Sem 1 Study Flashcards

Question

What is minimally invasive surgery

Answer 1

– any technique which allows a smaller incision

Answer 2

* Fasting Status – recommended 6hrs for food and 2 hrs clear fluids minimum * Anaesthetic * Positioning * Infection * Haemorrhage * Damage to other structures

Answer 3

- Total IV anaesthesia - inhalation

Answer 4

* Technique of choice for surgeries with significant duration or that require relaxation/uncomfortable position/control of ventilation * Balanced technique with adjunctive medications

Answer 5

Always injected * May be peripheral (e.g. brachial plexus block) or central (e.g. epidural block)

Answer 6

Loss of sensation in body region without loss of consciousness when specific nerve or group of nerves is blocked by administration of local anaesthetic

Answer 7

- Topical * Ophthalmic * Nebulised * Injectable

Answer 8

Produces loss of sensation without loss of consciousness

Answer 9

- age - nutritional status - medical/ surgical history - medications - lifestyle - procedural

Answer 10

- paeds - advanced age

Answer 11

* Obesity * Malnutrition * Electrolyte or fluid imbalances

Answer 12

* Previous reactions to anaesthetic * Kidney or liver impairment * Cardiovascular or respiratory disorders * Diabetes

Answer 13

* Anticoagulants * Diuretics * Antihypertensives * Antidepressants * Antibiotics * Herbal supplements

Answer 14

- smoking - alcohol use

Answer 15

- Anaesthetic - sedation - muscle relaxant - analgesia - prophylactic medication (antibiotics)

Answer 16

- analgesia - antibiotics - laxatives

Answer 17

* Respiratory * Cardiovascular * Fluid and electrolyte * Neuropsychological * Integumentary * Gastrointestinal * Renal * Endocrine * Musculoskeletal

Answer 18

* Include – patient and family (with consent) * Discuss – medications, potential complications or side effects to look for and what to do if they happen, appointments, who to contact if concerned, support needed, strategies to prevent problems at home * Educate – patient about their condition/discharge/plan of care * Assess – understanding of diagnosis/health plan. Use teach back * Listen – respect their goals and wishes/address their concerns

Answer 19

Routine Post Anaesthetic Observations

Answer 20

✓ Pre-operative – before admission/before surgery ✓ Intra-operative – during surgery ✓ Post-operative – after surgery, including before and after discharge

Answer 21

* Age * Nutritional status * Fluid and electrolyte balance * Co-morbidities * Medications * Lifestyle * Allergies * Anaesthesia * Procedure

Answer 22

↑ risk & severity of complications due to altered physiological, cognitive & psychosocial responses to surgery. Due to normal aging, even a healthy older person may have: * ↓ ability to cope with stress * ↓ tolerance of general anaesthesia & medications * ↓ muscle tissue → hypothermia & ↓ drug metabolism * ↓ respiratory function * Delayed wound healing * Co-morbidities * Polypharmacy * Malnourishment * ↓ body water (45%)

Answer 23

* Due to stress on multiple systems * Anaesthetic risk ✓ Difficulty with intubation * Slower recovery from anaesthetic ✓ Adipose tissue stores inhalation gases ✓ May require higher dosage of medications * ? decresed mobilisation → increase risk of VTE, atelectasis, pressure injury * Stress on abdominal suture line → wound dehiscence, delayed healing; incisional hernia * Skin folds moist & hard to keep clean → increased risk of infection * Adipose tissue less vascular → increased susceptibility to infection * May have comorbidities e.g. * Diabetes type II with abdominal obesity → ↑ risk of infection & poor wound healing * Cardiac complications: * Hypertension due to increased length of blood vessels due to excess weight & alterations in the renin/angiotensin mechanism * High cholesterol resulting in atherosclerosis * Atrial fibrillation * Gastro-oesophageal reflux disease (GORD)

Answer 24

Gastro-oesophageal reflux disease

Answer 25

* Urinalysis * ECG * Chest X-ray * Full blood count/examination (FBC or FBE) * Liver function test (LFT) * Electrolytes e.g. Na+, K+, Ca2+, Mg2+ & renal function – urea, creatinine (EUC) * Coagulation studies * Cross match, group and hold if blood transfusion required * Pregnancy test if applicable

