Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

JW: Principles II > PACU & Complications (Exam II) > Flashcards

PACU & Complications (Exam II) Flashcards

1
Q

What is Standard 1 for postanesthesia care?

A

All patients who have received any type of anesthetic care should receive appropriate post-anesthetic care.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is Standard 3 for postanesthesia care?

A

Upon arrival to PACU the patient should be re-evaluated and a verbal report to RN should be given by the anesthesia personnel.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is Standard 4 for postanesthesia care?

A

The patient shall be evaluated continually in the PACU.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is Standard 5 for postanesthesia care?

A

A physician is responsible for discharge of the patient from the PACU.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the more intense phase of post-anesthetic recovery?

A

Phase 1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

In what phase are HR, O₂sat, RR, ECG, and airway patency monitored continuously?

A

Phase 1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What has to be assessed if a patient is still intubated in the PACU?

A

Neuromuscular function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is Standard 2 for postanesthesia care?

A

A patient being transported to PACU has to be monitored and taken by qualified anesthesia personnel.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How often must vital signs be assessed and recorded during the 1st phase of recovery?

A
  • q5 min for 1st 15 minutes
  • q15 min for duration of phase 1.

Target vitals to 20% of baseline.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What tools are used to determine patients criteria for discharge from PACU?

A
  • Standard Aldrete Score
  • Modified Aldrete Score
  • PACU Discharge Score

My kid was here, I leave this for posterity.

?bn y ] t t y [;yh;..j.,jm.m./m.m.m.;.bhjn h;’./ \n\\\\\\\\\\\\\g fgdrrdf d

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Describe the Standard Aldrete Score.

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Describe the Modified Aldrete Score.

A

Modified Aldrete Score

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Describe the Postanesthesia Discharge Score.

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the standard for how often vital signs must be checked in Phase II of recovery?

A

30 - 60 min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What should be monitored in Phase II of recovery? (other than vital signs)

A
  • Airway and ventilation status
  • Pain level
  • PONV
  • Fluid balance
  • Wound integrity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the most common complications that could be seen in the PACU?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the causes (anatomically) of upper airway obstruction?

A
  • Loss of pharyngeal muscle tone
  • Paradoxical breathing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the treatment of upper airway obstruction?

A
  • Jaw thrust
  • CPAP
  • Oral/Nasal airway
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are laryngospasms?

A

Vocal cord closure leading to loss of air movement and hypoxemia and negative pressure pulmonary edema.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the three most common causes of laryngospasms?

A
  • Stimulation of pharynx and/or vocal cords
  • Secretions, blood, foreign material
  • Regular extubations
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is negative pressure pulmonary edema?

A

Non-cardiogenic pulmonary edema that results from high negative intrathoracic pressures attempting to overcome upper airway obstruction.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the most common etiology of negative pressure pulmonary edema?

A

Laryngospasm

Occurs in 12% of laryngospasm cases.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the physiology behind laryngospasm?

A

Prolonged exacerbation of glottic closure reflex due to superior laryngeal nerve stimulation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What would laryngospasms present like upon inspection?

A

Faint inspiratory stridor
Increased respiratory effort
Increased diaphragmatic excursion
Flailing of lower ribs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

At what pressure should the bag be squeezed when treating laryngospasm?

A

Do not squeeze bag during laryngospasm.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

How should a BVM be utilized in laryngospasm emergency?

A

Apply facemask with tight seal and 100% FiO₂ and closed APL valve.

Do NOT squeeze the bag.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is the first step in treatment of laryngospasm?

A

Call for help

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What should be done after a BVM is utilized for laryngospasm?

A
  • Suction airway
  • Chin lift and/or jaw thrust
  • Oral/nasal airways
  • Laryngospasm notch pressure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is Larson’s point?
What is its significance?

A

Pressure point behind of the lobule of the pinna of each ear that can help relieve laryngospasm.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What will indicate a patient who is crumping out from your inability to break a laryngospasm?

A
  • Tachycardia
  • Fast desaturation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What should be done for a laryngospasm thats failed to respond to conventional treatment?

A

Atropine, Propofol, Succinylcholine, reintubate.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What initial dose of Succinylcholine is typically used for laryngospasm?

A

1/10 of normal dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What neuromuscular blocking drug can cause bradycardia in pediatric patients.

