Sem 1 Study Flashcards
What is the clinical reasoning cycle? (CRC)
Clinical reasoning—the process of applying cognitive skills, knowledge, and
experience to diagnose and treat patients” ( Royce et al., 2019)
Why do we use the CRC
The clinical reasoning cycle was developed to help beginner nurses use the same
framework when evaluating patient care that experienced nurses do
What are the 8 aspects of the CRC
- Consider the pt
- collect cues/ information
- Process information
- identify problems/ issues
- establish goals
- take action
- evaluate outcomes
- reflect on process and new learning
What is the Roper Logan Tierney Model of Nursing
A model of nursing care which looks holistically at a patient and their needs
Who developed the roper logan tierney model of nursing?
Nancy Roper
What was the roper logan tierney model created
to identify the core nursing activities that
applied to all nurses regardless of speciality areas
What are risk factors of gall stones
age, female sex, pregnancy, obesity, metabolic syndrome, genetic predisposition, low levels of physical activity
What are symptoms of gall stones?
nausea and vomiting, tachycardia,
hypertension and diaphoresis.
3 Risks of gall stones
- Cause severe abdominal pain if blocks bile duct
- May also lead to bacterial infection of gallbladder
- May block pancreatic duct which can cause acute
pancreatitis
What is a Laparoscopic Cholecystectomy
Minimally invasive surgical procedure to remove
the gallbladder
When is a Laparoscopic Cholecystectomy used/ indicated
Indicated for chronic or acute cholecystitis
What are common complications of laparoscopic cholecystectomy?
bleeding, infection,
damage to surrounding structures – particularly
the hepatic duct.
What surgery would you use for chronic cholecystitis?
laparoscopic cholecystectomy
What is chronic cholecystitis?
swelling and irritation of the gallbladder
Less common complications of a laparoscopic cholecystectomy
may be a bile leak or conversion to open surgery.
What is Escitalopram?
SSRI – selective serotonin reuptake inhibitor. Used for major depression.
What are side affects of escitalopram?
nausea, diarrhoea, agitation, insomnia, drowsiness, tremor, dry mouth, dizziness, headache, sweating, weakness, anxiety, sexual dysfunction,
rhinitis, myalgia, rash, prolonged QT interval/tachycardia, abnormal platelet
aggregation/haemorrhagic complications
What are considerations of escitalopram?
can cause blurred vision and affect people’s ability to drive or operate machinery, must be slowly weaned off to avoid withdrawal affects
What is elective surgery in regards to wait times
clinical condition of patients means their procedure can be put
on a waiting list
what is the time frame for a Category 1 surgery
clinically indicated within 30 days
what is the time frame for a Category 2 surgery
Clinically indicated within 90 days
what is the time frame for a Category 3 surgery
Clinically indicated within 365 days
What is the time frame of emergency surgery?
the patient needs a procedure to treat trauma or acute
illness or deteriorating to an existing condition within 10 days.
What does open surgery mean?
requires larger cuts so the
surgeon can visualise the structures
involved
What is minimally invasive surgery
– any technique which
allows a smaller incision
Common risks of surgery (6)
- Fasting Status – recommended 6hrs for food
and 2 hrs clear fluids minimum - Anaesthetic
- Positioning
- Infection
- Haemorrhage
- Damage to other structures
What are two parts of general anaesthesia (administration)
- Total IV anaesthesia
- inhalation
What is general anaesthesia
- Technique of choice for surgeries with significant duration or that
require relaxation/uncomfortable
position/control of ventilation - Balanced technique with adjunctive medications
How is Regional anaesthesia administered?
Always injected
* May be peripheral (e.g. brachial
plexus block) or central (e.g.
epidural block)
What is the result of regional anaesthesia?
Loss of sensation in body region without loss of consciousness when
specific nerve or group of nerves is
blocked by administration of local
anaesthetic
What are types of Local anaesthesia (4)
- Topical
- Ophthalmic
- Nebulised
- Injectable
What does local anaesthesia do?