Answer 26

- Protein - Glucose - Ketones - Nitrates

Answer 27

none- small

Answer 28

none - small

Answer 29

- proteinuria - acute and chronic renal disease - hypertension - high protein diet - hypokalaemia - strenuous exercise - dehydration - fever - emotional stress

Answer 30

Vaginal secretions may contaminate urine and give a positive test

Answer 31

- glycosuria - diabetetis mellitus OR low urine threshold for glucose reabsorption - small amount may be found post glucose testing

Answer 32

a condition characterized by an excess of sugar in the urine, typically associated with diabetes or kidney disease.

Answer 33

Altered carbohydrates and fat metabolism indicates diabetes mellitus and starvation

Answer 34

Bacteruria with gram negative organisms which convert nitrates to nitrites eg E Coli.

Answer 35

Bilirubinuria, hepatice disorders, jaundice

Answer 36

The presence of bilirubin in the urine, usually detected while performing a routine urine dipstick test. Its presence is abnormal and can be the first clinical pointer of serious underlying hepatobiliary disorder even before clinical jaundice is appreciated.

Answer 37

1.003-1.030

Answer 38

Dilute urine - excess diuresis

Answer 39

Dehydration

Answer 40

Range 4.5-8 Best 6.0

Answer 41

Bacterial infection decompose uria -> ammonia. Metabolic or respiratory alkalosis

Answer 42

Respiratory or metabolic acidosis pH affected by diet and some drugs

Answer 43

Presence of blood in females may indicate menustration. Bleeding in urinary tract may be caused by calculi, tumours, glomerulonephritis, TB, kidney biopsy or trauma

Answer 44

Pyuria - UTI or inflammation

Answer 45

Contamination from vaginal secretions

Answer 46

Antibiotics

Answer 47

Airway Breathing Circulation Disability Exposure

Answer 48

Fluids/ full set of vital signs Glucose/ give comfort Head to toe assessment

Answer 49

Complete or partial collapse of a lung or a section (lobe) of a lung.

Answer 50

Uncontrolled spasm/ constriction of the laryngeal vocal cords

Answer 51

Anaesthetics gas or ET tube

Answer 52

decreased ability to expectorate due to flattened cilia

Answer 53

Cough or spit out fluid of phlegm from the lungs

Answer 54

decreased secretions and ability to exchange gases.

Answer 55

CVS maintains tissue perfusion i.e. O2 and nutrients to cells and removal of waste and CO2 from cells

Answer 56

Arrythmias Hypotension Hypertension VTE

Answer 57

Hypotension = low cardiac output = renal failure

Answer 58

Hypertension = increased risk of intra/post op bleeding/ stroke

Answer 59

Risk of PE/DVT due to immobility

Answer 60

up to 750ml

Answer 61

750ml - 1500ml

Answer 62

1500ml - 2000ml

Answer 63

greater than 2000

Answer 64

Greater than 40%

Answer 65

normal or increased

Answer 66

Greater than 40

Answer 67

Negligible

Answer 68

Normal or slightly anxious

Answer 69

Mildly anxious

Answer 70

Anxious and/or confused

Answer 71

Confused, lethargic

Answer 72

Anaesthetics + opioids - decreased mobility and increased nausea

Answer 73

decreased peristalsis gastric ulceration due to stress constipation vomiting

Answer 74

paralytic ileus

Answer 75

A condition in which the muscles of the intestines do not allow food to pass through, resulting in a blocked intestine.

Answer 76

Fluid and electrolyte imbalance can occur periop due to the release of hormones from surgical stress EG ADH and aldosterone

Answer 77

Electrolyte imbalances Hypovolaemia/ hypervolaemia

Answer 78

Low fluid volume

Answer 79

Excess fluid volume

Answer 80

Low Na+ due to release of ADH = low h2O retention

Answer 81

Anti-diuretic hormone - arginine vasopressin.

