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NU 568

Exam 1 - Principles of Nurse Anesthesia - Pre-op Assessment

The extent of the pre-op work-up depends on what 3 things? 1) Medical condition of the Pt 2) Type of surgery being performed 3) Type of anesthesia required for the surgery
Name the 3 assessment areas in the pre-op: 1) Review of medical records 2) Pt interview 3) Physical exam
The preanesthesia assessment clinic benefits patients by allowing them to complete what 5 things prior to surgery? 1) Registration 2) H & P 3) Teaching 4) Consults 5) Dx testing
How soon before surgery should a patient with a complex medical history be evaluated for surgery? 1 week
What are the 8 categories of health conditions whereby a patient would benefit from an early preop assessment? 1) General 2) CV 3) Respiratory 4) Endocrinologic 5) Hepatic 6) Musculoskeletal 7) Oncologic 8) GI
What 4 General Health conditions benefit from an early preop? 1) Inability to engage in normal ADLs 2) Conditions necessitating continual assistance or at-home monitoring w/in the past 6mos. 3) Acute episodes or exacerbations of chronic conditions w/in the past 2mos. 4) Meds that will require schedule modificatio
A patient with a history of what 6 CV conditions would benefit from an early pre-op anesthesia assessment? 1) Angina 2) CAD 3) MI 4) Symptomatic arrhythmias 5) Poorly controlled HTN (dia >110, sys >160) 6) CHF
What 3 respiratory conditions necessitate an early pre-op? 1) Asthma or COPD req'ing chronic meds; acute exac. or progression of these dx's w/in past 6mos. 2) H/o major airway sx, unusual airway anatomy, upper/lower airway tumor or obstruction 3) Chronic resp. distress req'ing home vent assistance or monitoring
What 3 endocrinologic factors would benefit from an early pre-op assessment? 1) Diabetes treated with insulin or oral antidiabetics 2) Adrenal d/o 3) Active thyroid dx
What hepatic condition would benefit from an early preop assessment? Active hepatobiliary disease
What musculoskeletal factors benefit from an early preop assessment? 1) Kyphosis/scoliosis w/functional compromise 2) TMJ w/restricted mobility 3) Cervical or thoracic injury
What 2 oncologic conditions benefit from an early preop assessment? 1) Pt receiving chemotherapy 2) Oncologic process w/significant physiologic residua or compromise
Patients with what GI symptoms would benefit from an early pre-op anesthesia assessment? 1) Massive obesity (>140% IBW) 2) Hiatal hernia 3) GERD
What can provide a basic direction of the patient interview and assessment? Patient chart
The "current medical information" in a patient chart contains key pieces of information for surgery. What are the 7 key pieces of information noted in the current medical history? 1) Surgical consent 2) Surgeon's name/date/proposed surgery 3) Baseline data (Ht/Wt, VS) 4) Progress notes and consults 5) Medical treatments w/drug doses and schedules 6) Diagnostics (XR, labs) 7) Social factors (cultural factors, coping mech
The pt interview is designed to reduce ______ and increase _______. anxiety, patient satisfaction
What does plasma cholinesterase break down and what can a deficiency of this enzyme lead to? Acetylcholine; prolonged paralysis w/paralytics
Patients that are reported as latex ______ should be treated as latex ______. Sensitive; allergic
Where should latex allergic patients be placed in the OR schedule? 1st case
What exam diagnoses a genetic predisposition for latex allergy? Caffeine muscle biopsy
Who is at risk for latex allergies? 1) Spina bifida pts 2) Healthcare workers 3) Individuals w/frequent exposure to latex
Nicotine is a toxic _____ that produces a _____ effect in the cardiovascular system. alkaloid, ganglionic
What are the ganglionic effects of nicotine? (6) Increased: 1 - HR 2 - BP 3 - Myocardial contractility 4 - Myocardial O2 consumption 5 - Myocardial excitement 6 - PVR
CO has an affinity for HGB that is _______X greater than O2. 250-300
Preop smoking cessation for at least ______ weeks may greatly improve pulm. mechanics. 8
What are 3 anesthetic complications noted in children exposed to second-hand smoke? 1) laryngospasm 2) coughing on induction or emergence 3) post-op desats
Chronic alcoholism creates resistance/tolerance to CNS depressants such as _________, ________, and __________. hypnotics, opioids, inhaled gases
Increased morbidity and mortality is associated with ETOH abuse due to what 4 effects? 1) poor wound healing 2) infx 3) bleeding 4) hepatic injury
What are the 2 most popular illicit drugs? cocaine, MJ
What are s/s of illicit drug use? (6) 1) evidence of injections 2) pupil constriction 3) lymphadenopathy 4) malnutrition 5) poor dentition 6) nasal perforation
What are the s/s of MJ use? 1) tachycardia 2) labile BP 3) euphoria
What are the s/s of cocaine/amphetamine use? 1) HTN 2) excitement 3) hallucinations
What are the s/s of hallucinogenic use? 1) dissociative reactions 2) hallucinations
What two organ systems are negatively affected by anabolic steroid use? hepatic and endocrine
What are 4 supplements that contribute to anticoagulation? Garlic, gensing, ginko ginger
How is the minimum alveolar concentration (MAC) of anesthesia affected with chronic alcoholism? MAC is increased
Ginger can alter serum levels of __________. glucose
Ephedra is a CNS [stimulant/depressant]. stimulant
What two herbal supplements have CNS depressant qualities? Ginger and kava kava
St. John's wort has been used to treat what psychologic malady? Depression
The physical airway exam includes assessments of what features? 1)Teeth 2)Inside of the mouth 3)Mandible 4)Neck
What is the patient asked to do during the Mallampati classification? Open their mouth as wide as possible and extrude their tongue without phonation.
