Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Test 1 Adv. HA
Adv. Health Ass. test 1
| Question | Answer |
|---|---|
| types of anesthesia | general, regional, monitored |
| what does ASA stand for | American Society of Anesthesiologist |
| what does ASA stand for | American Society of Anesthesiologist |
| ASA guidelines is | formulated health categories as guidelines for anesthesia administration |
| ASA III is | pt with severe systemic disease (HTN,DM) |
| ASA V | pt with high morbidity |
| ASA I | normal, healthy pt |
| ASA IV | pt with severe systemic disease that is a threat to life |
| ASA II | pt with mild systemic disease |
| ASA VI | brain death |
| what valves close during S1? | tricuspid and mitral valve |
| during S2 which valves close? | aortic and pulmonary |
| what is the order of valves closure? | MV, TV, AV, PV |
| systole takes twice as long as diastole? T or F | False;diastole is twice as long |
| when does the longer pause occure b/n S1 & S2? | b/n S2 and S1 |
| in a healthy adult a splitting of S2 can be heard during? | deep inspiration |
| when is the pulse palpable (S1,S2) | S1 |
| what is the location to hear the aortic valve? | 2nd ICS Rt. sternal border |
| where is S2 the loudest? | 2nd ICS, Rt. sternal border |
| mitral stenosis is what type of murmur | holodiastolic murmur |
| where is S1 heard the loudest? | 5th ICS |
| where is the location for auscultating the tricuspid valve | Lt. lower sternal border |
| Aortic stenosis is what kind of murmur? | holosystolic murmur |
| intensity of the murmur is graded according to? | Levine Scale |
| Level IV murmur? | medium intensity with a palpable thrill |
| ___ is a common high-volume state were physiologic flow murmurs are often heard. | Pregnancy |
| ___ & ____ can cause high-flow situations when the murmur is not pathologic itself, but indicates an underlying disease process. | Anemia & thyrotoxicosis |
| what pt. population can have a innocent murmur? | Children |
| Level II murmur | low intensity, but usually audible by all listeners |
| Level V murmurs? | loud intensity with a palpable thrill, audible even with the stethoscope placed on the chest with the edge of the diaphragm. |
| Level I murmurs | lowest intensity, difficult to hear even by expert listeners |
| Level III murmurs | medium intensity, easy to hear even by inexperienced listeners, but without a palpable thrill. |
| what are some murmur symptoms? | syncope, CP, palpitations, SOB, or paroxysmal nocturnal dyspnea |
| murmurs tend to change intensity with positional maneuvers, becoming louder with standing and quieter with squatting T or F | louder=squatting quieter=standing |
| a valsalva maneuver will increase the intensity of the murmur? T or F | false;decrease |
| what is a common murmur in children and the location? | venous hum;Rt. clavicle, radiates to the neck. |
| what is a venous hum? | a continuous murmur which does not change from systole to diastole, common in children |
| how can venous hum be obliterated? | by brief digital pressure on the ipsilateral internal jugular vein. |
| atrial septal defect; what prominent sound is heard and location? | mid-systolic flow murmur, wide "fixed" split S2/pulmonic area |
| ventricular septal defect is best heard where and what kind of murmur? | tricuspid (lower Lt. sternal border) with radiation to the Rt. lower sternal border/holosystolic murmur |
| whats the characteristic sound of mitral valve prolapse | mid-systolic click |
| immediately after the click, a brief ____-____ murmur is heard, usually best at the apex | crescendo-decrescendo murmur |
| MR is best heard at the apex with radiation to the ___ | axilla |
| quality usually describled as blowing, often associated with an S3 | MR |
| causes of AR | 66% rheumatic heart disease, congenital or associated with syphilis infection, Marfan syndrome, or valvular deterioration, infective endocarditis |
| an early mid-systolic flow murmur is freq. audible over the rt. upper sternal border with radiation to the neck | AR |
| and austion flint is what type of murmur | AR |
| this murmur can be heard radiating into the neck or the back, has a crescendo-descrescendo shape, and a harsh quality | PS |
| hear at the second ICS along the left sternal border | PS |
| best heard with the pt in the lt. lateral decubitus position | MS |
