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Physical assessment Q1 > physical assessment q1 > Flashcards

physical assessment q1 Flashcards

1
Q

who is credited with first use with diethyl ether anesthetic in 1842

A

Crawford Long-first use of diethyl ether in surgery for removal of small cyst

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2
Q

horace wells charles jackson

and what does william morton have to do with it?

A

experimented with ether and nitrous oxide but it was william morton who used it for surgery 1846

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3
Q

William Morton

A

Letheon-added red dye to ether, tried to get it patented

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4
Q

chloroform first usage for relief of labor pain

A

James Simpson

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5
Q

Harvey Cushing

A

founder neurosurgery-patient died was told it was not his fault, continued with studies but never forgot

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6
Q

John Snow

A

queen Victoria for delivery of children-chlorophorm

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7
Q

Catherine Lawrence

A

provided anesthesia during Civil War skillfull nurse is as important as skillfull MD

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8
Q

Who is earliest known NA

A

Sr. Mary Bernard, Erie PA St. Vincents

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9
Q

Sr. Mary Erhart

A

Administered anesthesia for 42 years in maui

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10
Q

Who known as the “mother of anesthesia”-by Dr.Charles Mayo,
Mayo Clinic
published report of 14000 cases with out a death

A

Alice Macaw

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11
Q

who is credited with forming AANA, first president of AANA, started with 47 members also first to introduce gas anesthesia(but dr. crile took credit) she mixed Nitrous Oxide with O2 during cases, first organized educational programs to teach anesthesia

A

Agatha Hodgins

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12
Q

Alice Weinberg

A

chief NA for Jewish hospital in Phila. PA in 1950, choose by Dr. Teller(chief surgeon) for her pugnacity

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13
Q

Alice Hunt

A

appointed to faculty of yale medical school

authored anesthesia principles and practices in 1949

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14
Q

Helen Lamb

A

Barnes Hospital in St. Louis

first successful pneumonectomy in 1929 (credit went to Dr. Evart Graham)

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15
Q

Gertrude Fife

A

2nd AANA president

Started Board Exams

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16
Q

Who performs accreditation of NA schools

A

COA-formed in in 1975 took over for AANA

AANA began process in 1952, recognized by government in 1955

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17
Q

CCNA

A

charged with protecting and serving public ensuring NA providers are qualified and standards are ensured for providing safe NA service

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18
Q

council of public interest

A

monitor concerns in public safety, quality care, risk management, and practitioner wellness for prospective of public interest

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19
Q

Phyllis Roberts

A

Student of Gertrude Fife
sole anesthesia provider, educator in rural hospital
regional anesthesia author

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20
Q

TEFRA

A

7 standards that supervising anesthesiologists must meet to obtain medical reimbursement direction of CRNAs

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21
Q

What are 7 requirements of TEFRA

A

1) pre anesthesia evaluation
2) prescribe anesthesia plan
3) personally participate in induction and emergence and other demanding procedures
4) monitor course of case at frequent intervals
5) remain physically available for emergencies
6) provide post anesthesia care
7) refrain from personally performing anesthesia procedure when performing medical direction

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22
Q

OPT out

A

a governor of a state can request from medicare that there is no supervision for CRNAs in their state
when a govenor sends this request, they must provide documentation and evidence for need, if approved state says there is no supervision requirements

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23
Q

What are requirements for becoming a CRNA

A

1) current and unrestricted state license as RN
2) graduate from COA accredited NA program
3) completion of passing score NBCRNA Board exam

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24
Q

AANA core values

A

quality professionalism, compassion, collaboration, wellness, diversity

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25
Q

AANA motto

A

safe and effective anesthesia care

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26
Q

AANA mission statement

A

advancing patient safety, practice, excellence, member profession

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27
Q

What is most common NA malpractice insurance claim

A

damage to teeth, gums, or dental prosthetics, central incisors are most effected

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28
Q

Judicial Branch

A

Federal and state set up common laws and statues, review laws

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29
Q

Legislative Branch

A

medicare A and B TEFRA, TJC, national practitioner bank congress sets up statutory laws

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30
Q

3 types of torts

A

intentional-assault battery, abuse, imprisonment bodily or emotional harm
strict liability-product liability torts
unintentional-negligance, malpractice person or organization through breach of duty causes damage to another

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31
Q

executive law federal and state

A 
Department of health and human services
department of education
department of justice
state-state boards of RN
example-accredit schools
help to define and enforce practice
state-you must know what you can do in a particular state
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32
Q

Difference between Criminal and Civil law

A

criminal-protect society from harm

civil-concerned with private rights and remedies

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33
Q

Examples of Criminal Law

A

fraudulent filing of insurance or medicare claims, falsely billing for procedures, falsifying who did case, practice without licensure
employs unlicensed person, misuse of controlled substances

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34
Q

proximate cause

A

as part of negligence case, plaintiff must prove that actions of defendant caused damage suffered but also that there was proximate cause=forseeable damages that could have been prevented and it took place anyways

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35
Q

what is burden of proof

A

up to prosecution-must prove something happened

36
Q

what does res ipsa loquitur

A

“the thing speaks for itself”

37
Q

what is occurrence policy

A

covers you indefinitely for duration of time that you had the policy

38
Q

what is claims made policy

A

covers you until you stop cover-if you stop working there you are not covered unless you buy a tail

39
Q

what does respondent superior mean

A

let the master answer employer is responsible for actions of employed, if employee is negligent, then employer may be also sued

