Module 2 Flashcards
Postural changes may alter lung volumes, ventilation, and pulmonary blood flow
Redistribution of V/Q (Ventilation/perfusion)
Worsened by the majority of surgical positions
Anesthetic respiratory depression
Dependent lung (bottom) is better perfused, while independent lung (top) is better ventilated
V/Q mismatching
FRC (functional residual capacity) and TLC (total lung capacity) are decreased in this position
Supine position
Improved oxygenation, improved V/Q mismatching, and ventilation is more uniformed because abdominal organs are not pushing down on lungs in this position (commonly used to treat ARDS)
Prone Position
This position alters V/Q mismatching and can impact oxygenation
Lateral Position
This position limits diaphragmatic movement because all abdominal organs are pushing down on diaphragm and lungs causing a decreased FRC
Lithotomy Position
Nerve transection that occurs as a result of surgical maneuver or traumatic injury; Cutting the nerve.
Transection Nerve injury
What injury occurs when a nerve is forced against a bony prominence or hard surface such as an arm board or OR table
Compression Nerve Injury
Most common compressed nerve
Ulnar Nerve
What injury can cause excessive elongation of a nerve may cause conduction changes, axonal disruption, or interruption of vascular supply
Stretching/ Traction nerve injury
Muscle relaxants may contribute to this injury by allowing increase mobility of joints
Stretching/ Traction nerve injury
Most commonly affects the brachial plexus nerve
Stretching/ Traction nerve injury
This nerve root (C8-T1) injury is the second most common post op injury; most vulnerable to injury if the arm is abducted, arm board falls off, the head is rotated away from arm, and if shoulder straps are used in steep Trendelenburg because it causes stretching and compression
Brachial Plexus
Abduct arms less than 90 degrees, avoid shoulder compression, and keep head midline
To avoid stretching injury
When a peripheral nerve is pinched between two immovable structures
Kinking
Blood flow that can be interrupted by stretch, compression or transection injury
Nerve Injury
Common component of all peripheral nerve injury
Ischemia
Form of preventing injuries
Ensure PPP (pressure points padded)
Most frequently reported injury after surgery; patient will have “claw hand” and loss of abduction/adduction of fingers
Ulnar neuropathy
Use padding, place arms in supinated position (palms up), and abduct arms less than 90 degrees. Or patient’s arms tucked at side of the body in neutral position with palms facing inward. Pronation (palms down) increases pressure on ulnar nerve
Prevention of Ulnar neuropathy
Compresses neural and vascular structures and may cause compartment syndrome
Improper placement of axilla roll
Nerve injury that can occur when legs are improperly placed in candy cane stirrups
Peroneal nerve injury
Contribute to postoperative positioning complications; weight of body causes external compression of dependent tissue and states of low perfusion
Prolonged surgical procedures