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What is the primary nuerotransmitter of the parasymphtatetic nervous sytsem? Acetlycholine
Elimination of of volatile anesthetics most varies with what Alveolar ventilation
what is the main physiologic effect of hydralazine? It relaxes and dilates the arteries
Which drug causes pain on injection? diazapem(valium), propofol, methohexital
What drug does not cause pain on injection Ketamine (Ketalar)
What is MAC? MAC / minimum alveolar concentration is defined as: the lowest concentration of an inhaled anesthetic that eliminates ventilation in 50 % of patients at 0.5 anesthetic concentration?
What is the relationship of MAC? Inverse, meaning a low MAC= very POTENT drug
What is the relationship of diazapem (valium) and midazolam(versed? Versed is 1/2 or 2/3 less when compared to Versed
What is the antidote to treat an anticholinesterase overdose atropine
What are some examples of cholinesterase inhibiting drugs/NDMR reversal agents? Neostigmine (Prostigmin) and edrophonium (tensilon)
What relationship to anticholinsterase medications (glycopyrallate-robinul/atropine) have on NDMR (non depolarizing muscle relaxants)? They decrease the effects of NDMR.
What is dexamethasone (decadron)? Decadron is an corticorsteroid that decreases inflammation
Which drug is associated with high incidence PONV? Etomidate, PONV and is further enhanced with Fentanyl
Why does an child's induction response to anesthesia different from an adults? Because kids tissues are highly vascular
What is succ (anectine) Succs is a DMR
What is Mivacurium? Mivacurium is a NDMR
What two muscle relaxants are metabolized by plasma cholinesterase? Succinylcholine and Mivacurium
what does ephineprine do when added to anesthesia? Epinephrine prolongs anesthesia, increases the intensity of the block, and minimizes the peak levels of the anesthetic
True/false Adipose tissue is found in the epidural space. FALSE
Airway spasms are commonly caused by what inhalation anesthesia drug? Desflurane
What is the MOA of local anesthesia? Local anesthesia prevents sodium channels from opening.
What are the signs and symptoms of anesthesia toxicity? Seizures Hypotension Bradycardia after initial HTN and tachycardia
What is the PACU"S nurses' goal when caring for a diabetic pt.? Maintain mild hyperglycemia, and avoiding hypoglycemia. So maintenance goal of blood sugar should be <200.
True/false Metoprolol is used to treat drug induced HTN(false)
What is Metoprolol? HTN drug class II of antidysrhytmias
What are the indication for use of Metoprolol? HTN, SVT, MI, ventricular dysrythmias
Meperidine (demerol) cause the the least amount of what? Smooth muscle spasms
What is a side effect of Ketorloac (toradol)? Toradol can INCREASE plasma liver levels, causing liver toxicity
What is so special about Nalbuphine (Nubain)? Nubain is a strong analgesia with BOTH agonist and antagonist effects on pain receptors.
What does Nubain do in relation to pain and respiratory depression? Because Nubain is so neat it can provide strong analgesia like Morphine, BUT does not create respiratory depression and is also less addictive
What pain receptors do AGonist effect? KAPPA and SIGMA KAPPASIGM(ag)
What pain receptors do ANTAgonist effect? MU ANTA(Mu)
True/False Magnesium decreases the potency of of both DMR and NDMR (false)
Why would a patient with pseudocholinesterase toxicity exhibit signs of paralysis? Because pseudocholineterase is an enzyme associated with metabolism of drugs like succs, which would cause prolonged paralysis
Is this a example of pseudocholinisterase toxicity? A 12 yr old boy is trying to climb off the stretcher in PACU, and very agitated. A 12 yr old boy is trying to climb off the stretcher in PACU, and very agitated. NO! Because pseudocholineterase is an enzyme associated with metabolism of drugs like succs, which would cause prolonged paralysis
What is Physostigmine occassionally used for? It is an anticholinesterase med used to counter emergence delirium. It increases the concentration of acetylcholine in the nueromuscular junctions.
What is a side effect that the nurse should watch after Physostigmine administration? BRADYCARDIA
What is Flumazenil used for? ***Flumazenil (Romazicon) is the ONLY benzo drug reversal (antagonist) 0.2 mg over 15 min, not to exceed 1 mg . So it reverses effects of drugs like versed, valium, and ativan
What is the main side effect of Flumazenil? Respiratory depression
What is an anticholingergic? Drugs use to decrease salivary secretions. ex.. atropine, robinul
What is Etomidate (amidate) used for? Emotidate (amidate) is a sedative like propofol
What is Theophylline used for? Wheezing, COPD, Asthama
What is the preferred post-pain method for pt. following gastrectomy? Low thoracic epidural. Second option would be a PCA.
What is an intrathecal injection? Intrathecal injection is a form of spinal anesthesia where nerve roots and part of the spinal cord is anesthesized. Should be injected below L1-L2 since the spinal cords end there. That will prevent spinal cord trauma
What is Flumazenil used for? Flumazenil is a benzo antagonist so it reverses the effects of benzo drugs like Diazapem(valium), Midazolem (versed) and Lorazepem (ativan)
What is a fundamental requirement for performing outpatient surgery? Identifying person responsible for caregibing post-operativerly
What is Succinylcholine (Anectine) classified as? DMR
Iddentify risk factors for PONV. 1.Female 2.Motion sickness/vestibular problems 3.Obesity, pregnancy, diabetes 4.Anxiety 5.Pain 6.Full stomach 7.Hypotension 8.Bradycardia 9.Dehydration Four risk factors considered SEVERE
What is atypical pseudocholinesterase? Pt.'s with atypical pseudocholinesterase have a weird resistance to succs. They should get NDMR that can be reversed rather than DMR like succs which can't be reversed. So if pt. had this disorder and got succs that is a big no no.
True/False.Dexamesthasone (decadron) with the use of anti-emetics increases the severity and incidence if PONV Dexamesthasone (decadron) DECREASES the severity and incidence if PONV, a good combination of decadron for PONV is with Scopalomine
True/False Propofol (diprivan) can be used as preferred anesthetic to decrease PONV (true)
Scenario: If a pt. is in for a quick surgery such as dental extractions and recieves the following drugs: Recuronium(Zemuron), Alfentanil (Alfenta) should their body metabolize these drugs fast or slow FAST. Recuronium (Zemuron) clears in 30 min. Alfentanil (Alfentil) small doses have effect for only 20-30 min. So becuase this drugs have shorter durations this patient will metabolize them faster amd feel pain sensation quicker.
What does Metaclopramide (Reglan) do? Reglan blocks dopamine receptors to increase gastric motility and decrease gastric volume.
How long does epidural Morphine last? 6-9 hrs. So pt. needs close observation.
Which NDMR has the most rapid onset, Vecuronium, Atracurium, or Recuronium? Recuronium with onset of 1 min. and duration of 15-20 min.
After electroconvulsive therapy what is most likely to develop? Hypertension and SVT
**Biochemically what to local anesthestics block in relation to nerve conduction? Sodium coming into the nerve cells
What is the best treatment for someone with postural puncture headache? Epidural blood patch
Name some Benzodiazepine drugs Versed, Valium, Ativan
Name some Opoids Morhphine,Dilaudid, Fentanly, Meperidine, Alfentanil
Name a common Anticholinsterase used or Moderate or Deep sedation Neostigmine
Name two commonly used PACU Anticholinergics Atropine and Glycopyrollate (ROBINUL)
What does epinephrine do when administered with Lidocaine? It decreases the vasodilation and absorption
What IV anesthestic agent is used for ECT or cardioversion? Thiopental (sodium penthotal)
What should the nurse asess for or implement after teh administration of Thiopental (sodium penthotal)? Asess for yawning, hiccoughs, and the injection site. Injection site may need warm compress Solution is BASIC so its not good with acidic solutions.
What is Methohexital (brevital)? Methohexital (Brevital) is an anesthetic induction agent.
Quick facts about Methohexital (brevital): 2x more potent than Thiopental Side effects of injection: hiccougghs, pain,
What is the anesthesia induction drug of choice for a cardiac pt. and why? ETOMIDATE (amidate) is drug of choice for pt. with cardiovascular pt. because it has excellent cardio stability, and HR and CO remain constant.
