Anesthesia Flashcards
(185 cards)
1
Q
What does anesthesia mean?
A
no sensation
2
Q
Anesthesia providers include?
A
- Anesthesiologist
- Certified Registered Nurse
- Anesthesia Assistance (Tech)
3
Q
What is considered clear liquids preoperatively?
A
- Water
- Sugar water
- Apple Juice
- Tea
- pedialyte
- black coffee
Stop 2 hours before surgery
4
Q
When do you stop Human Milk before surgery?
A
Stop 4 hours before surgery
5
Q
Infant milk or non human milk
A
stop 6 hours
6
Q
When do you stop Light meal toast and liquids?
A
6 hours before surgery
7
Q
When do you stop eating before surgery Heavy meals, fatty food, meat and alcohol, large volume?
A
8 hours before surgery
8
Q
Types of pt with delayed gastric emptying
A
Diabetic
obese
opioid use
9
Q
When do you stop Gastric tube feeding before surgery?
A
clear liquid- 2 hours
other liquids- 6 hours before surgery
10
Q
When do you stop Jejunal tube feeds?
A
may continue until time of surgery
11
Q
What are types of Regional anesthesias?
A
- Epidural
- Spinal
- axillary
- interscalene
- femoral
- sciatic
12
Q
What are common inhalation anesthetics?
A
FLUs nitrous oxide isoflurane sevoflurane desflurane
13
Q
Common IV anesthetics
A
propofol ( contains egg yolk pain on injection)
ketamine
etomidate
thiopental
14
Q
What is a depolarizing muscle relaxant?
A
succinylcholine
15
Q
non depolarizing muscle relaxant
A
URIUMs Cistracurium Rocuronium pancuronium vecuronium
16
Q
What are types of Benzodiazepine muscle relaxant?
A
produces, sedation and amnesia
Midazolam-Versed
Diazepam-Valium
Lorazepam- Ativan
17
Q
Narcotic muscle relaxant
A
Fentanyl rapid onset short duration
Morphine Sulfate
Meperidine (demerol) decreases shivering
18
Q
- Phases of General Anesthesia
A
- Induction
- Maintenence
- Emergence
19
Q
What occurs during the Excitement period of induction?
A
increase HR
High blood pressure
RN should remain at pt side(keep noise low)
20
Q
minimal sedation (anxiolysis)
A
pt respond normally to verbal command
21
Q
moderate sedation- conscious sedation
A
pt respond purposefully to verbal command
22
Q
deep sedation
A
pt cannot be easily aroused but responds purposefully following repeated painful stimulus
23
Q
*reflex withdrawal
A
from a painful stimulus is not considered a purposeful response
24
Q
infant, children preference for anesthesia
A
general
25
adults preference for anesthesia
regional and local for less invasive procedure
26
What physiological factors influence the choice of anesthesia
1. coexisting diseases( neuromuscular impairment, prefer no muscle relaxants when possible
2. High risk Intubation: prefer regional, spinal or local anesthesia
27
What psychological factors influence the choice of anesthesia
mentally and emotionally uncooperative pt prefer general anesthesia
28
What is the ASA classification influence on the choice of anesthesia?
Type and duration of surgical procedure
| long procedure: general
29
What type of anesthesia should you consider in prone position?
prone: ensure good airway and ventilation
prefer: general
30
Other factors influencing the determination of anesthetic technique includes
1. postop pain management
2. pt understanding and wish
3. expertise of anesthesia provider
4. surgeon preference
31
Intraoperative monitoring includes?
1. Airway
2. Ventilation
3. oxygenation
4. circulation
5. depth of anesthesia
6. muscle relaxation
7. temperature
32
What are types of Airway support?
1. spontaneous ventilation
2. blow by O2
3. Nasal canula
4. Face mask
5. Mask ventilation with or without
laryngeal mask airway
Et tube
33
What is the definition of General anesthesia?
is the reversible state of unconsciousness
34
What is Balanced anesthesia ?
A combination of drugs that is used together for the purpose of its beneficial effects
35
What technique is used for General Anesthesia: induction method?