Produces loss of sensation without
loss of consciousness
What are preoperative risk factors (6)
- age
- nutritional status
- medical/ surgical history
- medications
- lifestyle
- procedural
What are the two type of age preop risk factors
- paeds
- advanced age
What are nutritional status risks pre op (3)
- Obesity
- Malnutrition
- Electrolyte or fluid imbalances
What are medical surgery pre op risks (4)
- Previous reactions to anaesthetic
- Kidney or liver impairment
- Cardiovascular or respiratory disorders
- Diabetes
What are medication preop risks (6)
- Anticoagulants
- Diuretics
- Antihypertensives
- Antidepressants
- Antibiotics
- Herbal supplements
What are lifestyle choices preop risks (2)
- smoking
- alcohol use
What are common Intraoperative medication types? (5)
- Anaesthetic
- sedation
- muscle relaxant
- analgesia
- prophylactic medication (antibiotics)
What are common Postoperative medication types (3)
- analgesia
- antibiotics
- laxatives
What body systems have risks of postoperative complications (9)
- Respiratory
- Cardiovascular
- Fluid and electrolyte
- Neuropsychological
- Integumentary
- Gastrointestinal
- Renal
- Endocrine
- Musculoskeletal
What does IDEAL mean in discharge
- 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
What does RPAO
Routine Post Anaesthetic Observations
What are the 3 phases of perioperative nursing:
✓ Pre-operative – before admission/before surgery
✓ Intra-operative – during surgery
✓ Post-operative – after surgery, including before and after discharge
Perioperative risk factors (9)
- Age
- Nutritional status
- Fluid and electrolyte balance
- Co-morbidities
- Medications
- Lifestyle
- Allergies
- Anaesthesia
- Procedure
Risks for older adults >65yrs in surgery (10)
↑ 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%)
Risks relating to obesity surgically (14)
- 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)
What is GORD
Gastro-oesophageal reflux disease
What are different Diagnostic tests (9)
- 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
What are the elements in a urinalysis (4)
- Protein
- Glucose
- Ketones
- Nitrates
What is the normal level of protein in a urinalysis?
none- small
What is the normal glucose level in a urinalysis?
none
What is the normal ketone level in a urinalysis?>
none - small
What is the normal nitrate level in urinalysis?
none
What can increased protein in urinalysis mean? (9)
- proteinuria
- acute and chronic renal disease
- hypertension
- high protein diet
- hypokalaemia
- strenuous exercise
- dehydration
- fever
- emotional stress
What is a consideration in a protein result in a urinalysis for a female
Vaginal secretions may contaminate urine and give a positive test
What can abnormal glucose results in a urinalysis mean? (3)
- glycosuria
- diabetetis mellitus OR low urine threshold for glucose reabsorption
- small amount may be found post glucose testing
What is glycosuria?
a condition characterized by an excess of sugar in the urine, typically associated with diabetes or kidney disease.
What can abnormal ketone results mean in a urinalysis?
Altered carbohydrates and fat metabolism indicates diabetes mellitus and starvation
What can altered nitrates mean in a urinalysis?
Bacteruria with gram negative organisms which convert nitrates to nitrites eg E Coli.
What is the normal bilirubin in urine?
None
What can abnormal bilirubin in urine mean
Bilirubinuria, hepatice disorders, jaundice
What is Bilirubinuria
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.
What is the normal SG of a urinalysis
1.003-1.030
What does low SG in a urinalysis mean?
Dilute urine - excess diuresis
What does high SG in a urinalysis mean?
Dehydration
What is the normal PH of a urinalysis? Range and ‘best’
Range 4.5-8 Best 6.0
What could a PH of greater than 8.0 mean in a urinalysis
Bacterial infection decompose uria -> ammonia. Metabolic or respiratory alkalosis
What could a PH of less than 4.5 mean in a urinalysis? And what can the pH be affected by
Respiratory or metabolic acidosis
pH affected by diet and some drugs
What is the normal range of blood in a urinalysis
None
What can presence of blood in urinalysis mean? (7)
Presence of blood in females may indicate menustration. Bleeding in urinary tract may be caused by calculi, tumours, glomerulonephritis, TB, kidney biopsy or trauma
What should the WBC be in a urinalysis? (White blood cells)
None
What can presence of WBC in a urinalysis indicate?
Pyuria - UTI or inflammation
What can cause a false + WBC reading in a urinalysis?
Contamination from vaginal secretions
What can cause a false - WBC reading in a urinalysis?
Antibiotics
What does A B C D E mean as a primary assessment
Airway
Breathing
Circulation
Disability
Exposure
What dos F G H mean as a secondary assessment
Fluids/ full set of vital signs
Glucose/ give comfort
Head to toe assessment
What is atelectasis?
Complete or partial collapse of a lung or a section (lobe) of a lung.
What is a primary cause of atelectasis
GA
What is laryngospasm?
