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PACU STUDY GUIDES
CERTIFICATION REVIEW
| Question | Answer |
|---|---|
| ASA 1 | NORMAL HEALTHY PATIENT |
| ASA 2 | PT WITH MILD SYSTEMIC DISEASE (1 MEDICAL PROBLEM) SMOKERS. |
| ASA 3 | PT WITH SEVERE SYSTEMIC DISEASE THAT LIMITS ACTIVITY BUT IS NOT INCAPACITATING (MORE THAN 2 MEDICAL PROBLEMS). |
| ASA 4 | PT WITH INCAPCITATING DISEASE THAT IS A PERSISTANT THREAT TO LIFE. |
| ASA 5 | PT IS NOT EXPECTED TO SURVIVE 24 HOURS WITHOUT THE OPERATION. |
| E | AN EMERGENCY PT WITH UNKNOWN HISTORY. |
| ASA 6 | PT PASSED BRAIN DEATH CRITERIA AND IS AN ORGAN DONOR. |
| "ANESTHESIA IS A CONTINUUM ...... | FROM AN AWAKE CONSCIOUS STATE TO AN UNCONSCIOUS STATE". Quinn & Schick, p. 373 |
| MINIMUM SEDATION | PT REMAINS CONSCIOUS,RESPONDS TO VERBAL COMMANDS. |
| MODERATE SEDATION | MAC, PT DOES NOT LOSE CONSCIOUSNESS, MONITORED ANESTHESIA CARE. |
| DEEP SEDATION & ANALGESIA | MAY REQUIRE ASSISTANCE WITH AIRWAY, MAY SLEEP & BE AROUSED, PURPOSEFUL RESPONSE TO REPEATED OR PAINFUL STIMULI (NOT REFLEX WITHDRAWAL. |
| GENERAL ANESTHESIA | PT NOT AROUSABLE, UNABLE TO MAINTAIN OWN AIRWAY, VENTILATION IS IMPAIRED. |
| ANESTHESIA STAGE I: STAGE OF ANESTHESIA & AMNESIA | BEGINS W INITIATION OF ANESTHESIA, ENDS WITH LOSS OF CONSCIOUSNESS. PT CAN FOLLOW SIMPLE COMMANDS, PROTECTIVWE REFLEXES R INTACT. |
| ANESTHESIA STAGE II: STAGE OF DELIRIUM | BEGINS WITH LOSS OF CONSCIUOSNESS, ENDS W DISSAPPEARANCE OF LID REFLEX. |
| ANESTHESIA STAGE III: STAGE OF SURGICAL ANESTHESIA | CESSATION OF SPONTAINIOUS RESPIRATIONS, ABSENCE OF EYELASH RESPONSE, NEED AIRWAY MANAGEMENT. |
| ANESTHESIA STAGE IV: CESSATTION OF RESPIRATION TO CIRCULATORY COLLAPSE | CONSIDERED OVERDOSE OF ANESTHESIA |
| RECOVERY & EMERGENCE FROM ANESTHESIA | OCCURS IN REVERSE ORDER OF INDUCTION, SURGICAL ANESTHESIA, DELIRIUM, ANESTHESIA AND AMNESIA. |
| GENERAL ANESTHESIA ANESTHETIC AGENTS | INDUCTION AGENTS, MUSCLE RELAXANTS, INHALATION AGENTS, REVERSAL AGENTS, OPIOIDS, ADJUNCTS/ |
| BARBITUATE INDUCTION AGENTS | SODIUM THIOPENTAL (PENTOTHAL), METHOHEXITOL (BREVITOL). |
| NON-BARBITUATE INDUCTION AGENTS | ETOMIDATE (AMIDATE), PROPOFOL (DIPRIVAN). |
| DISSASSOCIATIVE AGENTS | KETAMINE (KETALAR), BENZODIAZEPINES, DIAZEPAM (VALIUM), MIDAZOLAM (VERSED), LORAZEPAM (ATIVAN). |
| BENZODIAZIPNE ANTAGONIST | ROMAZICON (FLUMAZENIL) |
| phsostigmine | aka (antilium) anticholinesterase, nonspecific reversal of CNS side effects of benzodiazepines, scopalamine and ketamine. |
| INHALATION AGENTS | NITROUS OXIDE (GASEOUS INHALATION AGENT), VOLATILE AGENTS.... HALOTHANE, ISOFLURANE, DESFLURANE, SEVOFLURANE, ENFLURANE. |
