Miscellaneous CPAN Topics Flashcards
What are the screening tools for OSA?
Berlin Questionnaire (limited application in preop)
STOP - BANG (excellent predictor of severe OSA but average predictor for diagnosis of OSA)
ASA OSA Checklist
What is the most advantageous position for a patient with OSA postoperatively?
Lateral
Lateral recumbent
Avoid supine unless clinically indicated
When can diagnosed or suspected OSA patient can be safely discharged in Phase II?
No evidence of hypoxia or obstruction when patient is left undisturbed for 30 minutes
What is the STOP Bang scoring criteria for OSA?
0-2 Low risk OSA
3-4 Intermediate risk
5-8 High risk (includes male/BMI >35/ + neck circ)
How many days before surgery should patient stop taking St. John’s Wort?
7 days
Herb same MOA as MAOIs/SSRIs/ antidepressant
Potentiates anesthetic effects
May affect BP
How many days before surgery should patient stop taking saw palmetto?
2 weeks
Increases urine flow, decrease urine frequency
May increase INR with warfarin
How many days before surgery should patient stop taking black cohosh?
2 weeks
Herb w/ estrogen, anti inflammatory effect
May cause hypotension, bradycardia
How many days before surgery should patient stop taking Gingko biloba?
2 weeks
Herb inhibits platelets and it is antioxidant
May potentiate anticoagulant effects
How many days before surgery should patient stop taking kava-kava?
24 hours
Herb a sedative hypnotic
Avoid use with benzo, etoh, barbiturates
DO NOT use with Parkinson’s medications
How much change in HGB/ HCT per 1 unit of PRBC (250cc, w/ RBCs + platelets)?
Hgb increase by 1 g/dL
Hct increase by 3%
How much change in platelet if given 1 pack = 50-300ml?
Increase platelet count 5000-10,000
S/p wound debridement, patient is febrile, with gross hemoglobinuria and flushed skin. Patient having which type of transfusion reaction:
anaphylactic
allergic
hemolytic
citrate intoxication
hemolytic
Name cranial nerves I-VI
I – Olfactory: Sense of smell
II – Optic: Sight
III – Oculomotor: Pupil, upper eyelid, eye movements
IV – Trochlear: Downward/inward eye movement
V – Trigeminal: Sensation of cornea, cheek/lips, chin; control of biting and chewing muscles
VI – Abducens: Lateral eye movements
Name Cranial Nerves VII-XII
VII – Facial: Movement of facial muscles; taste
VIII – Acoustic: Equilibrium; hearing
IX – Glossopharyngeal: Swallowing muscles; taste
X – Vagus: Pharynx/larynx sensation; movement of soft palate
XI – Spinal accessory: Sternocleidomastoid, trapezius muscles
XII – Hypoglossal: Movement of tongue
What is Cerebral Perfusion Pressure?
Brain perfusion calculated as
CPP=MAP - ICP
Normal range 70-100mmHg
Minimal adequate value @ 60mmHg
What is normal ICP?
Normal ICP 0 - 15 mmHg
Goal of care is to maintain ICP < 20 mmHg
Treatment starts when ICP > 20 mmHg
Patient with head trauma with intraparenchymal bolt in place. ICP 30-40 mm HG. Perianesthesia RN knows that cerebral hypoxia maybe aggravated by:
mannitol administration
raising HOB
hypercapia
tachycardia
hypercapia
What are common signs and symptoms of ICP increase complication?
Hypertension
Bradycardia
Respiratory disturbances
What is autonomic dysreflexia?
Sudden dramatic BP elevation
May occur with spinal cord injury
Caused by massive sympathetic response to a noxious stimulus (e.g. full bladder, IV line insertion, fecal impaction)
Results to extreme hypertension, bradycardia, headache, and facial flushing
Occurs to para/quadriplegic patient’s months or years after initial injury
What are other signs and symptoms of autonomic dysreflexia?
Changed in mental status
Pounding headache
Flushed skin above level of lesion, palor below level
What’s treatment for autonomic dysreflexia?
Straight cath to empty bladder
Elevate HOB
Administer antihypertensive
What is Virchow’s Triad ?
3 factors increase incidence of venous thrombosis:
hypercoagulability caused by alteration of platelet and clotting factors
venous stasis caused by incompetent venous valves
intimal (vessel) damage caused by trauma, IV infusions, and ischemia.
What are the signs and symptoms of cardiac tamponade?
BECK’S TRIAD:
Increased CVP
Muffled heart tones
Pulsus paradoxus (fall of SBP >10 mmHg upon inspiration)
What are other signs and symptoms of cardiac tamponade?
Tachycardia
Narrowing pulse pressure
JVD
Sudden cessation of drainage from mediastinal tube
What are the signs and symptoms of Right sided Heart Failure?
Right side unable to pump venous blood adequately into pulmonary circulation, results to swelling, abdominal bloating, ascites, weight gain, jugular venous distention, and dependent pitting edema.
What are the signs and symptoms of Left sided Heart Failure?
Left side unable to pump blood into the systemic circulation, results to accumulation of blood into the lungs, manifested by crackles, wheezes, weakness, fatigue, cough, and orthopnea.
Extra heart sounds heard R and L ventricular failure d/t filling patterns in a noncompliant ventricle.
What is Cushings Triage?
Caused by over-secretion of corticosteroids
Results to:
Altered fat distribution (moon face, buffalo hump)
Ecchymosis
Osteoporosis and poor wound healing due to chronic elevation in steroid secretion
Hyperglycemia
What are post-op considerations for Cushings Triage?