Inhalation
| Iv method
36
What is the phase of Induction?
awake state to anesthetized state (unconscious)
37
General Anesthesia: Before Induction
| RN responsibilities
- Be immediately available for assistance
- Check that suction is operational and within reach
- Know the location of emergency equipment, tracheostomy supply
- provide comfort and safety measures
- stay with the pt
- secure safety straps
- Keep pt covered for warmth and privacy
- Inform the pt when applying cold monitor leads and safety strap
- Be prepared to handle ET tube because anesthesia agent will result in rapid loss of consciousness
- Focus on pt and be at their side
38
What type of general anesthesia is used in children?
Inhalation agents are mostly used in children and masks are flavored for them
39
Methods of ET tube intubation
- Direct laryngoscopy
- Light wand
- Fiberoptic intubation
- Fast track laryngeal mask airway
- retrograde intubation
- blind nasal intubation
40
What can cause adverse events during intubation?
- reactive airway
| - aspiration
41
What pts are at risk for reactive airway?
- smoking, asthma, and other respirator conditions
| - at higher risk for bronchospasm or laryngospasm
42
What is the treatment for reactive airway?
administration of inhalants or bronchodilators before induction
43
What are risk factors for Aspiration?
- full stomach
- hx of gerd
- hiatal hernia
- obesity
- pregnancy
- ET tube of conscious pt
- tumor or polyp on vocal cord( may cause pt to aspirate blood)
44
What are preoperative measures to prevent aspiration?
- perform a thorough pre-sedation evaluation
- provide appropriate instruction and compliance with preoperative fasting guidelines
- -Neutralize stomach content pre-op (reglan, pepsid, bicitra)
- administer antiemetics such as ondansetron, zofran, droperidol, metoclopromide
45
What is rapid sequence intubation
- Another way to prevent aspiration
- perioperative RN are often requested to assist by applying cricoid pressure
( the cricoid cartilage is the only complete ring in the trachea)
46
What is applying cricoid pressure known as?
Sellicks maneuver
47
What fingers are used to apply cricoid pressure?
thumb and index
48
*When do you remove pressure from the cricoid?
Not until the ET tube placement is confirmed by anesthesia and the cuff is inflated and anesthesia provider says to let go, DO NOT let anyone take over
49
How is ET placement confirmed?
- Lack of breath sounds over stomach
-presence of bilateral and equal breath sounds over the chest
- symmetric movement of thorax with positive ventilation
- presence of condensation of moisture
from expired air in ET tube
50
When does the maintenance phase of general anesthesia begin?
- * starts with skin incision and proceeds throughout the surgery
- surgery is performed and medications are titrated to keep pt at a safe plateau
51
When is the emergence phase of general anesthesia?
- during the emergence phase, the pt exhibits spontaneous, regular breathing
- regain consciousness
- is extubated
52
What are possible adverse events during emergence?
1. Hypoxia
2. hypoventilation
3. Laryngospasms
53
What are causes of hypoventilation?
- pt tongue obstructing the airway ( reposition head)
- muscle relaxant not being fully reversed
- CNS depressants to help prevent hypoventilation
( encourage DB and check muscle strength by asking to lift their heads > 5 seconds
54
What causes laryngospasms?
- protective mechanism caused by spasm of vocal cord
- may experience d/t secretions, anesthetic agents, that act as irritants or trauma to vocal cord
- Most common after extubation
- exhibit stridor crowing
55
What is emergence delirium?
- responsive or unresponsive agitation or hyperexcitability state after emerging from anesthesia
- may need to reanesthesize and reawaken
56
possible cause of emergence delirium?
r/o hypoxia
57
General Anesthesia: Lost airway
THIS IS AN EMERGENCY
- pediatric tubes can be uncuffed which places a higher risk of dislodgement of ET tube
- Malignant hyperthermia is another true emergency
58
What is croup caused by ?
1. glottis
| 2. tracheal edema
59
What is Regional Anesthesia?
Anesthesia to a designated area of the body
60
*What are some nursing considerations for regional anesthesia?