| WHICH INHALATION AGENT IS NOT A TRIGGER FOR MALIGNANT HYPERTHERMIA? | NITROUS OXIDE |
| WHAT ARE CHARACTERISTICS OF NITROUS OXIDE? | GASEOUS INHALATION AGENT, ODORLESS TO SWEET SMELLING, HAS GOOD ANALGESIC EFFECTS, NOT AN MH TRIGGER, |
| NURSING IMPLICATIONS FOR INHALATION AGENTS ARE... | HYPOXIA, INCREASED RISK FOR ASPIRATION, MONITOR FOR ARRHYTHMIAS, NO ANALGESIC EFFECTS, CAUSES SHIVERING (DEMEROL IS DRUG OF CHOICE FOR DECREASSING SHIVERING. |
| Depolarizing muscle relaxant (the only one) | Succinylcholine (Anectine) |
| MUSCLE RELAXANTS WORK BY RELEASING WHAT CHEMICAL | ACETYLCHOLINE (ACH)WHICH IS RELEASED FROM NERVE CELL TO MUSCLE CELL. |
| WHAT IS HYDROLYZED BY PSEUDOCHOLINESTERASE | SUCCINYLCHOLINE (ANECTINE). |
| SIDE EFFECTS OF SUCCINYLCHOLINE | BRADYCARDIA, INCREASE IN K-LEVELS, CARDIAC STANDSTILL, MH TRIGGER. |
| NON-DEPOLARIZING MUSCLE RELAXANTS | USUALLY END IN NIUM (ROCURONIUM, VECURONIUM,PIPECURONIUM, ETC |
| REVERSAL AGENTS FOR NON-DEPOLARIZING MUSCLE RELAXANTS | ANTICHOLINESTERAS (NEOSTIGMINE, EDROPHONIUM, PYRIDOSTIGMINE) MAY USE ANTICHOLINERGIC DRUGS (ATROPINE, GLYCOPYROLATE [ROBINUL]TO PREVENT BRADYCARDIA, BRONCHOCONSTRICTION, EXCESSIVE SALIVATION. GLYCO & NEO, ATROPINE & ENDROP. |
| SIDE EFFECTS OF ANTICHOLINESTERASE DRUGS | BRADYCARDIA, INCREASED SECREATION. |
| REGIONAL ANESTHESIA (LOCAL ANESTHESIA INTO A SPECIFIC AREA OF THE BODY). | TOPICAL, LOCAL INFILTRATION, INTRAVENOUS REGIONAL BLOCK, PERIPHERAL OR CENTRAL NERVE BLOCK. |
| LOCAL ANESTHETIC AGENTS | ESTERS = COCAINE, CHLOROPROCAINE. TETRACAIN. AMIDES = PRILOCAINE (CITANEST), LIDOCAINE, MEPIVICAINE (CARBOCAINE). REMEMBER THAT THE AMIDES ALL HAVE 2 "I's" in their names. |
| PRESERVATIVE FREE MORPHINE | DURAMORPH, ASTRAMORPH |
| EPINEPHRINE IS ADDED TO LOCAL ANESTHESIA TO... | ENHANCE DURATION BY 50%, DECREASE BLEEDING ON SURGICAL FIELD, |
| CAUSE OF LOCAL ANESTHETIC TOXICITY IS.... | EXCESSIVE DOSE OR INJECTION INTO VERY VASCULAR AREA. |
| Symptoms of local anesthetic toxicity | tingling around mouth, dizziness, drowsiness, confusion, tinnitus, trmors of face, extremities, tonic clonic seizures, unconsciuosness, respiratory arrest. symptoms can occur 20 minutes after injection. |
| treatment of local anesthetic toxicity | early detection, airway management, circulation support. seizure control. cpr/acls, LIPID INFUSION. |
| WHAT IS BIER BLOCK? | A TOURNIQUET PLACED ON AN EXTREMITY FOR A PROCEDURE LESS THAN AN HOUR. USED FOR LOCAL ANALGESIA... IF TOURNIQUET COMES LOOSE A TOXIC REACTION CAN OCCUR. |
| EYE BLOCKS ARE DONE WHERE? COMPLICATIONS? | PERI AND RETRO BULBAR AREAS, / RUPTURED GLOBE, INADVERTENT INFILTRATION, RUPTURED ARTERY. |
