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bsnc 3000 > Module 1 - Perioperative & PSR > Flashcards

Module 1 - Perioperative & PSR Flashcards

1
Q

3 Operative stages

A

Pre-operative
Intraoperative
Post-operative

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2
Q

Pre-operative phase

A

before surgery –> pt admitted to OR room

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3
Q

Intraoperative phase

A

OR room –> pt admitted to PACU

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4
Q

Post-operative

A

once pt has been admitted to PACU –> discharge

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5
Q

What is contained in a CBC

A 
RBC
Hgb
Hematocrit
Mean Corpuscular volume
WBC count & differential 
Platelets
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6
Q

General Adaptation Syndrome

A

alarm
resistance
exhaustion

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7
Q

Negative consequences of stress & healing

A 
reduced sleep
reduced appetite
release of stress hormones 
impaired perfusion
increased metabolic demand 
hyperglycemia (impairs wound healing)
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8
Q

Types of stress

A

acute
chronic
episodic

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9
Q

Stress hormones

A 
cortisol
epinephrine/norepinephrine
growth hormone
glucagon
antidiuretic hormone 
RAAS activation --> angiotensin II/aldosterone
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10
Q

Physiologic stress mechanisms

A

SNS activation
SAM (Sympathetic NS Adrenal Medulla)
HPA Axis (Hypothalamic-APG-Adrenal cortex)

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11
Q

PSR

A

Physiologic Stress Response

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12
Q

Types of anesthesia

A

General (IV, inhaled, volatile liquid)
Regional (epidural or spinal)
Local (nerve block)

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13
Q

Types of surgery

A 
emergent (asap)
urgent (wi 24-30 hrs)
required (should do it, weeks-months)
elective (optional, but may be recommended)
optional (cosmetic)
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14
Q

Reasons for surgery

A 
diagnostic 
curative (cure pathology)
reparative (restore function)
cosmetic
palliative
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15
Q

Fasting Guidelines

A

solid meals >6 hrs before surgery
clear liquids 2 hrs before surgery
fasting from all intake 2 hrs before surgery

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16
Q

Clear liquids pre-op

A

prevents dehydration, hypoglycemia (carb loading decreases insulin resistance), caffeine withdrawal (increases stress)

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17
Q

Medications held pre-op d/t risk of bleeding

A

NSAIDs (increase risk of bleeding by inhibiting COX-1)
antiplatelet meds (increase clotting time)
anticoagulants (inhibit clotting cascade)
herbal supplements (drug-drug interactions)

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18
Q

Balanced anesthesia

A

use of anesthesia + another agent to maximize therapeutic fx and minimize amount of drug

anesthetic agents, opioids, sedatives, neuromuscular blocking agents

19
Q

3 stages of General Anesthesia

A

Induction
Maintenance
Recovery

20
Q

Complications of regional anesthesia

A 
hypotension, bradycardia (sympathetic block)
urinary retention (blocks sensation)
hypothermia
backache (insertion site)
spinal epidural hematoma
21
Q

Causes of post-op stress

A 
pain
tissue injury
blood loss/hemorrhage (hypovolemia)
complications
sleep disturbances
hospital environment
fear/anxiety
loss/grief
22
Q

Cortisol function

A

increase blood glucose levels (glycogenolysis, gluconeogenesis)
inhibit inflammation & immune system (LOX pathway)
mineralocorticoid function –> increase fluid retention
decrease protein synthesis
increase fat & protein catabolism
increase bone resoprtion
increase clotting factors & platelet synthesis (prepare for injury)
increase appetite

23
Q

Angiotensin II effects

A 
stimulate rls of aldosterone & ADH
vasoconstriction
Na+ reabsorption @ PCT
water retention 
enhance sympathetic response
24
Q

ADH (Vasopressor) effects

A

insertion of aquaporins in collecting duct –> increase water retention
vasoconstriction

25
Q

Glucagon

A

stimulated by sympathetic activation NOT hypoglycemia
increase glycogenolysis, gluconeogenesis, lipolysis
high levels of glucagon = increase HR & contractility

26
Q

Growth hormone function

A

increase glycogenolysis

increase lipolysis

27
Q

Aldosterone function

A

retain Na+ @ DCT –> increase water retention

increase loss of K+

28
Q

Epinephrine/Norepinephrine function

A

increase heart rate & contractility
vasoconstriction in skin, GI tract, kidneys
vasodilation bronchioles, skeletal muscle, heart
decrease GI motility & secretion (increase risk of peptic ulcers)
increase alertness, arousal, vigilance
increase muscle tension (minimize injury)
increase glycogenolysis, lipolysis
decrease insulin release
increase sweating
pupil dilation
increase RR & bronchodilation
increase blood coagulability

29
Q

Common post-op respiratory problems

A

atelectasis
pneumonia
pulmonary edema
pulmonary emboli

30
Q

PSR CV complications

A

dysrhythmia
angina (increased HR & contractility –> ischemia)
MI
CHF
tachycardia
hypertension
blood hypercoagulability (increase inflammatory/clotting proteins)

31
Q

PSR Resp complications

A 
hypoxemia
hypercapnia --> respiratory acidosis 
atelectasis --> pneumonia
DVT --> PE
hypoventilation d/t pain
hyperventilation (s/t hypoxemia) --> respiratory arrest
32
Q

PSR Endocrine complications

A

protein catabolism
hyperglycemia
excess fluid volume (d/t prolonged RAAS)
vasoconstriction

33
Q

PSR immune complications

A

decreased immunity –> increased risk of infection
sepsis
increased inflammation

34
Q

PSR GI complications

A

paralytic ileus
increased sphincter tone
decreased smooth muscle tone
indigestion

35
Q

PSR GU complications

A 
urinary retention (increased sphincter tone, relaxed detrusor muscle)
acute renal failure
36
Q

PSR Cognitive complications

A

insomnia
anxiety
decreased appetite
feelings of helplessness

37
Q

Negative fx of hypoventilaiton

A

build up of alveolar secretions
decreased surfactant production
decreased collateral ventilation thru pores of Kohn

38
Q

PSR & hypercoagulability

A

increased circulating coagulation proteins
increased platelet reactivity
decreased coagulation inhibitors
decreased fibrinolysis

39
Q

Obesity RF

A 
increased risk of infection
increased risk of dehiscence 
increased vascular demand (30 lbs = 25 extra miles of blood vessels)
shallow breathing
obstructive sleep apnea
40
Q

Phospholipase

A

enzyme that release arachidonic acid from plasma membrane of cells

41
Q

Where is histamine concentrated?

A

skin
airways
GI tract

42
Q

H2 receptors

A

concentrated in gastric glands

stimulate parietal cells to produce Hcl

43
Q

Fx of histamine

A

pruritis, urticaria
bronchoconstriction, narrowing of airways
increased mucous production
vasodilation, vascular permeability
increase gastric secretions (hydrochloric acid)
increase wakefulness
increase GI motility –> diarrhea

bsnc 3000 (11 decks)

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