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D3 Pharm > Nitrous > Flashcards

Nitrous Flashcards

1
Q

what is a normal reading for a patients pulse oximetry?

A

94-99%, under 90 is considered low

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2
Q

what is the average flow that will be used for nitrous?

A

5-6 liters per minute

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3
Q

what % nitrous do most pts begin to feel symptoms?

A

at 30% nitrous, 80% of pts begin feeling symptoms,

10% of pts are 30%

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4
Q

after the procedure, do what?

A

100% O2 for 3-5 minutes
then 5 minutes of room air (help prevent diffusion hypoxia)
-record vital signs
-modified romberg test

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5
Q

what is the romberg test?

A
  • stand with feet together
  • eyes closed
  • nose-finger contact
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6
Q

what is recorded in the N2O note?

A
  • N2O/O2 titrated to max of ___% for ___ min
  • how it was tolerated
  • 100% O3 for ___ minutes at the end
  • patient remained awake and cooperative
  • pt fully alert and oriented at discharge
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7
Q

stage 1 of Anesthesia

A

plane 1-no analgesia
plane 2- partial analgesia
plane 3- partial amnesia, analgesia

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8
Q

what are the signs of nitrous overdose?

A
  • restless, combative, incoherent
  • pt feels uncomfortable, disoriented
  • uncooperative, fails to respond to commands
  • cries, laughs
  • hard angry stare
  • profuse sweating
  • patient can go into stage 2 of anesthesia (excitement)
  • nausea
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9
Q

what should you do for a patient with nitrous overdose?

A
  • 100% oxygen
  • push O2 flush
  • lift mask from nose and squeeze reservoir bag
  • flush again and replace mask
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10
Q

eye signs

A
  • Analgesia: normal pupil size and response to light

- Excitement: pupils dilated, lateral (and superior) eye movement

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11
Q

chronic exposure of nitrous in dental workers has been associated with:

A
  • spontaneous abortion
  • reduced fertility
  • birth defects
  • liver, kidney, and general neurological disease
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12
Q

what defines chronic exposure?

A

an exposure that exceeds 50 ppm of Nitrous oxide as an 8 hour time weighted average

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13
Q

what should the ppm of nitrous be at (ideally) in the ambient air?

A

25 ppm

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14
Q

what are the absolute contraindications for the use of nitrous?

A

-Acute URI (upper resp infect) or nasal obstruction
-active infectious bronchitis
-first trimester of pregnanc
(those are the 3 he wants us to know, but for boards also know.. sever neuromuscular disease, or a pneumothorax, bowel obstruction, inner ear infection)

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15
Q

what are the relative contraindications for nitrous?

A
  • pregnancy after the first trimester
  • psychiatric instability
  • acute asthma (?)
  • Severe COPD ?
  • Recent eye surgery (can react with agents used and increase intraocular pressure)
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16
Q

primary site of action for nitrous

A

-cerebral cortex

17
Q

onset of N2O

A

within 2 minutes of conc change

-rapid recovery

18
Q

what is the second gas effect?

A

when a less potent gas (nitrous) is added in high concentration to a more potent gas (like sevoflurane), the potent gas will have a more rapid uptake

19
Q

diffusion hypoxia

A
  • at the completion of the procedure, N2O diffuses rapidly out of the blood and into alveoli
  • O2 content in alveoli is diluted, with possible headache and nausea
  • prevent with 100% O2 for 3-5 min after procedure
20
Q

definition of analgesia

A

-the diminution or partial elimination of pain in the conscious patient

21
Q

definition of general anesthesia

A

a drug-induced loss of consciousness during whcih patients are not arousable, even by painful stimulation

22
Q

what are the colors of the different tanks?

A
  • green is good (oxygen)

- blue and turn you blue (nitrous)

23
Q

what is the approx concentration of O2 in the air?

A

21%

24
Q

what is “DISS?”

A
  • diameter index safety system

- basically the ends of the hoses are different diameters so things are put in the right place

25
Q

PISS

A
  • pin index safety system
  • This feature assures that the oxygen gas cylinder is not inadvertently hooked into the nitrous oxide line and vice-versa
  • the oxygen tanks have pins that are PARALLEL and the nitrous pins are off-set
26
Q

how is the volume of gas assessed for the O2 and nitrous?

A
  • oxygen is measured by pressure (need at least 500 lbs pressure O2)
  • nitrous by weight
27
Q

which way do you turn the valve to open the tanks

A

to the left

28
Q

what is the first thing you do when you are setting up nitrous?

A

set the flow/concentration of oxygen

D3 Pharm (3 decks)

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