A

Succinylcholine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What would be noted on visual assessment that would indicate to the CRNA that a patient is developing airway edema?

A

Facial and scleral edema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What factors can precipitate airway edema?

A
  • Prolonged intubation (especially in prone or trendelenburg cases).
  • Cases with ↑EBL (aggressive fluid resuscitation).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What should be done prior to extubation with expected pulmonary edema?

A
  • Suction Oropharynx
  • ETT cuff leak test
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

How is an ETT cuff leak test done?

A

Remove small amount of air from cuff and assess for air movement around the cuff. If air cannot be heard then leave the tube in place.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

When are airway hematomas most often seen?

A
  • Neck dissections
  • Thyroid removal
  • Carotid surgeries
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

A rapidly expanding hematoma may precipitate ____________ edema.

A

supraglottic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

In the instance of airway hematoma, deviated tracheal rings and compression of the tracheal below the ________ ________ are seen.

A

cricoid cartilage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What is the treatment for airway hematoma post extubation?

A
  • Decompress airway be releasing surgical clips or sutures.
  • Remove SQ blood clot before reintubating
  • Reintubate
  • Surgical backup (tracheostomy)
42
Q

What surgeries and procedures is vocal cord palsy associated with?

A
  • ENT surgery
  • Thyroidectomy & parathyroidectomy
  • Rigid Bronchoscopy
  • Hyperinflated ETT cuff
43
Q

If vocal cord palsy is unilateral, then the patient is often ___________.

A

asymptomatic

44
Q

How would damage to the external branch of the superior laryngeal nerve present?

A
  • Vocal weakness and “huskiness”
  • Paralyzed cricothyroid muscle
  • Loss of tension → vocal cord looks “wavy”.
45
Q

What does bilateral Recurrent Laryngeal Nerve damage result in?

A

Aphonia & paralyzed vocal cords

46
Q

What position do the vocal cords assume with bilateral Recurrent Laryngeal Nerve damage?

A

Intermediate position (not adducted or abducted).

47
Q

What is the biggest risk associated with bilateral Recurrent Laryngeal Nerve damage?

A

Airway obstruction during inspiration

48
Q

How long does it typically take for the hypocalcemia associated with thyroid surgery to present?

A

24 - 48 hours postop

49
Q

What is Chvostek’s sign?

A

Facial spasm

50
Q

What is Trousseau’s sign?

A

Carpal spasm w/ BP cuff

51
Q

What are some ways to assess for residual neuromuscular blockade?

A
  • Grip strength
  • Tongue protrusion
  • Ability to lift legs
  • Able to hold head up for 5 seconds
52
Q

What medication class are OSA patients sensitive to?

53
Q

What is the STOP-BANG assessment?

A

Snore
Tired
Observed
Pressure
BMI > 35
Age > 50
Neck circumference > 16 in
Gender (male)

54
Q

What score on the STOP-BANG assessment is indicative of a low risk for OSA?

55
Q

What score on the STOP-BANG assessment is indicative of a intermediate risk for OSA?

56
Q

What score on the STOP-BANG assessment is indicative of a high risk for OSA?

57
Q

What is the full STOP-BANG questionnaire?

58
Q

What are common causes of arterial hypoxemia in a PACU patient?

A
  • Room air
  • Hypoventilation
59
Q

What are common treatments for arterial hypoxemia in the PACU patient?

A
  • O₂
  • Opioid/Benzo reversal
  • Stimulate patient
60
Q

What is Diffusion Hypoxia?

A

Rapid diffusion of N₂O into alveoli at end of anesthetic.

Dilutes PaO₂ and PaCO₂ → hypoxemia w/ ↓ respiratory drive.

61
Q

How long can diffusion hypoxia persist after discontinuation of N₂O anesthetic?

62
Q

What are the standard treatment thresholds for hypertension in the PACU?

A

SBP > 180
DBP > 110

63
Q

What medications (and doses) are typically used for treatment of systemic HTN in the PACU?

A

Labetalol (5 - 25mg)
Hydralazine (5 - 10mg)
Metoprolol (1 - 5mg)

64
Q

Hypotension that is due to decreased preload is __________.

A

Hypovolemic shock

65
Q

Hypotension that is due to decreased afterload is __________.

A

Distributive shock

66
Q

Hypotension that is due to intrinsic pump failure is __________.