Answer 82

K+ <3.5mmol/L due to release of aldosterone which retaines Na+ and excretes k+

Answer 83

2.1-2.6mmol/L

Answer 84

0.75-1.0mmol/L

Answer 85

135-145mmol/L

Answer 86

3.5-5.0mmol/L

Answer 87

- Anaesthetics decrease the ability to maintain homeostasis and body temp. Can increase nausea - surgery increase disruption of skin integrity

Answer 88

- poor wound healing/ wound infection and or tissue breakdown due to inadequate nutrition - pressure injuries due to decreased mobility -nerve injuries due to inappropriate position - hypothermia ^ cardiac arrhytyhmias

Answer 89

-Surgery/ anaesthetics are a stress on the body and negative nitrogen balance - anaesthetics suppress the immune system (pain affects the endocrine system ed. ^ adrenaline/noradrenaline

Answer 90

Stress hormones

Answer 91

- high or low BGL levels due to diabetes - long term glucocorticoids = ^^ risk of poor wound healing, fractures, GI haemorrhage, hyperglycaemia - hypothermia/ slower recovery from anaesthetic agents due to hypothyroidism - unable to cope with stress due to lack of cortisol response from adrenal glands

Answer 92

any of a group of corticosteroids (e.g. hydrocortisone) which are involved in the metabolism of carbohydrates, proteins, and fats and have anti-inflammatory activity.

Answer 93

-Anaesthetics can cause ^ levels of some drugs in the body due to increased blood flow to the liver . - Some drugs can interact with some anaesthetic agents

Answer 94

-Anaesthetics can cause ^ levels of some drugs in the body due to increased blood flow to the liver . - Some drugs can interact with some anaesthetic agents

Answer 95

- Anticoagulants, antiplatelets, NSAIDS = ^ increased risk of bleeding - ACE inhibitors = ^ hypotension post anaesthesia - Steroids = poor wound healing + increased risk of infection - St Johns Wart = ^ hypotension

Answer 96

an agent that prevents blood clotting

Answer 97

directed against or destructive to blood platelets; called also antithrombocytic

Answer 98

nonsteroidal antiinflammatory drug

Answer 99

Angiotensin-converting-enzyme inhibitors high blood pressure and heart failure

Answer 100

- Voluntary - Specific - Informed - Legal Capacity - Current

Answer 101

18+ sound mind and legally competent

Answer 102

- doctor - next of kin - carer - enduring (medical) power of attorney

Answer 103

- is a legal document that outlines the care a person wishes to receive if they no longer have the capacity to make their own decisions - cannot be over ruled by staff or relatives - contravening an ACD can result in criminal charges

Answer 104

- unconscious - has an intellectual disability such as dementia or brain injury - an emergency - a child - severe pain - opioids - being under the influence of illegal drugs or alcohol - language barrier

Answer 105

Threshold Test of Capacity

Answer 106

In an emergency where the patient is able to consent the health care professionals may provide reasonable treatment to SAVE LIFE or PREVENT SERIOUS INJURY OR DEATH

Answer 107

18 HOWEVER Gillick Competency is inplace

Answer 108

Children under 18 years can consent if the child is of an age and intelligence where they can understand and comprehend the consequence oof their decision they can legally consent

Answer 109

18 BUT Gillicks competency

Answer 110

Assault = to cause fear of injury to another person Example = Threaten to medicate/ restrain a patient if they do not cooperate

Answer 111

Battery = actual physical contact but not necessarily causing injury - touching without consent Example = dragging a pt out of bed

Answer 112

Breach of duty of care

Answer 113

A legal document where a person over 18 years and of sound mind is appointed by you to make limited or total financial decisions on your behalf eg manage shares and pay bills

Answer 114

If you loose your legal capacity

Answer 115

A legal document where you appoint someone to make decisions for you if you lose capacity

Answer 116

legislation in all states and territories that protects people who are incompetent or disabled

Answer 117

- has a disability within the definition in the legislation - is unable to make their own decisions - there is a need to appoint a guardian eg a minor