Uncontrolled spasm/ constriction of the laryngeal vocal cords
What can cause a laryngospasm in surgery?
Anaesthetics gas or ET tube
What impact does smoking cause in respiratory function that causes a GA risk?
decreased ability to expectorate due to flattened cilia
What does expectorate mean
Cough or spit out fluid of phlegm from the lungs
How does COPD/asthma and smoking impact respiratory systems from surgical perspective
decreased secretions and ability to exchange gases.
Why is there a cardiovascular risk in surgery?
CVS maintains tissue perfusion i.e. O2 and nutrients to cells and removal of waste and CO2 from cells
What are potential CVS complications due to anaesthetic agents
Arrythmias
Hypotension
Hypertension
VTE
Why is hypotension a CVS risk with surgery
Hypotension = low cardiac output = renal failure
Why is hypertension a CVS risk with surgery
Hypertension = increased risk of intra/post op bleeding/ stroke
Why is VTE a CVS risk with surgery
Risk of PE/DVT due to immobility
How many ml of blood is class 1 of hemorrhagic shock?
up to 750ml
How many ml of blood is class 2 of hemorrhagic shock?
750ml - 1500ml
How many ml of blood is class 3 of hemorrhagic shock?
1500ml - 2000ml
How many ml of blood is class 4 of hemorrhagic shock?
greater than 2000
What is the blood loss (% blood volume) in class 1 hemorrhagic shock?
up to 15%
What is the blood loss (% blood volume) in class 2 hemorrhagic shock?
15% - 30%
What is the blood loss (% blood volume) in class 3 hemorrhagic shock?
30% - 40%
What is the blood loss (% blood volume) in class 4 hemorrhagic shock?
Greater than 40%
What is the pulse rate (BPM) in class 1 hemorrhagic shock?
<100
What is the pulse rate (BPM) in class 2 hemorrhagic shock?
100-120
What is the pulse rate (BPM) in class 3 hemorrhagic shock?
120-140
What is the pulse rate (BPM) in class 4 hemorrhagic shock?
> 140
What is the blood pressure in class 1 hemorrhagic shock?
normal
What is the blood pressure in class 2 hemorrhagic shock?
normal
What is the blood pressure in class 3 hemorrhagic shock?
decreased
What is the blood pressure in class 4 hemorrhagic shock?
decreased
What is the pulse pressure in class 1 hemorrhagic shock?
normal or increased
What is the pulse pressure in class 2 hemorrhagic shock?
decreased
What is the pulse pressure in class 3 hemorrhagic shock?
decreased
What is the pulse pressure in class 4 hemorrhagic shock?
decreased
What is the resp rate (per min) in class 1 hemorrhagic shock?
14-20
What is the resp rate (per min) in class 2 hemorrhagic shock?
20-30
What is the resp rate (per min) in class 3 hemorrhagic shock?
30-40
What is the resp rate (per min) in class 4 hemorrhagic shock?
Greater than 40
What is the urine output (ml/hour) in class 1 hemorrhagic shock?
> 30
What is the urine output (ml/hour) in class 2 hemorrhagic shock?
20-30
What is the urine output (ml/hour) in class 3 hemorrhagic shock?
5-15
What is the urine output (ml/hour) in class 4 hemorrhagic shock?
Negligible
What is the CNS/ mental status in class 1 hemorrhagic shock?
Normal or slightly anxious
What is the CNS/ mental status in class 2 hemorrhagic shock?
Mildly anxious
What is the CNS/ mental status in class 3 hemorrhagic shock?
Anxious and/or confused
What is the CNS/ mental status in class 4 hemorrhagic shock?
Confused, lethargic
Why is the gastrointestinal system a surgical risk?
Anaesthetics + opioids - decreased mobility and increased nausea
What are potential surgical complications with the gastro system? (4)
decreased peristalsis
gastric ulceration due to stress
constipation
vomiting
Why is decreased peristalsis a surgical risk
paralytic ileus
What is paralytic ileus
A condition in which the muscles of the intestines do not allow food to pass through, resulting in a blocked intestine.
Why are fluids and electrolytes a surgical risk?
Fluid and electrolyte imbalance can occur periop due to the release of hormones from surgical stress EG ADH and aldosterone
What are potential fluid and electrolyte complications surgically?
Electrolyte imbalances
Hypovolaemia/ hypervolaemia
What is hypovolaemia?
Low fluid volume
What hypervolaemia?
Excess fluid volume
What is hyponatraemia?
Low Na+ due to release of ADH = low h2O retention
What is ADH?