The Mallampati exam is used to assess which features in the airway? Tonsils, tonsillar fossa, pharynx
What is visible in each classification of the Mallampati scoring system? Class: 1)Entire tonsil clearly visible 2)Upper half of tonsil fossa is visible 3) Soft and hard palates clearly visible 4)Only the hard palate is visible
The lower the Mallampati score the __________ the intubation, the higher the Mallampati score the ___________ the intubation. Easier, harder
The thyromental distance is the space between what two features? Prominence of the thyroid cartilage and bony point of the lower mandibular border
What is associated with a difficult endotracheal intubation in regards to the thyromental distance? <7cm or three finger breadths
The [thyromental/sternomental] distance is said to be more predictive of a difficult airway. sternomental
The sternomental distance measures the space between what two features? The upper border of the manubrium sterni and bony point of the lower mandibular border
A sternomental distance of less than _______cm is suggestive of a difficult airway. 13.5
4 finger breadths is approximately _______in. 3
What does the interincisor distance measure? The degree of mouth opening
The degree of mouth opening is controlled by what joint? temporomandibular joint
How far between the upper and lower incisors should an adult be able to open their mouth? At least 4cm (2 large finger breadths)
The antlantooccipital function measures the degree of movement between what two body parts? Head and neck
Moderate flexion of the neck on the chest and full extension of the atlantooccipital joint aligns the axes of what three important airway features? Oral cavity, pharynx, larynx
The McGill position is also known as the ________ position. "sniff"
What types of oral equipment should be removed prior to surgery? Dentures and partial plates
The removal of what object can prevent aspiration during anesthesia? Loose teeth
Obesity is defined as a bodyweight more than _________% above ideal bodyweight (IBW). 20
Morbid obesity is defined as a bodyweight more than __________% above IBW. 40
What is the equation used to calculate IBW for men? Women? Men: 105lbs + 6lbs for each inch > 5ft // Women: 100lbs + 5lbs for each inch > 5ft
What is a more specific approach to measure weight in relation to height? BMI
What is the equation to calculate BMI? Weight in kg divided by height in meters sq.