A

Cardiogenic shock

67
Q

What are four common causes of decreased preload?

A
  • Third spacing
  • Inadequate fluid replacement
  • Neuraxial blockade → SNS tone loss
  • Bleeding
68
Q

What are four common causes of decreased afterload?

A
  • Sepsis
  • Anaphylaxis
  • Critical illness
  • Iatrogenic sympathectomy
69
Q

What are the two primary types of allergic reactions?

A

Anaphylactic & Anaphylactoid

70
Q

What is the drug of choice for hypotension in an allergic reaction?

A

Epinephrine

71
Q

What are the most common drug classes to cause anaphylactic reactions?

72
Q

What inflammatory mediators can cause bronchial constriction and increased vascular permeability?

A

Leukotrienes and Prostaglandins

73
Q

__________ drugs are associated with quaternary ammonium ions.

A

Neuromuscular blocking

74
Q

What patient populations are at high risk for latex allergy?

A
  • Repeated exposures (HCW’s)
  • Spina Bifida patients
75
Q

What are the three latex-mediated reactions?

A
  • Irritant contact dermatitis
  • Type IV cell-mediated reactions
  • Type I IgE-mediated hypersensitivity reactions
76
Q

What antibiotic causes a direct histamine release?

A

Vancomycin

77
Q

What is the most common ABX allergy?

A

Penicillin

78
Q

What two surgical procedures mentioned in lecture can lead to sudden sepsis?

A

Procedures involving urinary tract & biliary tract manipulation

79
Q

What are the three most common causes of intrinsic pump failure?

A
  • Myocardial ischemia/infarction
  • Tamponade
  • Dysrhythmias
80
Q

What is the risk stratification guideline for non-cardiac surgery?

81
Q

What are factors that decrease myocardial O₂ supply?

82
Q

What are factors that increase myocardial O₂ supply?

83
Q

What are the most common causes of sinus tachycardia?

A
  • SNS stimulation
  • ↓ volume
  • Anemia
  • Shivering
  • Agitation
84
Q

Risk for atrial dysrhythmias is greatest after what types of surgeries?

A

Cardiac and Thoracic

85
Q

What are risk factors for atrial dysthrythmias?

A
  • Pre-existing cardiac conditions
  • Hypervolemia
  • Electrolyte abnormalities
  • O₂ desaturation
86
Q

Patients that are hemodynamically unstable due to atrial dysrhythmias require _________.

A

cardioversion

87
Q

What medications tend to work well for atrial fibrillation?

A
  • β blockers
  • CCBs
88
Q

Greater than ____ ms QRS complex is considered wide.

89
Q

What should be investigated with true ventricular tachycardia?

A

H’s & T’s

90
Q

What procedures are associated with bradydysrhythmias?

A
  • Bowel Distention from GI stuff
  • ↑ ICP (Trendelenburg, etc.)
  • ↑ Intraocular (eye sx’s)
  • Spinal Anesthesia
91
Q

High spinals reaching the _______ level can block the cardioaccelerator fibers.

92
Q

What risk factors for Postoperative Cognitive Dysfunction (POCD) were discussed in lecture?

A
  • > 70 years old
  • Pre-operative cognitive impairment
  • ↓ Functional status
  • EtOH abuse
93
Q

What intra-operative factors are associated with POCD?

A
  • Surgical blood loss (HCT < 30%, PRBC infusions)
  • ↓ BP
  • NO administration
  • GETA
94
Q

What is the #1 cause of delayed awakening?

A

Residual sedation from anesthetic

95
Q

For delayed awakening secondary to opioids treat with ________ mcg of naloxone.

A

20 - 40 mcg

96
Q

For delayed awakening secondary to benzodiazepines treat with ________ mg of flumazenil.

97
Q

For delayed awakening secondary to scopolamine treat with ________ mg of ___________.

A

0.5 - 2mg IV Physostigmine.

98
Q

What (besides residual sedation) are some common reasons for delayed awakening from anesthesia?

A
  • Hypothermia < 33°C
  • ↓BG
  • ↑ICP
  • Residual NMBD’s
99
Q

What are some basic recommendations for discharge from PACU?

100
Q

What is/are the criteria for Determination of Discharge from PACU Score?

JW: Principles II (28 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions