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N506 Health Assessment > Positioning > Flashcards

Positioning Flashcards

0
Q

In the supine position, making sure the patient’s hands are supinated protects what?

A

Supinated hands protects the ulnar nerve

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1
Q

Weight limit and length of an OR table?

A

Weight: 136 kg (300 lb)
Length: 80.7 inches

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2
Q

What is a way to protect the back in the supine position?

A

Pillow under knees

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3
Q

What can cause stretching of the brachial plexus?

A

Neck extension, abduction of arm over 90 degrees, or arm fell off the table

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4
Q

What causes compression of the radial nerve? What does this lead to?

A

Compression from surgical retractors, ether screen, mismatched arm board, BP cuff going off too frequently
Wrist drop, weakness/numbness in 1,2 ring fingers, inability to extend elbow

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5
Q

What is the most common peripheral nerve injury? What are s/s of this?

A

Ulnar Nerve, compressed between olecranon and medial epicondyle or stretching
S/S: inability to abduct/oppose pinky, weakness/numbness on 4th/5th fingers, claw hand

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6
Q

How would you prevent ulnar nerve injury?

A

pad arm boards, avoid compression by strap, assure surgical personal doesn’t compress the arm, place BP cuff proximal to ulnar groove, avoid prolonged flexion of elbow

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7
Q

What physiological changes occur in the supine position?

A

Cardio: initial increase in venous return (increase CO, BP), reduced venous drainage from lower extremities, IVC compression if big belly
Resp: FRC decreases 800 mL (give PPV)
Head: minimal change in CBF due to autoregulation

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8
Q

What is trendelenburg used for?

A

Central line insertion (prevents air embolism), hypotension
Abdominal and laparoscopic surgery
(Reverse trendelenburg is good for upper abdominal surgery)

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9
Q

What physiologic changes occur in the trendelenburg position?

A

Cardio: increases venous return/ BP
Resp: increases work of breathing, V:Q mismatch, decreases FRC, increases PIP, risk aspiration, risk of face/airway edema
Head: increased ICP, increased intraocular pressure
Note: consider another position for patient with glaucoma or CNS disease

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10
Q

What physiological changes occur in reverse trendelenburg?

A

Cardio: reduced preload, CO, and BP, increased HR, RAA activation, venous pooling
Resp: FRC increases, ventilation is easier
Head: ICP decreases
Uses: upper abdominal/laparoscopic surgeries

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11
Q

What is the most common lower extremity nerve damaged? How is it commonly damaged? What are s/s?

A

Common peroneal nerve injured from compression of lateral knee against stirrup in lithotomy or in lateral position
s/s: foot drop, inability to evert the foot, loss of dorsal extension of the toes

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12
Q

How is the sciatic nerve injured and what are s/s?

A

Stretching or excessive external rotation

s/s: weakness/paralysis below the knee, numbness in foot and lateral calf, foot drop

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13
Q

How is the femoral nerve injured and what are the s/s?

A

Injured with compression at pelvic brim by retractor or angulation of thigh or abduction of thighs and external rotation of hips
s/s: loss of flexion of hip and loss of extension of knee, decreased sensation of superior thigh

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14
Q

What positions put a patient at risk for lower extremity compartment syndrome with long surgeries?

A

Lithotomy and lateral decubitus

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15
Q

How much does perfusion pressure drop for each 2.5 cm an extremity is raised above the heart?

A

Perfusion pressure drops 2 mmHg for each 2.5 cm an extremity is above the heart

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16
Q

What physiological changes happen in the lithotomy position?

A

Cardio: increased venous return/preload, increase CO/BP, less perfusion to lower extremities
Pulm: if pressure on belly, reduced lung compliance/TV/VC, aspiration risk
Head: increased CBF/ICP

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17
Q

What are risk factors for blindness during a surgery?

A

prone position, operative hypotension, large blood loss, large crystalloid use, anemia, smoker, diabetic, vascular pathology, HTN, male

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18
Q

What is thoracic outlet syndrome? Why should you test for it?

A

Test by having the patient clasp hands behind head for 2 min and see if there is numbness/tingling or diminished pulses
If the test is positive, the patient should not have their arms elevated in prone during the procedure, instead tuck the arms down at the patient’s sides

19
Q

What physiologic changes occur with prone position?