What are side effects of Etomidate (amidate)? Pain may occur on injection though,and it decreases cortisol levels.
What type of drug is Ketamine (Ketalar)? An anesthesia induction agent
What is a respiratory effect of Ketamine(Ketalar)? and what drug is used to treat this effect? Ketamine (Ketalar) causes increased salivary gland secretions and pt. may need premedication with drug like glycopyrrolate (robinul).
What is the main nursing consideration for Ketamine (ketalar)? IT MAKES THEM GO CRAZY.hallucinations, delirium
Which 2 inhalation anesthetics is are more useful in initiating anesthesia by mask? Halothane and Sevoflurane. The others are too irritating to inhale when pt. is awake.
Which inhalation anesthetic is more likely to produce a lingering CNS depressant effect in PACU? Halothane, Sevofluarane, Desflurane, or Eflurane? Esflurane because it is most slowly eliminated
Which inhalation anesthetic has the fastest onset and offset of CNS effects? Halothane, Sevofluarane, Desflurane, or Eflurane? Desflurane as its rapid offset leaves no room for lingering anesthesia. So the requirement for suppl. O2 must be anticipated by nurse.
Which inhalation anesthetic is least irritating of all the volatile agents? Halothane, Sevofluarane, Desflurane, or Eflurane? Sevoflurane
Describe the pharmcodynamics of NDMR NDMR block the binding of ACh to the postsynaptic receptors of skeletal muscle, which then IMPAIRS SKELETAL MUSCLE CONTRACTIONS
True/False. A pt. can be paralyzed and not speaking but be fully awake and alert with a NDMR. TRUE. This is because NDMR have no CNS effects. So on the nsg. part. -Never assume that a paralyzed pt. is asleep. -A paralyzed pt. may be fully awake and feeling pain.
When pt. has recieved long acting NDMR like( doxacurium, pancuronium, pipecuronium, and tubocurarine) what are some nsg. considerations 1.Watch for RE-PARAYLISIS (the pt. may not be reversed adequately, or still have high residual amounts of the long-acting NDMR. 2.Need to clinically assess pt. muscle strength 3.Ask how much, and when NDMR was given
Many of the intermediate NDMR are eliminated by what common process? THE HOFFMAN elimination process where the NDMR spontaneously "self-destructs" systemically with porduction of metabolites
How many times stronger is Fentanyl than Morphine? 100x
How many times stronger is Cistracurium than Atracurium(both are NDMR)? 3x
What are the names of the long lasting NDMR? Dox, pan, pipe, tubo...curonium -Be watchful for downward trend in ventilation in PACU
True/False. Reversal blockade should be attempted after administration of NDMR. FALSE. reversal blockade should not be attempted unless spontaneous recovery has begun. This applies to all the NDMR, especially the long-acting ones
The only DMR? Succs -Ultra short acting -Very rapid onset and offset
What is the main thing to be concerned about after administration of Succs? In children , nurse must aware of CARDIAC STANDSTILL as Succs causes a release of potassium that quickly causes a "hyperkalemic crisis" that depolarizes the contractility of the hearts tissue.
How should "Hyperkalemic crisis" induced by Succs be treated? Initially with Calcium chloride, in addition to BLS, then with insulin , bicarb (that help push the potassium back into the cells where it belongs).
True/False.Succs can be used in children with nueromuscular injuries and chronic illnesses. FALSE. It is contraindicated in pt.'s with: -multiple trauma -major burns -upper and lower neuron injuries -CVA -atrophy -severe infections -recent d/c of prolonged use of NDMR
What is the normal dose range of Succs? 1-1.5 mg/kg not to exceed 3 mg/kg
What is Pseudocholinisterase? Its an enzyme that has a direct relation to serum albumin, and its responsible for metabolism of drugs like Succs, local anesthestics (esters), and Trimethapan (anti-HTN). A NDMR reversal (neostigmine) will inhibit it causing longer period of paralysis.
What are two common NMDR reversals? Neostigmine and pyridostigmine.
What are common effects of NDMR reversals? And what can be used to decrease these effects? -enhanced secretions -enhanced peristalis -bronchospasms -bradycardia -miosis Atropine and glycopyrolate (robinul)
Is Bupivacaine (Marcaine) a high, low, slow or fast acting spinal anesthesia. If so how long does it last Marcaine is high potent, long acting spinal anesthetic and can have residual effects for 3-10 hours.
Which drug combination is best for treating PONV? Scopolamine patch (goes behind the ear) and Dexamethasone (Decadron)
What is important for nurse to consider with use of epidural fentanyl infusion? The accuracy of the catheter placement. This is because fentanyl likes to bind to fat and is the catheter is not placed correctly it can cause it to bind to the epidural fat limiting the spread from the injection site.
How many categories of Latex reactions are there? Which one is most immediate? There are 4 classes of latex reactions. I-IV. Type I is the most immediate. Type II=Reaction of specific organ Type III= Reaction is related to immune system Type IV= Reaction localized
If pt. reports breaking out, swelling, and itching from latex, what is the appropriate category? Type IV- reaction is localized
How long can a pt. with atypical pseudocholinesterase be apneic for Up to 48 hrs
What is a nursing consideration when performing an external uterine massage? Support the lower uterus.
True/false.A nurse can perform a bimanual compression technique for a boggy fundus. False. The MD.
What should the nurse teach a pt. when performing a fundus check? Tell the pt. to take slow deep breaths to relax the tummy muscles. Shallow breaths would not be good.
In relation to the hearts conduction system what do inhalation agents like halothane, enflurane etc. do? Inhalation agents SLOW down the rate of the SA node discharge which can cause ventricular ectopy
FYI on Versed -quick onset, great amnesia, water soluble, CONTRAINDICATED with acute NARROW angle glaucoma.
How long does pain relief last if pt. got an Extended release epidural morphine (EREM)? EREM lasts for 48 hrs.
What is the best post-op position for a bariatric pt. after surgery? Semi-recumbent with HOB elevated 30-45 degrees.Recliner chair like http://www.med.umn.edu/img/assets/6803/recline.jpg This increases pulmonary function residual capacity and optimizes O2 ventilation.
For post-op pain education. When should a nurse tell pt. to take pain medicine? At the earliest onset of pain to control and maintain within pt.s established post-op pain goal.
True/false. Propanolol is a beta adrenergic receptor antagonist. FALSE. It is a ALPHA. Think "pro-alpha"
What is the maximum recommended dose for Propanolol? 0.1 mg/kg
With the interaction of inhaled anesthetics what should the nurse monitor after Propanolol has been administered? After Propanolol nurse should assess HR and BP closely. As HR and BP can decrease
What is drug of choice to treat SVT? Propanolol
If pt. is recieving Propanolol what drug should the nurse question if the MD has ordered in conjunction? ****HEPARIN AND PROPANOLOL= NO!!!!!! They have a drug interaction that is known to depress the heart. Nurse needs to notify MD Stat if ordered.
Equation: Total lung capacity? Child: 70mL/kg Adult: 80mL/kg Just know
Which inhalation agent is most associated with increased emergence and behavioral changes? SEVO. Other benefits include rapid induction, emergence, decreased airway irritation, non-pungent smell for easier mask induction.
True/false. Drug receptor sites increase in the elderly False. The receptor sites decrease. So does albumin levels, and renal and hepatic clearance decrease which slows med metabolism and clearance
According to evidenced- based research what is the most appropriate intervention for re-warming? Forced air warming
What is a "Stellate Ganglion block" It's a type of anesthesia that is used to diagnose and treat reflex sympathetic dystrophies (RSD). It is also used to manage CIRCULATORY INSSUFFICIENCY in the upper extremities.
In relation to a "Stellate Ganglion Block" what are some signs to prove the block has been successful? Successful signs of a stellate ganglion block are: miosis(contraction of pupil), ptosis, anhidrosis (no sweat), ***nasal congestion on the same side of the block. ***increase in temp of arms and hands on the same side of block. -HORNER's classic signs
What are common side effects from a "stellate ganglion block" Classic sign: "lump in throat", temporary hoarseness (cuz larynx blocked).
Stellate ganglion blockade can cause what? A high ***spinal anesthesia****, pneumothorax, and damage the laryngeal nerves.
Describe pt. rights with a pre-existing DNR, surgery, and the policy of "required reconsideration." If pt. had a DNR prior to surgery the ethical solution is to provide pt. with choice to maintain, suspend, or modify DNR order before anesthesia induction.
True/false. Propofol has less psychomotor impairments True
Equation for "Extubation criteria" TV-tidal volume VC=vital capacity NIF=negative inspiratory force TV=5mL/kg VC=15-20mL/kg NIF=20-25 cm of water JUST KNOW!
EQUATIONS TO KNOW (jot down when 1st get test) 1.Extubation criteria 2.Total lung capacity Write down!
Does hypothermia cause a left or right shift on the oxygen hemoglobin curve? It causes a left shift. Think "hipo-left"
True/false. Fentanyl is water-soluble FALSE.Its lipophilic
Mallampati scoring. What in the world? Used by MD for scoring of airway assessment prior to surgery.
What is the cause of central anticholinesterase syndrome (CAS)? CAS is caused by anticholinergic medications (primarily Atropine and Scopolamine) that cross the blood-blood barrier.
What are the 2 most commonly reported drugs that can cause anticholinesterase syndrome (CAS)? Atropine and Scopolamine
True/False. Clinical signs and symptoms of anticholinesterase syndrome (CAS) are very specific. FALSE. Clinical signs of CAS are nonspecific. Pt. may exhibit signs ranging from agitation to coma?
True/False. Anticholinesterase syndrome (CAS) most frequently occurs in adults TRUE
How is anticholinesterase syndrome (CAS) treated? Anticholinesterase syndrome (CAS) can be treated with PHYSOSTIGMINE. But need to remember that all other potential causes of CAS need to be ruled out.
What can be done to prevent anticholinesterase syndrome (CAS)? Anticholinesterase syndrome (CAS) can be prevented by -considering the use of regional anesthetics with sedation for a pt. with a history with CAS- not using atropine or scopolamine
What is the most common side effect of an epidural placement? Hypotension is the most common side effect of epidural placements.
True/False. Pt.s who have received a peripheral nerve block require more opiods during recovery? FALSE.
What are a few contraindications for a nerve block? Pt's with -coagulopathies (increases risk for hematoma) -anatomic anomalies (landmarks hard to see) -Hepatic clearance ( decreased clearance) -Anxiety -Low tolerance to positioning -Allergies
What is the mechanism of action of that "Bier block"? Bier blocks are inserted distal to the surgey site and diffuse rather than direct injection to reach the achieved anesthestic effect
What is the order of a block? Sympathetic, Sensory, Motor- going under Motor, Sensory, Sympathetic- waking up NSG implication: Pt. is able to move legs before they can feel them when waking up. **sym-sen-mot
What are the classic signs of anesthesia toxicity? Dysrhythmia, confusion to coma, ***metallic taste, blurred vision, tinnitus
What would a nurse need to asses for in a pt. who has recieved a Interscalene block? Nurse needs to asses for dyspnea and breath sounds on the AFFECTED side. These pt.'s have a high risk for tension pneumonthorax. **brachial plexus nerve is involved.
What is an interscalene block? A closed shoulder manipulation that affects the BRACHIAL PLEXUS.
Nursing Considerations for pt. recieving INTERSCALNE BLOCK -Pt head to be turned away from site -Ipsilateral phrenic paralysis(stay with pt., semi fowler's, x-tra O2) *phrenic nerve allows diaphragm to move (breathing) -Monitor for HORNER's SYNDROME (Ipsilateral pupil constriction, hoarseness, nasal conges
What is the most commom symptom related to ipsilateral phrenic paralysis? Anxiety
True/false.Pt's with mitral valve stenosis require antibiotic endocarditis prophylaxis prior to dental work or any other invasive procedure regardless of age, cause, and severity of disease. TRUE
How many does prior to surgery should a pt. stop taking Aspirin? At least 7 days prior.
True/false. If pt. has an automatic implanatable cardiac defribillator (AICD), it is ok to use cautery. FALSE. Oh no. If pt. has an AICD, cautery is not permissible. If cautery must be used the AICD, it must be turned off.
What is the first sign of delirium tremens in a pt. who is still sedated under general anesthesia? Tachycardia
Patients who are inappropriate for ambulatory: -Drunk pt. -Asthma pt. with present URI -Pt. with acute hepatitis **- Pt. with Myasthenia gravis type IIB, III, and IV. -Pt. with acute renal failure
What are the 4 stages of Myasthenia gravis? Type I- only extraocular muscles involved TpeIIA- slow muscle weakness with no respiratory involvement. TypeIIB-Type IV- Severe, rapid deterioration with respiratory involvement and high mortality.
What should the nurse instruct pt. with Parkinson's Disease in relation to medicine they take for the Disease? Pt. with Parkinson disease should take their medicine (ex. Levodopa) on the day of surgery. if the drug is interrupted for 6-12 hrs this can cause a loss in its therapeutic effect, that makes it harder to sustain. ventilation. In stage II be sure to te
How many days prior to surgery should Coumadin be stopped? 48 hrs.
What is the most accurate temperature measurement? A pulmonary artery temperature because the artery brings brings blood directly from the core and its surroundings.
Define values fro normo, hypo, and hyper thermia. Normothermia=96.8-100.4 Hyperothermia=<96.8 Hyperthermia=>100.4
Temperature regulation in the conscious adult is mediated where? Temperature is mediated by the hypothalamus that regulates heat loss with heat production
Why do all patients receiving anesthetics become hypothermic unless they are actively warmed? This is because the normal physiological responses used to regulate core temp are impaired by the anesthesia gases.
When should a patients thermal comfort level and temperature be monitored in Phase I? Every 30 min.
Who is at risk for MH? -relatives of pt's who has had a MH crisis-inheritance of autosomal dominant pathway
What is MH characterized by physiologically? MH is characterized by a muscular hypercatabolic reaction in which the re-uptake level of calcium in the cell is impaired causing TETANY.
What is the main triggering agent of MH? SUCCS. Others in all volatile inhalation agents
What is a safe alternate inhalation agent that can be used in pt. with MH? Nitrous oxide.
What is the most reliable test for pre-operative diagnosis of MH? Caffeine-halothane contracture test
What are some EARLY signs and symptoms of MH? Muscle rigidity, generalized rigidity, tachycardia, dysrhythmias, skin feeling warm.
What are some LATE signs of MH? Temp. elevation (hallmark sign, but late one), DIC, rhabdomyolysis (muscle breakdown manifested by "coca-cola colored urine")
What is the drug of choice used to treat MH? DANTROLENE 1.discontinue anesthesia and surgery STAT 2.Administer O2 3.Dantrolene 4.Immediate cooling
What is used to reconstitute Dantrolene? Dantrolene comes in 20mg vials and needs to be reconstituted with 60mL sterile water then vigorous shaking.
What is the normal dose of Dantrolene? 2.5mg/kg, with up to 10mg/kg. BUT...if MH is not controlled yet, may use more.
When utilizing blood pressure monitoring with a transducer, what is the preferred site for an approximation of the right atrium The ***phlebostatic axis (4th intercostal space) is an approximation of the right atrium and is used for leveling the port used for blood pressure monitoring
Which of the following surgeries are appropriate indications for the use of an A-line? Bypass, carotid endarterectomy, aortic aneurysm resection, or a craniotomy. answer: ALL OF THE ABOVE, as the A-line allows BP and MAP monitoring
What is the most common placement for an A-line? The radial artery.
what should the nurse consider to have been done before a line is placed in the radial artery? Nurse needs to be sure the "ALLEN testing " was performed before insertion to assess for collateral ulnar flow.
Describe "Allen testing." Allen testing is done by pressing on the radial and ulnar arteries while pt. makes to squeeze blood out of hand, then releases it.There should be reperfusion seen by blush of color within 5-10 min.
What does the reading from our pulse ox tell us? Pulse ox readings indicated the partial pressure of dissolved oxygen in the ***arterial blood
Define the oxyhemoglobin curve. The oxyhemoglobin curve shows us the relationship between Pao2 and Spo2.
What causes the oxyhemoglobin curve to shift to the left? -hypothermia (hypo-left) -increase in pH -decrease in CO2
What causes the oxyhemoglobin curve to shift to the right? -hyperthermia -decrease in pH -increase in CO2
True/False. Clear nail polish does not effect pulse ox reading. TRUE. Dark color have more interference.
True/false. It's easier to get an accurate pulse ox reading on a darker skin person. False. with deeply pigmented skin false high recordings may be recorded or unattainable. The finger more accurate than ear.
What are the 3 common complications following a bronchoscopy? Laryngospasms, Bronchospasm, Glottic or subglottic edema
What are the common signs if cardiac tamponade Cardiac tamponade leads to decreased cardiac output (ex. no output from chest tubes).Other classic signs are increased CVP pressures, muffled heart sounds, JVD, pulsus paradoxus.
True/False. Zeroing of of a transducer should be done directly at the phlebostatic access point, not above or below. TRUE.
What is a common complication of a central venous catheter being placed improperly? Pneumothorax is a complication of improper placement of a CVP catheter and should be assessed for by chest x ray and listening to breath sounds.
Increased levels of capnography indicate that not enough CO2 is being expired from the lungs or that too much CO2 is being produced. Too much CO2 can also be indicative of what? MH
Which oxygen device is a better choice for a COPD pt. needing well-controlled titration of FiO2. A venturi mask.
True/False. Pleural effusion is an expected complication after the creation of a percutaneous tracheostomy. FALSE. expected complications after a tracheostomy placement include: subcutaneous emphysema, peumothorax, hemorrhage, and post placement obstruction. Pt. may complain that they are SOB, despite enough O2 becuase the "new" airway has a smaller diameter
True/False. High pressure ventilation leads to hypotension. False. HTN. Other factors that may lead to HTN are: full bladder, pain, anxiety, RD, MI, renal disease, symp. nervous system stimulation.
What is a common complication after an ET tube placement, and what can the nurse do about it? After an ET tube placement verification of the tube is vitally important. If breath sounds not equal, or no chest rise is seen, nurse can PULL TUBE BACK 1 cm to correct "MAIN STEM INTUBATION"
What are the primary measurements for measuring pre-load? CVP, RAP, PCWP. SVR measures afterload.
FYI. Cardiac index takes into account body size and vascular flow.
What may an "over-damped" form on an aterial wave form possibly be indicative of? Overdamped= questionable hypotensionNsg. clear bubbles from tubing.***DO NOT FLUSH
PACU nursing considerations after a bronchoscopy. AIRWAY, OBSERV FOR GAG REFLEX, OBSERVE COUGH
What should Stage II nurse teach pt.after an ICD placement? -Bed rest -NO paddles over ICD, x-ray (nursing thing) -Written device instructions -temp. id card -no driving for at least 6 months -no MRI(duh)
True/false. An internal AV fistula/autogenous fistula, can be used immediately for dialysis. FALSE. You better not. An autogenous fistula must completely HEAL BEFORE USE to prevent aneurysm formation.Healing time usually 3-6 weeks.
In the pre-operative setting what may weight pt. be indicative of? Weight gain may be indicative of worsening CHF.
In relation to CHF, what may tachycardia and narrowing pulse pressures be indicative of in Stage I(PACU)? Tachycardia in relation to CHF means decreased cardiac output, and a narrowing pulse pressure may be an indication of decreases stroke volume.
Stage II education for CHF **daily weight, call MD for weight gain of >/= 3 lbs.
What are the 3 sub-classifictions of cardiomyopathy? -Dialted(systolic dysfunction) -Hypertrophic(diastlole dysfunction -Restrictive(cardiac muscle stiffness)
Pericarditis may reflect with what characteristics on an ECG strip? ST elevation
What is the most common place for an IABP (Intraaortic balloon pump) to be placed through? An IABP is usually inserted through a femoral artery (most common).
What are the 2 major functions of an IABP? IABP 1) Decreases afterload 2) Increases coronary artery perfusion
What should patient management of an IABP include. -Frequent assessments of insertion site and extremity -Hourly urine output
What is a VAD used for? A VAD is an ventricular assist device that allows temporary circulatory support for failure of one or two ventricles
What are the 2 most common complications of a VAD? VAD complications: bleeding and embolus.
True/False. It is expected for complaints of tremors after an albuterol treatment. TRUE. It is an expected side effect for pt.'s to experience TREMORS, headache, tachycardia, or nervousness after albuterol.
READ THE SCENARIOS WELL AND UNDERLINE **remember the PROCEDURE being done Test taking tip
If a pt. is known to have a difficult airway, why would a "fiberoptic bronchoscope" be useful to have? A fiberoptic scope allows for pre-extubation view and guided extubation.
In an MH pt, what is coca-colored urine output indicative of? Renal failure
FYI. Phenylephrine and Ephedrine are two vasoconstrictors that are effective in treating hypotension. BUT Ephedrin has an INDIRECT action on norepinephrine receptor sites that limits the amount that can be used
What is the most important indicator that displays extubation readiness? Neuromuscular function (ex. ability to keep head up for >5 seconds)
If question on who is at greater risk from complications from delayed extubation...think... Any pt. undergoing NEURO surgery, due to potential increase of ICP.
FYI...CRITICALLY THINK Test taking tip
How can a nurse "shoot" cardiac output readings using a central line? Nurse can "shoot" CO by injecting 3-5 inejections of iced or room temperature injectate to ensure consistent results.
How can nurse "shoot" PAWP(pulmonary artery wedge pressure)? Nurse can "shoot" PWAP by inflating balloon at the end of the distal port.
True/False. Frequent suctioning can cause elevations in ICP and should be done sparingly. True.
What is the normal inspiratory/expiratory ratio? I:E ratio for a normal person in 1:2
When flushing and capping a lumen on a central line , what should the nurse keep in mind and do? Nurse has to remember that during inspiration , intrathoracic pressure is less than atmospheric. If the cap is off, it can cause an AIR EMBOLISM. So by clamping the line or by having pt. bear down, it avoids the air emboli.
When and why is BiPAP considered? BiPAP is used when a pt. can't tolerate CPAP. CPAP unlike BiPAP delivers a constant pressure rather than reacting to pressure changes when a pt. exhales or inhales.
True/false. CPAP allows for timed breaths much like a ventilator. FALSE. BiPAP is a noninvasive equal to a vent because of the pressure support and timed breaths.
Third degree block. OH no! better get those paddles on quick
What is Ramipril? What does it do? Ramipril is a ACE-inhibitor inhibiting the production of angiotensin II(a vasoconstrictive agent)to DECREASE BLOOD PRESSURE
True/False. If pt. with known acute renal failure is scheduled for a CT with contrast...does that sound right? Pt. with acute renal failure better not be doing for a CT with contrast or receive any NSAIDS as they could further harm the kidneys.
When is the assessment of hyponatremia important and why? Assessment of hyponatremia is imporatnt after a transurethral resection of the prostate (TURP),this is common because pt.'s after TURP surgery usually get irriagted with GLYCINE a hypotonic solution and causes increases absorption of the venous channels e
What is normal sodium range? Sodium 135-145mmol/L.
Is TURP an example of "dilutional" or "sodium deficit" hypnatremia? TURP is an example of dilutional hyponatremia because the body has too much fluid compared to the normal sodium in the body.
Though logical, why would NS not be used a an irrigation solution after TURP? NS can't be used as irrigation after TURP becuase of it's electroconductive properties. Cautery would not be a good mix here.
What is one common syndrome that causes hyponatremia? One syndrome that causes hyponatremia is SIADH (syndrome of innapropriate antidiuretic hormone).
What is SIADH characterized by? SIADH is characterized by and excess of the ADH hormone that then stimulates water re-absorption back in the collecting ducts of the kidney. This then leads to water retention, causing decreased sodium=HYPONATREMIA.
What are the classical signs of hyponatremia? Hyponatremia= ***confusion, personality change, anorexia, nausea, vomiting.
What is the goal for hyponatremia therapy in a STABLE pt.? Goal for hyponatremia in as stable pt. is to gradually decrease body water and increase sodium levels. Furosemide(Lasix) is commonly given.
How is hyponatremia treated in an UNSTABLE pt? -Pt. with seizures activity -Pt. in a coma -Sodium <120mmol/L Unstable pt.treatment for hyponatremia usually include a hypertonic solution such as 3% SALINE!
If the diagnosis of hyponatremia is made what is the nsg. priority? Provide a safe environment for the confused pt.If 3%saline is ordered nurse must be vigilant in ICF and ECF fluuid shifts that can result in heart failure or pulmonary edema.
Thyroid storm is diagnosed when T3 lecel is greater than what? Thyroid storm dx when T3 level > 204ng/dL. Normal T3 range: 40-204ng/dL
True/false. Because Thyroid storm leads to a hypermetabolic state, this also leads to an increase in oxygen consumption. TRUE.
What is the most common trigger of thyroid storm? Stress
What are classic symptoms of pt. in thyroid storm crisis? Pree-operative tremors (unresolved with Demerol), tachycardia,hypertension, and weight loss.
Nursing consideration for pt. in thyrois storm crisis: -adequate O2-careful monitoring of BP-peripheral cooling-NS (isotonic solution)-LOC
Care of the orthopaedic pt. Preoperatively , pt.'s should be instructed not to shave the operative site before surgery. Tiny nicks and cuts resulting from shave increase surgical site infection
When considering risk factors look at the following: Age, size frame, total surgery time, surgery type, pt. hx
What is the mainstay treatment for DVT? Anti-coagulation (Heparin)
Remember when asked for "best nursing action" to TREAT THE PT.'S IMMEDIATE SYMPTOMS. Think....what can I do right now.
Lung anatomy knowledge. -Right bronchus bigger than left (causing it to be common site for aspiration, greater ventilation) -Left bronchus has sharper angle towards lung
True/false. Bubbles in the water SEAL chamber of chest tube indicate that there is a leak. True
True/false. Tidaling in the water seal chamber of chest tube is a BIG concern . False. Tidaling in the water seal chamber of the chest tube is an EXPECTED finding that correlates with respirations.
True/false. Wall suction of chest tube directly pulls air and fluid out of the lungs. False. Wall suction of suction chamber creates a "pull" or negative pressure that works to remove the air or fluid from the chest.Negative pressure does the direct job.
What is an endoleak? An endoleak is defines as a continued flow of blood into an original aneurysm sack despite repair.
How is an endoleak diagnosed? Via CT scan. Pt. is usually asymptomatic.
True/false. Lidocaine prior to induction lowers the risk of pulmonary edema and aspiration False. Lidocaine not known to protect mentioned, but known to DECREASE COUGH< DECREASE ICP< LIMITS EFFECT ON HEART
FYI on Rapid sequence intubation (RSI). RSI success and reduction of complications include appropriate mix of drugs usually in this order: PRE-OXYGENATE then amnesic/hypnotic (ex. etomidate)then paralytic (ex. succs)
Inotropic effect a.k.a as? Muscle contractility
If and elderly man has a known history of mitral valve regurgitation what are the to main perianesthesia implications? Pulmonary HTN and fluid overload.
What are the risk factors for Cerebral emboli? male, >55 yrs, hx of mitral valve regurgitation and atrial fibrillation.
If pt. in acute renal failure think... Serum albumin, and isotonic fluids (NS)
What primary prevention measures can be taken to reduce FAT EMBOLI in pt. with fractures? Stabilize fractured extremities and adequate O2
Back surgery in prone position nsg. considerations. Nurse needs in PACU to watch for excess** swelling of face and neck which may also translate into AIRWAY tissue swelling. BAD!
True/false. Hypotension can be attributed to hypothermia. False. HYPERtension is more seen with shivering and hypothermia.
If a pt. is tachycardic but still somewhat sedate and verbalizes that they are comfortable . What might the nurse consider as a cause? Probably just residual effect the reversal agents such as atropine or robinul.
What is a mediastinoscopy? Medianstinoscopy is a means of getting tissue from the lymph nodes, so SUBCUTANEOUS EMPHYSEMA is more common with a mediastinoscopy rather than a bronchoscopy because entrance is gained through the chest rather than the trachea.
What is the basics of nursing care for a child who has congential heart defects? Nurse must be sure with kids that have a congenital heart defect that AIR FILTERS are in all the IV tubings. Lack of an air filter can cause a stroke.
True/False.Ease of insertion of a NP airway is facilitated by inserting the NP in an anterior, lateral position. False. When inserting an NP airway, must insert bevel in an POSTERIOR, MEDIAL direction.
What is a left bundle block always indicative o? Left bundle branch block is always indicative of heart disease of some type. Note: "bunny ears" prolonged QRS on ECG
What is the mainstay treatment for low O2 sats and inevitable atelectasis? Coughing and deep breathing. Note: Coughing and deep breathing DO NOT promote increased bronchiole functioning.
FYI. In consideration for the possibility of fluid and blood administration, fluids can be given as fast as can be handled by the IV access and pt. Go is good
FYI. A pt's face and shape and presence of facial hair may alter the fit of a CPAP mask, which will alter its efficacy.
FYI. Vital capacity measurement determines the lung function and severity of trauma or the disease process.
FYI. Most pacemakers have the ability to pace, sense, and respond to the atria and/or ventricles in a variety of ways.
Describe setting of a pacemaker. First letter=chamber being paced Second letter=chamber being sensed V=ventricles/A=atrium/D=both/O=none
What is the main difference between paroxysmal SVT and ventricular tachycardia? In the case of v-tach the QRS is wide, of course, but in PSVT QRS is normal.
True/false. Aldosterone triggers the kidney to re-absorb more potassium and excrete more sodium. False. Aldosterone,which responds to decreased sodium and increase potassium levels, triggers the kidney to reabsorb more sodium do to the loss and excrete more potassium.
True/False. Cations have a higher charge than anions. False. The numeric values of cations and anions maintains electrical neutrality.
If a pt. had received 5 units of packed RBC's, the pt. is at increased rick for developing what? Pt. recieving alot of packed RBC's is at an increased risk for developing HYPOCALCEMIA related to citrate preservatives.Citrate binds to calcium in the blood, decreasing the amount of calcium to circulate.
What are signs of HYPOCALCEMIA? Nueromuscular irritabilty, tremors, tingling, dysrythmias, ***positive Chovstek's and/or Trousseau's sign
How can nurse assess for Chovstek's sign related to HYPOCALCEMIA? Tap around the cheek over the facial nerve. If pt. has an abnormal facial spasm, then pt + for hypocalcemia.
How can nurse assess for Trousseau's sign related to HYPOCALCEMIA? Inflate blood pressure cuff. If pt. has hand and feet spasms, then pt + for hypocalcemia
How is HYPOCALCEMIA treated? Treatment includes calcium chloride administered slowly,close observation of dysrythmias and vitamin D.
In what type of surgeries is planned perioperative hypothermia usually seen? "Planned" hypothermia is usually seen in pt.'s undergoing nuero surgeries, because the hypothermia decreases bleeding and ICP. "Planned" hyopthermia is also seen in pt.'s undergoing cardiac surgery, because it decreases O2 needs of the heart cells, and me
Why is blood type O negative considered the universal donor? Because it has no antigens.
What percentage of total body weight(TBW) is found in a childs and adults extracellular fluid? Child TBW=75% Adult TBW=33-40%
FYI. Preoperative CBC indication caries with age, Hx, risks, and complexity of surgical procedure.
What should nurse be aware of in a post op diabetic pt, that recieved an epidural anesthetic? Nurse should know that spontaneous voiding is highly preferable rather than a catheter in a Type 1 diabetic pt. to avoid UTI
FY. Hemoglobin and Hematocrit levels are parallel. For each unit of packed RBC's, the rise in Hgb is 1 g and Hct 3%
When is fresh frozen plasma(FFP) indicated? FFO is indicated to correct coagulation deficiencies
Red blood cell production is stimulated by which organ? The kidney
The operative approach commonly used for a hypophysectomy procedure is? A commom operative approach for a hypophysectomy is by using a transphenoidal resection. Basically an incision is made in front of the hard palate.
