxygen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Steps for inhalation induction

A 
Prime circuit
Monitors (primarily pulse ox)
Mask application
Loss of consciousness
Ventilation
PIV placement
Airway instrumentation (LMA/ETT)
Verify placement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Maintenance goals

A

Maintain surgical anesthesia
Maintain physiological homeostasis
Monitoring is needed to ensure these goals are met

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Maintenance phase provides

A

Unconsciousness, amnesia, analgesia, immobility, muscle relaxation, and control of system response to noxious stimuli

24
Q

During maintenance phase the BP must be maintained

A

within 20% of baseline

25
Q

Most sensitive indicator in anesthetic depth in inhalation anesthesia is…

A

pattern of respirations

26
Q

Begins with administration of induction agents and ends with loss of consciousness
Pain response is altered but patient has same perception of pain

A

Stage I : analgesia

27
Q

Begins with loss of consciousness and is a period of excitation and involuntary movements

A

Stage II: delirium

28
Q

S/S of stage II : delirium

A

IRREGULAR respirations
Dilated pupils and divergent gaze
Tachycardia
Hypertension

29
Q

What stages are seen for IV induction

A

Go from stage I straight to stage III skippping stage II

30
Q

Begins with onset of regular breathing pattern and ends with loss of spontaneous respirations (for inhaltion induction)
Nonreactive to painful stimuli, deep sleep not subject to rousing

A

Stage III : Surgical anesthesia

31
Q

Loss of lid reflex
Respirations regular and deeper than normal
Pupils react to light
Swallowing, retching, and vomiting reflexes disappear and reappear in that order
Respiratory response to skin incision decreased

A

Plane I of stage III

32
Q

Starts when eyeballs become concentrically fixed
Regular respirations with decreased tidal volume
Respiratory response to skin incision disappears
Moderate loss of muscle tone
Reflex closure of vocal cords begins to disappear
Pupils unreliable

A

Plane 2 of stage III

33
Q

Begins with decrease in intercostal muscle activity
Ends with intercostal activity absent and respirations is completely diaphragmatic
Diaphragmatic breathing > jerking movement
Pupils continue to dilate

A

Plane 3 of stage III

34
Q

Begins with complete loss of intercostal activity
Ends with loss of spontaneous respiration
Pupils completely dilated
Nonresponsive to light
All muscle tone lost

A

Plane 4 of stage III

35
Q

What planes are usually desired to keep the patient in

A

Plane 1 or plane 2 of stage 3

36
Q

Respiratory paralysis - TOO DEEP
Cessation of respiration due to concentration of anesthetic agent
Ends with circulatory collapse and anesthesia should be lightened immediately

A

Stave IV : Overdosage

37
Q

A transition process where a patient goes from general anesthesia to awake and spontaneously breathing

A

Emergence

38
Q

Critical period of recovery from general anesthesia with the return of:

A

Consciousness
Neuromuscular conduction
Airway protective reflexes

39
Q

A good indicator for adequate analgesia is

A

RR and opioid administration can de titrated according to rR

40
Q

In emergence how should O2 be administered and why

A

100% oxygen for 5-10 minutes to prevent diffusion hypoxia from N2O

41
Q

Deep extubation is performed while patient is in which stage and who is a good candidate

A

Stage III when under deep surgical anesthetic depth

Patient MUST be spontaneously breathing

Good for plastic surgery patients, hernia patients anyoen they do not want coughing or bucking the vent

42
Q

Emergence phases

A

Stage III (deep anesthesia) to Stage II (excitation) then to stage I (awake)

43
Q

What phase should NOT be extubated in

A 
Stage II (excitement)
WILL causes laryngospasm
44
Q

How to assess what stage the patient is in in order to determine extubation

A

Assess respiratory pattern and look at pupils, if irregular they are in stage 2 and CANNOT be extubated
Suction patients mouth, if they hold their breath they are in stage 2

45
Q

Patient purposefully follows commands and is extubated

A

Stage I - awake extubation

46
Q

Awake extubation

A

Trachea is extubated only when the patient responds to simple commands and is breathing spontaneously

47
Q

Awake extubation criteria

A

Patient conscious and responding to simple commands “open your eyes” “squeeze my hand”
If full stomach or high risk for aspiration, or if difficult intubation, extubate only when patient fully awake
Patient hemodynamically stable, normothermic, not having received massive amounts of fluid
Adequate spontaneous ventilation with TV > 6-8 mL/kg, rate >8
Adequate reversal of paralytics

48
Q

Chosen when the presence of the ETT is to be avoided during emergence to prevent “bucking” and “straining”

A

Deep extuabtion

Examples: hernia repair, carotid endardectomy, tummy tuck, plastic surgeries

49
Q

Indications for deep extubation

A

Avoid bucking, coughing, straining response to ETT
Avoid bronchospasm in a patient with a low risk for aspiration of gastric contents
Avoid CV response to ETT

50
Q

Contraindications to deep extubation

A

Full stomach - severe GERD
Difficult intubation
Risk of regurgitation and/pr aspiration of gastric contents is a concern
Obesity

51
Q

Does not describe the continuum of depth of sedation, rather it describes “a specific anesthesia service in which an anesthesiologist has been requested to participate in the car of a patient undergoing a diagnostic or therapeutic procedure”

A

Monitored Anesthesia Care

52
Q

What do you need to know about a local anesthetic

A 
Which drug
Recommended dose
Characteristic/knowledge
Max dose
Concentration
With/without preservatives
53
Q

Who is not a good candidate for local anethetic

A 
Children
Confused
Uncooperative
Unable to follow commands
Patient with tremor/RLS
Patients unable to lie down flat
54
Q

A drug-induced state during which patients respond normally to verbal commands

Although cognitive function and physical coordination may be impaired, airway reflexes, and ventilator and CV functions are unaffected

A

Minimal sedation (anxiolysis)

55
Q

A drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation.

No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate. Cardiovascular function is usually maintained.

Reflex withdrawal from a painful stimulus is NOT considered a purposeful response.

A

Moderate Sedation/analgesia (“conscious sedation”)

56
Q

A drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully following repeated or painful stimulation.

The ability to independently maintain ventilatory function may be impaired. Patients may require assistance in maintaining a patent airway, and spontaneous ventilation may be inadequate. Cardiovascular function is usually maintained.

A

Deep sedation/analgesia

57
Q

Unarousable even with painful stimulus
Airway intervention often required
Spontaneous ventilation is frequently inadequate
CV function may be impaired

A

General anesthesia

Physical Science in Nursing Anesthesia (1 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions