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final exam principles of nurse anesthesia > mini study guide (LASER to hypothermia) > Flashcards

mini study guide (LASER to hypothermia) Flashcards

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1
Q

Laser is an acronym for?

A

light amplification by stimulated emission of radiation

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2
Q

there are two types of lasers what are they?

A

long wavelength lasers

short wavelength lasers

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3
Q

long wavelength lasers do what?

A

absorb more water and do not penetrate deep into tissue

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4
Q

short wavelength lasers do what?

A

absorb less water and penetrate deeper into tissue

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5
Q

when using lasers you should use how much FIO2?

A

less than 30%

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6
Q

should you use nitrous oxide with lasers? why?

A

no

because it supports combusion

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7
Q

what must be immediately avaiable when using a laser?why?

A

water or saline

most ETT are flammable

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8
Q

what ETT are flammable?

A

made from polyvinyl chloride (PVC) red rubber, and silicone

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9
Q

how should you protect the eyes during a laser case?

A

tape eyelids closed
avoid petroleum based lubricants
cover eyelids with saline soaked gauze
use protective glasses specific to the laser being used.

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10
Q

what is the most vulnerable component of the ETT?

A

the cuff

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11
Q

laser resistent ETT do not have laser resistant?

A

cuffs

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12
Q

name the three components fo the fire triad?

A

ignition source
oxidizer
fuel

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13
Q

name examples of the ignition source?

A

electrosurgeical cautery

laser

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14
Q

name examples of the oxidizers?

A

oxygen

nitrous oxide

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15
Q

name examples of the fuel

A

ETT
drapes
surgical supplies

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16
Q

according to the ASA operating room fire guidelines, what should you do in order, when a fire is present?

A
  1. stop ventilation and remove the ETT
  2. stop the flow of all airway gases
  3. remove other flammable material from the airway
  4. pour water or saline into the airway
  5. if fire isn’t extinguished on the first attempt, then use a CO2 fire extinguisher
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17
Q

according to the ASA operating room fire guidelines, what should you do in order, after the fire is controlled?

A
  1. re-establish ventilation by mask, avoid supplemental O2 or nitrous oxide
  2. check the ETT for damage, fragments may remain in the patient’s airway
  3. perform bronchoscopy to inspect for airway injury or retained fragments
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18
Q

why do you not squeeze the reservoir bag as you extubate the patient when an airway fire has been present?

A

this can create a blow torch effect at the distal end of the ETT and/or push debris into the lower airway

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19
Q

the body regulates core temperature between ___ and ___ degrees celsius.

A

36.7 - 37.1 celsius

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20
Q

hypothermia is defined as core body temperature less than _____ celsius

A

36 degrees

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21
Q

who is at the greatest risk of developing perioperative hypothermia?

A

patients at extremes of age are at the greatest risk of developing perioperative hypothermia

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22
Q

the maintenance of body temperature involves three components which are:

A

afferent limb
control center
efferent response

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23
Q

what components make up the afferent limb of thermoregulation?

A

thermoreceptors:
skin
deep tissue
spinal cord

24
Q

what components make up the control center of thermoregulation?

A

hypothalamus: preoptic region

brainstem

25
Q

efferent response to cold produces what?

A

vasoconstriction
piloerection
shivering
non-shivering themogensis

26
Q

shivering increases oxygen consumption by up to what percent

A

400-500%

27
Q

what are you at increased risk for when you are shivering d/t increased oxygen consumption?

A

myocardial ischemia and infarction

28
Q

non-shivering thermogenesis occurs in what population?

A

babies

29
Q

what is the efferent response to being hot?

A

vasodilation and diaphoresis

30
Q

list the 4 ways to transfer heat in order from greatest to least?

A

radiation
convection
conduction
evaporation

31
Q

describe radiation?

A

heat follows a temperature gradient. if the patient is warmer than the environment, then heat is lost to the environment in the form of infrared radiation

32
Q

most heat is lost how with radiation?

A

skin

33
Q

how can you reduce radiation heat loss?

A

covering the patient

34
Q

describe convection?

A

the transfer of heat by the movement of matter (air)

35
Q

wind chill is an example of what type of heat loss?

A

convection

36
Q

what type of flow increases the amount of heat lost to convection?

A

laminar flow

37
Q

the rate of evaporation is based on?

A

function of the exposed surface area and the relative humidity of the environment

38
Q

describe how evaporation can happen during surgery?

A

from respiration, wounds, and exposure of internal organs during surgery

39
Q

describe conduction?

A

heat lost when the patient comes into direct contact with a cooler object

40
Q

what determines the amount of conductive heat loss?

A

the temperature gradient and the thermal conductivity of the object

41
Q

give examples of how you can loss heat due to conduction?

A

cold OR table, IV fluids, and irrigation fluids

42
Q

how many stages are there in intraoperative heat transfer?

A

three

43
Q

what happens in phase 1 of intraoperative heat transfer?

A

heat distribution from core to periphery

44
Q

what happens in phase 2 of intraoperative heat transfer?

A

heat transfer is greater than heat production

45
Q

what happens in phase 3 of intraoperative heat transfer?

A

heat transfer is equal to heat production

46
Q

during what types of procedures does the distribution of heat from core to periphery occur with?

A

general
spinal
epidural anesthesia

47
Q

anesthetic agents impair the thermoregulation in three ways which are?

A

altering hypothalamus response
prevent shivering
cause vasodilation

48
Q

A _____ amount of heat is lost during phase 1

A

nominal, heat redistribution is way more important during this phase

49
Q

how can the anesthesia provider improve the redistribution of heat from the core to periphery in phase 1?

A

place a warm blanket on the patient before entering the OR, minimizes the central to peripheral temperature gradient.

50
Q

perioperative hypothermia increases the risk of ?

A

morbidity and mortality

51
Q

what 3 medication are used to treat postoperative shivering includes?

A

meperidine
clonidine
dexmedetomidine

52
Q

oxygen consumption is reduced by ____ percent for every 1 degree C reduction in body temperature

A

5-7%

53
Q

name 7 incidences where induced hypothermia is useful during?

A 
cerebral ischemia (stroke)
cerebral aneurysm clipping
TBI
cardiopulmonary bypass
cardiac arrest
aortic cross clamping
carotid endarterectomy
54
Q

name three ways to minimize intraoperative heat loss?

A

HME
warming blanket
Fluid warmers

55
Q

perioperative hypothermia affects the patient pharmacologically how?

A

slowed drug metabolism = prolonged effects of anesthetic agents

increased solubility of volatile agents = prolonged emergence

56
Q

perioperative hypothermia affects the patient cardiovascular status how?

A

SNS stimulation - myocardial ischemia and dysrhythmias

shifts the oxyhemoglobin curve to the left- decreased o2 available to the tissues

vasoconstriction meaning decreased tissue PO2 = surgical site infection

coagulopathy and plt dysfunction - increased blood loss

sickling of hemoglobin 5- risk of sickle cell crisis

final exam principles of nurse anesthesia (12 decks)

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