Anestesia

Question 1

What is a nursing diagnosis related to anesthesia?

Answer 1

High risk for injury related to anesthesia

Factors include drug reactions, airway issues, cardiac output, fluid imbalance, ineffective breathing, altered thought processes, and thermoregulation issues.

Question 2

What factors influence the risk for complications during anesthesia?

Answer 2

Factors include:
* Type of anesthesia
* Anesthetic agents
* Surgical procedure
* Patient’s pre-anesthesia physiologic condition

Question 3

What are the desired outcomes after anesthesia?

Answer 3

Outcomes include:
* Successful recovery
* Return to pre-anesthesia physiologic state
* Normothermia
* Unimpeded air exchange
* Adequate ventilation
* Maintenance of cardiac output and fluid volume
* Electrolyte balance
* Absence of allergic reaction
* Unimpaired thought processes

Question 4

What is the Aldrete scoring system used for?

Answer 4

To assess a patient’s recovery from general anesthesia

Evaluation criteria include patient activity, respiration, circulation, and oxygen saturation.

Question 5

What does a patient’s discharge from the PACU depend on?

Answer 5

Discharge depends on the score achieved on each criterion of the Aldrete system.

Question 6

Who documents relevant times related to the anesthesia procedure?

Answer 6

The anesthesia provider and the circulating nurse.

Question 7

What is included in the hand-off report to the PACU nurse?

Answer 7

Report includes:
* Patient name, age, and sex
* Surgical procedure
* Surgeon and anesthesiologist/CRNA/AA
* Anesthetic agents/technique
* Intraoperative medications
* Estimated blood loss
* Fluid and blood administration
* Urine output
* Response to surgery/anesthesia
* Lab results
* Chronic and acute health history
* Drug allergies
* Concerns, possible problems, and desired patient outcomes not met
* Discharge plan

Question 8

What are the responsibilities of the perioperative nurse?

Answer 8

Responsibilities include:
* Assist anesthesia provider and PACU nurse
* Stabilize the patient
* Provide patient care through recovery in some facilities
* Demonstrate competence in monitoring equipment and interpreting data

Question 9

What is the trend in preoperative testing?

Answer 9

The trend is toward minimal preoperative testing; healthy patients may require no laboratory or diagnostic procedures.

Question 10

What should be confirmed for all female patients of child-bearing age?

Answer 10

Confirmation of pregnancy status.

Question 11

What does the ASA classification system assess?

Answer 11

The patient’s physical status, ranging from PS 1 (normal healthy patient) to PS 6 (declared brain-dead).

Question 12

What is the significance of the ‘E’ in ASA classification?

Answer 12

‘E’ denotes emergency surgery.

Question 13

What should preanesthesia instructions include?

Answer 13

Instructions should include:
* Preoperative shower or enema
* Medications to be taken
* Food and liquid intake guidelines
* Expectations of the surgical experience

Question 14

Fill in the blank: Patients receiving general anesthesia have been instructed to take nothing by mouth (NPO) for ______ hours prior to surgery.

Answer 14

6 to 8

Question 15

What are the fasting recommendations for healthy patients?

Answer 15

Recommendations include:
* Clear liquids: 2 hours
* Human milk: 4 hours
* Infant formula: 6 hours
* Nonhuman milk: 6 hours
* Light meal: 6 hours
* Fried or fatty foods: 8 hours

Question 16

True or False: The fasting guidelines apply to all patients regardless of their health conditions.

Answer 16

False

Question 17

What conditions may require modified fasting guidelines?

Answer 17

Conditions include:
* Coexisting diseases affecting gastric emptying
* Pregnancy
* Obesity
* Gastroesophageal reflux disease
* Emergency care
* Difficult airway management

Question 18

What should patients on beta-blockers do prior to surgery?

Answer 18

Take their beta-blocker medication prior to arrival.

Question 19

What should be assessed in patients who will be intubated?

Answer 19

Assess for:
* Cracked lips
* Lacerations
* Loose or chipped teeth
* Remove dentures

Question 20

How does smoking affect surgical patients?

Answer 20

Smokers experience:
* More difficulty with wound healing
* Increased pulmonary and cardiac complications
* Increased need for postoperative intensive care
* Longer hospitalization
* Need for increased anesthetic dosages

Question 22

What are the primary purposes of anesthesia medications?

