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Module V DAANCE
3/21 Test
| Question | Answer |
|---|---|
| What is the deficiency of oxygen in the body's tissues? | Hypoxia |
| What can hypoxia result in? | Cardiac dysrhythmias, cardiac arrest, brain damage, and ultimately death |
| Who does hypoxia occur more rapidly in? | Children |
| Why does hypoxia occur more frequently in children? | Diminished respiratory reserve |
| All patients that receive IV anesthesia should have a period of what prior to administration of medications? | Pre-oxygenation period |
| What can be done to prevent potential problems with the airway during surgery? | Airway maintenance |
| What is evaluated preoperatively to give clues to a difficult airway? | Anatomy: Neck, mandible, tongue, and body obesity |
| What characteristics of the neck would be a clue to a poor airway? | Short, thick, with little flexibility |
| What is most commonly the cause of complete or partial airway obstruction? | Posterior positioning of the tongue |
| What is the correct positioning of the patients head and mandible? | Head tilt-chin lift position |
| What are the signs of airway obstruction? | Choking, gagging, suprasternal notch retraction, labored breathing, and rapid pulse followed by decreased pulse |
| 4 steps to follow in early treatment of airway obstruction: | 1) 100% oxygen via nasal mask 2) Place patient in Trendelenburg position & pack off surgical site 3) Digital traction of the tongue 4) Suction oropharynx |
| If the tongue continues to fall backwards & occlude airway what should be utilized? | Airway adjuncts |
| What airway adjunct should be utilized first? | Nasopharyngeal or oral airway & advancing if necessary |
| When the patient is conscious or semi conscious what airway is used? | Nasopharyngeal |
| When the patient is unconscious what airway can be used? | Oropharyngeal |
| Give an example of a supraglottic airway | LMA |
| What is used after nasopharyngeal, oropharyngeal, and LMA | Endotracheal intubation |
| What is done when all other conventional methods for establishing an airway have failed? | Cricothyrotomy |
| What is the quickest, easiest surgical airway? | Cricothyrotomy |
| How is a cricothyrotomy obtained? | Make an opening through thin cricothyroid membrane between cricoid and thyroid cartilages in larynx |
| What is the surgical airway below the level of the larynx into the trachea (usually preferred in a hospital setting) | Tracheostomy |
| 4 steps of cricothyrotomy: | 1) activate EMS + clean overlying skin 2) locate cricothyroid membrane by palpation 3) emergency cricothyrotomy needle/cannula or large gauge to enter trachea 4) attach tube of cricothyrotomy device to 100% oxygen |
| How do you locate cricothyroid membrane? | Palpation |
| What are some examples of foreign bodies can cause airway obstruction? | Partial dentures, surgical packs, & teeth |
| How can airway obstruction be prevented? | Removal of foreign bodies preop, effective placement of packs, adequate suctioning and assistance, good visualization of field |
| 4 ways to treat airway obstruction: | 1) Digital removal of foreign body 2) Chest compressions 3) Direct laryngoscopy 4) Cricothyrotomy |
| What is to never be attempted during removal of foreign bodies? | Blind finger sweep |
| Why are chest compressions preferred when removing foreign bodies? | there is more pressure developed inside the chest for expelling the foreign body and less chance that the sharp tip is pointed at the lower end of the breastbone |
| What can be done if the patient is sitting upright for foreign body removal? | The Heimlich |
| What is a laryngoscopy used for when removing foreign object? | Visualization to remove object with forcep or suction |
| What type of reflex is a laryngospasm? | Protective |
| What sound is made during a partial larygospam? | Crowing |
| What sound is made during a complete laryngospasm? | Nothing |
| What type of chest movements occur during complete larynospasm? | Paradoxical/ a rocking pattern of chest and abdomen |
| How can you prevent a larynogspasm? | proper pack placement, changing packs, suctioning, control of secretions, and adequate anesthetic level |
| What is primary treatment of laryngospam? | close observation of ventilatory status with stethoscope, pulse ox, and capnography |
| 6 steps to treat laryngospasm? | 1) 100% oxygen via nasal hood 2) head positioning and airway maintenance 3) pack surgical site 4) suction oral cavity & oropharynx with tonsil suction 5) positive pressure 6) 10-20mg Succinylcholine |
| What issue may Succinylcholine (Anectine) cause? | Malignant Hyperthermia |
| What does the administration of Succinylcholine lead to in pediatric patients? | Bradycardia |
| What should be administered with Succinylcholine in pediatric patients? | Atropine |
| What is a bronchospasm? | Contraction of smooth muscles of the small bronchi and bronchioles |
| During a bronchospasm does a patient have more trouble with inspiration or expiration? | Expiration |
| What sound is made during bronchospasm? | Wheezing |
| Patients with what in their medical history would be more susceptible to bronchospasm? | Allergies, asthma, COPD, & bronchitis |
| The diagnosis of ______ can be suspected when a patient exhibits labored breathing? | Laryngospasm & bronchospasm |
| Cyanosis & decreased ventilation patterns on capnography are signs of what? | bronchospasm |