| all cases are caused by rheumatic fever in origin or congenital 2:1 F:M | MA |
| AS is best heard | over right second ICS, mid-sys eject murmur |
| what are the aortic stenosis complications ASC | Angina, Syncope, CHF |
| with AS an early peaking murmur is usually associated | with a less stenotic valve |
| with AS a more severe degree of stenosis can be differentiated by | late peaking murmur |
| murmurs tend to be located b/n the ___ & ___ , have minimal radiation, occur during early to mid-syst, have a crescendo-decrescendo shape, and a vibratroy quality. | apex & left lower sternal border |
| this is the main substrate for energy production; oxidative phosphorylation | glucose |
| increased glucose in the bld..increased ___ ___ | brain metabolism |
| what is used interchangeably with CMRO2 | CMRglucose |
| brain receibes __% of cardiac output | 15 |
| coupling mechanism belong with | CBF and CMRO2 |
| increase CBF in one region= increase in ____ same region | CMRO2 |
| increase in CO2 will | vasodilate and increase CBF |
| what directly and indirectly effects vasodilation effects | indirectly CO2 directly H |
| what does luxury mean | increase in CBF; luxuay flow to normal brain |
| what does stea mean | decrease in CBF; steal away flow from injured areas(requires more O2) |
| what is the robinhood or inverse steal effect | ischemic/comprised areas are already dilated maximally, bld would shunt to the maximally dilated atrterioles |
| what is beneficial to the brain if a clots occurs in certain areas in the circle of willis? | there are communication arteries that could provide bld to the occluded side |
| autoregulation of CBF normotensive=____ mmHg MAP | 50-150 |
| autoregulation of CBF hypertensive=___mmHg MAP | 70-170 |
| <50mmHg MAP= | mild s/s of cerebral ischemia |
| disruption of BBB...cerebral edema for autoregulation of CBF | >170 |
| what are the 4 varaibles on the autoregulation chart and what are the x and y axis | PaO2, PaCO2, CPP, ICP x=pressure y=CBF |
| most electrolytes values in the CSF>ECF T or F | false; greater in CSF |
| what is choroid plexus? | (highly vascular folds of pia) of the cerebral ventricles produces CSF |
| CSF is reabsorbed into the venous system of the brain from what? | arachnoid villi |
| normal CSF volume | 100 to 150mls |
| CSF is formed and reabsorbed at a rate of | 0.3 to 0.4ml/min |
| CSF is replaced | 3 to 4x/day |
| causes of CSF BBB disruptions | Acute HTN, osmotic shock, diseases, tumor, trauma, irradiation, ischemia |
| cranium content volumes | Bld 12%(CBF) Brain 80% (BTV) CSF 8% |
| normal ICP | <10 mmHg |
| first and major component to reduce is with ICP | MAP |
| what are the two major effects and causes of increased ICP | brain ischemia brain herniation increased CSF:blockage of CSF absorpt.,formation increased CBF:vasodilation hematoma increased TBV: tumor or edema |
| Which have coupling effects inhalations or IV meds | IV meds increase in both CBF and CMRO2 |
| what are the EEG waves | Delta, Theta, Alpha, Beta D:deep S/T:sleep A:awake B:concentrating |
| what is the range for BIS monitoring for general anesthesia and lt./mod. sedation? | 40-60;70-90 |
| these monitor the integrity of specific sensory and motor pathways | EP evoked potentials |
| what are EP measured by | ht and wt |
| IV anesthetics and volatiles __ amplitude, and __ latency of responses. | decrease, increase |
| which are very, somewhat, and barely sensitive somatosensory EP, brainstem auditory EP, visual EP | VEP:very, SSEP:somewhat, BAEP:barely |
| what are the indications for MEP motor EP | intramedullary tumors, scoliosis surgery, cerebral tumors |
| what are the cautions of MEP | h/o seizures, poss. skull fx, implanted metallic devices, pacemakers, and CVP or PAC's |
| what are the concerns of MEP | repetitive electrical or magnetic stimulation can induce epileptic activity, neural damage and cognitive or memory dysfx |
| which cranial nerves can be preserved for motor components? and the indications | V, VII, IX, X, XI, XII post. fossa and lower brainstem procedures |
| what is used for clinical imaging of intracranial vasculature | TCD;transcranial doppler u/s |
| transcranial oximetry uses and indications | infrared spectroscopy (NIRS); CEA, head injury, SAH clip |
| O2 sat of jugular venous is assess by | jugular bulb venous oximetry |