- correct site
- monitor for toxic reaction
- Monitor for complications of blocks
- monitor for sensation and movement of pt extremity
61
How does toxic reaction occur?
- when concentration of drug in the blood affects the CNS or when local or regional anesthesia is injected inadvertently into the intravascular space
62
What are classic toxic signs of the CNS?
- Slurred speech
- numbness of tongue
- blurred vision
- tinnitus
- lightheadedness
63
What are classic toxic signs of cardiovascular system?
- ecg change
- cardiac output
- blood pressure change
64
What are severe symptoms of toxic reaction?
- asystole
- sinus bradycardia
- hypotension
- muscle twitching
- tremors
- seizure
- cardiovascular collapse
- LAST) local anesthetic toxicity can cause cardiac arrest
65
Local Anesthetic System Toxicity (LAST)
Uncommon potentially fatal toxic reaction that occurs when the threshold blood levels of a local anesthetic are exceeded by inadvertent, intravascular injection or slow systemic absorption of large volume of local anesthetic
66
What are complications of blocks?
- pneumothorax
- atelectasis
- air embolism
- laryngeal nerve paralysis
67
What considerations should be monitored for sensation and movement of patient's extremity?
- position limb to ensure no pressure on nerves or bony prominences and the limb is secure
- CMS checks
- Motor functions returns first after anesthesia followed by sensory function
- additional pain med if short acting is used
- remind pt of limited control of extremity and importance of immobilizer device to prevent injury
68
What are contraindications for epidural and spinal techniques?
pt who are:
- experiencing bleeding
- on anticoagulation drugs
- experiencing increase intracranial pressure
- experiencing septicemia
- experience skin infection at the insertion site
- experiencing systemic disease with neurological sequelae
- hypotension
- refusing these techniques
69
What pt factors should be taken into consideration before epidural or spinal technique ?
- hx of spinal deformities
- previous spinal surgery
- psychological status of the pt
- age( these techniques are contraindicated in children
70
Spinal HA- (spinal and epidural adverse reaction and complication)
- incidence(rare event)
- size of catheter to percent of pts who get postop headaches
-Cause: loss of CSF from dura leak
- duration: up to 3 days
- Tx: HOB flat; Hydration: Analgesics
Severe cases require epidural blood patch
Anesthesia will obtain 5-10 ml autologous blood and inject at puncture site
71
Hypotension (spinal and epidural adverse reaction and complication)
- Technique blocks the vagus nerve causing vasodilation and stasis of blood
- Caution when moving pt may cause sudden drop in BP
- May exhibit bradycardia
- Tx elevate HOB; Increase IV rate, administer Vasopressors, oxygen, administer atropine for bradycardia
72
Nausea( spinal and epidural adverse reaction and complication)
- Cause: hypotension and motion changes
- NAUSEA is the first sign of hypotension
- Treatment: increase fluids, change position slowly and administer antimetic
73
Respiratory Depression (spinal and epidural adverse reaction and complication)
- Difficultly breathing
- Causes : sedative medication paralysis of PHRENIC NERVE
- Tx: treat underlying cause of respiratory depression
74
Bladder Distention (spinal and epidural adverse reaction and complication)
-Cause: sacral autonomic fibers are last to recover; pt lacks sensation of full bladder
Tx: assess bladder distension offer urinal or bedpan and obtain order to catheterize bladder
75
Falls (spinal and epidural adverse reaction and complication)
- Prevention of falls is a key concern for pt who have received an epidural or spinal anesthetic
76
Skin Breakdown
- Pt are at risk on their heels, sacrum and other bony prominences while recovering from spinal or epidural anesthesia
77
What are complications of spinal and epidural anesthesia?
1. Neurogenic Shock or Total spinal anesthesia
Cause: high levels of anesthesia which causes partial paralysis of the respiratory muscle, myocardial depression and hypotension
THIS IS AN EMERGENCY!!!!!!
