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Anesthesia Techniques > Preop > Flashcards

Preop Flashcards

1
Q

what is a significant predictor of cardiac risk

A

exercise intolerance

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2
Q

how should a dm patient dose their oral meds vs insulin preoperatively

A

hold oral dm meds
adjust insulin doses

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3
Q

predictors of ponv

A

female
history of ponv/motion sickness
nonsmoking
<50 years old
general anesthesia
volatiles and nitrous oxide
postop opioids
duration of anesthesia
surgery type: chole, laparscopic, gynecologic

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4
Q

name some herbs that can cause increased bleeding

A

feverfew
garlic
ginger
ginkgo
ginseng
vitamin E

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5
Q

t or f- by itself, the Mallampati classification has a high positive predictive value in identifying patients who are difficult to intubate

A

false
low positive

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6
Q

what can be seen on each grade on the Mallampati scale

A

1- soft palate, uvula, tonsillar pillars
2- soft palate, upper uvula
3-soft palate
4- hard palate only

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7
Q

list other identifiers of difficult tracheal intubation

A

-long upper incisors
-prominent overbite
-inability to protrude mandibular incisors anterior to maxillary incisors
-uvula not visible when tongue protruded while pt sitting
-shape of palate highly arched or narrow
-mandibular space non compliant
-tmd < 3 fingers
-neck short/thick
-limited rom of neck/head

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8
Q

what heart problems should specifically be auscultated for during cv system preop examination

A

aortic stenosis
abnormal rhythms
gallops suggestive of Heart failure

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9
Q

how does an aortic stenosis murmur sound on auscultation

A

murmur radiating to the carotids

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10
Q

what further workup is needed if bruits are heard over the carotid arteries

A

determine risk of stroke

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11
Q

what are the categories of MACE (major adverse cardiace events)

A

low risk procedure= < 1% incidence of MACE
High risk= >1% risk of MACE

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12
Q

Which ASA PS class is a normal healthy patient, no organic, physiologic, biochemical, or psychiatric disturbance

A

ASA 1

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13
Q

Which ASA PS class is mild to moderate systemic disease that is well controlled and causes no organ dysfunction or functional limitation

A

ASA 2

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14
Q

Which ASA PS class is treated hypertension

A

ASA 2

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15
Q

Which ASA PS class is severe systemic disease of at least one organ system that does cause functional limitation

A

ASA 3

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16
Q

Which ASA PS class is stable angina

A

ASA 3

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17
Q

Which ASA PS class is severe systemic end stage disease of at least 1 organ system that is life threatening with or without surgery

A

ASA 4

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18
Q

Which ASA PS class is congestive heart failure

A

ASA 4

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19
Q

Which ASA PS class is renal failure

A

ASA 4

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20
Q

Which ASA PS class is a moribund patient who has little chance of survival but is submitted to surgery as a lest resort

A

ASA 5

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21
Q

Which ASA PS class is a ruptured aortic aneurysm

A

ASA 5

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22
Q

Which ASA PS class is resuscitative effort

A

ASA 5

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23
Q

Which ASA PS class is a declared brain dead patient whose organs are being removed for donor purposes

A

ASA 6

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24
Q

The preoperative evaluation of the patient with known or suspected cardiovascular disease is focused on what two areas