| PERIPHERAL NERVE BLOCKS ... TYPES OF | CERVICAL PLEXUS, BRACHIAL PLEXUS: INTERSCALENE, SUPRACLAVICULAR, INFRACLAVICULAR, AXILLARY., INTERCOSTAL |
| WHAT IS HORNER'S SYNDROME? | SYMPTOM'S OF PARALYSIS OF THE CERVICAL SYMPATHETIC NERVE SUPPLY, PTOSIS, MIOSIS, NASAL CONGESTION, VASODILATION, INCREASE SKIN TEMP. |
| COMPLCATION OF BRACHIAL PLEXUS, INTERSCALENE OR SUPRACLAVICULAR BLOCKS... | HORNER'S SYNDROME.UNILATERAL PHRENIC AND LARYNGEAL NERVE BLOCK, VETEBRAL ARTERY INJECTION, POSS HIGH SPINAL OR EPIDURAL. |
| COMPLICATION OF CERVICAL PLEXUS NERVE BLOCKS... | INJ TO VETEBRAL ARTERY INJ. |
| COMPLICATION OF SUPRACLAVICULAR NERVE BLOCKS.... | PNEAUMOTHORAX, SUBCLAVIAN AERTERY PUNCTURE. |
| COMPLICATION OF AXILLARY NERVE BLOCK... | INTRAVENOUS INJECTION, HEMATOMA IF AXILLARY ARTERY PUNCTURED. CONTRAINDICATED IF THE PATIENT HAS INFECTED GLANDS OR THE ARM CANNOT BE ABDUCTED TO 90 DEGREES AT THE SHOULDER JOINT. |
| ORDER OF SPINAL OR AUBARCHNOID BLOCKS.... | AUTONOMIC (VASOMMOTOR, BLADDER CONTROL). SENSORY, MOTOR,PROPRIOCEPTION |
| ORDER OF RECOVERY FROM SPINAL | PROPRIOCEPTION, MOVEMENT, TOUCH, PAIN, SENSE OF TOUCH, AUTOMATIC FUNCTIONS. |
| LOCATIONS OF SPINAL BLOCK.... | INJECTED L2-L3 INTERSPACE OR BELOW |
| SPINAL BLOCK CAN BE MANIPULATED BY..... | ADDING DEXTROSE TO DRUG SOLUTION (HYPERBARIC) FOR SPECIFIC AREA USE ISOBARIC. |
| WHICH ANESTHETIC (EPIDURAL OR SPINAL) HAS A GREATER CHANCE OF CAUSING SYSTEMIC TOXICITY? | EPIDURAL, BECAUSE A HIGHER AMOUNT OF DRUG IS NEEDED. |
| COMPLICATIONS OF AN EPIDURAL ANESTHETIC ARE... ********** *********** | INCREASED RISK OF SYSTEMIC TOXICITY, GREATER RISK OF POSTDURAL PUNCTURE HEADACHE (PDPH), BE ALERT FOR EPIDURAL HEMATOMA / ABCESS FORMATION, EMERGENT SITUATION!!! LOOK FOR SIGNS OF PAIN CHANGE IN MOTOR MOVEMENT. |
| PREMATURE NEONATE | BORN BEFORE 40 WEEKS GESTATION |
| NEWBORN | < 72 HOURS OLD |
| INFANT | < 1 MONTH OLD TO 12 MONTHS OLD |
| TODDLER | 1-3 YEARS OLD |
| PRESCHOOL | 3-6 YEAR OLD |
| SCHOOL AGE | 6-12 YEARS OLD |
| ADOLESCENT | 12-18 YEARS OLD |
| SUBGLOTTIC STENOSIS | NARROWING AND STIFFENING OF THE PEDIAATRIC AIRWAY, SUSPECT IN PATIENTS WITH HX OF CROUP, DOWN SYNDROME OR ANY OTHER SYNDROME. |
| OPTIMAL AIRWAY POSITION FOR INFANT IS.... | NEUTRAL OR "SNIFFING" POSITION. |
| TYPE 1 MUSCLE CELLS IN DIAPHRAGMATIC AND INTERCOSTAL MUSCLES MATURE BY AGE .... | 2 |
| TYPE 1 MUSCLE CELLS OF THE DIAPHRAGM AND INTERCOSTAL MUSCLES PERFORM.... | REPEATED EXERCISE ASSOCIATED WITH RESPIRATION. |
| RESP RATE OF ____ IS A SIGN OF RESP DISTRESS IN A CHILD OF ANY AGE. | 60 |