Manage hyperglycemia and blood pressure
Monitor airway closely
Take care when repositioning due to thin skin
What is Addison’s disease?
Decreased secretion of cortisol and aldosterone d/t autoimmune reaction, infection, congenital
Results to:
Hypernatremia and hyperkalemia related to decreased aldosterone
Weakness, dizziness, polyuria
HYPOGLYCEMIA
Addisonian Crisis
Shock
Lack of response to vasopressors
What is pheochromocytoma?
Increase in catecholamine secretion
Results to:
Severe hypertension, tachycardia, palpitations
Hyperglycemia
Hypermetabolism, weight loss
Nausea, Abdominal pain
Irritability, diaphoresis
What is the treatment for pheochromocytoma?
Adrenalectomy
What are the post-op considerations for pheochromocytoma?
Monitor BP closely! Can have rebound hypotension post-adrenalectomy and may require vasopressors. Will need cortisol replacement
What are classifications of renal failure?
PRERENAL – volume depletion, volume shifts, vascular compromise (MH, AAA)
INTRARENAL – Occurs within the renal tissue (Glomerulonephritis, acute tubular necrosis, etc.)
POSTRENAL – Renal stone, outlet obstruction (back-flow of pressure into kidney causes damage)
What is steal syndrome?
Steal syndrome: complication due to fistula formation can lead to ischemia
What are the signs and symptoms of steal syndrome?
Pallor
Diminished pulses
Pain distal to new graft site
How to assess peroneal nerve damage?
Peroneal nerve assessment:
Sensory: touch lateral side of great toe, medial side of second digit
Motor: dorsiflex ankle, hyperextend great toe
Which of the following oxygen delivery devices offers the highest concentration of oxygen (FiO2)?
Venturi mask
Partial non-rebreather mask
Non-rebreather mask
Simple face mask
Non-rebreather FiO2 of close to 80-95%
Venturi mask 24-55%
Simple face mask 40-60%
Partial rebreather mask 60-75%
A patient with severe COPD requires both humidification of oxygen and a tightly controlled flow rate. Which of the following would be the best choice for oxygen therapy?
Venturi mask
Partial non-rebreather mask
Non-rebreather mask
Simple face mask
Venturi mask allows well-controlled titration of FiO2 and humidification.
Which of the following would be an unexpected complication seen in a patient with a newly created tracheostomy?
Mediastinal subcutaneous emphysema
Pleural effusion
Pneumothorax
Feeling of shortness of breath despite adequate oxygenation
Pleural effusion NOT anticipated
Complications include:
subcutaneous emphysema, pneumothorax,
hemorrhage,
post-placement obstruction.
Patients report SOB despite adequate oxygenation d/t smaller diameter and anxiety
In a patient experiencing laryngospasm, the nurse would expect to find which of the following after doing a complete respiratory assessment?
Patient states that it is hard to breathe and is visibly dyspneic
Audible wheezes and use of accessory muscles
Pink, frothy sputum
Inspiratory stridor with tracheal tug
A patient experiencing laryngospasm represents a clinical emergency in which the vocal cords are partially or fully closed. Although it would be hard for the patient to breathe, he or she would not be able to speak in the event of a true laryngospasm. The other items listed are more representative of bronchospasm . A patient experiencing laryngospasm may not be moving any air and may not even experience stridor. In the event of partial laryngospasm, high-pitched stridor, tracheal tub, and patient anxiety or agitation are common
What is the rule for maintenance iv fluid administration?
First 10kg = 4 mL/kg/hr
Next 10kg = 2mL/kg/hr
Weight > 20kg = 1ml/kg/hr
What is the rule for maintenance iv fluid administration?
First 10kg = 4 mL/kg/hr
Next 10kg = 2mL/kg/hr
Weight > 20kg = 1ml/kg/hr
In a patient who has undergone pectoralis major pedicle flap procedure, the perianesthesia nurse will suspect failure of the graft if the flap became:
cool and bluish
cool and grey
warm and grey
warm and bluish
cool and bluish
Which of the following nursing actions is contraindicated in patients with a laryngeal mask airway in place?
- tactile stimulation to assess neurological responses
- application of noninvasive BP cuff and EKG electrodes
- auscultating anterior breath and heart sounds
- attaching t-pice with 40% humidified O2
tactile stimulation to assess neurological responses
After successful recovery from malignant hyperthermia crisis, patient reports muscle tightness and weakness in the forearm, as well as severe pain with finger movement. The patient’s forearms are pale and the skin is tight. The perianesthesia nurse priority intervention is to:
- elevate the arms above the level of the heart to assist venous return
- reassure the patient that this is normal side effect of dantrolene
- apply ice packs to the patient’s forearms to decrease swelling
- maintain the patient’s arm in neutral position
maintain the patient’s arm in neutral position
How many nurses to care for the following: awake and crying 5 year old; an intubated patient unconscious with spontaneous breathing; 2 awake and stable patients; a patient entring PACU?
4
Patient s/p breast mastectomy and TRAM flap reveals pale, cool flap that does not bleed when stuck with a needle. Perianesthesia nurse suspects:
venous thrombosis
arterial thrombosis
vasoconstriction
vasodilation
arterial thrombosis
Patient with history of malignant hyperthermia can safely receive?
succinylcholine
nitrous oxide
sevoflurane
isolfurane
nitrous oxide