| What is the initial treatment of bronchospasm? | Observe ventilatory status with sthetoscope, pulse ox, and capnography |
| What is emesis? | Vomiting or passive regurgitation |
| What is aspiration? | When contents of the stomach enter the lungs |
| What can happen due to aspiration? | Pneomonitis, rales, dypenea, & tachycardia |
| According to ASA how long should patients be NPO from solid foods? | 6 hours |
| According to ASA how long should patients be NPO from clear liquids? | 2 hours |
| Although ASA states 6 hours NPO is whats recommended, how long do oral surgeons typically prefer? | 8 hours |
| What is the normal gastric emptying time? | 30-90 minutes |
| What can prolong gastric emptying? | Apprehension, pain, opiate analgesics, and sedatives |
| What are protective reflexes the body utilizes to prevent aspiration? | Closure of trachea at vocal cords & vigorous coughing |
| This occurs when patient is breathing at a rate faster than their normal breathing pattern- or breathing more deeply than body requires. | Hyperventilation |
| The patient exhales too much of what during hyperventilation? | Carbon Dioxide |
| How will a patient feel when hyperventilating? | Anxious and light headed |
| What causes hyperventilation? | Anxiety, apprehension, pain, fear, and overdose of certain medications |
| True/False: You administer O2 when a patient is hyperventilating? | False |
| What is apnea? | Absence of breathing |
| What can respiratory depression/apnea result in? | Increased heart rate, development of hypoxia & cyanosis |
| What muscle relaxant medication can cause cessation of a patients breathing? | Succinylcholine (Anectine) |
| What is used to reverse benzodiazepines? | Flumazenil (Romazicon) |
| What is used to reverse narcotics? | Naloxone (Narcan) |
| True/False: The effects of the drug causing respiratory depression may outlast the reversal effects. | True |
| What should be done when respiratory depression is caused by drugs that cannot be reversed? | ventilation with positive pressure via bag mask valve |
| What are the 2 components to Acute Coronary Syndrome? | Angina & Myocardial Infarction |
| What is referred to as damage to the myocardium from diminished blood flow through coronary arteries? | Angina |
| What is represented by death of myocardial tissue when coronary arteries become totally occluded? | Myocardial Infarction |
| Where will patient feel pain with angina? | Center of the chest and radiating above to diaphragm |
| What is the primary symptom of coronary artery disease? | Angina pectoris |
| What causes angina pectoris? | spasm in the coronary arteries that supply blood to the heart |
| What is angina pectoris indicative of? | diminished blood flow of ischemic heart disease |
| What is important to know when gathering medical history of patient with past anginal attacks? | When it last happened, how frequently they happen, and at what level of exercise precipitates the attack |
| What is considered unstable/ atypical angina? | Angina that occurs at rest |
| What is the goal of treatment for patient with angina? | Increase coronary artery blood flow by dilating the coronary arteries |
| What types of drugs are used to manage angina that the patient may already be prescribed? | Nitrates, calcium channel blockers, beta-adrenergic blockers |
| What medicine is most commonly used in OMS for angina? | Nitrates- nitroglycerin |
| How is Nitroglycerin administered? | .4mg under tongue, or .4mg spray |
| Example of calcium channel blocker? | verapamil (Calan), diltiazem (cardizem) |
| Example of beta blocker? | propanolol (Inderal), or atenolol (Tenormin) |
| What should be done if patient has angina attack during surgery? | 1) terminate surgery 2) 1 dose nitroglycerin 3) 100% oxygen by mask 4) place in comfortable position 5) loosen all tight clothing |
| How long do you wait if first dose of nitroglycerin does not provide relief? | 5 minutes |
| What is to be assumed if third dose of nitroglycerin does not provide relief? | patient in having a myocardial infarction |
| What is a heart attach usually preceded by in the medical history? | angina and/or other cardio complaints |
| What are the most common symptoms of a heart attack? | Chest pain, anxiety, weakness, sweating, cardiac dysrhythmias, and drop in bp |
| What should take place if MI occurs during surgery? | 1) terminate surgery & mouth cleared of any foreign materials 2) placed in comfortable position 3) 100% oxygen 4) monitor placed to observe dysrhythmias- bp/respirations monitored 5) IV line established |
| What medication is preferred for pain if patient is having MI? | Morphine sulfate |
| What mg can patient receive aspirin by mouth for heart attack | 325 mg |
| What is the correct order of interventions with MONA acronym? | ONAM - oxygen, nitroglycerin, aspirin, morphine |
| What does V.Fib often precede? | Asystole |
| How many sequences are there in treatment for V.Fib? | 6 |
| Difference in Asystole and PEA? | Asystole has no waveform of any type, PEA there is no pulse but normal appearing rhythm on monitor |
| What is the contraction of the ventricles? | Systolic pressue |
| What is the relaxation of the ventricles? | Diastolic pressure |
| What systolic pressure should be considered an acute problem? | 200 mg Hg |
| What diastolic pressure should be considered an acute problem? | 100 mg Hg |
| What drugs are given for hypertensive emergencies | Beta-blockers (Labetalol, Esmolol, Atenolol) |