| brain tissue oxygenation= | PO2, PCO2, pH, and temp |
| what are the 3 main principles of radiation and which is most important? | time, distance, shielding; distance |
| what are examples of neuroradiology | CT, MRI, PET, cerebral angiography |
| generalized pre-op eval. of neurosurgery | overall medical condition, length of procedure, positioning, institutional special techniques: hyperventilation, cerebral dehydration, deliberate hypoTN |
| what are some s/s of intracranial HTN | H/A, N/V, papilledema, unilateral papillary dilation, and oculomotor or abducens palsy. Adv: depress. LOC, irreg. RR |
| causes of supratentorial ICTumors | meningiomas, gliomas, metastatic lesions |
| what kind of posturing is noted with supratentorial | decorticate |
| what must be controlled prior to cranium opening for optimal operating conditions | ICP |
| what are the prerequisites for awake craniotomy and meds | cooperative pt, able to participate in neurocognitive testing, uncomplicated airway, candidate for GA Propofol, dexmedetomidine, versed, fentanyl, remifentanyl |
| what does the infratentorial portio consist of | medulla, pons, cerebellun, major motor and sensory pathways, primary resp. and CV centers, and lower cranial nerve nuclei |
| what posturing is seen with infratentroial | decerebrate |
| what is one of the major complications with infratentorial intracraninal surgery | venous air embolism |
| what are the advantages of sitting position surgery | excellent surgical eposure, facilitates venous and CSF drainage, better ventilation, easy access to chest, airway, ETT, and extrem., reduced facial and conjunctival edema |
| what are causes and incidence of VAE | operative field is elevated 5 cm or more above the heart's right atrium and 40-45% operated on sitting |
| from mot sensitive to least sensitive monitors | TEE>precordial dopples>PAC>capnography(ETCO2).Mass spectrometry(ETN2) |
| VAE interventions | notify surgeon immed, surgical field flood saline and packed, bone edges waxed, N2O off, Fi02 100%, neck viens compress.=↑jugular v.p., aspirate air from TLC, ↓head to heart level, avoid PEEP or valsalva, postion horiz. if fail lt.lateral fail supine CPR |
| preop eval for pituitary tumors | assoc. med. do(HTN, CHF, obese, ↓K, metabolic alkalosis, acromegaly 2.airway condition:hoarseness, dyspnea,inspir. stridor=xray 3.approach?transphenoidal needs nasal cx to guide ax tx |
| what kind of tube is used with pituitary turmors | (RAE) Ring-Adair-Elwyn |
| what are some considerations with pituitary tumors | lateral wall:venous structures(hemorr), internal carotid artery(spasm or thrombotic occl), and CN II, IV, V and VI(weakness 2ndary streching) front pit. stalk:optic nerves n tracts, optic chiasm(visual complicat.) |
| more considerations with pit. tumors | if visual acuity is same or improved proceed with extubate. Awake and following commands prior to extubate 2ndary to nasal packing, pt will need to mouth breathe postop:steroid coverage, strict I&O, airway status, freq neuro checks. |
| incidences of ICA | occurs in 8 to 10 per 10,000 peak is 50's and 60's women>men |
| IA with SAH affects | 27,000 yearly |
| risk factors for aneurysm rupture | smoking, HTN, ETOH, cocaine and amphetamine abuse, BC, plasma chl>6.3, genetic, familial(first-degree relatives) |
| some s/s of SAH | sudden severe H/A, stiff neck, photphobia, N/A, transient loss of LOC, HTN, dysrhymias |
| what effects 70% of pts with SAH | cerebral vasopasm |
| IA complications | rebleeding and cerebral vasopasm, IC HTN, acute obstructive hydrocephalus, hyponatremia/vol., seizures |
| what is triple "H" therapy | treat with hypervolemia, HYN, Hemodilution |
| IA surgical intervention endovascular txment:occ. of IA with insertion of | guglielmi detachable coils (GDC), microballoons, stents, liquid embolic agents, bioactive coils |
| goal for IA anesthesia | avoid aneurysm rupture, maintain CPP and provide a slack brain. discuss BP parameters prior to clipping |
| prior to aneurism clipping | replace NPO deficits, bld available, thiopental bolus, temp. clipping should not exceed 10 min., recirculation to be established and another thiopental bolus prior to reclipping |
| emergence goal after aneurysm clipping | avoid coughing, straining, hypercarbia, HTN |