| SIGNS / SYMPTOMS OF LARYNGOSPASM | CROWING SOUNDS *****DYSPNEA, HYPOVENTILATION, HYPOXIA, HYPERCARBIA, INCREASED WORK OF BREATHING, DIMINISHED BREATH SOUNDS. |
| TREATMENT FOR LARYNGOSPASM | ELEVATE HOB, POSITIVE PRESSURE WITH BAG TO MASK, O2, RACEMIC EPINEPHERINE, DECADRON, LIDOCAINE, ATROPINE, SUBTHERAPEUTIC DOSES OF MUSCLE RELAXERS, REINTUBATE. MAY BE DUE TO IRRITATION WITH ARTIFICIAL AIRWAY. |
| TREATMENT OF BRONCHOSPASM | INCREASE O2, REMOVE IRRITANT, ADMINISTER MUSCLE RELAXANT, DEEPEN ANESTHESIA, BRONCHODIALATORS, TERBUTAMINE (BRETHINE),EPINEPHRINE, ANTIHISTAMINE. |
| TREAMENT FOR CROUP | HUMIDIFIED O2, STEROIDS, AEROLIZED EPINEPHRINE, HYDATION, OBSERVE. |
| CAUSES OF NON-CARDIOGENIC PULMONARY EDEMA.. | bucking, coughing on closed glottis, biting on et-tube, narcan. |
| Cardiac output is 30-50% higher in _______ to meet oxygen demands. | infant |
| YOU SHOULD MONITOR THE APICAL PULSE OR HEART RATE UNTIL AGE __.********* | SIX |
| T / F ALL PATIENTS ARE ON CARDIAC MONITOR, PULSE, 02 SAT, BP DURING RECOVERY | TRUE |
| WHAT IS THE FIRST SIGN OF DECOMPENSATION IN YOUNGER CHILDREN? | BRADYCARDIA |
| BRADYCARDIA IN YOUNGER CHILDREN CAN BE CAUSED ALSO BY PARASYMPATHETIC STIMULATION. PARASYMPATHETIC STIMULATION WOULD MOST LIKELY BE FROM ________ OR _________. | SUCTION OR DEFECATION |
| IN YOUNGER CHILDREN THE CARDIAC STROKE VOLUME IS FIXED BECAUSE .... | THE MYOCARDIUM IS LESS CONTRACTILE THAN IN AN ADULT. |
| SINCE THE STROKE VOLUME IS FIXED IN CHILDREN INCREASING FLUIDS (PRE-LOAD) WILL NOT.... | NOT... INCREASE CARDIAC OUTPUT, |
| TO INCREASE THE CARDIAC OUTPUT IN CHILDREN, INCREASE HEART RATE WITH _____ NOT _____. | MEDS NOT FLUIDS. |
| THE PEDIATRIC PATIENT'S ECG MAYBE DOUBLE COUNTED ON THE CARDIAC MONITOR BECAUSE.......... | THE T-WAVES MAY BE THE SAME SIZE AS THE QRS (BECAUSE OF THE LEAD PLACEMENT CLOSE TO THE HEART). |
| pediatric bradycardia usually means patient needs .... | more 02 |
| WHAT % OF PEDIATRIC PATIENTS HAVE EMERGENCE DELIRIUM. | 18 |
| *******EMERGENCE AGITATION IS A MILD STATE OF RESTLESSNESS / MENTAL DISTRESS WHICH MAY BE CAUSED BY..... | HYPERCAPNIA, HYPOXIA, AIRWAY OBSTRUCTION, RESIDUAL MUSCLE RELAXANT, PAIN, GASTRIC DISTENTION, URINARY DISTENTION, CEREBRAL EMBOLIZATION, HEMMORRHAGE, HYPOPERFUSION, METABOLIC ISSUES. |
| in pacu A CRYING CHILD IS A ..... | HEALTHY CHILD!!!! |
| A PEDIATRIC PATIENT LOSES 75% OF BODY HEAT THROUGH THEIR.... | HEAD |
| HYPOTHERMIA IN A PEDIATRIC PATIENT CAN INCREASE METABOLISM AND OXYGEN CONSUMPTION WHICH CAN LEAD TO..... | METABOLIC ACIDOSIS |
| IF A PEDIATRIC PATIENT IS HYPERTHERMIC YOU SHOULD SUSPECT..... | INFECTION OR MALIGNANT HYPERTHERMIA. LOWER TEMP GRADUALLY,, DO NOT UNCOVER COMPLETELY. |
Created by:
kbpacurn