| What medication is given for hypotensive emergencies? | Ephedrine |
| What position is patient placed in for hypotensive emergency? | Trendelenburg |
| What is infiltration? | Leakage into surrounding tissues- causing edema & pain |
| What is hematoma? | Blood leakage into surrounding tissues- results in firm, tender, & swelling |
| Treatment for hematoma? | First apply firm pressure, followed by moist heat |
| What is phlebitis? | Irritation/inflammation of vein- results in pain, erythema(redness), edema, warmth and cord like feeling to vein |
| Treatment of phlebitis? | Elevation of limb, moist heat, and NSAIDS |
| 4 Venipuncture complications: | Infiltration, hematoma, phlebitis, & intra-arterial injection |
| Mild symptoms like nausea, hunger, and tachycardia happen when blood glucose falls below what range? | 60-65 mg/dL |
| Moderate symptoms like irritability, lack of energy, anxiety & restlesness occur if blood glucose drops below what range? | 50 mg/dL |
| Severe symptoms such as loss of consciousness, seizures, come, and hypothermia occur when blood glucose drop to what range? | 30 mg/ dL |
| How does acute adrenal insufficiency happen? | inadequate production of cortisol |
| What produces cortisol? | Adrenal Gland |
| What is syncope? | Fainting |
| What is syncope due to? | sudden, sharp, usually transient drop in blood pressure |
| What part of the nervous system shunts the blood flow to the extremities before syncope? | Sympathetic nervous system |
| What causes syncope? | anxiety or fear- but can include cardiac dysrhythmias, metabolic disease, and dehydration |
| Who does syncope affect more? (males or females) | males |
| Once patient reaches full syncope what happens to the heart rate? | it decreases and become bradycardic |
| What causes seizures? | Abnormal discharge within the brain |
| What normally follows seizures? | Respiratory depression or apnea |
| What can be placed in the patients mouth to protect oral structures from injury during a seizure? | Rolled towel or soft airway |
| What type of seizure requires no medication? | Epileptic-type seizure |
| If a seizure is prolonged and hypoemia has been ruled out as a cause, what medicines can be given? | IV dose diazepam- Valium/Versed IM dose midazolam- Versed |
| There is a period of ________ usually following a Grand Mal seizure | Depression |
| During the period of depression after a Grand Mal seizure how may the patient exhibit symptoms? | Unresponsive & may have some respiratory depression |
| What is a cerebrovascular accident also known as? | Stroke |
| What is a CVA/stroke? | damage to a portion of the brain caused by a blood clot or piece of plaque in one of cerebral arteries, arterial rupture and hemorrhage due to high blood pressure, or various other causes such as trauma |
| How do strokes and TIA's differ? | Stroke is neurologic impairment lasting greater than 24 hours- TIA lasts less than 24 hours |
| What medications are some patients on with a history of stroke or TIA? | Coumadin or heaprin |
| What will patients present/exhibit when suffering a stroke? | paralysis, localized weakness, headache, numbness, slurred speech, aphasia (inability to speak), memory loss, dizziness, blindness in one eye, confusion, loss of consciousness, diplopia (double vision), or ataxia (gait/walking disturbance |
| An allergic reaction is the response of the body's immune system to an irritant or _____? | Antigen |
| What is an antigen? | A foreign substance that elicits an immune response? |
| In an allergic reaction the antigen combines with what? | Antibody |
| Example of a potentially harmful substance released by the body during an allergic reaction | Histamine |
| What antibiotic possess a 10% cross-reactivity with penicillin? | Cephalosporin |
| What are the most common allergic reactions to drug administration? | Allergic skin reactions |
| How may allergic skin reactions present? | Uticaria(rash), erythema (redness), angiodema (swelling of the lips) |
| What is the other name for Benadryl? | diphenhydramine |
| What is the most severe/ life threatening allergic reaction? | Anaphylaxis |
| How quickly does anaphylaxis occur? | within first 5-10 minutes after exposure |
| What meds in the OMS office can be given for severe allergic reaction? | Diphenhydramine (Benadryl), & corticosteroids (Solumedrol, Decadron, & Solucortef) |
| What is the first drug of choice for a patient suffering anaphylaxis? | Epinephrine- it improves cardiac tone, raises bp, reduces bronchospasm, and relieves edema |
| What is malignant hyperthermia? | genetically transmitted myopathy (muscle disorder) that is triggered by some inhalation anesthetic agents( Succinylcholine) |
| What is the first sign of malignant hyperthermia? | Tachycardia |
| What follows tachycardia as signs of hyperthermia? | Masseter muscle rigidity, elevated temperature, CO2 retention, total body rigidity, or lethal arrhythmias |
| If significant bleeding is not controlled, what will it lead to? | Hypovolemia ( inadequate blood volume) |
| Who are at most risk in the OMS office for intra-artierial injection? | patients who have anomalously positioned arteries, are obese and/or have low pulsations in the artery |
| Which site for injection would be most likely affected by intra-arterial injections? | antecubital fossa |
| What color is the blood to be indicative of an intra-arterial injection? | Bright red |
Created by:
amandadanie11e
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