Answer 22

To induce amnesia, analgesia, and muscle relaxation

Question 23

List the factors that influence the selection of anesthetic agents and techniques.

Answer 23

• Age
• Medical history
• Current physical status
• Emotional or mental status
• Intended surgical procedure
• Expected length of recovery
• Patient preference
• Surgeon preference
• Anesthesia provider preference
• Previous anesthesia experience
• Elective versus emergent surgery
• Postoperative pain management considerations

Question 24

What are the different anesthesia techniques?

Answer 24

• General anesthesia
• Regional anesthesia
• Local anesthesia
• Moderate sedation/conscious sedation

Question 25

What is general anesthesia?

Answer 25

Depresses the central nervous system, rendering the patient unconscious and reflexes obtunded

Question 26

What are the characteristics of general anesthesia?

Answer 26

* Amnesia * Analgesia * Muscle relaxation

Question 27

What is regional anesthesia?

Answer 27

Anesthesia effects limited to a region of the body, such as a limb or lower half

Question 28

What are the two divisions of regional anesthesia?

Answer 28

* Central techniques (neuraxial blocks) * Peripheral techniques (plexus blocks, single nerve blocks)

Question 29

How can regional anesthesia be administered?

Answer 29

* As a single injection * By inserting a catheter for prolonged medication administration

Question 30

What is an intravenous regional block (Bier block)?

Answer 30

Isolates limb vasculature with a double tourniquet and injects local anesthetic into the vein

Question 31

What is local anesthesia?

Answer 31

A form of regional anesthesia that infiltrates a small, localized area

Question 32

What is moderate sedation/analgesia also known as?

Answer 32

Conscious sedation, anesthesia standby, or local standby

Question 33

What does monitored anesthesia care (MAC) require?

Answer 33

Presence of an anesthesia provider for monitoring

Question 34

What is the typical timing for administering oral preoperative medications?

Answer 34

60 to 90 minutes prior to surgery

Question 35

What are the goals of preoperative medication?

Answer 35

* Reduction of anxiety * Sedation * Analgesia * Amnesia * Prevention of nausea and vomiting * Reduction in gastric volume and acidity * Facilitation of induction * Reduction of risk of allergic reaction * Decrease of secretions * Prevention of infection

Question 36

What types of agents are commonly used for preoperative medication?

Answer 36

* Benzodiazepines (e.g., midazolam, diazepam) * Barbiturates (e.g., secobarbital, pentobarbital) * H2-receptor blocking agents (e.g., ranitidine, cimetidine) * Dopamine antagonists (e.g., metoclopramide) * Anticholinergic agents (e.g., atropine, scopolamine) * Antiemetic agents (e.g., ondansetron, diphenhydramine)

Question 37

What conditions suggest a high risk for aspiration?

Answer 37

* Morbid obesity * Old age * Pregnancy * History of hiatal hernia with reflux * Uncertain NPO status with emergency surgery * History of diabetes with gastroparesis * History of partial bowel obstruction * History of peptic ulcer disease

Question 38

What are the effects of anticholinergic agents?

Answer 38

* Decrease oral and tracheobronchial secretions * Prevent bradycardia * Act as antiemetics

Question 39

What is the purpose of administering prophylactic antibiotics before surgery?

Answer 39

To reduce the incidence of surgical site infections (SSI)

Question 40

What factors influence the choice and timing of antibiotic administration?

Answer 40

* Probable risk of infection * Probable contaminating flora * Activity of the antibiotic against pathogens

Question 41

What are common narcotics used for pain relief?

Answer 41

* Meperidine * Fentanyl * Alfentanil * Sufentanil * Remifentanil * Hydromorphone * Morphine

Question 42

True or False: Patients undergoing general anesthesia should expect their premedication to put them to sleep.

Answer 42

False

Question 43

What is the importance of patient monitoring during anesthesia?

Answer 43

Detects physiologic changes and allows for timely interventions

Question 44

What standards has the ASA established for intraoperative monitoring?

Answer 44

Qualified anesthesia personnel should be present and the patient's oxygenation, ventilation, circulation, and temperature should be continually evaluated

Question 45

What types of monitoring devices are used during anesthesia?

