Special Topics Flashcards
What is anesthesia?
controlled, reversible state of unconsciousness
What is the goal of anesthesia?
maintenance of physiologic homeostasis, function of all systems during operation to minimize adverse outcomes
What is amnesia?
result of GA
What is a neuromusclar blockade?
allows muscle relaxation for prolonged periods of time
What are some advantages of GA?
useful for surgery, controls airways, can be used for unpredicted durations or events
What are 3 phases of GA?
- induction- IV meds
- maintenance- volatile gases- NO or TIVA total IV anesthesia
- emergence
What are characteristics of emergence stage?
autonomic hyper responsiveness- HTN, tachycardia, bronchospasm
can be blunted with short acting narcotics, BB or lidocaine
What are some complications from GA?
endotracheal intubation- leads to sore throat or damage to teeth
also: N/V, pain, cardiac arrhtymias, MI, CVA
What is neuraxial anesthesia?
spinal, needle inserted into L3-L4 subarachnoid space
leads to temporary numbness and muscle relaxation
What is SA generally used for?
lower extremity procedures such as THA
decreased surgical time, blood loss
What is epidural anesthesia?
type of NA, small gauge catheter into epidural space
used in combo with GA to reduce peri op stress response
What are complications from EA?
puncture headaches, spinal hematoma, epidural abcess
What is a nerve block?
commonly used when involving extremities
used in brachial plexus, sciatic, femoral
What is advantage of nerve block?
avoid hemodynamic instability associated with GA and neuromuscular blockade
What are local nerve block complications?
pain, weakness, ecchymosis, hematoma, infection, numbness , nerve laceration
What are systemic effects of a nerve block?
systemic toxicity, allergic reactions, pneumo, phrenic nerve paralysis
What are other types of anesthesia?
monitored anesthesia care- no complete LOC
conscious sedation- should be able to maintain airway integrity
What are pt implications for GA?
N/V, precautions of on going effects of anesthesia, complications, level of arousal
What should you watch for in response to activity after GA?
pain, BP/OTN, HR response, more vomiting
What is a thoracentesis?
therapeutic or diagnostic removal of pleural fluid
complication: pneumo
What is a thoracotomy?
incision into chest, usually along intercostal, rib occasionally cut
What are complications from thoracotomy?
atelectasis, PNA, excess bleeding, infection
What are PT implications?
pulm hygeine, deep breathing, segmental, mobilization, ROM, positioning
What are signs of lung transplant rejection?
decreased SaO2 at rest, CXR showing inflammation
What is PT role in someone with transplant rejection?
continue pulm hygeine
re evaluate activity tolerance
What is an anastomotic dehiscence?
sudden or increasing air leak in lungs/incision
stop mobility notify team
What is most important for PT for lung transplant pts?
move early and often
What is a laparotomy?
surgical procedure to open the peritoneal space
What is NIH criteria for gastric bypass?
BMI of 40 or higher
or BMI of 35 plus with one or more co related co morbidities
What are post op nutritional concerns?
weight loss of 65-80% excess weight typical
What is a whipple procedure?
used for severe pancreatitis or pancreatic cancer
What is malnutrition?
imbalance between the boys nutritional requirements and intake of these nutrients
What is cause of undernutrition?
inadequate intake, malabsorption, hyper metabolism, poverty/SES, elderly GI cancers
What is cause of over nutrition?
over eating, lack of activity, meds, endocrine dysfunction
What are malabsorption syndromes?
inability of small or large intestines to absorb nutrients
causes: HIV (CD4 receptors), pancreatic disorders (can’t break down proteins and fats), crohns surgery
What is normal calorie per kg intake?
30 cal/kg
After elective surgery?
32 cal/kg
After multiple traumas?
40 cal/kg
After sepsis?
50 cal/kg
after burns?
protein requirements are doubled
What is pulmonary cachexia?
occurs in 1/3 of pts with COPD, severe weight loss and muscle wasting
resting energy is proportionally higher as severity of COPD increases
usually aligns with mortality rates
What meds can cause overeating?
steroids, antidepressants, antipsychotics, cushing’s (increased cortisol secretion from increased ACTH)
What is a clear liquid diet?
consists of foods that are clear and liquid, used to maintain hydration and keep colon contents to minimum
good for fluids but lack carbs, fat and proteins
What is full liquid diet for?
used when person has difficulty chewing or swallowing
What is a mechanical soft diet?
consists of food the require minimal chewing
What is difference between TPN and PPN?
TPN= large diameter veins
PPN = small diameter veins
What is house diet?
no restrictions
What is ADA diet?
diabetes, restrict calories and carbs
What is cardiac diet?
restricts fats and cholesterol, sodium
encourage potassium
may limit fluids
What is renal diet?
restricts proteins, sodium, potassium calcium
possible fluid restriction
What is neutropenic diet?
no unpasteurized milk
all meats cooked, packaged and no deli
no unwashed fruit, veggies
bottled water