Answer 118

- unexpected, violent or unnatural (homicide or suicide), due to accident or injury - occurred during or following a health- related procedure that the doctor would not have expected death - death cert has not been signed as cause of death unclear - death that occurs within 24 hours of presentation to hospital or 24 hour post surgery - has not seen dr in 6 months - unknown identity - died in custody - was in or temporarily absent from a mental health facility

Answer 119

The amount of chemical that is required to produce an effect

Answer 120

A particular drugs ability to produce the desired effect on receptors, cellular processed or tissues

Answer 121

Relationship between the structure and the pharmacological agent

Answer 122

- source - chemical formula or structure - pharmokinetics - activity -mechanism of action - clinical use

Answer 123

Pharmacy medicine

Answer 124

Pharmacist only medicine

Answer 125

Prescription only medicine

Answer 126

controlled drug

Answer 127

prohibited substance

Answer 128

One of the central objectives of australias national medicines policy

Answer 129

- right medication - right route - right dose - right time - right person - right documentation - right reason - right response - right education - right to refuse

Answer 130

The study of the interaction between the drug and its molecular target and the pharmacological response = what the drug does to the body

Answer 131

- absorption - distribution - metabolism - excretion

Answer 132

Strength of the interactions between the drug and the molecular target

Answer 133

- transporters - ion channels - enzymes - receptors

Answer 134

A drug binds to a receptor and causes a response

Answer 135

Binds to a receptor without eliciting a response or prevents (blocks) activation of the receptor

Answer 136

- Absorption - Distribution - Metabolism - Excretion

Answer 137

Diffusion across membranes

Answer 138

- blood flow - formulation - route of admin - bioavailability - first pass metabolism - bioequivalence

Answer 139

The process of reversable transfer of a drug between one location and another in the body

Answer 140

- permeability of capillaries - partitioning - perfusion - drug transporters - plasma protein binding - tissue binding - tissue specific barriers

Answer 141

1. oral ingestion of the drug 2. gradual absorption 3. to the liver 4. drug metabolism in liver 5. drug moves gradually into general circulation 6. through the heart 7. to brain 8. to muscle 9. muscle to fatty tissue - storage 10. urine

Answer 142

The process of chemical modification of the drug by enzymes - most common in the liver

Answer 143

- age - genetics - drug interactions

Answer 144

- Excreted unchanged - Phase 1 - Functionalisation - Phase 2 - Conjunction

Answer 145

Modify drugs - oxidisation, reduction, hydrolysis

Answer 146

Gentamicin

Answer 147

joined with an endogenous substance (glucuronic adic, sulfate, glycine) - drug detoxification

Answer 148

Paracetamol

Answer 149

Removal of chemically unchanged drugs and metabolites from the body

Answer 150

- exhalation - saliva - tears - sweat - breast milk - urination - defecation Primarily occurs in kidneys and GIT

Answer 151

- Glomerular filtration - reabsorption - tubular secretion

Answer 152

- Canalicular membrane - Bile - Secreted to duodenum

Answer 153

A response to a medicine which is noxious and unintended and which occurs at doses normally used in man

Answer 154

Any untoward medical occurrence that may present during treatment with a medicine eg unwanted effect that occurs in a different mechanism from the pharmacological

Answer 155

- age, gender, genetics - hepatic disease - polypharmacy - frequencys - chemical characteristics - renal insufficency

Answer 156

Involves study of drugs

Answer 157

The study of interactions between drugs, molecular targets and the pharmacological response

Answer 158

Refers to how the drug is absorbed, distributed, metabolised and excreted

Answer 159

- general - local - regional - sedation/ analgesia

Answer 160

Central Nerve Blocks

Answer 161

- spinal - epidural

Answer 162

- opioids - benzodiazepines - neuromuscular blocking agents (muscle relaxants) - antimetics

Answer 163

Positive modulation of the inhibitory function of the GABA neurotransmitter (gama-amniobutyric) through GABA-A receptors