2. CNS disturbance
Causes: Accidental injection of medication into the epidural vein
local anesthetic toxicity can cause CARDIAC ARREST
78
What are s/s of Neurogenic shock
- Tachycardia
- Hypotension
- Pallor
- Clammy Skin
- Sweating
- Dysrhythmia
79
What is the treatment for Neurogenic Shock
immediate ventilation and prepare for intubation and administration of vasopressors and IV fluids
80
S/S of CNS Disturbances
- Slurred speech
- Numbness of tongue
- blurred vision
- tinnitus
- talkative euphoria
- restlessness
- muscle twitching
- convulsion
- coma
81
Treatment for CNS disturbances
- Diazepam
- barbiturates
- mechanical ventilation
- vasopressors
82
Complications of general and regional anesthesia Postoperatively?
- Ineffective breathing
- Fluid volume deficit( hypovolemia)
- Hypertension
- Cardiac output decrease or arrhythmia
- Injury to extremity
- Alteration in body temperature
- Shivering
- n/v
- pain and discomfort cause by ineffective comfort and pain management
- GI status
- DVT or Emboli
- Corneal abrasion
83
S/S of alteration in breathing patterns
- Oxygen sats less than 90
- Restlessness/agitation
- Confusion/delirium
- Anxiety
- Crowing
- Difficulty breathing
84
Alteration in breathing patterns include
- airway obstruction
- respiratory depression
- aspiration
85
What is pharyngeal obstruction?
- sagging tongue
86
How do you treat pharyngeal obstruction?
Stimulate the pt and reposition airway
87
Pharyngeal obstruction cause?
hypoxia caused by PE and Pneumothorax
| intrapulmonary shunts and DECREASED cardiac output
88
How do you assess for airway obstruction?
by auscultation of the lungs
observing chest movement
feeling for flow of expired breath with the hand
89
Alteration in breathing pattern: Laryngospasm
- Irritable airway
- Can become hypoxic
- RN should present calm demeanor
and reassure the pt
Tx: positive pressure ventilation by mask/bag medication for muscle relaxants or reintubation.
90
Alteration in breathing pattern: Respiratory Depression?
Opioids can lead to respiratory depression
91
Alteration in breathing pattern: Bronchospasm
-Lower airway obstruction spasm of the bronchiole tubes
92
S/s of bronchospasm
- wheeze
| - dyspneic can suffer total airway closure
93
Treatment for bronchospasm
- inhaled bronchodilators
- IV aminophylline
- Steroids
- Life threatening is treated with epinephrine
94
Fluid volume deficit
- Blood loss can manifest as hypotension
| - Tachycardia may indicate hypovolemia, hypoxia, pain, or anxiety
95
Hypovolemia
-Hemorrhage
-Inadequate fluid replacement
- Anesthetic or other medication
- Anaphylactic reactions
Tx: epinephrine, antihistamine, additional, IV fluids
96
Hypotension
- Fluid volume loss
- cardiac dysfunction
- anesthetic medication
97
Clinical signs of hypotension
- Rapid thready pulse
- disorientation
- restlessness
- Oliguria
- Cold pale skin
98
Treatment for hypotension
- IV saline
- LR at max rate
- Oxygen
- Cardiac Stimulants
- Hemodynamic monitor
99
Arrhythmia
- disorders of the heart rhythm d/t electrical problems
100
Causes of Arrhythmia?
- Abnormal levels of blood levels of potassium
- MI or damage to heart muscle from pa MI
- Congenital heart diseases, heart failure, cardiomyopathy
- An overactive thyroid gland
- Medication, ETOH, Caffeine, Cigarette smoking
101
S/s of arrhythmia?
CP
Diaphoresis
Dyspnea
Dizziness
102
Treatment of arrhythmia?
Medication
Oxygen administration
IV solution
Cardioversion
103
Types of arrhythmia
1. Bradycardia
2. Tachycardia
3. PVC
4. Atrial Fibrillation
104
Bradycardia causes
- Vagal stimulation or pressure on internal organs
| - Administration of opioid and reversal agents
105
Tachycardia
- Inadequate blood volume
- hypoxia and fever
- pain
106
PVC
- Hypoxia
- Low potassium
- Low magnesium
- Cardiac ischemia
107
Atrial fibrillation
- A flutter
- multifocal atrial tachycardia
- paoxysmal superaventricular tachycardia
- sick sinus syndrome
- ventricular fibrillation
- Vtach
- wloft- parkinson white syndrome
108
Types Positioning injury: - Brachial Plexus Injury
- Arm placed greater than 90 degree
- Obturator nerve
- Saphenous Nerve
-Femoral Nerve
Skin burn by prep and ESU pad
109
During regional anesthesia position pt
in a natural body alignment
| move pt slowly
110
Standard discharge criteria for spinal, epidural anesthesia from PACU is?
pt must stand, walk and void
111
Hypothermia
- Core body temp less than 96.8
- * vulnerable pt include ELDERLY and PT UNDER 2 yrs
- High risk pt: BURN and NEONATES, pt going under general with NEUROAXIAL anesthesia
112
Contributing factors for hypothermia?
- general anesthesia depresses the hypothalamus preventing pt from compensating for the temperature in the OR
113
Treatment of hypothermia
full body active warming device and fluid blood warmers
114
Shivering
can raise the pt OXYGEN CONSUMPTION by 300-400% resulting in HYPOXIA, HYPERCARBIA, and ACIDOSIS
this is dangerous for a pt with cardiac hx
115
Treatment for shivering?
Demerol 25-50 mg IV
116
N/V
increase to 30% experience postop
117
Preoperative risk factors for N/V?
- FEMALE gender
- Non smoker
- Motion sickness
- Obesity
- Hx of N/V
- Young
- Pain
- Middle ear and endoscopic surgery
118
Treatment for N/V
- protect AIRWAY
- Antiemetic, zofran, anapsine, reglan
- Prevent rapid movement
- Head elevation for awake pt
- Place sedated/ non reactive pt on side
119
SEDATION and RELAXATION put a pt at risk for ?
aspiration
120
pain management?
```
nsaid
cox-2 inhibitor
pca
epidural catheter placement and delivery
Single shot extended relieve
```
121
Comfort measures for pain?
- position for comfort
- DB&C
- talk quietly w pt
- apply heat or cold at surgical site
- distract wit music
122
Physiological S/s of pain?
- elevated BP
- Perspiration
- Dilated pupils
123
What are complications from unrelieved post op pain?
- Reduced lung compliance/thoracic movement
- Decreased mobility
- Delay in return of bowel function
124
GI Status alteration: Postop Ileus
- Normal pt returns several hours after surgery
| -
125
Stomach motility returns to normal
24-48 hours after surgery
126
Large intestine returns to normal
48-72 hours after surgery
127
Delay in normal peristalsis is caused by?
- Mechanics of surgery ( manipulation of the instestine)
- Medications
- Hormones
128
Neurogenic causes of delay peristalsis?
- Inflammation
- Open laparotomy
- Mis cases peristalsis can be up to 3 to 5 days
129
Postop ileus (paralytic Ileus)
- gastromotility is delayed beyond 72 hours after surgery
-Causes: bloating
n/v
pain
discomfort can lead to bowel obstruction
130
The presence of bowel sounds indicate
return of small intestine motility
131
The presence of indicate peristalsis has returned
flatus and stool
132
VTE
- all pt at risk
- occur in lower extremity
- pe may result
- tx combo of non pharmacologic/ pharmacologic factors
133
VTE cause?
- venous stasis
- vessel wall injury
- hyper-coagulability
134
Corneal abrasion
pt undergoing general anesthesia have risk
135
S/s of corneal abrasion
- photosensitivity
- tearing
- pain
- complaining of sand in the eye
136
treatment of corneal abrasion
- artificial tear drops to eyes as lubricant
- taping eyelids
- protecting pt from scratching their eyes
137
Anesthesia awareness cause?
inadequate anesthesia , equipment failure, or misuse
- High Risk Surgeries( using deep anesthetic may not be in the best interest of the pt
- Lasting Impact ( Some pt may experience PTSD after anesthesia awareness event
138
Preventing anesthesia awareness?
