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Brandon’s AFN Health Assessment > Test 4 Bringing it all together part 1 > Flashcards

Test 4 Bringing it all together part 1 Flashcards

1
Q

those with genetic predisposition to MH have a mutation in the ____________ receptor of skeletal muscle –> uncontrolled elevation of _______

A

ryanodine (RYR1); intracellular calcium

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2
Q

times (in lifespan) when you expect a decrease in enzymatic activity of pseudocholinesterase

A

pregnancy
newborn
infants

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3
Q

what drug therapies can cause pseudocholinesterase def?

A

echothiophase iodide
neostigmine
chlorpromazine
oral contraceptives
cyclophosphamide
pancuronium bromide
phenylzine
trimethaphan camsylate

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4
Q

disease states that can cause a pseudocholinesterase deficiency

A

hepatic failure
acute MI
acute infection
uremia
malnutrition
myxedema
collagen vascular dz
carcinoma
TB

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5
Q

what is the expected apnea time in minutes for someone with a dibucaine number of 20

A

480 minutes (8 hours)
(atypical homozygte for pseudocholinesterase def: A-A)

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6
Q

what is the expected apnea time in minutes for someone with a dibucaine number of 60

A

10-30 minutes
(heterozygote for pseudocholinesterase def : W-A)

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7
Q

what is the expected apnea time in minutes for someone with a dibucaine number of 80?

A

10 minutes (this is a typical homozygote for pseudocholinesterase def : W-W)

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8
Q

someone who is an atypical homozygote (A-A) for pseudocholinesterase deficiency will have a dibucaine number of ___________

A

20

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9
Q

someone who is a heterozygote (W-A) for pseudocholinesterase deficiency will have a dibucaine number of ______________

A

60

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10
Q

someone who is a typical homozygote (W-W) for pseudocholinesterase deficiency will have a dibucaine number of _____________

A

80

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11
Q

what is the dibucaine number

A

The Dibucaine Number is the PERCENT INHIBITION of pseudocholinesterase activity.

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12
Q

________________ is a local anesthetic that can detect individuals with abnormal pseudocholinesterase

A

dibucaine

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13
Q

T/F: all patients susceptible to MH will show signs of MH upon exposure to triggering agents

A

false

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14
Q

which med given for prophylactic tx of PONV in pts with increased risk is not an anti-emetic, but allows the anesthesia provider to give less opoids thus reducing chance of PONV

A

pregabalin

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15
Q

pt is at increased risk of PONV, you tell them to apply scopolamine patch _________ hours prior to surgery

A

4

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16
Q

who do you NOT give reglan to ? (like in the prophylactic tx of PONV)

A

parkinsons
bowel obstruction

17
Q

what is the concern with using droperidol for PONV prevention in high risk patient?

A

has sedation effects lastin up to 12 horus

18
Q

what are some of the different drugs used to preventatively tx PONV if at increased risk?

A
  1. zofran
  2. reglan
  3. droperidol
  4. decadron
  5. scopolamine transdermal
  6. pregabalin
19
Q

if pt has 3-4 risk factors for PONV they are __________________ risk, and it should be attempted to be prevented with what interventions?

A

severe; avoid GA or use propofol based anesthetic, minimize opoids, prevention with 3 drugs from different classes

20
Q

if pt has 1-2 risk factors for PONV they are __________________ risk and anesthetic plan should consist of prevention with ___________ drugs from different classes

A

moderate - to - severe; 2-3

21
Q

what is the scoring mechanism use to stratify risk and preventative management of PONV

A

simplified apfel score

22
Q

anesthesia related risk factors for PONV

A
  1. volatile anesthetics
  2. N2O
  3. intra/postoperative opoids
23
Q

surgery related risk factors for PONV

A
  1. increased duration (>3 hrs)
  2. type of surgery: intrabdominal, breast, laparoscopy, gyno, ENT
  3. being NPO
24
Q

pt related risk factors for postoperative N/V

A
  1. female gender
  2. non-smoker
  3. hx of PONV/motion sickness
  4. childhood/young adulthood (age)
25
Q

diagnostic test results are deemed current if within ___________ of scheduled surgery

A

6 months

26
Q

what is the initial tx for malignant hyperthermia

A

dantrolene 10 mg/kg

27
Q

tx for malignant hyperthermia

A
  1. dantrolene 10 mg/kg
  2. hyperkalemia protocol
  3. refrigerated IV crystalloid infusion
  4. icepacks
28
Q

what are triggering agents for malignant hyperthermia

A

volatile inhalation anesthetics
succinylcholine
exposure to heat/exercise (rare)

29
Q

what are the symptoms/signs you will see with malignant hyperthermia

A

hypercarbia
tachycardia
elevated core temp
muscle rigidity
metabolic acidosis
rhabdomylosis
hyperkalemic arrhythmias

30
Q

a patient with severe systemic dz or more than one systemic dz would recieve what physical status class?

A

ASA III

31
Q

a brain dead pt who is only presenting for organ procurement would recieve what physical status class?

A

ASA VI

32
Q

patient with severe systemic disease that is a constant threat to life would recieve what physical status class

A

ASA IV

33
Q

a moribund pt who is not expected to survive without the operation would be given what physical status class ?

A

ASA V

34
Q

what physical status class would you give a pt who is presenting with any of the following: current smoker, social etoh, pregnancy, obesity (BMI btwn 30 and 40), well controlled DM/HTN and or mild lung dz

A

ASA II (PS II)

35
Q

what physical status class would you give to a patient that is young, no comorbidities, non smoker, and 0 - minimal etoh use?

A

ASA I (PS I)

36
Q

what type of anesthesia should be done for the placement of an AV fistula/block?

A

local anesthesia and/or brachial plexus block

37
Q

techniques for skilled interviewing

A
  1. active listening
  2. empathetic responses
  3. guided questioning
  4. nonverbal
  5. validation
  6. reassurance
  7. partnering
  8. summarization
  9. transitions
  10. empowering pt
  11. humor
38
Q

what are the goals of the preoperative assessment and preparation of the pt?

A
  1. optimize patient care, satisfaction, comfort and conviencence
  2. minimize perioperative morbidity and mortality
  3. minimize surgical delays or preventable cancellations on dos
  4. determine appropriate postoperative disposition of the patient
  5. evaluate the patients health status, determining which if any preop investigation/specialty consults are required
  6. optimize preexisting medical conditions
  7. formulate a plan for most appropriate perianesthetic care and postop support
  8. communicate patient management issues effectively among care providers
  9. communicate and provide specific instructions to patients for preop prep
  10. educate pt on surgery, anesthetis, periop care
  11. ensure time/cost efficient patient eval

Brandon’s AFN Health Assessment (17 decks)

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