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GNURS630/Advanced Physical Assessement > Quiz 1 Part 2 - Harold's Portion > Flashcards

Quiz 1 Part 2 - Harold's Portion Flashcards

1
Q

What is visualized with Mallampati 1?

A
  • Soft Palate
  • Fauces Uvula
  • Pillars
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2
Q

What is visualized with Mallampati 2?

A
  • Soft Palate

- Fauces Uvula

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3
Q

What is visualized with Mallampati 3?

A
  • Soft Palate

- Uvular Base

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4
Q

What is visualized with Mallampati 4?

A

-Hard Palate

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5
Q

What is visualized with Cormack Grade 1?

A

Glottis is fully visualized. (Entire glottis)

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6
Q

What is visualized with Cormack Grade 2?

A

Landmarks are identifiable, but laryngeal aperture is partially obscured. (Posterior Commissure)

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7
Q

What is visualized with Cormack Grade 3?

A

Laryngeal aperture is almost completely obscured. (Tip of epiglottis)

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8
Q

What is visualized with Cormack Grade 4?

A

Unable to visualize the laryngeal aperture. (No glottal structures)

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9
Q

An extremely loose tooth may be extracted before laryngoscopy to prevent its aspiration during anesthesia?

A

True

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10
Q

It is not necessary to properly document dentition because patient assumes all risk?

A

False

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11
Q

What is the thyromental distance?

A
  • Straight distance with neck fully extended and mouth closed between prominence of the thyroid cartilage and the bony point of the lower mandibular border.
  • Normal adult thyromental distance >= 7 cm.
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12
Q

What is interincisor distance?

A
  • Degree of the mouth opening (Top incisor to lower incisor).
  • normal gap in adult is 4.6 cm or more
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13
Q

What is the Atlantooccipital Extension (AO) of head and neck?

A

Aligns the oral, pharyngeal, and laryngeal axes into the sniff position (McGill).

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14
Q

What is mandibular mobility?

A

Ability to move the jaw forward and bite their upper lip.

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15
Q

List the pulmonary complication?

A
  • Atelectasis
  • Pneumonia
  • Aspiration Pneumonia
  • Bronchitis
  • Bronchospasm
  • Hypoxemia
  • Exacerbation of COPD
  • Respiratory failure requiring mechanical ventilation.
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16
Q

What is the length of surgical time that will lead to increased risk of pulmonary complication?

A

Greater than 2 to 3 hours.

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17
Q

The prophylaxis for asthmatic patients are?

A
  • Systemic steroid coverage of 100 mg Hydrocortisone IV q 8 hours
  • Use of personal bronchodilator immediately pre-induction
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18
Q

What are the risk factors for a smoker?

A
  • increased carboxyhemoglobin levels, sputum production, and peri-operative airway reactivity
  • decreased ciliary function and stimulation of cardiac system from nicotine.
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19
Q

What is obstructive sleep apnea?

A

-Syndrome defined by periodic obstriction fo the upper airway during sleep
-Episodic oxygen desaturation and hypercarbia
-Found in 9% women and 24% of men
Physical charecteristics
-obese with BMI >35 kg/m^2
-increased neck circumference
-severe tonsillar hypertrophy
-anatomic abnormalities of upper airway

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20
Q

Anesthesia management of obstructive sleep apnea patient.

A
  • Decrease use of narcotic
  • Regional anesthesia preferred
  • Use of CPAP post-operatively
  • Continuous pulse oximetry
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21
Q

Acute intoxication does what for the anesthetic patient?

A
  • Lowers anesthetic requirements
  • Predisposes to hypothermia
  • hypoglycemia
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22
Q

Withdrawal does what for the anesthetic patient?

A
  • Hypertension
  • increase anesthetic requirements
  • Tremors
  • Delirium
  • Seizures
23
Q

Stimulant abuse does what for the anesthetic patient?

A
  • Palpitations
  • True angina
  • Lowered threshold for serious arrhythmia
  • Convulsions
24
Q

What does routine use of Narcotics/Benzodiazepines do to the anesthetic patient?

A
  • Increase the dose to induce anesthesia
  • Increase the dose to maintain anesthesia
  • Routine use will impact post-op pain requirements
25
Q

Patient with hypertension associated with LVH places patient at greater risk for what?

A

Myocardial infarction and cerebral vascular accident.

-WATCH for patient on diuretic use they may have hypovolemia and electrolyte imbalance.

26
Q

What are the S/S of clinical significant valvular disease?

A
  • Angina
  • Syncope
  • CHF r/t aortic stenosis
  • Mitral Valve Prolapse (MVP) that requires prophylaxis for sub-acute bacterial endocarditis
27
Q

What is the clinical significance of cardiac arrhythmias?