| this consist of a tangle of congenitally malformed bld vessels that forms and abnormal communication b/n the arterial and venous syst. | AV malformation |
| management of AVMs | surgical excision, embolization, stereotactic radiosurgery, combination of above, leave it alone |
| leading causes of traumatic brain injury | MVA, violence and falls |
| intubate if GCS is | 8 or less |
| Emergency Therapy: (2) things | ABC's MILS manual in line stabilization |
| what type of cervical spine xrays are recommended | anteroposterior and odontoid views (misses 7%) lateral misses 20% of fx |
| cushing triad with head injuries | reflex arterial HTN, bradycardia, irregular respirations |
| anesthesia concerns with head injures | fiberoptic intubation or AII RSI, ketamine, Sch, server IC.HTN |
| cause of CVD | emboli air, fibrin or ca;ischemia;severe sustained hypoTN..IC thrombosis/infart;HTN..hemorrhagic stroke/disrput of BBB |
| anesthesia concerns with CVD | regional vs. gerneral, rightward shift of autoregulation curve, no rely on pressor=MI, avoid Sch in recent stroke pts, muscle wasting, hyperkalemia, paralysed can result to overdose(resistance to NMB) |
| classification of partial (focal) seizures | i.simple, ii.complex, iii.2ndary generalized tonic-clonic |
| classification of generalized seizures | i.absence(petit mal) ii.myoclonic iii.clonic iv.tonic v.tonic-clonic vi.atonic vii.unclassified |
| mechanisms of seizures do | loss of inhib. GABA act.,enhanced release of excitatory amino acids (glutamine), enhanced neurofiring |
| interventions during seizures | maintain an open airway with O2, IV bolus thiopental, phenytoin or benzo |
| avoid potentially epieptogenic drugs | ketamine in small doses, lg doses of atracurium, cisatracurium, meperidine |
| a pt that takes seizure meds you need to increase MAC b/c | hepatic microsomal enzyme induction |
| degenerative and demyelinating diseases | parkinson, alzheimers, MS, amyotrophic lateral sclerosis, G-B syndrome, automonic dys./dysautonomia, syringomyelia |
| intaoperative phase consist of | induction, maintenance, and emergence |
| anesthesia and elective operations should not procedd until the pt's medical condition has been | optimized |
| disease state already present or hospital acquired | morbidity |
| 2 majoy elements of preop phase | gathering info, formulation an anesthetic plan of care |
| what does the gathering info consists of | reviewof pertinent current and past med records, interview, phy. exam |
| what is the communication of the anesth. plan | informed consent |
| unlawful threat of actions by a perosn intended to inflict, my force, corporal injury | assualt |
| battery | unlawful constraint or phy. violence inflicted on a person without his consent, administation of anesthetic to an unwilling person |
| peds that are at risk for developing hypoxia intra and post op | upper resp infection |
| cross sensitives allergies | beta lactam anx, sulfa, amides |
| disadv. of ASA | imprecise, subjective, higher ASA only roughly predicts anesthetic risk |
| what is a red flag with airway assessment | old trach scar |
| medical conditions assoc. with potential airway diff. | soft tissure enlargement=obstructive sleep apnea, obestiy, epiglotittis, down's) restrictive oral opening=RA, facial trauma,receeded mandible Cervial spine abd=prev. spine fusion, ankylosing spondy. Active airway infect.=ped for T&A |
| test for airway assess. | exam oropharynx(mallampati test), thyro-mental distance, temporo-mandibular jt., neck ROM |
| class I airway | soft palate, fauces, uvula, ant. and post. tonsillar pillars |
| class III airway | soft palate, base of uvula |
| class II airway | soft palate, fauces, and uvula |
| class IV airway | soft palate only |
| mental space/thyro-mental distance | while pt in stiff posit. normal is 6.5cm or 3-4 fingerbreathes < 6 difficult |
| TMJ test | open mouth as wide as possible more than 2 fingerbreathes |
| Neck ROM | range of motion, ability to attain sniff position |
| no solid foods, unrestricted clear liquids, pre-op meds w/ sips | 8,2,1-2hrs |
| ped npo status | clear=2hrs breast milk=4hrs formula milk/solid food=6hrs increased risk for aspiration >25cc |
| high risk for aspiration | GI ob, h/o GERD, DM, recent solid food intake, abd distent, depressed consc., up/low GIB,airway trauma, emerg. surg., N/A |
Created by:
melbacs
Popular Nursing sets