40
Q

Preoperative anesthesia assessment

A

under standard 1 of AANA standards of practice, if you do not do this you are negligent

41
Q

what is PAC clinic

A 
pre anesthesia assessment clinic
obtain med history exam
what meds to take 
lab tests
NPO status
complete pre op diagnostic
coordination with other relevant MD
should be done at least 1 wk prior to surgery
42
Q

thyromandibular distance

A

distance of tip of thyroid cartilage to tip of chin

43
Q

Sniffing position

A

external meatus of ear with sternum, brings laryngeal axis in you direction

44
Q

What effect do chronic Seizure meds have on MAC

A

induce CYP enzymes, need higher doses of meds, induction agents

45
Q

Predictors of pulmonary complications

A

Surgical site-thoracic, aortic, upper airway, neck, neurosurgery, risk increases as surgical site approaches diaphragm, surgeries over 2 or 3 hours, PPV (altered respiratory cycle) V/Q mismatch

46
Q

What does STOP BANG stand for

A 
S-snoring
T-tired
Observed apnea during sleep
p-blood pressure
b-BMI
Age-greater then 50
N-neck circumference
G-male gender
high risk greater then 3-have on 24 hour pulse ox order
47
Q

METS

A

METS1-bad activity tolerance
4OK walk up stairs
10 physically fit

48
Q

Aortic Stenosis

A

greatest risk for non-cardiac surgery MI

49
Q

cardiac considerations, BP and HR

A

maintain BP within 20 % of baseline, HR is major component of myocardial o2 demand, avoid shivering as it increases O2 consumption

50
Q

beta blockers

A

must be given pre op if patient is on one, prevents preoperative ischemia

51
Q

sellick manuver

A

down right and up, 10 lbs of pressure RSI

52
Q

Mendelson syndrome

A

chemical pneumonitis
aspiration gastric volume greater then 25 ml.
pH less than 2.5
particulate aspirate>clear aspirate

53
Q

fasting guidelines

A 
no chewing gum after midnight
clear liquids 2 hours before surgery
breast milk 4 hours before surgery
non human milk, infant formula 6 hours
meds with a sip of water 150 ml of H20 up to one hour
54
Q

diabetic med rules peroperatively

A

hold oral med morning of surgery
take 1/2 insulin
check BS upon arrival, frequently during surgery
total joints check BG whether diabetic or not

55
Q

thyroid cases

A

use beta blockers to reduce peripheral conversion of t4 to t3 such as propanerol
controls SNS

56
Q

renal disease avoid

A

benzodiazapines

57
Q

liver disease

A

altered med metabolism

58
Q

musculoskeletal disease

A

MH

59
Q

cocaine use

A

avoid beta blockers because you will further decrease coronary flow
ca channel blockers used to manage HTN, tachycardia
avoid ephedrine

60
Q

recuronium

A

most common cause of introperative allergic reaction

61
Q

shellfish allergy

A

avoid contrast dye

62
Q

atypical pseudocholinesterase

A

post op vent support needed until SUX metabolizes

63
Q

ASA classifcation 1

A

healthy, no medical issues-healthy kids

64
Q

ASA 2

A

mild to moderate systemic disturbances, well managed DM, HTN, etc.

65
Q

ASA 3 severe systemic disease limits activity

A

severe systemic disease that limits activity, poorly controlled HTN, diabetes

66
Q

class 4 ASA

A

severe systemic disease that is constantly life threatening-ICU patients

67
Q

Class 5 ASA

A

If they don’t get surgery, they will die

68
Q

Class 6 ASA

A

brain dead, organ harvest

69
Q

E after ASA

A

emergency surgery required

70
Q

failure to obtain consent

A

battery

71
Q

anesthesia consult note

A

date, time, planned procedure, description of extraordinary circumstances, allergies, meds, labs, disease processes, ASA status

72
Q

SOAP

A 
Suction
Oxygen
Airway
PPV, pharmacy
Monitors, mediations
73
Q

general anesthesia

A

any instance when patient loses consciousness as defined by ability to respond purposefully, patient loses ability to protect their airway

74
Q

regional anesthesia

A

spinal, epidural, subarachnoid, intrathecal, peripheral nerve blocks

75
Q

MAC

A

monitored anesthesia care, should respond if stimulated, should maintain, airway reflexes, should protect their own airway, sedation may progress rapidly into general

76
Q

3 standards of AANA

A 
preoperative assessment (history, pt interview)
informed consent
constructing a patient specific anesthesia care plan(basics about types of anesthesia)
77
Q

august bear

A

first spinal anesthesia

78
Q

exemplary damages-punative

A

monetary awards, draw public attention to negligence of defendant

79
Q

mititgation

A

minimize impact action make a mess, clean it up

80
Q

safe device act of 1190

A

fda reporting of a med or device malfunction

81
Q

direct verdict

A

one party has not proved their case as a matter of law

82
Q

replivin

A

lawsuit to recover goods by intake from another

83
Q

HIPAA

A

right to view medical records, confidential unless court ruling against a parent

84
Q

indemnification

A

clause that can appear in employment contract to sue employee if damages are caused by actions of employee

85
Q

duties of executive director of AANA

A 
maintaining minutes of AANA meetings
policy formation
representing AANA to other organization
does not vote on matters overseeing board
clinical standard of guideline
participates in activities

Physical assessment Q1 (1 decks)

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