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CNOR > Preparing For Anesthesia > Flashcards

Preparing For Anesthesia Flashcards

1
Q

Bigeminy

A

PVC on every other heartbeat

Arrhythmia

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2
Q

Trigeminy

A

PVC on every third beat

Arrhythmia

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3
Q

Clear liquids

A

2 hours before

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4
Q

Breast milk

A

4 hours before

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5
Q

Infant formula

A

6 hours before

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6
Q

Light meal (toast, apple sauce)

A

6 hours before

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7
Q

Full fatty meal or fried foods

A

8 hours before minimum

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8
Q

Gum and candy

A

Increase gastric secretions

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9
Q

ASA 1 (or P1)

A

Normal healthy patient
No smoking, minimal or no alcohol use
No physiologic, psychologic, biochemical, or organic disturbance

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10
Q

ASA 2 (or P2)

A

Mild systemic disease, no substantial functional limits
Current smoker, BMI 30-40, well controlled DM/HTN
Asthma

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11
Q

ASA 3 (or P3)

A

Severe systemic disease w/ health issues, cardiac or pulmonary limiting activities
BMI >40, poorly controlled DM/HTN, COPD, pacemaker
Renal failure, dialysis

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12
Q

ASA 4 (or P4)

A

Severe systemic disease, threat to life, severely low EF
Requires regular medical intervention
Sepsis, DIC, ESRD no dialysis, cardiac ischemia, valve disease

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13
Q

ASA 5 (or P5)

A

Not expected to survive without surgery within 24 hours, near-death
Cerebral trauma, ruptured aneurysm, multiple organ failure, large PE

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14
Q

ASA 6 (or P6)

A

Declared brain dead
Organ procurement

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15
Q

Normal range for hemoglobin levels in adult woman

A

12 g/dL-16 g/dL 

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16
Q

Normal range for hemoglobin levels in adult men 

A

14 g/dL- 18 g/dL

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17
Q

Perioperative briefing process includes

A

Identification of the patient
Introduction of team members
Signed consent
All required documentation 

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18
Q

Person responsible for granting permission for a parent to accompany a child into the operating room is

A

Anesthesia professional 

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19
Q

Liver disease increases risk for

A

-anesthesia related complications
-bleeding due to increased liver enzymes
Liver produces vitamin K

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20
Q

Addiction causes:

A

-liver changes
-Esophageal varices
-pancreatitis
-malnutrition
-Withdraw (tremors, palpitations, clammy, skin, nausea, vomiting)

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21
Q

Renal dialysis

A

-fluid and electrolyte imbalances common
-Medications metabolized in the kidneys avoided
-Should know last time of dialysis

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22
Q

Burn patients

A

Prone to hypothermia
Fluid and electrolyte imbalances are common

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23
Q

Diabetes

A

-Glucose control can be a challenge
-Prone to high blood pressure, GERD
-Delayed wound healing
-Stress from injury/surgery increases glucose level

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24
Q

Diabetes insipidus

A

-Causes body to make large amount of urine
-Be mindful in surgeries involving the pituitary or hypothalamus or head trauma
-Treat with fluid ML/ML urine output
-vasopressin or desmopressin (DDAVP): antidiuretic hormones

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25
Q

Smokers

A

-7 to 8 weeks for Ciliary function to return
Helps clear airway up, cough things out

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26
Q

Elevated blood pressure

A

120-129 / less than 80

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27
Q

High blood pressure, hypertension stage one

A

130-139 / 80-89

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28
Q

High blood pressure hypertension stage two

A

140 or higher / 90 or higher

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29
Q

Hypertensive crisis

A

Higher than 180 and/or higher than 120

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30
Q

Hemophilia

A

Factor VIII deficiency
Synthetic factor VIII replacement throughout surgery, started in preop

31
Q

Pregnancy

A

Check on all females from 11 to 55
Always position off vena cava, elevate right side
Have fetal heart monitor
-20 weeks or more
-20 weeks or less, monitor in preop/PACU

32
Q

CHF

A

Prone to fluid overload
NPO and don’t take the diuretic
Under anesthesia, they dilate and need fluid 

33
Q

Morbid obesity

A

BMI >40
Wound healing compromised
Difficult intubation common
Positioning can make ventilation difficult
-Decreased tidal volume, increased work of breathing
-ex: jackknife(kraske), prone

34
Q

Obesity

A

BMI >30

35
Q

Overweight

A

BMI >25

36
Q

COPD

A

Low O2 stimulates breathing not high CO2 (normal ppl-breathing stimulated by high CO2 levels)
No rebreather
NC 2 L mask
Want low concentration O2 (<30%)

37
Q

When is postop ventilator needed?