A
  1. identify clinical risk
  2. preoperative cardiac testing
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25
what are clinical s/s of heart failure
dyspnea limited exercise tolerance orthopnea jvd crackles third heart sound peripheral edema ef < 30%
26
in heart failure patient, what 2 symptoms should be optimized before elective surgery
ventricular function pulmonary edema
27
patients with moderate to severe valvular stenosis or regurg should have an echo within __ year(s) of surgery
1
28
why should an ekg be done preoperatively on every dm patient
high risk for silent MI- look for Q waves
29
when should bp be treated for those over 60 vs those younger than 60
> 60= 150/90 <60- 140/90
30
what processes are involved in metabolic syndrome- 4
htn atherogenic dyslipidemia high fasting glucose central obesity
31
what is atherogenic dyslipidemia
high triglyceride low HDL
32
what are examples of 1 MET
daily self care walk indoors around house walk a block light work around house
33
what are examples of 4 MET
climb a flight of stairs heavy work around house golf, bowling, throw football
34
what is highly suggestive of past MI in high risk patients on an EKG
abormal q waves
35
what is considered a positive pharmacologic stress test ECG
severe regional wall motion abnoramlities
36
what types of patient should have stress testing before surgery
unstable angina chf significant dysrhythmias severe valvular disease
37
how long should noncardiac elective surgery be delayed after the following stents: -coronary ballon angioplasty -bare metal -drug eluting
-coronary ballon angioplasty= 14 days -bare metal= 30 days -drug eluting= 6-12 months
38
how long does a person need to stop smoking to reduce ther ate of postop pulmonary complications
4-8 weeks
39
what can you give a patient with severe asthma for prophylaxis against pulmonary complications
steroids
40
stopbang
S-Snoring T-Tired during the day O-Observed apnea P -pressure- htn B- BMI>35 A-age>50 N-neck circum: M > 17 in, F >16 in G-gender male
41
what is the leading cause of renal failure requiring dialysis
DM
42
what type of cells are destroyed in pancreas of those with type 1 diabetes
beta cells
43
which type of diabetes is dka more common
type 1
44
what is hgb A1c goal for type 1 vs type 2 dm
1- <7.5% 2- < 7%
45
what are the 4 sx of the classic clinical presentation of a patient with pheochromocytoma
intermittent htn headache diaphoresis tachycardia
46
what syndrome is a potential disorder in patients on long term corticosteroids
cushing syndrome
47
what are s/s of cushing syndrome
skin striations truncal obesity htn hypovolemia easy brusing
48
your patient on long term steroids has hotn that isn't responding to fluid or vasopressors. What could you try
steroid
49
how does liver disease affect iv drugs
decreased plasma protein production= affects drug binding, volume of distribution, metabolism, clearance
50
what are considered clear liquids
water fruit juice without pulp carbonated beverages clear tea black coffee
51
what is the minimum fasting period in hours for the following: clear liquids breast milk infant formula nonhuman milk light meal
clear liquids- 2 h breast milk- 4 h infant formula- 6 h nonhuman milk- 6 h light meal- 6 h fried meal- > 8h
52
which has the longest serum half life: cimetidine, ranitidine, famotidine
famotidine
53
what is the moa of metoclopramide
dopamine antagonist stimulates upper gi motility, increase GE sphincter tone, relaxes pylorus and duodenum thereby reducing gastric volume
54
what can occur with the rapid administration of reglan
abdominal cramping
55
t or f- regland is recommended in those with bowel obstruction
false
56
reglan is recommended for which type of patients
obese parturients emergency surgery trauma dm with gastroparesis
57
where do benzodiazepines work
gaba receptor in cns
58
which is more potent, diazepam or midazolam
midazolam: 2-3x
59
what heart problem can fentanyl cause
bradycardia
60
t or f- fentanyl causes myocardial depression
false
61
which anticholinergic produces more sedation or amensia
scopolamine- tertiary amine
62
which anticholinergic produces the most increase in heart rate
atropine
63
how do anticholinergic drugs produce vagolytic action
blocks acetylcholine at the heart
64
how can central anticholinergic syndrome be treated
physostigmine
65
what are s/s of central anticholinergic syndrome
confusion restlessness obtundation delerium
66
administration of anticholinergic drugs does what to the bodies heat response
decreases sweating, increases body temp
67
why are cephalosporins the most popular abx
cover common skin microbes
68
vancomycin should be given ___ hours prior to incision
2
69
medical malpractice refers to the legal concept of professional ________________
negligence
70
the most common anesthesia lawsuits are for what 4 issues (excluding dental injuries)
death brain damage nerve damage airway injury
71
what are three eye injury complications that can be blamed on anesthesia
corneal abrasion ischemic optic neuropathy central retinal artery occlusion
72
what are 3 risk factors of ischemic optic neuropathy after spinal fusion
wilson bed frame obesity long anesthetic duration
73
what is the most common injury leading to anesthesia malpractice clames
damage to teeth or dentures
74
how are dental injury complaints usually resolved
hospital risk management department
75
what are the 3 key factors in the prevention of patient injury
vigilance adequate monitoring up to date knowledge
76
what are the principal causes of death due during anesthesia related to
ventilation/oxygenation
77
t or f- parents of a minor child can legally prevent that child from receiving blood
false
78
what 4 things need to be proven by a patient/plaintiff to be successful in a malpractice lawsuit
1. duty- crna owed patient a duty 2. breach of duty- crna failed to fulfil duty 3. causation- reasonable causal relation 4. damages- damages resulted from breach of standard of care
79
what is the term for professional negligence aka professional misconduct
malpractice
80
what is the duty of the crna for the patient
adhere to standard of care for the treatment of patient
81
what are the two tests to establish causation and therefore proximate cause
but for test- if injury would not have occurred but for the action of crna substantial factor test- crna action was substantial factor in injury
82
what is the difference between standards and guidelines
guidelines should be adhered to standards must be adhered to

Anesthesia Techniques (11 decks)

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