Brainscape's Knowledge GenomeTM

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


See full index

Brandon’s AFN Health Assessment > Metabolic II > Flashcards

Metabolic II Flashcards

1
Q

cushings disease, specifically cushings syndrome is d/t?

A

pituitary secretion of excessive ACTH

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

s/sx of cushings syndrome

A
  1. Obesity/OSA (moon face and buffalo hump)
  2. HTN with volume overload
  3. electrolyte imbalances
  4. glucose intolerance
  5. GERD
  6. Myopathy/weakness/bruising
  7. infections/poor wound healing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Anesthesia considerations with Cushings

A
  1. will have htn
  2. normalize intravascular volume with diuresis (spirolactone)
  3. correct electrolytes and blood glucose
  4. consider etomidate
  5. Obesity/OSA will have issues with airway, IV access and positioning
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

why do we consider etomidate with cushings syndrome?

A

it inhibits steroid synthesis

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

primary adrenal insuffciency

A

destruction of adrenal gland

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is secondary adrenal insufficiency

A

anterior pituitary fails to secrete sufficient ACTH

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

what are some causes of primary/secondary adrenal insufficiency

A

autoimmune adrenalitis
TB
tumor
surgery
HIV
pituitary radiation

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

tertiary adrenal insufficiency

A

process that interfere with ACTH release

  1. exogenous high dose glucocorticoid therapy
  2. prednisone > 20 mg/day > 3 weeks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what is the average basal adrenal cortisol secretion per day?

A

30 mg/day

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

the stress of surgery, trauma, and infection can increase adrenal output of glucocorticoids up to ___________ mg/day

A

300

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

what are the s/sx of adrenal insufficency

A
  1. fatigue
  2. loss of appetite
  3. weight loss
  4. hypoglycemia
  5. hyponatremia
  6. hyperkalemia
  7. orthostatic hypotension
  8. hyperpigmentation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

anesthesia considerations with adrenal insuffiency

A
  1. determine electrolyte levels, and glucose and manage
  2. myopathies –> conservative approach to NMB & respiratory insufficiency postop
  3. refractory to vasopressor and fluid therapy
  4. AVOID etomidate
  5. possible corticosteroid supplementation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

when would you consider corticosteroid supplemenation intraoperatively in patient with adrenal insufficiency

A

if pt having major procedure and takes > 20 mg/day of prednisone or its equivalent

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

T/F: pts with adrenal insufficiency should discontinue glucocorticoid/mineralcorticoid drug therapy day of surgery

A

false; should continue

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

what is the risk of taking high dose steroid supplementation

A

adrenal insufficiency risk remains up to 1 year after cessation

unable to increase endogenous cortisol to respond to surgical stress

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

stress dose corticosteroid administration for minor procedures (adrenal insuff)

A

hydrocortisone 25 mg or methylprednisolone 5 mg DOS

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

stress dose corticosteroid administration for moderate procedures (adrenal insuff)

A

hydrocortisone 50-75 mg or methylprednisolone 10-15 mg DOS then taper over 1-2 days

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

stress dose corticosteroid administration for major procedure (adrenal insuff)

A

hydrocortisone 100-150 mg or Methylprednisolone 20-30 mg DOS then taper over 1-2 days

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

patient with pheochromocytoma has surgery scheduled; what should be prescribed to them outpatient and started 10-14 days prior to surgery date?

A

alpha blockade (phenobenzamine)

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

for patient with pheochromocytoma, once BP is undercontrol with alpha blockade, then you initiate _______________________

A

beta blocker

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

T/F: pts with pheochromocytoma should take all BP meds day of surgery

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What should you expect intraoperatively for pt with pheochromocytoma

A
  1. aggressive hydration for euvolemia
  2. major hemodynamic changes: need Aline, vasoactive meds, and plan for postop care
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what hormones come from posterior pituitary gland

A

oxytocin, ADH

24
Q

what hormones come from anterior pituitary gland

A

TSH
ACTH
FSH
LH
prolactin
GH
endorphins

25
Q

abnormal fx of the _____________ may render the inability to appropriately respond in periods of stress (surgery) and/or critical illness

A

adrenal cortex

26
Q

_________________ results from excess growth hormone, resulting in overgrowth of skin, connective tissue, cartilage, bone, and viscera