What is a hypophysectomy used to treat? Primary pituitary disease and tumors and as a palliative measure in prostate and breast cancer.
True/false. Pulse ox readings are less reliable in pt.'s with anemia. TRUE
If a type 2 diabetic pt. arrives to the PACU with an elevated suger, what is this most likely related to. The Stage I hyperglycemia is most likely related to an increase in the adrenal cortisol secretion, caused by the surgical stress.
FYI. Pregnancy is a normal state of respiratory alkalosis.
If a pt. with on long term steroid therapy experiences decreased cortisone production, what can be given to treat this. Pt. will need post-op IV hydrocortisone in the PACU to treat signs of acute adrenal insufficiency.
Where to hypotonic solutions move water to? Hypotonic solutions can cause water to move to the "cell to the serum" and have a osmolality >340. This movement of water increases circulating blood vloume.
True/False. Hypertonic solutions are more concentrated in the intracellular fluid. FALSE. Hypertonic more concentrated in the extracellular. ex. D5 in LR,D5 in 1/2NS, D10 in water.
Men's normal Hgb and Hct. Men Hgb 14-18 Men Hct 40-52.
What does rapid infusion of packed RBC's promote? Peripheral vasodilation for comfort.
During an inflammatory response, where do leukocytes function? They function in the interstitial space during inflammation where they can phagocytize unwanted organisms.
True/false. Vitamin B12 deficiency is a causative factor of polycythemia. False. Vitamin B12 deficiency is a causative factor of pernicious anemia resulting in lowered amounts of RBC's
The most common diagnosis of leukemia is: Adults with acute myelocytic leukemia (AML), AML is the most common form of the disease. (ALL) is most common in kids <19 yrs (CML, CLL) is most common in elderly >5o yrs
True/False. HTN is related to Addisonian crisis. False. Early clinical signs of Addisonian crisis(adrenal insufficiency) include: N/V, HYPOtension, flaccid muscles in the extremities, and azotemia (increased, urea and creatinine in blood)
Acute adrenal insuficiency is also known as what? Addinonsian crisis.
What are the classic signs and sypmtoms od addisonian crisis? nausea and vomiting, hypotension,a nd muscular weakness
If a pt. recieved Coumadin 16 hrs prior to pre-op admission the nurse needs to recognize what? Nurse needs to know that the administration of Vitamin K may be indicated. Coumadin decreases coagulation factors.
What is the drug of choice for Addisonian crisis? Dexamethasone(DECADRON).
Post-op after a Jackson-Pratt drain and neck dressing, what should nurse be assessing for? Nurse needs assess the pt.'s ability to swallow, as the laryngeal nerve may have be damaged
True/false. Increased immature neutrophils are found in response to overwhelming infection. True. Nuetrophils are white blood cells that respond to acute bacterial infection
What is Protamine sulfate used? Protamine sulfate is used to decrease the effects of Heparin.
How should Protamine sulfate be administered? Rate should never excees 50 mg in any 10-minute period.
what is an infant's primary compensatory response to hypothermia? An infant's primary response to cold is INCREASED METABOLISM.
What is Protamine Sulfate? Protamine Sulfate is a Heparin antagonist.
Heparin is an anitcoagulant that: Inhibits circulating coagulation factors (other wise known as the intrinsic coagulation pathway)
True/false.Heparin prolongs bleeding by reducing platelets ability to stick together. TRUE.
True/false. Heparin disrupts platelet prducti
What is Protamine sulfate used? Protamine sulfate is used to decrease the effects of Heparin.
How should Protamine sulfate be administered? Rate should never excees 50 mg in any 10-minute period.
what is an infant's primary compensatory response to hypothermia? An infant's primary response to cold is INCREASED METABOLISM.
What is Protamine Sulfate? Protamine Sulfate is a Heparin antagonist.
Heparin is an anitcoagulant that: Inhibits circulating coagulation factors (other wise known as the intrinsic coagulation pathway)
True/false.Heparin prolongs bleeding by reducing platelets ability to stick together. TRUE.
True/false. Heparin disrupts platelet production False. Heparin has nothing to do with platelet production
Who is at risk for developing autonomic hyperreflexia? Pt. who had spinal cord resection above T6***
What is a the primary contributor to post-op HTN. The most common contributor to post-op HTN,whether documented or not is pre-op HTN.
If a pt.is receiving epinephrine and also receives as antidepressant such as Amitriptyline(Elavil) or Phenelzine (Nardil), what is the anticipated reaction? The interaction of epinephrine and MOA antidepressants "increase adrenergic stimulation" this will cause pt. to be hypertensive and tachycardiac.
True/false. The incidence of post-dural puncture headache is high, and requires use of a large bore needle. False. Not so fast buddy. PDHD incidence in LOW, and small 27 g needle use prevents fluid leakage during local anesthetic injection.
After SPINAL ANESTHESIA, what must the pt. be able to do, to meet d/c criteria? The pt. must pee sponataneously. Note: ability to control bladder, and remain hypotension free indicates post-spinal recovery of S3 and S4 nerves and sympathetic tone.
Which cranial nerve allows clenching of teeth, movement of jaw, sensation to face, scalp, cornea, interior nose and mouth. TRIGEMINAL nerve- cranial nerve V
Which class of antibiotics effect the nueromuscular junction? "MYCIN" antibiotics. ex. gentamycin
With knowledge of nueromuscular junction and a certain class of antibiotic function, why would a nurse question order for Gentamycin, in a pt. with hx of mysasthenia gravis that is being treated with Pyridostigmine? "mycin" antibiotics affect the nueromucular junction, and they increase muscle weakness, and reverse effects of anticholinesterase drugs like Pyridostigmine.
What must a post-op spinal surgery pt. avoid as far as positioning goes, and what can the nurse do to fix this? Post-op spinal surgery pt. must avoid twisting and mal-alignment. Nurse needs to use "LOG-ROLL" to ensure alignment, decrease spinal muscle spasms and limit twisting of back when repositioning.
The combination of severe incisional pain and decreased motor and sensory function suggest what? HEMATOMA-intraspinal.
What is the primary reason for adding epinephrine to a spinal anesthetic solution? Epinephrine PRIMARILY increases the anesthetic duration.
If a pt. is scheduled for a nuero type surgery, what complaint form the pt. would the nurse yield as a "red flag" Headache and neck stiffness. This may be indicative of subarachnoid bleeding.
What are nursing considering for administration of transdermal Fentanyl patch? In this order: WATER WASH skin, and CLIP body hair-NO SHAVING
LOC definitions. LETHARGIC: Drowsy, yet arouses to follow simple commands STUPOROUS: Very difficult to arouse and only with strong stimuli AWAKE:Fully orientated and appropriate when stimulated
With decorticate posturing was is pt. most likely to develop? Herniation of the brainstem a.k.a 'central herniation'
If a pt. is suspected to have an increased ICP,and MD orders Mannitol, what is the best measure to protect the pt.'s neuro status? Would need to HYPERVENTILATE this pt.(increase RR rate and depth). Rationale; decreasing CO2 by manually hpyerventilating reduces blood flow, and decreased rise in ICP.
Which system allows awareness of sensory stimuli and degree of alertness? The reticular activating system(RAS). RAS helos maintain cinsciousness and is active during awakening from sleep.
True/false. The Corpus callosum connects the brains hemispheres and is essential in coordinating activities between them. OH yeah!
What is aniscoria? ANISCORIA= unequal pupils. -temporal lobe displacement
What is essential to be done before an epidural infusion of whatever? The epidural catheter MUST be aspirated to determine contents. Bloody drainage=no good < 0.5cc clear fluid=okay
True/false. A purely narcotic epidural solution that contains no local rarely produces hypotension. True.
ANESTHESIA TOXICITY ***dizziness, tinnitus, tingling****. Further develops into muscle tremors,so anticipate tremor and/or seizure
When consideration spinal anesthesia, and ortho cases, remember **alignment*** roses are red, violets are blue, oh CAPA can't wait till I'm through with you.
