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Orientation Test 3 > Week 4 Test > Flashcards

Week 4 Test Flashcards

0
Q

civil law definition

A

body of law concerned with the private right and remedies. civil law applies to torts and breaches of contract

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1
Q

def of criminal law

A

body of law established to protect society from harm declaring what conduct is criminal and establishing punishment for violation of the law

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2
Q

tort definition

A

civil wrong committed against a person or property independent of a contract

  • -intentional=assault and battery
  • -unintentional=malpractice
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3
Q

Criminal law vs Civil law

A
  • Criminal law is to protect society (fraud, misuse of drugs)
  • Civil law is private law (malpractice, battery, tort-personal)
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4
Q

malpractice definition

A

the person who commits malpractice did not intend to cause harm that resulted from negligence

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5
Q

The law presumes the practitioner will follow a _________ _________ __ _____

A

minimum standard of care

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6
Q

Four necessary elements of malpractice

A
  • legal duty practitioner owes pt
  • breach of duty by practitioner
  • reasonable close causal connection btw breach of duty and damages that result
  • actual damages to the persons owed duty
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7
Q

Informed consent vs Consent

A

Informed consent (as opposed to consent) is when the practitioner informs pt about

  • the diagnosis and proposed procedure
  • probability of procedure’s success and assoc risk
  • reasonable alternatives to the procedure
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8
Q

Standard of Care definition

A

act according as a reasonable average CRNA would act

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9
Q

Battery definition

A

unwanted touching of an individual

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10
Q

Negligence definition

A

failure to use reasonable care resulting in damage or injury to another

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11
Q

What five things have implied consent?

A
  • IV starts
  • A line insertion
  • intoxication
  • medical emergency/unconscious
  • illness rendered pt unable to sign and procedure is life threatening
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12
Q

Assault definition

A

placing someone in fear of being touched

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13
Q

Other than pt who can give consent

A
  • relatives of minors or incapacitated persons
  • persons designated by pt before incapacitated (POA)
  • persons designated by a court

(not a minor)

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14
Q

Parent of minors and consent for emergencies

A

consent is implied for parents with children in emergencies

every attempt should be made to contact gaurdians

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15
Q

What do you do when a parent refuses to consent for medical care for their child?

A
  • contact hospital administrator

- there is a judge on call 24/7 to try to obtain court order

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16
Q

When can a minor consent?

A
  • emancipated
  • lives on their own
  • married
  • parent to a minor
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17
Q

What 4 things are covered in the PAT

A
  • permits pt registration
  • obtain med hx and perform exam
  • promote pt teaching
  • complete preop testing and specialty consults
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18
Q

What is the most-cost effective way of “one-stop shopping”

A

Pre-anesthesia Testing

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19
Q

What does JAWS stand for?

A

Jaw thrust
Airways
Work together
Slow, small squeeze

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20
Q

Contents of anesthesia preop

A
  • Med Hx
  • Surgical Hx
  • Anesthetic Hx
  • Family Anesthetic Hx
  • Drug Hx
  • Social Hx (ETOH, drugs, smoker, herbal)
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21
Q

Name the 5 upper airway test

A
  • thyromental distance
  • mallampati classification
  • interincisor distance
  • head and neck movement
  • mandibular mobility
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22
Q

Most common reason for medico-legal claims

A

Dental injuries

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23
Q

How do you calculate BMI?

A

wt in kg/ ht in m2
(weight in kg/ ht in meters squared)

so 1inch=2.54cm
100cm in 1 m-then square number

so 60in=152.4cm/100=1.524 (squared)=2.32
so 80kg pt that is 60in = 80/2.32=34.5bmi

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24
Q

How do you number the teeth?

A

start top right with wisdom tooth=1, then go around front of teeth to top left=16, then drop to bottom left wisdom tooth=17, then around to bottom right =32

(if no wisdom, missing 1,16,17,32)

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25
Q

What type of sx places a pt at higher risk (>5% of a cardiac event?)

A
  • aortic sx
  • major vascular sx
  • peripheral vascular sx
26
Q

What questionnaire is used for OSA?

A

Stop-bang

27
Q

duty definition

A
  • provider - patient relationship is established
  • the relationship is a type of contract
  • we agree to services for a fee
28
Q

How many METS is good for a pt to have?

A

4 or more is needed

29
Q

No matter what type of procedure, what must be documented

A

basic core of information

  • pt info
  • provider info
  • equipment check
  • minimal monitors
  • technique
  • meds
  • I&O’s
  • procedural data
30
Q

What three functions does the intraoperative documentation have?

A
  • intraoperative monitor
  • future reference for Anesthesia
  • source for quality improvement
31
Q

What things are recorded q5m?

