Unit 1 Module 2 (Exam 1) Flashcards
What is the main reason for obtaining baseline vital signs during pre-op assessment for shoulder surgery?
A. To assess patient hydration
B. To monitor for Bezold-Jarisch reflex
C. To measure respiratory rate trends
D. To identify allergies
B. To monitor for Bezold-Jarisch reflex
“we really need to make sure that we are
monitoring our hemodynamics, especially our heart rate and blood pressure. Hence we
need our baseline”
Slide 7
Which of the following diagnoses is NOT commonly associated with shoulder surgeries?
A. Rotator cuff tear
B. Glenohumeral instability
C. Labral tear
D. Subacromial stenosis
D. Subacromial stenosis
Slide 7
What should be prioritized in pre-op planning for shoulder surgeries?
Select 2
A. Pre-existing nerve conduction
B. Assessing airway
C. Monitoring body temperature
D. Assessing for Carpal tunnel syndrome
A. Pre-existing nerve conduction
B. Assessing airway
slide 7
Which are the main positioning options for shoulder surgeries? Select 3
A. Beach chair
B. Sitting Position
C. Supine
D. Prone
E. Lateral decubitus
A. Beach chair
B. Sitting Position
E. Lateral decubitus
“the beach chair we use, because as you can see in the picture on the right, the knees are flexed, the legs are elevated and it
prevents the pulling of the hamstrings to the gluteal muscles and then our lower
back muscles.”
Slide 8
What is a critical consideration for securing the patient during shoulder surgery positioning?
A. Positioning the arms for IV access
B. Rotating the patient frequently
C. Securing the head, neck, hips, and legs
D. Keeping the patient supine at all times
C. Securing the head, neck, hips, and legs
Slide 8
Securing the head and neck during positioning for shoulder surgeries prevents __________.
A. Muscle strain
B. Airway obstruction
C. Blood pooling
D. Skin breakdown
B. Airway obstruction
Slide 8
True or False
The ultimate responsibility with positioning lies only with the surgeon and the anesthesia provider.
False
“it is a shared responsibility”
* Surgeon
* Anesthesia provider
* Operating room nurses
* PA/RNFA
* Scrub Tech
* Other O.R. personnel
Slide 9
Positioning the patient in surgery involves __________ and potential risks.
A. Physiologic changes
B. Extended surgical time
C. Reducing blood flow
D. Increasing airway resistance
A. Physiologic changes
Slide 9
What happens to central blood volume in the sitting position?
A. It increases due to improved venous return
B. It decreases due to pooling in the lower body
C. It remains unchanged
D. It increases due to elevated heart rate
B. It decreases due to pooling in the lower body
Slide 10
Due to pooling of blood in the lower body during the sitting position, which parameters might increase in response to BP and CO decreasing?
A. Heart rate and systemic vascular resistance
B. Cardiac output and arterial blood pressure
C. Functional residual capacity and CBF
D. Blood pressure and respiratory rate
A. Heart rate and systemic vascular resistance
Slide 10
How does the sitting position affect lung volumes and functional residual capacity (FRC)?
A. Both decrease
B. Both remain unchanged
C. Both increase
D. Lung volumes decrease, while FRC increases
C. Both increase
Slide 10
What is a neurovascular consideration in the sitting position?
A. Increased cerebral blood flow
B. Increased intracranial pressure
C. No change in cerebral blood flow
D. Decreased cerebral blood flow
D. Decreased cerebral blood flow
Slide 10
What is the incidence rate of venous air embolism in patients in the sitting position?
A. 10%
B. 25%
C. 40%
D. 60%
C. 40%
Slide 11
Which of the following positions are associated with venous air embolism?
A. Supine, lateral decubitus, reverse Trendelenburg
B. Sitting, prone, reverse Trendelenburg
C. Supine, prone, Trendelenburg
D. Sitting, lateral decubitus, Trendelenburg
B. Sitting, prone, reverse Trendelenburg
Slide 11
To prevent venous air embolism, it is important to maintain __________ at the wound site.
A. Negative pressure
B. Neutral pressure
C. Venous pressure above 0
D. Arterial pressure above 0
C. Venous pressure above 0
Slide 11
What increases the risk of venous air embolism in the sitting position during surgery?
A. Open venous vessels above the heart level
B. Use of mechanical ventilation
C. Reduced systemic vascular resistance
D. High central venous pressure
A. Open venous vessels above the heart level
Slide 12
Approximately what percentage of the population has a patent foramen ovale, increasing the risk of severe VAE?
A. 10–20%
B. 20–30%
C. 30–40%
D. 40–50%
B. 20–30%
Air may reach the cerebral and coronary circulation via a patent foramen ovale
Slide 12
Venous air embolism occurs when air enters open venous vessels and travels to the __________ and interfers with blood flow to the pulmonary artery.
A. Left atrium
B. Superior vena cava
C. Pulmonary veins
D. Right ventricle
D. Right ventricle
Slide 12
Which of the following are potential consequences of venous air embolism?
Select 3
A. Pulmonary edema
B. Reflex bronchoconstriction
C. Increased arterial blood pressure
D. Acute cardiovascular collapse
E. Reflex bronchodilation
F. Decreased venous blood pressure
A. Pulmonary edema
B. Reflex bronchoconstriction
D. Acute cardiovascular collapse and arterial hypoxemia
Slide 12
What is the first step in managing a suspected venous air embolism?
A. Apply bilateral compression of the jugular veins
B. Discontinue nitrous oxide
C. Inform the surgeon
D. Place the patient in a head-down position
C. Inform the surgeon and prevent further air entrainment
They can prevent it by further entraining air, by irrigating with whatever irrigant fluid that they have on the table, and applying an occlusive dressing. An occlusive dressing can be in the form of any wetsponge or such as with open craniotomies, they can apply bone wax to secure or to close that areas to avoid further entrainment or further absorption of air from the incision site
Slide 13
What is the purpose of placing the patient in a head-down position during venous air embolism treatment?
A. To increase venous return
B. To trap air in the right atrial apex
C. To reduce arterial pressure
D. To increase systemic vascular resistance
B. To trap air in the right atrial apex and prevent pulmonary artery entry
Slide 14
What can be used to directly remove air during venous air embolism management?
A. Endotracheal suction
B. Pulmonary artery catheter
C. Intravenous cannula
D. Right atrial catheter
D. Right atrial catheter
Slide 14
Which of the following are treatments for venous air embolism? Select 2
A. Use inhalational anesthetics to reduce air expansion
B. Discontinuing nitrous oxide
C. Bilateral compression of jugular veins.
D. Placing the patient in a head-down position
B. Discontinuing nitrous oxide
C. Bilateral compression of jugular veins.
Slide 14
In venous air embolism management, cardiovascular collapse is treated using __________.
A. Vasopressors like ephedrine and phenylephrine
B. Bronchodilators like albuterol
C. Antiarrhythmics like amiodarone
D. Diuretics like furosemide
A. Vasopressors like ephedrine and phenylephrine
Slide 14