A

Tidal volume lower than 500ml in an adult
PCO2 >45

38
Q

Rheumatoid arthritis

A

-Joint immobility- creative positioning
-Causes anemia, low hemoglobin
-Steroid coverage puts them at risk for an impaired stress response (hypo-adrenal crisis)

39
Q

Sickle cell anemia

A

Specific anesthesia management
Avoid triggers
-Hypothermia (bair hugger, room can go over 75° for these patients)
-Hypotension
-Hypovolemia (can have clear liquids with calories two hours before surgery, Gatorade)
-Hypoglycemia (glucometer checks)
-Hypoxia

40
Q

Infant

A

up to 18 months
-Sooth with pacifier
-Hold and rock

41
Q

Toddler

A

18 to 30 months
-Separation anxiety
-Communicate with simple sentences
-Soothe with distraction and familiar objects
-include caregiver as member of team

42
Q

Preschooler

A

2 1/2 to 5 years
-May believe they are in the hospital because they are in trouble
-Fear pain and mutilation, abandonment
-Provide independence when possible, have them help
-Communicate using compound sentences
-stories and imagination

43
Q

School-age

A

6 to 11 years old
-Give honest simple information
-Able to be more cooperative
-give positive reinforcement
-Watch for loose teeth

44
Q

Adolescent

A

12 to 18 years old
-Fear loss of privacy
-Body image is important
-talk to about good incision care
-hypersensitive to the opposite sex as caregivers
-Give honest information

45
Q

How should neck alignment be maintained for young infants?

A

Neutral neck alignment
Young infants have short tracheas

46
Q

Pediatric considerations

A

-very sensitive to heat loss
-Weigh sponges to keep accurate count of blood loss (1g = 1ml)
-Decompensate more suddenly/recover quickly

47
Q

Newborn physiology of thermoregulation

A

-immature vasomotor control
-no shiver response prior to six months old
-Low muscle mass

48
Q

Elderly physiology of thermoregulation

A

-Poor peripheral vasomotor control
-Low muscle mass
-Ineffective shiver response

49
Q

Postop Pediatrics considerations

A

-semi prone for oral procedures
-Swaddle an infant to maintain position and comfort
-May need safety restraints to maintain tubes and drains

50
Q

What is the best postop position for pediatrics?

A

Lateral
-Allows drainage or excess bleeding to be easily assessed
-keeps airway open

51
Q

Braden scale

A

Assesses skin breakdown, the higher the score the less risk
Risk factors scored 1-4
-sensory perception
-Moisture
-Activity
-Mobility
-Nutrition
-Friction/shear

52
Q

Braden scale- severe score

A

Less than 10

53
Q

Braden scale – high risk score

A

10 to 12

54
Q

Braden scale – moderate score

A

13 to 14

55
Q

Braden scale – mild score

A

15 to 18

56
Q

Number of people for transferring patient that weighs 72 kg or more

A

Four people

57
Q

Number of people to transfer a patient that weighs less than 72 kg

A

Three people

58
Q

Number of people to transfer a patient that weighs less than 20 kg

A

Two people

59
Q

Obturator nerve

A

Closest to the surface in the groin
-Can be damaged during lithotomy
-Some devices or equipment leaning on the pt
-Pain and numbness of the inner thigh (years to recover)

60
Q

Popliteal nerve

A

Common peroneal nerve and tibial nerve in posterior knee
-Weight of leg on thighs and knees, when in boot stirrups and candy canes
-1 to 4 months to recover
-Prone to re-injury

61
Q

Sciatic nerve

A

-External rotation of the hips
-Lower vascular procedures, lithotomy, herniated disc
-Recovers without surgery in 80 to 90% of patients

62
Q

Peroneal nerve

A

Runs laterally to hip and knee
-Can assess by having patient dorsiflex foot (toes to nose)
-Injury with long leg casts, lateral hip and total knee procedures, positioning

63
Q

Saphenous nerve

A

Is medial to hip and knee
-Injury from vein harvest or stripping procedures

64
Q

Brachial plexus

A

At Shoulders
-Injury increases when head is turned to the side
-some recover, some have permanent disability

65
Q

Where does the kidney rest positioner go?

A

On the dependent iliac crest

66
Q

What does ax roll help with?

A

Brachial plexus
Dependent lung to expand

67
Q

Common types of hemodynamic monitoring

A

Central venous pressure (CVP)
Swan-Ganz catheter
Arterial line

68
Q

Hemodynamic monitoring for what type of patients ?

A

Blood pressure
-Heart disease
-Respiratory disease
-High risk/type of surgery
-Shock

69
Q

Central venous pressure

A

Pressure in the right atrium
-Normal 4 to 8 mmHg
-Low= hemorrhage, venous pooling, vasodilation
-High= pulmonary hypertension, pulmonary edema, right ventricular failure

70
Q

Swan-Ganz catheter

A

Intra-jugular or subclavian, usually on the right side
-sits in pulmonary artery
-Risk: microshock from laparoscopic instruments with break in insulation 

71
Q

Arterial line

A

For continuous monitoring of blood pressure
-Required for infusion of Nipride or other hemodynamic drugs requiring tight control
-Frequent blood test, ABGs
-Radial artery most commonly used
-Allen test before insertion

72
Q

After transfer of a tonsillectomy patient to the transportation vehicle, which of the following positions should a patient be placed to facilitate drainage?

A

Semi prone

73
Q

An eight year old boys being prepared for surgery. As the anesthesia provider is about to start the IV, the boy begins to cry. The most appropriate action at this point would be to:

A

Give the patient psychological support through tactile contact and verbal reassurance

74
Q

In the instruction of an eight year old child, reasonable grasp of the information can often be ensured by the use of:

A

Audiovisual equipment

CNOR (14 decks)

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