- Performing ongoing research
- using clinical judgement
- brain monitoring device
139
Local anesthesia: AMIDES
- Bupivicaine
- Mepivacaine
- Lidocaine
- Ropivacaine
* Reduce doses in
Young
Geriatric
Debilitated patients
140
Ester
- Cocaine
- Procaine
- Proparacaine
- Tetracaine
- Chloroprocaine
141
Adverse reactions to local anesthetics ?
- Urticaria
- Tachycardia
- Laryngeal edema
- N/V
- Increase temp
- Low BP
anaphylactic shock
142
Local anesthetic toxicity?
- Metallic taste
- Syncope, lightheadedness, visual disturbances
- numbness of tongues
- confusion, tremors, shivering, seizure
- heartrate changes
- cardiac or respiratory arrest
143
Berlin questionnaire
Tool to assess a pt for obstructive sleep apnea
144
Bispectral Index
RN can assess pt level of consciousness
145
Aldrete Scale
Assess pt readiness for discharge
146
Naloxone
Reversal agent for opioids
| onset 1-2 mins duration 30 mins
147
Flumazenil
reversal agent for benzodiazepine
| onset 1-2 mins duration 30-60 minutes
148
Tools for assessing anxiety?
- Rapid assessment anxiety tool
- State trait anxiety inventory
- Visual analog
149
before administering moderate sedation
- baseline vs
- o2 sats
- inspect iv
- o2 tank > 500
- o2 pulse alarm on
- communication process establish with pt
150
Valium
-sedative
- titrate 1-2mg
-onset 30 seconds to 2 min
-duration 2-4 hours
kids
0.1-02mg/kg
*contraindicated in glaucoma
151
Versed
- Sedative
- Titrate 0.5-1mg( 2 min in between dose)
- Kids 0.02-1.0 mg/kg po nasally
152
Morphine
- Narcotic
- 10 mg increment
- onset 1-3 minutes
- duration 4 hours
153
Demerol
- Narcotic
- 10 mg increment
- 1-2 mg
- Onset 1-3
- Duration 1-3 hr
154
Fentanyl
- Narcotic
- kids 1-2 mcg/kg
- Onset 1-3 mins
- Duration 30-60
155
Desirable Effects of sedation?
- intact protective reflexes
- relaxation
- comfort
- cooperation
- appropriate level of verbal communication
- patent airway with adequate ventilation
- easily a rousable
156
Undesirable effects of sedation?
- Loss of reflexes
- aspiration
- slurred speech
- difficult to arouse
- agitation
- hypo/hypertension
- respiratory depression
- airway obstruction
- apnea
157
Midazolam adverse reaction
hiccups
158
Benzo adverse reaction
decrease reflex
159
Narcotic adverse reaction
decrease respiration
hypotension
n/v
160
Fentyl adverse reaction
itchy nose
| chest wall rigidity
161
Hemodynamic Monitoring
```
Candidates
- Pt who suffer from
r/l heart failure
-Cardiac valvular disease
-Cardiogenic shock
- Respiratory distress
- Trauma
- High risk surgery
-Cardiac surgery
-Surgery requiring controlled hypotension
```
162
What measuring device is used to monitor circulating blood?
- CVP central venous pressure
- Left side heart pressure
- Adequacy of blood flow to hand
163
What is central venous pressure?
- Measured in the right atrium
- assesses cardiac preload
- reading is the amount of venous blood flow returning to the heart
- it is affected by blood volume, vascular tone (venous) right ventricular function and pulmonary tree pressure
- used as indirect late index of Left ventricular function
164
What is a Normal CVP readings?
- spontaneous breathing pt: 5-10 cm/h2O
| - ventilated pt increases 3-5 cm/H2O
165
What causes decrease CVP?
- Hemorrhage
- Fluid loss
- Venous pooling
166
What causes increase in CVP?
- Fluid volume overload
- Right ventricular failure
- Cardiac Tamponade
- Pulmonary hypertension (COPD, PE)
- Left ventricular failure( Pulmonary Edema)
167
What are complications related to changes in CVP?
- Pneumothorax
- Arterial Puncture
- Air embolism
- Infection
168
What is a pulmonary artery catheter (PAC)
- Left sided heart pressure
| - measures hearts ability to maintain its pumping efficiency
169
PAC is performed in order to ?
