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Basic Principles N928 > Positioning > Flashcards

Positioning Flashcards

1
Q

What standard is positioning according to the AANA?

A

Standard 8: patient positioning collaborate with the surgical or procedure team to position, assess, and monitor proper body alignment. Use protective measures to maintain perfusion and protect pressure points and nerve plexus

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2
Q

What is the most common closed claim analysis?

A

ulnar and brachial plexus nerve

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3
Q

Goals of Positioning

A 
patient safety
optimize surgical exposure
preserve patient dignity
maintain hemodynamic stability
maintain cardiorespiratory function
no ischemia, injury or compression
JC Patient Safety Goal #14- prevent healthcare associated pressure ulcers
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4
Q

How do volatile agents effect our cardiovascular system?

A

myocardial depressants

decrease CO and BP

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5
Q

How do NMB effect our cardiovascular system?

A

Decrease muscle tone and venous return

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6
Q

How do opioids effect our cardiovascular system?

A

decrease HR (CO and BP)

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7
Q

Cardiovascular concerns while positioning

A

redistribution of circulating blood volume
depressed CO
compression of extremities or great vessels
impaired autonomic NS function
anatomy cephalad to heart risks hypoperfusion/ischemia

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8
Q

Pulmonary Problems d/t Positioning

A

Barriers to thoracic excursion
Positive pressure ventilation
Gravity related effects

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9
Q

Mechanisms associated with nerve injury

A

compression
stretch
traction
transection

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10
Q

Risk factors of Integumertary Issues:

A 
elderly
diabetes
PVD
surgical time
chronic hypotension
increased Body temperature
body habitus
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11
Q

Nerve Sheath Ischemia can be

A

direct and indirect

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12
Q

Pressure Points in Supine

A

heel, toes, thighs, sacrum, elbow, humerous, vertebrae, occiput

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13
Q

Describe the Supine position

A

arms secured, armboards padding w/ straps
Arms are laterally or abducted at less then 90degree angle and supinated
Legs are flat, uncrossed with heels padded

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14
Q

If the arms are proned in supine, which is erroneous, what will it cause?

A

ulnar nerve compression (at the cubital tunnel at elbow)

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15
Q

describe arms are tucked in supine position

A 
palmar aspects of hands parallel to thighs/trunk
elbows padded (ulnar nerve)
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16
Q

Cardiopulmonary Implications in Supine

A 
BP stable
ANS mechanisms to compensate
Reduced TLC and FRC
diagraphm shifted cephalad
GA and NM enhance
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17
Q

Ventral Decubitus

A 
Prone
often intubated
induction/intubation occurs on stretcher
head and neck are neutral
Arms <90
elbow, axilia
body/trunk support
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18
Q

What type of cases are performed prone?

A

spine, buttocks, rectum, peri-rectal, ankle, intracranial

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19
Q

Cardiovascular and Pulmonary Implications for Prone

A

pooling of blood in (lower extremities/gut)
compression of IVC
epidural engorgement
Decreased compliance if chest not freely hanging
increased FRC

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20
Q

Post-Operative Vision Loss

A 
prolonged surgical time spine surgeries
central retinal artery occulsion
central retinal vein occulsion
ischemic optic neuropathy
cortical blindness
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21
Q

What is the most common POVL?

A

ischemic optic neuropathy at 89%
associated with: extended surgical time and excessive blood loss
not associated with global pressure
obesity, male gender, wilson frame,

22
Q

Prevention of POVL

A

surgical duration <6hrs
10-15 degrees head up (reduce orbital edema)
BP 20% of pre-operative baseline (MAP >70mmHg)
Maintain Hct >25