A

Cardio: IVC/Aortic compression or venous pooling causes hypotension
Pulm: V:Q mismatch (posterior ventilation, anterior perfusion), compliance decreases, peak pressure increase, work of breathing increases (use PPV)
Head: turned head leads to increased ICP, excessive turning can lead to obstruction

20
Q

Why would you place a patient in lateral decubitus position?

A

Thoracotomy, kidney, shoulder, hip surgery

Thoracic surgery, one-lung ventilation

21
Q

Lateral position: Physiological changes?

A

Cardio: minimal to no change (kidney rest can cause vena cava obstruction)
Pulm: nondependent (top) lung is better ventilated, dependent (bottom) lung is better perfused (VQ mismatch)
Head: minimal changes

22
Q

What physiologic changes occur in the sitting position?

A

Cardio: hypotension, lower extremities pooling of blood, HR and SVR increase
Resp: Lung volume/compliance increases, work of breathing is easier
Head: decreased ICP, caution hypoperfusion

23
Q

What is a venous air embolism, what are risks, what are s/s?

A

VAE is the inability of venous sinuses to collapse, can be lethal
VAE is a risk when the surgical site is above the level of the heart
s/s: change in heart tones, new murmur, dysrhythmias, hypotension, desat, decreased EtCO2, exhaling nitrogen, cardiac arrest

24
Q

How is venous air embolism detected and treated?

A

Detection with TEE or doppler
Treatment: d/c nitrous oxide, place on 100% oxygen, give PEEP, trendelenberg, flood surgical field with NS, close open vessels, apply wax to cut bony edges, aspirate air from R atrium

25
Q

What cardiac changes are there as a patient goes from sitting to supine?

A

Venous return increases as pooled blood from the lower extremities redistributes to the heart.
This will increase BP, activating baroreceptors, resulting in compensatory decrease in sympathetic flow, decreasing HR, SV, and CO
(Respiratory change: decrease FRC)

26
Q

Complications of supine positioning?

A

Pressure alopecia due to ischemic hair follicles from prolonged immobilization of the head
Backache
Peripheral nerve injury

27
Q

Uses for lithotomy position?

A

Gynecologic, rectal, and urologic surgeries

28
Q

Lithotomy position complications?

A

Most common is common peroneal nerve injury
Paresthesias in the obturator, lateral femoral cutaneous, sciatic, peroneal nerve
Lower extremity compartment syndrome
Note: risk of femoral nerve kinking vs. sciatic nerve stretching

29
Q

Prone position indications?

A

Posterior skull, posterior spine, buttocks, perirectal, and lower extremity surgeries

30
Q

Indications for sitting position?

A

Posterior cervical spine surgery

Neurosurgery with pins

31
Q

Appendectomy positioning?

A

Supine/ trendelenburg

32
Q

Sinus surgery and knee arthroscopy positioning?

A

Supine

33
Q

Laparoscopic hysterectomy positioning?

A

Trendelenburg

34
Q

Craniotomy positioning?

A

Supine. Lateral or sitting positions used occasionally

35
Q

Kidney transplant positioning?

A

lateral

36
Q

Hemorrhoidectomy positioning?

A

Lateral

37
Q

Rotator cuff repair positioning?

A

lateral

sitting, beach chair also used

38
Q

C-section positioning?

A

Supine/ lithotomy

39
Q

Laminectomy positioning?

A

Prone

40
Q

Thoracotomy positioning?

A

Lateral

41
Q

Cholecystectomy positioning?

A

Reverse trendelenburg

42
Q

When using a foot-board in reverse trendelenburg, what is the associated risk?

A

Excessive plantar flexion over a long period of time leads to tibial nerve injury, resulting in foot drop

43
Q

Symptoms of common peroneal nerve injury?

A

Foot drop, inability to evert the foot, loss of dorsal extension of toes (plantar-flexion)
Peroneal= PE (Plantar-flexion and Eversion)

44
Q

How much space should be left between the sternum and mandible in the sitting position, why?

A

2 finger-breadths
Excessive cervical flexion obstructs venous outflow causing hypoperfusion or venous congestion in the brain, stretch cervical nerve roots, obstructs ETT, can place pressure on tongue (swelling)

N506 Health Assessment (7 decks)

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