A

acromegaly

27
Q

s/sx of acromegaly

A
  1. airway abnorm d/t overgrowth of pharyngeal, laryngeal, epiglottic tissues
  2. OSA
  3. V/Q mismatch d/t visceromeg
  4. HTN, CAD, valvular disease, HF
  5. DM
  6. arthralgia
  7. fractures common
28
Q

pt presents with acromegaly, you should anticipate you will need a ____________ ETT

A

smaller; d/t overgrowth of airway tissues

29
Q

SIADH dx

A

elevated ADH with hyponatremia, and hypo-osmolality with concentrated urine in euvolemic state

30
Q

s/sx SIADH

A

headache
lethargy
disorientation
hallucinations
N/V
Seizures
coma

31
Q

perianesthesia management of SIADH - due to chronic asymptomatic hyponatremia

A

water restriction and diuresis

32
Q

how would you correct acute severe hyponatremia (<120) in someone with SIADH

A

3% NS + lasix
slow IV correction
Vasopressin-3-receptor antagonist (Tolvaptan)

33
Q

why does hyponatremia (W/ SIADH) complicat anesthesia management?

A

potentials NMB
delays emergence
increases delirium
fluid shifts

34
Q

Neurogenic DI

A

insufficent production of ADH

35
Q

nephrogenic DI

A

inadequate response to ADH by target cells in the kidney

36
Q

s/sx of DI

A

polyuria
polydipsia
alteration in mental status
arrhythmias (Na > 160)
higher serum osm with low urine osm

37
Q

perianesthesia management of DI

A

correct free water deficit:
1. drink water if thirst mech intact
2. IV hypotonic saline (D5W)
3. DDAVP
4. off label meds
5. monitor Na and volume status

38
Q

what are some off label medications for DI tx

A

carbamazepine
thiazide diuretics
NSAIDs

39
Q

_____________ can occur with rapid Na correction in patients with chronic hypernatremia

A

cerebral edema

40
Q

T/F: elective procedures should be postponed in pt with DI d/t hypernatremia

A

true

41
Q

carcinoid tumors secrete

A

serotinin
histamine
kinins
substance B
prostaglandins
kallikrein

42
Q

s/sx of carcinoid tumor

A
  1. episodes of flushing
  2. diarrhea
  3. tachycardia
  4. bronchospaz
  5. increased serotonin –> +inotropy/chronotropy d/t release of NE –> CAD and HF
43
Q

anesthesia implications with carcinoid tumor

A

avoid carcinoid crisis through:
1. manipulation of tumor
2. chemical stimulation
3. tumor necrosis d/t induction of anesthesia and surgical stress

44
Q

how do you manage pt with carcinoid tumor intraop?

A

octreodtide 100 mcg to suppress release of mediators

45
Q

normal weight BMI

A

20-24.9

46
Q

overweight BMI

A

25-29.9

47
Q

obese BMI

A

30-34.9

48
Q

severely obese BMI

A

35-39.9

49
Q

morbidly obese BMI

A

> /= 40

50
Q

super (morbidly) obese BMI

A

> /= 50

51
Q

what are the pulmonary/airway anesthesia implications with obese pt

A
  1. reduced compliance of lungs and chest wall
  2. increased incidence of OSA
  3. obesity hypoventilation syndrome
  4. high risk of difficult airway, difficult mask ventilation
52
Q

obesity hypoventilation syndrome: daytime hypercapnea + OSA –> ___________ and _____________

A

HTN; R-sided HF

53
Q

Cardiac anesthesia implications with obese pt

A
  1. s/sx of cardiac disease
  2. HTN + LVH + HF
  3. dysrrhythmias are common
54
Q

GI/metabolic/endocrine anesthesia implications with obese pt

A
  1. increased gastric residual volume, abdominal pressure, Hiatial hernia
  2. increased risk of fatty liver dz
  3. metabolic syndrome + DM
  4. increased subclinicl hypothyroidism
55
Q

in an obese pt what can you use to stratify risk for that patient

A

obesity surgery mortality risk

56
Q

perianesthesia management with obese pt

A
  1. consider BP cuff size/ABP
  2. OR table weight limitations
  3. IV access may be difficult
  4. planning for difficult intubation and extubation
  5. potential for aspiration
  6. postoperative SpO2 and CPAP
  7. possibly post op ICU

Brandon’s AFN Health Assessment (17 decks)

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