Anti-diuretic hormone - arginine vasopressin.
What is hypokalaemia?
K+ <3.5mmol/L due to release of aldosterone which retaines Na+ and excretes k+
What is the normal range of Ca2+ (calcium)
2.1-2.6mmol/L
What is the normal range of Mg2+ (magnesium)
0.75-1.0mmol/L
What is the normal range of Na+ (sodium)
135-145mmol/L
What is the normal range of K+ (potas)
3.5-5.0mmol/L
What is the surgical risk for the integumentary system?
- Anaesthetics decrease the ability to maintain homeostasis and body temp. Can increase nausea
- surgery increase disruption of skin integrity
What are potential surgical complications in the integumentary system? (4)
- 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
What is the surgical risk for the endocrine system? (2(
-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
What type of hormones are adrenaline/noradrenaline
Stress hormones
What are potential surgical complications for the endocrine system? (4)
- 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
What is glucocorticoids?
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.
Why are medications a potential surgical risk? (2)
-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
Why are medications a potential surgical risk? (2)
-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
What are complications that can occur surgically from medications?
- Anticoagulants, antiplatelets, NSAIDS = ^ increased risk of bleeding
- ACE inhibitors = ^ hypotension post anaesthesia
- Steroids = poor wound healing + increased risk of infection
- St Johns Wart = ^ hypotension
What are anticoagulants
an agent that prevents blood clotting
What are antiplatelets?
directed against or destructive to blood platelets; called also antithrombocytic
What are NSAIDS
nonsteroidal antiinflammatory drug
What are ACE inhibitors and what do they treat?
Angiotensin-converting-enzyme inhibitors high blood pressure and heart failure
What are the elements of valid consent?
- Voluntary
- Specific
- Informed
- Legal Capacity
- Current
When does a person have legal capacity
18+ sound mind and legally competent
Who might be able to consent on a patients behalf if the person doesnt have capacity?
- doctor
- next of kin
- carer
- enduring (medical) power of attorney
3 points about advanced care directives
- 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
8 Factors that affect legal capacity
- 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
How do you test capacity
Threshold Test of Capacity
What is the ‘Doctrine of Emergency’ or “Doctrine of Necessity’
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
What is the age of consent in NSW
15
What is the age of consent in Victoria
18 HOWEVER Gillick Competency is inplace
What is Gillick Competency
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
Age of consent in ACT
18
Age of consent in QLD
18 BUT Gillicks competency
What is a medical example of assault and what is assault
Assault = to cause fear of injury to another person
Example = Threaten to medicate/ restrain a patient if they do not cooperate
What is battery and give a medical example
Battery = actual physical contact but not necessarily causing injury - touching without consent
Example = dragging a pt out of bed
What is negligence
Breach of duty of care
What is power of attorney (POA)
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
When would a general POA end
If you loose your legal capacity
What is an enduring/ medical POA
A legal document where you appoint someone to make decisions for you if you lose capacity
what is guardianship
legislation in all states and territories that protects people who are incompetent or disabled
What are the three criteria that a person needs a guardian
- 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
Does a guardain control finances
no
What are deaths that are reportable to the coroner (8)
- 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
What does potency mean in drugs
The amount of chemical that is required to produce an effect
What does selectivity mean in drugs
A particular drugs ability to produce the desired effect on receptors, cellular processed or tissues
What does specificity mean in drugs
Relationship between the structure and the pharmacological agent
What impacts a drug class (6)
- source
- chemical formula or structure
- pharmokinetics
- activity
-mechanism of action - clinical use
What is a schedule two drug
Pharmacy medicine
What is a schedule three drug
Pharmacist only medicine
What is a schedule 4 drug
Prescription only medicine
What is a schedule 8 drug
controlled drug
what is a schedule 9 drug
prohibited substance
What is the quality use of medications (QUM)
One of the central objectives of australias national medicines policy
What are the 10 rights of medication administration
- right medication
- right route
- right dose
- right time
- right person
- right documentation
- right reason
- right response
- right education
- right to refuse
What is phamacodynamics
The study of the interaction between the drug and its molecular target and the pharmacological response = what the drug does to the body
What are 4 factors that affect the concentration of the drug
- absorption
- distribution
- metabolism
- excretion
What does affinity mean (pharm)
Strength of the interactions between the drug and the molecular target
What are 4 molecular drug targets
- transporters
- ion channels
- enzymes
- receptors
What is an agonist
A drug binds to a receptor and causes a response
What is an antagonist
Binds to a receptor without eliciting a response or prevents (blocks) activation of the receptor
What does the drug do in the body?