23
Q

Ocular Perfusion Pressure

A

OPP= MAP-IOP

24
Q

Central Retinal Artery Occlusion Clinical

A

eye stroke
sudden, profound vision loss
painless, monocular

25
Central Retinal Artery Occlusion Etiology
``` Embolism vasculitis vasospasm sickle cell trauma glaucoma ```
26
Central Retinal Artery Occlusion Diagnosis
retinal pallow macular cherry red spot +/- afferent pupillary defect
27
Central Retinal Artery Occlusion Treatment
consult Optho + neurology case reports of intra-arterial TPA limited evidence- digital massage, lowering IOP
28
Central Retinal Vein Occlusion Clinical
Eye DVT variable- blurred vision to sudden vision loss painless monocular
29
Central Retinal Vein Occlusion Etiology
typical stroke risk factors hyper coagulability states glaucoma compression of the vein in the thyroid or orbital tumors
30
Central Retinal Vein Occlusion Diagnosis
Optic disk edema | diffuse retinal hemorrhages (blood and thunder)
31
Central Retinal Vein Occlusion Treatment
optho + neuro consult | no specific treatment
32
Lithotomy Position
legs abducted, elevated fingers free watch footboard legs free watch peroneal nerve
33
Hip Flexion in lithotomy position
sciatic/ obturator stretch | femoral nerve palsy
34
Lithotomy facilitates access to
perineal structures gynecological urology
35
Cardiovascular and Respiratory Implications of Lithotomy
``` 20% reduced FRC Reduced VC hypoventilation breathing spontaneously increased CVP auto-transfusion 250-300ml/leg when raised ```
36
Describe Lateral Positioning
head neutral and supported pressure free eyes/ears/face shoulders, hips, head, and legs aligned chest and hips supports or bean baf regularly assess perfusion of arms dependent arm on padded arm board, less then 90 degrees and perpendicular to torso axillary roll under dependent side of thorax (slightly caudad, not directly in axilla)
37
When is lateral positioning used?
kidney shoulder orthopedic (THA, Hip) thorax
38
Cardiovascular and Respiratory Implications of Lateral Position
Euvolemic, minimal changes V/Q mismatch possible FRC: increased in nondependent lung (top) decreased in dependent lung (buttom) Dependent lung lower then left atrium, prone to: atelectasis and fluid accumulation
39
Sitting position is used for
cervical spine surgery shoulder surgery posterior fossa breast reconstruction
40
When kidney rest is elevated in the lateral position, cardiovascular changes include
slowly, under iliac crest great vessels compressed decreased venous return
41
Describe the sitting position
HOB 30-90 degrees above horizontal plane OR table flexed and backrest elevated Head secured (2 fingerbreadths b/t neck and mandible) endobronchial intubation dislodge head w/ headrest w/ vigrous surgical manipulation pad heels, legs flexed (prevent sciatic stretch) arms secured (padded arm boards or patients lap with drawsheet
42
Potential Complications of Sitting
VAE d/t negative pressure gradient pnemocephalus quadriplegia
43
VAE
negative pressure gradient RA and operative site veins most common
44
Pnemocephalus
Neuro procedures, often benign | air enters open dura, CSF drainage, surgical decompression
45
Quadriplegia
spinal cord stretch when head flexed + loss of autoregulation with GA ensure 2 fingerbreadths = limit strain at C5 verbetra
46
Sitting Cardiovascular and Respiratory Implications
``` reduced SV and CO (up to 20%) decreased MAP and CVP lower extremity venous pooling decreased cerebral perfusion increased FRC increased compliance ```
47
Trendelenburg
head down degree T burg (dependent edem) increased ICP, IOP, CVP) shoulder braces- plexus stretch, plexus compression
48
Reverse T
bed flat, head up increased pulmonary compliance, FRC decreased IOP,ICP, CPP and BP
49
Brachial Plexus
supine- arms abducted >90, humeral head rotated lateral decubits: stretch/traction/tension chest- dependent compression
50
Avoid
excessive pressure at peripheral nerves, bony prominences, eye pressure, abrasions, irritants extremity injury strain/dislocation of joints and muscles
51
Ensure
adequate circulation, head and neck support, airway protection, antatomical alignment access

Basic Principles N928 (10 decks)

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