Part III. Clinical notes Flashcards
There are two general types of anesthesia for childbirth. What are they?
General anesthesia
Regional anesthesia
Why is general anesthesia not commonly used for childbirth except in emergency procedures?
Renders woman unconscious and unaware of labor and delivery so childbirth occurs passively under control of maternal hormones with out feedback from mother so she must be closely monitored.
Where is anesthetic agent introduced in a spinal block?
into subarachnoid space at L3/L4
What does the spinal block anesthetize?
Anesthetizes everything inferior to waist including perineum, pelvic floor, birth canal, uterine pain sensations, motor/sensory of lower limbs
What type of regional anesthesia requires electronic monitoring of contractions?
Spinal block, because everything from the waist down in numb
Can you readminister a spinal block if labor is long?
Difficult or impossible to re-administer anesthetic
What is a common side effect of spinal block after delivery?
After delivery, when lying flat, anesthetic circulates to cranial cavity commonly resulting in a severe headache
Where is anesthetic agent introduced in a caudal epidural block?
Via an in-dwelling catheter in sacral canal to nerve roots of S2-S4
What are the benefits of epidural block in childbirth?
- can be administered in advance of labor
- enables readministering of anesthesia
- Woman is aware of uterine contractions but doesn’t experience most pain
- no spinal headache
Why does the epidural block not result in a spinal headache?
because vertebral epidural space is not continuous with
cranial epidural space
What does the epidural block anesthetize?
Anesthetizes fibers in Pudendal N plus uterus and upper vagina - woman is aware of contractions and therefore they do not need to be monitored
Where is anesthetic administered in a pudendal nerve block?
injected near Pudendal N where it passes over ischial spine
What does the pudendal nerve block anesthetize?
S2-S4 dermatomes (majority of perineum and lower vagina)
Does pudendal nerve block anesthetize sensations of uterine contractions?
No
Does epidural block anesthetize sensations of uterine contractions?
No
Does spinal block anesthetize sensations of uterine contractions?
Yes
Can anesthesia be readministered with a pudendal nerve block is labor is long?
Yes
Can anesthesia be readministered with an epidural block if labor is long?
Yes
What is a hysterectomy?
Excision of the uterus
How can the hysterectomy be performed?
Through abdominal wall or through vagina
What are some reasons for performing a hysterectomy?
Uterine cancer, cervical cancer, uterine prolapse
What type of anesthesia is administered before doing an episiotomy?
Pudendal nerve block
what does a total hysterectomy mean?
Cervix was also taken
What other procedure is also commonly done with a hysterectomy?
Oopherectomy - removal of ovaries
What structures can be palpated by digital rectal exam in both males and females?
Sacrum
Coccyx
Ischial spines
Ischial tuberosities
What structures can be palpated by digital rectal exam in males?
Prostate
Seminal vesicles
What structure can be palpated by digital rectal exam in females?
Cervix
What are you palpating for on a digital rectal exam?
Pathology such as enlarged nodes, thickened ureters or abscesses
What is a proctoscope used for?
Proctoscope may be used to visualize rectal lumen and remove lesions (hemorrhoids)
Benign prostatic hypertrophy is associated with which lobe of the prostate?
Middle lobe
What are the symptoms of BPH?
It obstructs prostatic urethra and impedes urine flow, causing nocturia, dysuria and urgency
When palpating for BPH on a digital rectal exam, when is it best done?
with a full bladder which provides resistance to push against
What is a transurethral procedure?
Procedure to widen urethra by removing some gland tissue
Prostate cancer occurs most commonly in men over the age of ___.
55
Prostate cancer is associated with which lobe of the prostate?
Posterior lobe
How will a cancerous prostate feel on digital rectal exam?
firm and irregular
Metastatic cells associated with prostate cancer will move to which lymph nodes?
internal iliac and sacral lymph nodes
What is the treatment for prostate cancer?
often combines radiation and hormone therapy
Sometimes removal of prostate - Prostatectomy
What are the risks of a prostatectomy?
damaging nerves involved in erection and urinary control
