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Spring '14 Advanced Health Assessment > Operative Positioning > Flashcards

Operative Positioning Flashcards

1
Q

What is the purpose of operative positioning? (list 3)

A
  • comfort
  • patient safety
  • surgical exposure and or surgical access
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2
Q

Who is responsible for supervising and assuring no nerve or soft tissue injury and minimize physiological changes?

A

the anesthetist

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3
Q

How should you establish position changes?

A

gradually, particularly at the conclusion of long surgeries

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4
Q

The most imporant thing an anethetist can do while positon a patient is:

A

be vigilant!

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5
Q

What needs to be documented in regards to patient positioning?

A
  • baseline ROM
  • Intraoperative position
  • use of padding
  • body position
  • checks done and frequency
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6
Q

What is the OR table weight limit?

A

136kg (200 lbs)

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7
Q

How long is the OR table?

A

80.7 inches

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8
Q

Is this proper hand position for a supine patient in the OR?

A

Yes, but be careful that the stuff behind the arm supporting it is not too rigid, otherwise you could damge the radial nerve.

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9
Q

How should the feet be,while in the supine position?

A
  • not hanging off the bed
  • heels padded
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10
Q

How do you supply lumbar support while in the supine position in the OR?

A
  • slight flexion of hips and knees
  • Pillow under the knees (caution)
  • Legs/ feet should not be crossed
  • TEDs/ SCDs increase venous return, decrease risk of DVT
  • Safety strap
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11
Q

If you put too many pillows under the knees what would happen?

A

You could obstruct venous blood flow

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12
Q

What are the 5 mechanisms of nerve injury?

A
  • stretching
  • compression
  • kinking
  • ischemia
  • transsection
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13
Q

The brachial plexus goes through what 2 fixed points.

A
  • the verterbral foramina fascia
  • axilla
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14
Q

What 3 things in the OR for the patient in supine positon, would cause injury to the brachial plexus?

A
  • neck extension or head turned to one side
  • when arm board extended or abducted >90 degrees
  • arm/ arm board falls of the table (mostly stretching injuries)
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15
Q

What are the symptoms of a brachial plexus injury?

A
  • electric shocks or burning sensation shooting down the arm
  • numbness or weak arm
  • no or weak motor control of shoulder and elbow
  • pain
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16
Q

How does radial nerve damage occur in the OR?

A

compression of the radial nerve on the lateral aspect of the humerus from surgical retractors, ether screen, mismatched arm board, repeat BP inflation

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17
Q

What is the physiological result of radial nerve injury in the OR?

A
  • wrist drop
  • weakness in abduction of the thumb
  • numbness 1, 2 ring fingers
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18
Q

What is the most common peripheral nerve injury obtained in the OR?

A

Ulnar nerve injury

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19
Q

What 2 types of injuries can occur to the ulnar nerve in the OR?

A
  • It is in the cubital tunnel at the elbow groove. Compression of the nerve between the olecranon of the ulna and medial epicondyle of the humerus (entrapment with arm extension)
  • Also injured by stretch with severe elbow flexion, dislocation with pronation of the hand, nerve dislocation over medial epicondyle w/stretching, compressing against bed
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20
Q

What 4 things happen with claw hand, what nerve is injured?

A

Claw hand is an ulnar nerve injury.

  • Inability to abduct or oppose the 5th finger
  • Weak grip ulnar side of fist
  • Loss of sensation to the palmar surface to the 4th or 5th fingers
  • Atrophy of intrinsic muscle of the hand (side of the hand)
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21
Q

What can you do to reduce injury to the ulnar nerve? (list 5)

A
  • pad the arm boards
  • avoid downward compression by strap
  • assure surgical personnell don’t compress the patient’s arm
  • Place BP cuff proximally so it doesn’t compress the ulnar groove or cubital tunnel
  • Avoid prolonged flexion of the elbow
22
Q

How common is the occurence of lower extremity nerve damage from the lithotomy position?