What is the BMI range to be considered overweight? Obese? Morbidly obese? 1)25-29.9 2)30-35 3)>35
What are illnesses associated with obesity? (8) 1)HTN 2)Dysplipidemia 3)CHF 4)Gallstones 5)Hernias 6)OSA 7)OA 8)Respiratory disorders
What possibility needs to be considered with the obese patient? Difficult intubation
What type of intubation needs to be considered with the difficult airway? Fiberoptic
What two types of medications should be considered in preparation for a fiberoptic intubation? Anticholinergics and antisialagogues
What inflammatory arthropathy causes severely compromised upper airway management of the cervical spine? Ankylosing spondylitis
What pharmacologic considerations should be made for patients with ankylosing spondylitis? NSAIDs, corticosteroids
Patients who have been on steroids must be considered for a ______________ dose of steroids. Pre-op
Rheumatoid arthritis affects the mobility of __________. Joints
In what three ways does rheumatoid arthritis affect the airway? 1)Limited ROM of the TMJ 2)Restrictions in vocal cord movement 3)Tracheal stenosis
Hoarseness, stridor, painful speech, and dysphagia are all signs and symptoms that can occur with exacerbations of what inflammatory disease? Rheumatoid arthritis
What cardiopulmonary complications may occur with ankylosing spondylitis and rheumatoid arthritis? (5) 1)Restrictive lung disease 2)Pleural effusions 3)Pericardial effusions 4)Polychodritis 5)Cardiac conduction abnormalities
The initial neuro exam consists of assessment of what 4 areas? 1)Musculoskeletal 2)Sensory system 3)Cranial nerves 4)Mental status
What are clinical manifestations of neurological disease? 1)Increased ICP 2)Sympathetic overactivity 3)Fever and leukocytosis 4)Coma and obtundation
A glasgow coma scale of less than _______ is considered comatose. 8
A Glasgow coma scale of less than _______ requires mechanical ventilation support. 7
If indicated, a neuro preop assessment should be followed by what 5 things? 1)review of diagnostic results 2)neurology consult 3)interpretation of CT scans 4)review of the degree of cerebral vascular occlusion 5)12-lead ECG and cardiology consult
Anesthetic management of a patient with a neurological disorder should include monitoring levels of what two things? Anticonvulsants (if presently taking) and glucose
In relation to anesthesia, what medications should be avoided in patients with neurological disorders? Sedatives
In relation to anesthesia, what medications should be given to patients with neurological disorders? Corticosteroids
Evaluation of the CV system should include what key points? (3) 1) Pre-existing cardiac disease 2)Disease severity, stability, and prior treatment modalities 3)Type of indicated surgery
What are the MAJOR CV risk factors for anesthesia? (8) 1)Unstable coronary syndrome 2)Recent MI 3)Unstable/severe angina 4)CHF 5)High grade AV block (3rd degree) 6)Symptomatic ventricular arrhythmias 7)Supraventricular arrhythmias 8)Severe valvular disease
What are 4 INTERMEDIATE CV risk factors for anesthesia? 1)Mild angina 2)Prior MI 3)Compensated or prior CHF 4)Renal insufficiency
What are the 6 MINOR CV risk factors for anesthesia? 1)Advanced age 2)Abnormal ECG 3)Rhythm other than sinus 4)Low functional capacity 5)History of stroke 6)Uncontrolled systemic HTN
The New York Heart Association (NYHA) divides patients into categories that assess what factor? Degree of heart failure with CV disease
What is stable angina characterized by? Substernal discomfort w/exertion but relieved with rest or SL NTG
What is unstable angina characterized by? Angina is progressive with increases in frequency, intensity, and duration that is less responsive to medications or rest.
Which patients are at prominent and great risks for a peri-operative MI? Patient with left ventricular failure and especially ischemic cardiomyopathy
What are pertinent signs and symptoms of LVH or ischemic cardiomyopathy? Rales, resting tachycardia, S3 heart sounds, JVD
In the presence of CHF, surgery should _____________. Postponed
Cardiac valve incompetence is also known as cardiac valve _______________. regurgitation
What are the two most common valves of stenosis and/or regurgitation? Aortic, mitral
What is the most common cause of valvular disease? Rheumatic fever
It is imperative to obtain a pre-op _________ for patients with a history of cardiac valve disease or arrhythmias. EKG
What significant pre-op labs should be collected in a patient with a history of cardiac disease or valvular disease? Potassium, magnesium, serum levels of antiarrhythmics
What are the three categories of ventricular arrhythmias? Benign ventricular, potentially malignant, malignant
Describe each category of ventricular arrhythmias. Benign: unifocal PVCs w/low periop risk. Potentially malignant: known heart disease on antiarrhythmic Rx. Malignant: Heart disease w/hemodynamic compromise and family h/o sudden death.
When is the DOO/VOO mode necessary for a patient with an intrinsic pacemaker? When electrocautery of cardiac muscle is involved
True/False: Pacemakers can mask toxic effects. True
Succinylcholine is associated with an increased release of what electrolyte? Potassium
What are two indications for pacemaker placement? Persistent bradycardia, bi-fascicular block
When should pre-op cardiac testing not be performed? When results will not influence the patient management
What are the two types of chemical stress tests? Adenosine and dobutamine
Which stress test involves coronary steal syndrom? adenosine
What occurs in the adenosine stress test in relation to coronary blood flow? Blood flow is redestributed without negative inotropic effects
What three values indicate poor ventricular function? CI <2.2, LVEDP > 18mmHg, EF <40%
Created by: philip.truong