What are the physiological benefits of retransfusion (cleaning intra-op blood loss, then re-infusing) Retransfusion allows for quick availability, normal K+ levels, preserved platelet number and function.
Describe normal eye responses. Conjugate, brisk constriction to light.
Which cranial nerves control eye function? Cranial nerves III, IV, VI.oculmotor, trochleat, and abducens.
FYi. Upper arm strength are best assessed when arms are extended with palm facing up. Loss of strength causes a weak arm to to rotate and begin to fall-PRONONATOR DRIFT
Daily production of CSF in adults is? 500-600 mL
CUSHING TRIAD-u better know this Systole goes up, diastole does down, bradycardia...not good, must act earlier to notice signs of increase ICP and herniation
Contralateral crossing of spinal tracts occur where? At the brainstem which allows the connection between the higher and lower structures (tracts)
True/false. Enlarged tonsils is a reason for surgical removal in children. FALSE. Most kids have big tonsils that atrophy as they grow.
What is the best educational strategy for a preschooler? Magical thinking, immature coping, "fear of body mutilation", understanding of concrete explanations. So letting them play with supplies is good.
How is the optic nerve protected after ocular surgery? optic nerve is protected after ocular surgery by administration of corticosteroids to prevent the nerve from swelling.
True/false. Poor glycemic control impairs the body's ability to eliminate bacteria and can lead to increase in infections. TRUE. Nurse must control BS levels in a post-op diabetic pt. that underwent any type of surgery.
True or false. The last pt. in Stage I (PACU) only needs one competent RN and RT according to ASPAN guidelines. FALSE. Pt. in phase I can expect to have two nurses.
After radial neck dissection surgery what can the nurse anticipate that the pt. will not be able to do. The pt. will be unable to raise both shoulders against resistance. This is because radial neck surgery usually involves removing the sternocleidomastoid muscle and surroundings with inclusion of the XI cranial nerve aka spinal accessory nerve=motor
What is peri-operative hypothermia associated with in terms of would healing? Impaired wound healing with increase susceptibilty to infection.
What is one way that Myasthenia gravis may be treated? By removing the thymus gland (thymectomy).
What is an essential post op assessments that nurse should focus on after a thymectomy? Prevent respiratory muscle failure.
FYI. Cocainne is strong local anesthetic used (LEGALLY) in surgery for it's strong ***vasoconstrictive properties. So it can shrink mucous membranes, ***reduce hemostais, provides brief topical anesthesia.
True/false. PONV is most likely to occur after a TURP. Nay
When should an LMA be removed? LMA should be removed when pt. is DEEPLY ANESTHETIZED OR AWAKE TO AVOID LARYNGOSPASMING
What is normal intraocular pressure range? 10-20mmHG
How an intraocular pressure be decreased during surgery? By hypocarbia (decreased CO2 by hyperventilation and respiratory alkalosis) and hypovolemia.
FYI. When monitoring intracranial pressure NEVER EVER flush the system.
What does the Monro-Kellie hypothesis reflect? The Monro-Kellie hypothesis reflects the principles of intracranial pressure. It shows the relationship between:**brain, cerebral blood flow, and CSF volume.
What is the normal cerebral perfusion pressure(CPP) range value? cerebral perfusion pressure(CPP) normal range=70-100mmHg
If cerebral perfusion pressure(CPP)40 mmHg, what does this mean. Well, normal CPP is 70-100mmHg, so CPP of 40 means there is inadequate brain flow and ischemia.
Remember again with nuero surgery's post-op positioning and alignment very important. "Log-rolls" are your friend
After steroid administration such as methylprednisone what is pt. at risk of developing? Infection, adrenal suppression, ****gastric irritability.
FYI. Sufantenil is 5-10 times more potent than Fentanyl, and recurrent respiratory depression is likely to occur. It will also "outlive" any reversal provided by Narcan.
What are the "hallmark" signs of compartment syndrome? ****The 5 P's****:pain, pallor, paralysis, paresthesia (burning), decreased pulse!!! Cyanosis is a later sign.
What is a contraindicated intervention when caring for a pt. with compartment syndrome? DO NOT ELEVATE. Elevation above the heart level decreases arterial perfusion. *Good to know*
Which part of the brain is responsible for nuerogenic hyperventilation, apneustic and cluster breathing patterns, Cheyne-Stokes respirations? BRAINSTEM!!!
GLASCOW COMA SCALE info. 15=normal, 8 or <=coma, lowest score of 3=most severe***
Which of drug is contraindicated for an elderly pt. with renal dysfunction? DEMEROL. because it breaks into a metabolite in pt.'s who have renal or liver failure, which leads to confusion.
What does a shift to the right mean on the oxyhemoglobin curve? Shift to right means that O2 loading of hemoglobin has DECREASED.
What is the the only treatment or a Type I Diabetes pt. to attain euglycemia? Transplant the pancreas.
What should be adminsitered prior to transplanation? Immunosuppresive agents are given before graft reperfusion to promote circulation through the donor organ.
What medicine is used to prevent DVT? low-molecular weight Heparin.
True/false.In terms of peripheral chemoreceptors:Carotid bodies are more physiologically important than the aortic bodies.
Which condition mimics flaccid paralyis caused by a NDMR? Hypermagnesia.
What is the primary cause of respiratory acidosis? Hypoventilation. So in this case, nurse can instruct pt. to deep breath ****without need of increased O2**** if PaO2 within normal range
Oliguria refers to: Less than 400mL daily urine
Nurse should be concerned for a new stoma of what color? Light gray stoma, remember new stoma should be pink or red. Gray may indicate decreased blood flow.
True/false. Nurse can re-inject and alter the infusion rate of an epidural catheter with physician orders when managing a non-ob pt. True. Facility policies must state this
What is the normal bile drainage amount for a post cholecystectomy pt? Normal bile output is <30 mL/hr. Anything greater should be brought to MD attention.
Decreased blood and renal perfusion pressure prompt: Renin release with renovascular constriction
True/false. An anticholinergic such as Scopolamine can cause agitation and excitement. True
What do the following symptoms represent in a post-op TURP pt.-epigastric pain, suprapubic pain, left shoulder pain, firm abdomen, nausea, diaphoresis. BLADDER PERFORATION
FYI.The amount of tissue damage differentiates pre-renal origins of renal failure vs. acute tubular necrosis.
After succs induced relaxation, which returns first? Muscle function to the respiratory muscles or eye `opening? Abdominal muscle function will precede eye opening. Muscle function 1st returns to resp. intercostal muscles, then to shoulders and abdomen, then neck, then eye, ears finger, etc. *bottom to top*
With surgical procedures involving single doses of succ, what is the most common side effect. Pt.'s usually complain of pain when smiling, turning head, and moving. Muscle tremors/FASICULATIONS occur when the cells depolarize, and that's what causes that pain.
What is the capacity of a normal functioning bladder? 500 mL
When shivering is not hypothermia induced, and pt. has increased temp. What must nurse consider? Possible septic shock
What are the hallmark physiological signs of septic shock? Hyperventilation and alkalosis
To prevent potential adverse reactions after a laparoscopy what can the nurse do? Administer H2 antagonists to reduce gastric volume.
If a patient is unable to dorsiflex the big toe what is this indicative of? Peroneal nerve dysfunction
What is Cisatracurium? **Cisatracurium is an intermediate acting nondepolarizing muscle relaxant with an effect longer than succs.
Why must vancomycin be adminstered over 1 hr. Vancomycin administered slowly reduced risk for a hypotensive crisis.
True/false. Saturation of one pad is okay Nope, call MD. monitor for shock, hypotension, and fluid deficit
FYI. Bladder distention can contribute to post-op RESTLESSNES
O2 saturation monitoring, promotes: Ventilation
ISOFLURANE FACTS. ISOFLURANE: Useful anesthetic for maintenance if anesthesia.****rare toxic effects***
What is the normal value of serum creatinine? 0.7-1.5mg/dL
After TURP, which fluid should be used to irrigate: Hypertonic, isotonic, or hypotonic. Better be ISOTONIC-ex. normal saline
FYI. Unbound drug circulates freely in the blood and has a prolonged effect in patients whose failing kidneys cannot eliminate the drug.