A
  • VS
  • Meds
  • Fluids
32
Q

Article overview

A

Results: Over a 4-yr period from 2004 to 2008, 53,041 attempts at mask ventilation were recorded. A total of 77 cases of impossible mask ventilation (0.15%) were observed. Neck radiation changes, male sex, sleep apnea, Mallampati III or IV, and presence of beard were identified as independent predictors.
19 impossible mask ventilation patients (25%) also demonstrated difficult intubation, with 15 being intubated successfully. Twelve patients required an alternative intubation technique, including two surgical airways and two patients who were awakened and underwent successful fiberoptic intubation.
Conclusions: Impossible mask ventilation is an infrequent airway event that is associated with difficult intubation. Neck radiation changes represent the most significant clinical predictor of impossible mask ventilation in the patient dataset.

33
Q

NPO guidelines

A
  • 2 hrs CL
  • 4 hrs breast milk
  • 6 hrs light meal/formula
34
Q

definition of anesthesia and its 3 components

A

-the absence or abolition of sensation (not pain)

  • unconsciousness,amnesia
  • analgesia
  • muscle relaxants
35
Q

What is the first step of anesthesia and what are the 5 classifications used?

A

preoperative medications

  • opioids
  • benzo’s
  • histamine blockers (pepcid)
  • antacids
  • antiemetics
36
Q

why does succ’s cause fasiculations?

A

the only way for fasiculations to occur=to simultaneously occupy both types of alpha sub-units post synaptically

only depolarizer can do this

37
Q

depolarizer vs nondepolarizers and how they affect muscle

A
  • depolarizers contract muscle so it cant quickly contract again
  • nondepolarizers prevent contraction
38
Q

which nondepolarizing agent is ok to use with kidney and liver dz?

A

cisatracurium (nimbex)

-little affect on BP and HR

39
Q

what does sevoflurane produce that can be harmful?

what can we do to prevent?

A 
compound A (produced by soda-lime and sevo)
-at least 2L + FGF
40
Q

which opioid is good to use for neuro cases?

A

remifentanil–quick on/off

allows for quick neuro check

41
Q

what induction agent can raise BP?

A

ketamine

42
Q

how do muscle relaxant reversals work?

neostigmine

A
  • -inhibits the enzyme that breaks down acetylcholine (which is necessary for muscle contraction)
  • -greater amounts of acetylcholine accumulate in muscle
  • -allows muscle contraction to return and reverses the muscle relaxant
43
Q

mechanism of phenylephrine

A

a1 agonist =vasoconstrictor

-does not affect HR or CO

44
Q

what three things are written on a graphic anesthesia record

A

-description of techniques (regional)
-description of events
(unusual rxn/responses)
-complications

45
Q

how do you correct a mistake

A
  • draw a simple line through and write error and initial

- correct above if room or in narrative

46
Q

Obesity BMI

A

> 40

47
Q

Ketamine

A
  • may raise BP (not lower)
  • hallucinogen (can give benzo to tx)
  • analgesia properties
  • increases circulating catecholamines so good for CO
48
Q

Remifentanil

A
  • shortest acting opioid
  • only as infusion
  • good neuro cases (quick neuro check)
49
Q

Sufentanil

A
  • most potent
  • used for intensely painful surgeries
  • big resp depression
  • can cause lead chest (tx with succs)
50
Q

Fentanyl

A

-70-100x stronger than morphine

51
Q

Morphine

A
  • original/natural
  • from opium poppy
  • tx post op pain
52
Q

Nitrous Oxide

A
  • major risk PONV
  • works quickly/off quickly
  • strong analgesic properties
  • overuse can cause bone marrow dysfunction
53
Q

Sevoflurane

A
  • 2 or more L of gas flow to prevent Cmd A from being produced from sodalime and sevo
  • perfect for inhalation induction
54
Q

Desflurane

A
  • airway irritant
  • requires special vaporizer (warm)
  • NUMBER 1 used for obese pts b/c insoluble
55
Q

Isoflurane

A
  • potent
  • may increase HR
  • flurane breath
  • slightly soluble in tissues (so longer to reach equilibrium and longer to wake up)
56
Q

Rocuronium

A
  • quickest onset non-depolarizer

- used for RSI if no succs

57
Q

Vecuronium

A
  • no affect on VS (except RR)
  • longer duration of action in kidney and liver pts
  • must be reconstituted
58
Q

Cisatracurium

A
  • requires NO kidney or NO liver function to be broken down

- minimal affects on BP and HR

59
Q

Succinylcholine

A
  • only depolarizer
  • main one for RSI
  • DO NOT use for malignant hypothermia, kidney dz, muscle dz, burns, trauma, hyperkalemia
60
Q

Etomidate

A

-pt may shake with injection
-frequently used with critical pts
(does not cause drop in BP)

61
Q

Propofol

A
  • major drops in BP and CO
  • requires caution in critical pts
  • lidocaine with injection for pain
62
Q

Pre-Op benzo’s

A
  • most common is versed

- most common preop med

Orientation Test 3 (1 decks)

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