Answer 45

* Invasive monitors * Non-invasive monitors

Question 46

What is pulse oximetry used for?

Answer 46

Measures oxygen saturation of arterial hemoglobin

Question 47

What do pulse oximetry readings below 90% indicate?

Answer 47

Significant hypoxemia

Question 48

Fill in the blank: Oxygen saturation readings should be near _______.

Answer 48

100%

Question 49

What physiological condition can result from prolonged hypoventilation?

Answer 49

Accumulation of carbon dioxide

Question 50

What is the significance of satisfactory oxygen saturation readings from pulse oximetry?

Answer 50

They are not a guarantee that tissues are being adequately perfused with oxygen. ## Footnote Other factors, such as hemoglobin level, must also be considered because hemoglobin carries oxygen.

Question 51

What can cause respiratory acidosis in patients?

Answer 51

Hypoventilation for an extended period. ## Footnote Respiratory acidosis can occur more rapidly than a decrease in oxygen saturation.

Question 52

What has improved pulse oximetry technology diminished the impact of?

Answer 52

Nail polish and acrylic nails on oximetry readings.

Question 53

Name two factors that can interfere with the accuracy of pulse oximetry readings.

Answer 53

* Bright lights * Intravascular dyes, such as methylene blue

Question 54

What conditions can prevent an accurate pulse oximetry reading?

Answer 54

* Vasoconstriction * Raynaud’s disease * Severe peripheral vascular disease * Hypotension

Question 55

What does blood pressure monitoring measure?

Answer 55

The pressure in the heart during contraction and relaxation.

Question 56

What should be avoided when positioning blood pressure cuffs?

Answer 56

Compressing IV lines.

Question 57

What effect does general anesthesia have on the hypothalamus?

Answer 57

It prevents the patient from compensating for changes in ambient temperature.

Question 58

Define unintended hypothermia.

Answer 58

Core body temperature less than 36ºC/96.8ºF.

Question 59

List factors contributing to hypothermia in surgical patients.

Answer 59

* Low temperature setting in the operating room * Evaporation of surgical skin preparation * Exposure of body tissues in open procedures * Infusion of cool fluids * Effects of anesthetic drugs

Question 60

What are the consequences of unintended hypothermia?

Answer 60

* Decreased resistance to infection * Discomfort and stress on the body * Increased oxygen consumption due to shivering * Increased duration of action of medications * Increased length of hospital stay * Increased risk of morbid cardiac events

Question 61

How does maintaining normal body temperature during the perioperative period affect patient outcomes?

Answer 61

It has a positive impact on patient outcomes and patient satisfaction.

Question 62

What correlation exists between intraoperative hypothermia and surgical site infections (SSIs)?

Answer 62

Temperature less than 35ºC doubles the risk for postoperative SSI.

Question 63

Who are patients at greatest risk for unplanned hypothermia?

Answer 63

* Infants * Young children * The elderly * Patients with endocrine disorders

Question 64

What is the most effective method for maintaining normothermia during surgery?

Answer 64

Forced-air warming blankets.

Question 65

When should a forced-air warming blanket be used?

Answer 65

Beginning in the preoperative period and continuing throughout the intraoperative and recovery periods.

Question 66

What is the most significant change in patient temperature during surgery?

Answer 66

The first hour of surgery.

Question 67

What should be monitored if a procedure is expected to last more than 30 minutes?

Answer 67

The patient’s temperature.

Question 68

What is one method to help maintain normal body temperature in infants?

Answer 68

Using a head covering made from stockinette and Webril to wrap the arms and legs.

Question 69

What additional measure can be taken to prevent hypothermia in the operating room?

Answer 69

Raising the temperature of the room.

Question 70

How should warm fluids and IV solutions be administered?

Answer 70

Strictly according to the manufacturer’s instructions.

Question 71

What does capnography monitor?

Answer 71

The inhaled and exhaled concentration or partial pressure of carbon dioxide in the respiratory gases.

Question 72

What does carbon dioxide do in capnography?

Answer 72

Absorbs infrared radiation.

Question 73

What do most capnography units provide?

Answer 73

A digital display of end-tidal CO2 and a waveform readout of expired CO2 partial pressure versus time.