What is the best drug of choice for pain, for a pt. with renal failure? Morphine
What is the biggest cause of obstruction in adults and kids? tongue
FYI. Kids with Aspert's, Downs, Pierre-Robin, and Klippel- Feil syndrome have difficult airways, and make intubation and make extubation harder.
Which muscle cells are responsible for breathing? When do these cells mature? Type I muscle cells are responsible for breathing and they mature at the age of 2 yrs.
True/false. Peds chest wall encloses the lung and opens the chest as readily on inspiration. FALSE. Peds chest wall does enclose the lungs and DOES NOT open as readily on inspiration due to the type I muscle cells that don't develop until 2yrs.
True/False. Child has decreased functional residual capacity. True.
What happens cardiovascular wise when a child is in hypoxic? Bradycardia.
What is the first sign of early shock in a child? Unexplained Tachycardia
FYI. Hypothermia can lead to bradycardia in infants. True.
FYI. Metabolic acidosis/alkalosis=KIDNEY ISSUE
What is an early indicator of MH? Doubling of end tidal CO2.
FYI. When a child responds in to surgical stress, there is an increase in ADH and Aldosterone which causes the child to retain water, resulting in HYPERVOLEMIA
What is the normal dose of Dantrolene for MH? 2.5mg/kg up to 10 mg/kg.
Dev. Stages: Preschool 3-6 yrs old INITIATIVE VS. GUILT -injury, pain, mutilation -**pain as punishment -**involve child in handling equipment
FYI. BRADYCARDIA is the first sign of Hypoxia i n peds pt.
Domains of learning: Cognitive Affective Psychomotor Cognitive- learners knowledge & understanding Affective- learners attitude & emotion Psychomotor- learners motor skills
Which domain of learning? You are teaching about diet and activity Cognitive domain
Which domain of learning? You are asking pt. to return demo of wound dressing change Pschymotor
Which domain of learning? You are educating pt. on risks of excessive alcohol related to post-op liver biopsy for cirrhosis Cognitive and Afffective
Which domain of learning: Learning to apply dressing. Cognitive and Motor
What is the main learning characteristic of the elderly? They have slow process time, so be sure to WRITE DOWN THE STEPS OF THE INSTRUCTIONS
If pt. is taking Vitamin E supplement, what should nurse instruct prior to surgery? Pt. taking Vitamin E, should stop taking 2-3 weeks prior to surgery. Vitamin E has anti-platelet properties,and can cause bleeding. "Vitamin E Bleed" Gingko, gingko biloba, also have same effect!
FYI. Pregnancy is a state of metabolic alkalosis
In relation to cardiac performance how should pregnant women be positioned? On left side to prevent compression of the superior vena cava. This keeps the uterus off the aorta and promotes blood flow to baby
PACU considerations for pregnant mommy O2 is your friend/massage fundus q 15 minutes for 1 hr in PACU
Where is deep sedation to be done? In the PACU
True/false. Deep sedation is considered as Conscious sedation. Nope
On the cellular level, local anesthetics are thought to do what in reference to Sodium channels? Local anesthesia blocks nerves impulses, which decrease the permeability of nerve membranes to sodium ions. Basically SODIUM can't come in!
CAPA test If answer says something about airway...IT IS OUR BUSINESS
Which cranial nerves do an eye block impair? Eye block impairs cranial nerves 3, 4, 6 (OTA)
What is a potential complication after administration of eye block? *OCULOCARDIAC reflex- making eye block to cause *bradycardia and hypotension* in response to the mechanical stimulation. Treat with atropine*
FYI. After a supraclavicular block, always assess breaths sounds ,as pnuemothorax is potential complication
When should dermatomes be assessed Dermatomes should be assessed upon arrival to PACU after a spinal, epidural, or caudal, then 15-30 min, afterwards
DERMATOMES **good to know** S2=perineal and rectal areas L1=groin, lower limb surgery T10=umbilicus T6-8=lower abdomen surgery(c-sections, hernia repairs, renal surgery) T4-5= upper abdominal surgery
What is the vasopressor of choice to increase HR and CO. Ephedrine
Since the sacral automatic fibers are the last to return after spinal anesthesia...What is essential for the nurse to assess for? Nurses needs to assess for distention. Pt. should be able to void prior to discharge home.
FYI. Pt.' s to receive spinal anesthesia need to have fluid on board, to prevent hypovolemia.
Post caudal management: -airway/breathing -treat BP with fluids and vasopressors like Ephedrine*
FYI. IV anesthetics are typically used to induce anesthesia, while inhaled agents are used to maintain general anesthesia
Etomidate (Amidate) facts -GREAT cardiovascular stability -No analgesic properties
Ketamine (Ketalar) facts -produces dissociative anesthesia(lights on, but no one home) -emergence delirium -Psychosis -keep pt. in dark room with minimal stimulation
Halothane facts -depresses mucous and ciliary action **so educate in stir-up regime, TCDB
Desflurane (Suprane) facts -Can cause laryngospasms on induction
Sevoflurane (Ultane)facts -Mask induction well tolerated, minimal irritation* -Used often in peds setting -**Can be used safely in pt.'s with renal/hepatic function
What group of NDMR are Cisatracurium and Atracurium? Intermediate NDMR
How are intermediate acting NDMR Cisatracurium and Atracurium? By *Hoffman elimination, which is where they produce their own metabolites for breakdown at physiological temp. and ph.
FYI. All reversal agents have **muscarinic effects** which means they cause: bradycardia, hypotension, and bronchoconstriction
Post-op consideration for respiratory depression STIR UP REGIME
Ativan facts - benzodiazepine - **Longest half life
Demerol facts Can lead to increased toxicity in renal pt.'s so not rally good choice for them, Morphine better choice
What is the diagnostic to determine Pulmonary embolism? VQ/Lung scan
Nursing consideration post gastrectomy/colectomy/ any GI surgery, what is the priority? Pt. respiratory function
Nursing consideration post BREAST surgery what is important to monitor? Drains** Also keep affected arm on pillow to decrease edema and increase circulation(same goes for lymph node surgery)
Nursing consideration post LAPAROSCOPIC surgery. (Cholecystectomy, herniarraphy, splenectomy, nephrectomy) -*referred shoulder pain from CO2 mobilization -fever and peritonitis common
After a HEMORRHOIDECTOMY what should nurse educate pt. on? *pt. needs to respond to defecation urge *avoid straining *administer stool softener prn **warm sitz baths and compress
Nursing considerations post THYROIDECTOMY?
Education post THYROIDECTOMY? -Instruct pt. on need to remain silent to rest vocal cords
Nursing considerations post NUEROLOGICAL surgery? *Assess LOC -assess dressing for CSF leaks, hematomas, motor and sensory loss - Be on alert for complaint of tingling, numbness
Nursing considerations post ORTHOPEDIC surgery? *Compartment syndrome=extreme pain with passive flexion or extension *Embolism =chest pain, tachy, SOB, restlessness(especially post hip surgery)-assess lung sounds
Nursing consideration post PULMONARY surgery? Pneumonectomy, Lobectomy,Wedge resection -Priority resp. function -**maintain negative pressure
True/false. After a punemonectomy (removal of whole lung) it is okay to put chest tube to suction. BAD IDEA. Might just suck out the remaining lung
FYI. With any pt. with a chest tube (post-thoracoromy) lay pt. on unaffected side
Nursing considerations post VASCULAR surgery? 5 P's: pulse/pulseness, pain, paresthesia, paralysis, pallor (poikllothermia-coldness)
Nursing considerations post CAROTID ENDARTERECTOMY? -Assess LOC -Assess cranial nerves*** -Assess for bilateral equal hand grasps in pre-op then compare in post-op
Phase II nung staff 2 competent personnel, one of which is an RN competent in Phase II post anesthesia care, should be present where pt is receiving Phase II care.
Staffing ratios in Phase II 1:3 one nurse to 3 pt.'s (age >5 yrs old) 1:2 < 5 yrs old 1:1 unstable pt needing to be transferred
Created by: much2magpie