- Absorption
- Distribution
- Metabolism
- Excretion
What does absorption mean (pharm)
Diffusion across membranes
What is drug absorption affected by (6)
- blood flow
- formulation
- route of admin
- bioavailability
- first pass metabolism
- bioequivalence
What does distribution mean (pharm)
The process of reversable transfer of a drug between one location and another in the body
What impacts the rate and extent of drug distribution
- permeability of capillaries
- partitioning
- perfusion
- drug transporters
- plasma protein binding
- tissue binding
- tissue specific barriers
What is the process of oral digestion of a drug (10)
- oral ingestion of the drug
- gradual absorption
- to the liver
- drug metabolism in liver
- drug moves gradually into general circulation
- through the heart
- to brain
- to muscle
- muscle to fatty tissue - storage
- urine
What is drug metabolism
The process of chemical modification of the drug by enzymes - most common in the liver
3 affecting factors of drug metabolism
- age
- genetics
- drug interactions
What are the classifications of metabolism (pharm)
- Excreted unchanged
- Phase 1 - Functionalisation
- Phase 2 - Conjunction
What happens in the metabolism stage Functionalisation
Modify drugs - oxidisation, reduction, hydrolysis
What is an example of a drug that goes through phase 1 metabolism
Caffeine
What is an example of a drug that goes through metabolism excreted unchanged
Gentamicin
What happens in the drug metabolic stage conjugation
joined with an endogenous substance (glucuronic adic, sulfate, glycine) - drug detoxification
What is an example of a drug that goes through stage 2 metabolism: Conjugation
Paracetamol
What is drug excretion
Removal of chemically unchanged drugs and metabolites from the body
How can drug excretion occur and where does it primarily occur
- exhalation
- saliva
- tears
- sweat
- breast milk
- urination
- defecation
Primarily occurs in kidneys and GIT
How are drugs excreted in the kidneys
- Glomerular filtration
- reabsorption
- tubular secretion
How are drugs excreted in the GIT
- Canalicular membrane
- Bile
- Secreted to duodenum
What is an adverse drug reaction (ADR)
A response to a medicine which is noxious and unintended and which occurs at doses normally used in man
What is an adverse drug event (ADE)
Any untoward medical occurrence that may present during treatment with a medicine
eg unwanted effect that occurs in a different mechanism from the pharmacological
What are risk factors of an ADE or ADR
- age, gender, genetics
- hepatic disease
- polypharmacy
- frequencys
- chemical characteristics
- renal insufficency
What is pharmacology
Involves study of drugs
what is pharmacodynamics
The study of interactions between drugs, molecular targets and the pharmacological response
What is pharamcokinetics
Refers to how the drug is absorbed, distributed, metabolised and excreted
What are types of anaesthetics
- general
- local
- regional
- sedation/ analgesia
What is an example of regional anaesthetics
Central Nerve Blocks
What are the central nerve blocks
- spinal
- epidural
What are adjuncts used in anaesthesia
- opioids
- benzodiazepines
- neuromuscular blocking agents (muscle relaxants)
- antimetics
What is the mode of action of propofol
Positive modulation of the inhibitory function of the GABA neurotransmitter (gama-amniobutyric) through GABA-A receptors
What is the onset time of propofol
10-20 seconds
What is the duration of propofol
3-5 mins
What is the half life of propofol
elimination 3-8 hours
What is propofol
A rapid acting non-barbituate
What is propofol used for
Induction and maintenance for GA/ light sedation/ day surgery
What is the IV induction dose of propofol
1.5-2.5mg/kg
What is the infusion dose of propofol
4-12mg/kg/hr
What are ADE of propofol
- respiratory and cardiac depressant
- involuntary muscle spasms
- ^ inter-cranial pressure
- pain at injection site
What are some drug interactions with propofol
Sedative and bradycardic effects of other drugs are increased w/ other CNS depressants (fent)
4 Facts about intravenous induction agents
- induction/ maintenance of GA
- rapid onset - unconscious in approx 20 secs
- short acting
- iv injusion or injection
What are two examples of intravenous induction agents
- Thopentone
- Propofol
5 Facts about inhalation anaesthetics
- 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
4 examples of inhalation anaesthetics
- sevoflurane
- isoflurane
- oxygen
- nitrous oxide