Answer 164

10-20 seconds

Answer 165

elimination 3-8 hours

Answer 166

A rapid acting non-barbituate

Answer 167

Induction and maintenance for GA/ light sedation/ day surgery

Answer 168

1.5-2.5mg/kg

Answer 169

4-12mg/kg/hr

Answer 170

- respiratory and cardiac depressant - involuntary muscle spasms - ^ inter-cranial pressure - pain at injection site

Answer 171

Sedative and bradycardic effects of other drugs are increased w/ other CNS depressants (fent)

Answer 172

- induction/ maintenance of GA - rapid onset - unconscious in approx 20 secs - short acting - iv injusion or injection

Answer 173

- Thopentone - Propofol

Answer 174

- gasses/ volatile liquids mixed with oxygen via alveoli in the lungs - lung function is critical for effective use and excretion - rapid onset - variable concentration - quick recovery

Answer 175

- sevoflurane - isoflurane - oxygen - nitrous oxide

Answer 176

- induction and maintenance for GA/ light sedation/ day surgery - used for paediatrics

Answer 177

up to 8% +/- N2O

Answer 178

0.5% - 5% (up t0 7% child)

Answer 179

elimination 15-23 hours

Answer 180

Depress neurotransmission of excitatory paths within the CNS

Answer 181

- cardia + resp depression - shivering - ^ salivation - ^ post op N&V - coughing and laryngospasm - agitation post op

Answer 182

- renal/hepatic impairment - coronary artery disease -nitrous oxide - analgesic effects

Answer 183

Joint administration of multiple drugs eg anxiolytics, antipsychotics and opioids

Answer 184

a medication or other intervention that reduces anxiety. This effect is in contrast to anxiogenic agents which increase anxiety

Answer 185

- fentanyl - morphine - pethidine Induce and maintaine anaesthesia + reduce stimuli

Answer 186

Mu-selective opioid agonist. Stimulate opioid receptors within the CNS (opioid antagonist)

Answer 187

- resp depression - vomiting - bradycardia - peripheral vasodilation when combined with anaesthesia - pruitis

Answer 188

- Midazolam - Lorazepam - Diazepam Antianxiety + sedation + amnesia - induce and maintaine anaesthesia

Answer 189

Mu-selective opioid agonist. Causes the neurotransmitter dopamine (Da) is increased causes relaxation effects

Answer 190

- potentiates effects of opiods - hallucinations - dysphoria

Answer 191

Skeletal muscle relaxtion agents

Answer 192

Suxamethonium (succinycholine)

Answer 193

- rocuronium - vercuonium

Answer 194

Negostigmine

Answer 195

1. motor neuron action potential 2. Ca+ enters voltage-gated channels 3. acetylcholine release 4. Na+ entry 5. Local current between depolarized end plate and adjacent muscle plasma membrane 6. muscle fibre action potential initation 7. propagated action in muscle plasma membrane 8. Acetylcholine degradation

Answer 196

Noncompetitive skeletal muscle relaxants that act as acetycholine receptor antagonists

Answer 197

Act as acetylcholine receptor agents

Answer 198

In the muscle

Answer 199

Competitive antagonists that compete with acetylcholine for receptor binding sites

Answer 200

function as competitive antagonists

Answer 201

- ACh receptor agonist - bind to the ACh receptors and generate an action potential

Answer 202

- hyperkalemia - malignant hyperthermia

Answer 203

- competitive antagonists - bind to ACh receptors - unable to induce ion channel openings - Prevent ACh from binding - end plate potentials do not develop

Answer 204

- hypotension - bronchospasm

Answer 205

1 - analgesia 2 - delirium stage 3 - surgical anaesthesia 4 - medullary depression

Answer 206

it blocks pathways eg. bupivacaine

Answer 207

Into epidural space

Answer 208

Into CSF (subarachnoid space)

Answer 209

- ECG - Blood pressure (direct - ART line, indirect - cuff) - Central venous pressure (CVP) - Pulse ox - capnography - temp - fluids + electrolytes - blood loss - art blood gas

Answer 210

intact skin and mucous membranes

Answer 211

AIR and fever

Answer 212

B & T lymphocytes

Sem 1 Study Flashcards

(272 cards)