A

Ventricular Arrhythmias

  • Benign
  • Potentially malignant
  • Malignant
28
Q

When do you do an EKG on the anesthetic patient?

A

-Patient over 40 years old
-New Q waves
-ST-segments depression/elevation
-T-wave inversions
-Rhythm distubances
PVC
A-Fib/A-flutter
LBBB
2nd or 3rd degree AV Block

29
Q

Assessment of neuro status on a patient should include what?

A
  • Baseline neuro status
  • History of increased ICP
  • Seizure disorder
  • Preexisting neuromuscular disease
  • Cranial nerve function
  • Cognition
  • Peripheral sensory-motoer function
  • Preexisting nerve injury
30
Q

Assessment of endocrine history should include what?

A
  • Diabetes Mellitus
  • Thyroid disease
  • Parathyroid Disease
  • Endocrine-secreting tumors
  • Adrenal cortical suppression
31
Q

What are the microvascular effects of diabetes mellitus?

A
  • Retinopathy
  • Neuropathy
  • Nephropathy
32
Q

What are the macrovascualr effects of diabetes mellitus?

A
  • MI

- Stroke

33
Q

What is the regimen for patients on glucose management the morning of surgery?

A

Administeration of one fourth to one half the usual daily intermediate acting dose.

34
Q

What is the cause of hyperthyroidism?

A

Excess secretion of T3 and T4

35
Q

What do the s/s reflect in hyperthyroidism?

A

Hypermetabolic state with sympathetic overactivity resulting from the primary effects of thyroid hormones on the adenylate cyclase system.

36
Q

What are the associated conditions of hyperthyroidism?

A
  • Graves disease
  • Toxic goiter
  • Thyroid carcinoma-Pituitary tumors that over secrete thyroid stimulating hormone
37
Q

The s/s of hyperthyrodism are?

A
  • Anxiety
  • Fatigue
  • Skeletal muscle weakness
  • Tachycardia
  • Tachydysrhythmias
  • Exophtholmos
38
Q

What are the preoperative goals for hyperthyroidism?

A 
Consider intraoperative use of beta-blockers
-preoperative labs CBC/platelets
-Euthyroid state
     Antithyroid drugs 6 to 8 weeks
       Mehimazole or propylthiouracil
     Followed by iodine for 1 to 2 weeks
39
Q

What associated conditions go along with hypothyroidism?

A
  • Chronic thyroiditis

- Hashimoto disease

40
Q

Will hypothyroidism delay surgery usually?

A

NO

41
Q

What are the S/S of hypothyroidism?

A
  • lethargy
  • Intolerance to cold
  • Bradycardia
  • Decreased
42
Q

What are the adrenal disorders?

A
  • Pheochromocytoma
  • Long term corticosteroid use(Cushing Syndrome)
  • Hyperaldosteronism
  • Adrenocortical insufficiency (Addison’s Disease?
43
Q

What are the s/s of pheochromocytoma?

A
  • Paroxysmal hypertension
  • Triad of diaphoresis, tachycardia, and headache
  • Tremulousness
  • Weight loss
  • Decreased intravascular fluid volme (orthostatic hypotension) (Hematocrit >45%)
  • Cardiomyopathy
  • Intracerebral hemorrhage
44
Q

What are the pre-op preperation for patient’s with adrenocortical dysfunction?

A
  • Correction of fluid and electrolyte disorders
  • Treatment of coexisting disorders (HTN)(DM)
  • Exogenous corticosteroid therapy
45
Q

What is the perioperative glucocorticoid supplementatioin for patients receiving chronic corticosteroids?

A

Hydrocortisone

46
Q

Does a patient with a past history of gastric bypass receive a NG tube?

A

NO

47
Q

Consideration for patients with GERD, small bowel obstruction, N/V, Hx barium swallow?

A
  • At increased risk for pulmonary aspiration

- Rapid sequence induction

48
Q

What is the description of a physical status classification of a PS-1 by the ASA?

A

A normal health patient.

49
Q

What is the description of a physical status classification of a PS-2 by the ASA?

A

A patient with mild systemic disease that results in no functional limitations.

50
Q

What is the description of a physical status classification of a PS-3 by the ASA?

A

A patient with severe systemic disease that results in functional limitations.

51
Q

What is the description of a physical status classification of a PS-4 by the ASA?

A

A patient with severe systemic disease that is a constant threat to life.

52
Q

What is the description of a physical status classification of a PS-5 by the ASA?

A

A moribund patient who is not expected to survive without the operation.

53
Q

What is the description of a physical status classification of a PS-6 by the ASA?

A

A declared brain-dead patientwhose organs are being removed for donor purposes

54
Q

What is the description of a physical status classification of a E by the ASA?

A

Any patient in whom an emergency operation is required.

GNURS630/Advanced Physical Assessement (9 decks)

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