- evaluate heart failure
- determine if pulmonary edema is caused by a weak heart or leaky pulmonary capillaries
- Monitor therapy after MI
- Check fluid balance of pts in shock as well as those recovering from heart surgery, burns, or kidney disease
- Monitor effects of medication on the heart
170
PAC procedure
PAC catheter
- has four lumens with ports for right atrium
- pulmonary artery
- balloon
- cardiac output
171
Inserting a PAC
- Use sterile technique
- Access to large central vein is obtained
- Internal jugular is used also subclavian
- Catheter is passed through the right atrium
- and right ventricle out to the pulmonary artery
- Highest risk of pneumothorax when subclavian is used*
- Caution with internal jugular vein because artery is near by
- If the carotid is inadvertently pierced the pt requires heparinization for the procedure ( case may be cancelled d/t possibility of formation of an expanding hematoma in the neck area
- PAC is flushed and threaded through the introducer
- The line is attached to the transducer that converts pressure into numerical value and gives continuous waveform indicating pressure at the tip of the catheter
- Normal pressure reflect a normally functioning heart with no fluid accumulation
172
PAC parameters
Rely on healthcare policy and procedures
- cardiac output 4-8 liters
- CVP 2-6 mm hg
- Right ventricular Pressure20-30 mm hg systolic
- Pulmonary Artery Pressure 20-30 mm hg systolic 8-12 diastolic
- Pulmonary capillary wedge pressure 4-12 mm hg
173
Causes of change in pulmonary artery DECREASE pressure
- hypovolemia
| - vasodilation
174
Causes of change in pulmonary artery INCREASE
- Hypervolemia
- PE causing increase pulmonary resistance
- Chronic Lung Disease
- Left ventricular failure
- Vasoconstrition
175
PAC complications?
- Arrhythmias
- Knotting and misplacement
- Cardiac valve treatment
- Pulmonary infraction
- Pulmonary artery rupture
- Balloon rupture
- Catheter thrombosis or embolism
176
Arterial line
- continuous BP monitoring
- procedures ( adrenalectomy, cardiothoraic, major neurosurgery, major vascular surgery
- Blood sampling
- Arterial blood gas monitoring
- Pt on dopamine or nipride
* Most common site : Radial artery
177
Allen's test
- Should be performed before insertion
- done to assess adequacy of blood flow to hand through the ulnar artery because the radial artery will be partially occluded
178
Performing Allen's test what do you do?
- elevate pt arm
- *compress the ulnar/radial arteries until hand becomes blanch
-Pressure on the ulnar artery is released while maintaining pressure on radial artery
-Normal color to the hand should return to ulnar artery if patent
- some pt may not left or right artery status post CABG
-* Most frequent complication is accidental disconnection of catheter with subsequent blood loss
it is important to check like connection
179
Pain mangement
- pain behavior
- evaluation techniques
- pharmacological/non pharmacological strategies
180
Affects on pain
- age
- socioeconomic status
- gender
- ethnicity
- culture
- values
181
Caring for pt with pain
- consider all pain real to pt
| - *be observant to non verbal behavior pt self report is most reliable measure of pain
182
Types of pain
1. Acute
- sudden onset
- short term
2. Chronic
- presents overtime
- sudden leading to pain
- duration of six months or more
- due to unknown sources
- signs of hopelessness or depression
- complete relief of chronic pain is not possible
3. Cancer pain
- tumor involvement
- pain associated with cancer treatment
183
Theories associated with pain: Gate
-- Pain occurs when a gate impulses
| ascending to the brain opens the gate closes when impulses descend and pain is decreased
184
Pattern theory r/t pain
- a patter of noxious stimuli is coded by cns resulting in perception of pain
- pain is produced by spatiotemperal patterns of neuronal impulses rather than by specific receptors
185
Physiology of pain management
- localize pain
- cns controls emotional affect response to pain
- thalamus
- hypothalamus
- medulla
- cortex
- reticular formation system
- limbic system