A

1 in 3608 patients

23
Q

What percentage of lower extremity nerve injuries are to the common peroneal nerve?

A

78%

24
Q

What percentage of nerve injuries are to the sciatic nerve?

A

15%

25
Q

What percent of nerve injuries are to the femoral nerve?

A

7%

26
Q

Lower extremity nerve injuries are most common in what 3 patient populations?

A
  • low body mass index
  • prolonged surgery
  • recent cigarette smoking
27
Q

Name the nerve branches.

A
28
Q

The common peroneal nerve is a branch of the:

A

sciatic nerve

29
Q

The common peroneal nerve lies lateral to the:

A

neck of the fibula

30
Q

How does injury to the common peroneal nerve occur in patients in lithotomy position?

A

Compression of the lateral aspect of the knee against stirrup or if patient in lateral position.

31
Q

What are the symptoms of common peroneal nerve injury?

A
  • foot drop
  • inability to evert the foot
  • loss of dorsal extension of the toes
32
Q

What two things could cause sciatic nerve injury in the OR?

A
  • excessive external rotation of the hips
  • pressure on sciatic notch from stretching
33
Q

What are the symptoms of sciatic nerve injury?

A
  • weakness or paralysis of muscles below the knee
  • numbness foot and lateral half of calf
  • foot drop
34
Q

How does femoral nerve injury occur in the OR?

A
  • compression at pelvic brim by retractor
  • excessive angulation of the thigh
  • abduction of thighs and external rotation of hips
35
Q

What are the symptoms of femoral nerve injury?

A
  • Loss of flexion of the hip
  • Loss of extension at the knee
  • decreased sensation over the superior aspect of the thigh
36
Q

How does saphenous nerve injury occur in the OR?

A

When medial aspect of lower leg is compressed against support bar

37
Q

What are the symptoms of saphenous nerve injury?

A

paresthesias medial and antermedial side of calf.

38
Q

What causes lower extremity compartment syndrome?

A
  • When perfusion to an extremity is inadequate, resulting in
  • ischemia,
  • edema, and
  • excessive rhabodmyolosis from increased tissue pressure
  • occurs with long surgeries (>2-3 hours)
39
Q

Lower extremity compartment syndrome is associated with which two surgical positions?

A
  • lithotomy
  • lateral decubitus
40
Q

How do you calculate perfusion to the lower extremities?

A

Perfusion pressure changes 2mmHg for every 2.5cm that a given point varies in vertical height above or below a reference point (the heart).

41
Q

What is this prone frame called?

A

Wilson frame, it is good for ventilatory expansion

42
Q

What is this prone frame called?

A

Jackson table. There is not base. You can get x-rays very easily

43
Q

With a head rest with mirror, what should you be watching for?

A
  • eyes
  • nose
  • airway
  • neck alignment
44
Q

With a horseshoe head rest what do you have to watch for?

A
  • eyes
  • nose
  • bony structures of face
  • airway
  • neck alignment
45
Q

What do we have to watch for with Mayfield head tongs/ pins?

A
  • slippage
  • neck alignment
  • nose
  • metal components touching
46
Q

What causes corneal abrasions in the OR?

A
  • direct trauma
  • dry eye
  • swelling
47
Q

How do you treat corneal abrasions if they occur?

A

antibiotic ointment, eye patch

48
Q

What causes blindness in the OR?

A
  • caused by ischemic optic neuropathy via central vein or artery obstruction or via sustained, direct pressure on the eye/retina
  • visual changes/ partial or complete blindness
49
Q

List some risk factors for blindness in the OR via ischemic optic neuropathy?

A
  • prone position
  • operative hypotension
  • large operative blood loss
  • large crytalloid use
  • anemia
  • smoker
  • diabetic
  • patients with vascular pathology
  • HTN
  • male
  • microemboli
50
Q

Which 2 types of surgery place patients at increase risk of ischemic optic neuropathy?

A
  • spinal surgery
  • cardiac surgery

Spring '14 Advanced Health Assessment (5 decks)

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