What is sevoflurane
- induction and maintenance for GA/ light sedation/ day surgery - used for paediatrics
What is the dosage of sevoflurane induction
up to 8% +/- N2O
What is the dosage of sevoflurane maintenance
0.5% - 5% (up t0 7% child)
What is the onset of sevoflurane
2 mins
What is the half life of sevoflurane
elimination 15-23 hours
What is the MoA of sevoflurane
Depress neurotransmission of excitatory paths within the CNS
ADE of sevoflurane
- cardia + resp depression
- shivering
- ^ salivation
- ^ post op N&V
- coughing and laryngospasm
- agitation post op
Contradictions and precautions of sevoflurane
- renal/hepatic impairment - coronary artery disease
-nitrous oxide - analgesic effects
What is neuroleptoanalgesia
Joint administration of multiple drugs eg anxiolytics, antipsychotics and opioids
What are anxiolytics
a medication or other intervention that reduces anxiety. This effect is in contrast to anxiogenic agents which increase anxiety
What are three examples of opioid analgesics + what do they do
- fentanyl
- morphine
- pethidine
Induce and maintaine anaesthesia + reduce stimuli
What is the MOA of fent, morph, peth
Mu-selective opioid agonist. Stimulate opioid receptors within the CNS (opioid antagonist)
Adverse effects of opioids (fent, morp, peth)
- resp depression
- vomiting
- bradycardia
- peripheral vasodilation when combined with anaesthesia
- pruitis
What are three examples of benzodiazepines and what are they used for
- Midazolam
- Lorazepam
- Diazepam
Antianxiety + sedation + amnesia - induce and maintaine anaesthesia
what is the MoA of benzodizepines
Mu-selective opioid agonist. Causes the neurotransmitter dopamine (Da) is increased causes relaxation effects
Adverse effects of benzodiazepines
- potentiates effects of opiods
- hallucinations
- dysphoria
What are neuormuscular agents
Skeletal muscle relaxtion agents
What is an example of a depolarising neuromuscular agent
Suxamethonium (succinycholine)
What are two examples on non depolarising neuromuscular agents
- rocuronium
- vercuonium
What is an example of a neuromuscular agent that can be reversed by anticholinesterase agents
Negostigmine
What is the pathway of neuromuscular agents (1-8)
- motor neuron action potential
- Ca+ enters voltage-gated channels
- acetylcholine release
- Na+ entry
- Local current between depolarized end plate and adjacent muscle plasma membrane
- muscle fibre action potential initation
- propagated action in muscle plasma membrane
- Acetylcholine degradation
What is the definition of depolarising neuromuscular blockers
Noncompetitive skeletal muscle relaxants that act as acetycholine receptor antagonists
What is the MoA of depolarising neuromuscular blockers
Act as acetylcholine receptor agents
Where to depolarizing neuromuscular blockers depolarize?
In the muscle
Do depolarising neuromuscular blockers open the sodium channels
No
What is the definition of nondepolarizing neuromuscular blockers
Competitive antagonists that compete with acetylcholine for receptor binding sites
what is the MoA of nondepolarizing neuromuscular blockers
function as competitive antagonists
do nondepolarizing neuromuscular blockers open sodium channels
Yes
2 facts about depolarising anaesthetic agents
- ACh receptor agonist
- bind to the ACh receptors and generate an action potential
ADE of depolarising anaesthetic agents (2)
- hyperkalemia
- malignant hyperthermia
3 facts about non depolarising anaesthetic agents
- competitive antagonists
- bind to ACh receptors - unable to induce ion channel openings
- Prevent ACh from binding - end plate potentials do not develop
ADE of non depolarising anaesthetic agents (2)
- hypotension
- bronchospasm
What are the 4 stages of anaesthesia
1 - analgesia
2 - delirium stage
3 - surgical anaesthesia
4 - medullary depression
What is an example of local anaesthetia and what does it do
it blocks pathways eg. bupivacaine
Where does an epidural go
Into epidural space
Where does a spinal nerve block go
Into CSF (subarachnoid space)
What is included in haemodynamic monitoring (9)
- ECG
- Blood pressure (direct - ART line, indirect - cuff)
- Central venous pressure (CVP)
- Pulse ox
- capnography
- temp
- fluids + electrolytes
- blood loss
- art blood gas
What is the first line of defence
intact skin and mucous membranes
What is the second line of defence
AIR and fever
What is the third line of defence
B & T lymphocytes
What is innate immune response
Generic
What is adaptive immune response
Specific
