Brianna’s CAPA Misc Notes

Question 1

Herbals that impair coagulation due to platelet inhibition

Answer 1

-chamomile
-Vit E
-Feverfew (clotting time)
-garlic

Question 2

Herbals that prolong bleeding time

Answer 2

-Ginger
-Garlic

Question 3

Herbals that inc risk of bleeding

Answer 3

-Gingko Biloba
-Black Cohosh

Question 4

Herbal that reduces blood concentration of certain anesthesia agents

Answer 4

St Johns Wart

Question 5

Desflurane

Answer 5

Highest incidence of laryngospasm

Question 6

Sevoflurane

Answer 6

-lowest incidence of laryngospam
-choice for pediatrics
-sweet smelling
-fast emergence… may in risk for emergence delirium

Question 7

Neostigmine

Answer 7

-last approx 75 minutes

Question 8

Pediatric Pain Scales

Answer 8

-Wong Baker FACES 3+
-FLACC 2 mo-7 yrs (face, legs, activity, cry, consolability)

Question 9

Hypocalcemia

Answer 9

<8.5-10.5 watch for laryngeal spasms or skeletal muscle spasms

Question 10

Flumanezil

Answer 10

-benzo reversal
-0.2mg over 15 seconds, repeat Q 1 min, max 1 mg
-peds 0.01mg/kg
-duration 1-2 hrs

Question 11

Narcan

Answer 11

-adults 0.2-0.4mg
-(duration 1-4 hrs)
-peds 0.1mg/kg

Question 12

Medications okay to take day of surgery

Answer 12

Beta Blockers, clonidine, nitrates, digoxin, Ca Channel blockers (-ipine, cardizem), antidysrhythmics, statins, ACE (-pril), ARBs (-artan), seizure meds, antiparkinson, antidepressants, pain meds except NSAIDS

Question 13

Medications to hold prior to surgery

Answer 13

Diuretics, MAO inhibitors , diabetic meds, MVIs, herbals 2 weeks. Anticoagulants:
-aspirin- 1 week
-NSAIDS 3-5 days
-Coumadin 4-5 days
-plavix/clopidrogrel 1 week
-ticlopidine (ticlid) 10-14 days

Question 14

Hyper vs Hypokalemia

Answer 14

Hyperkalemia: peaked T waves, depressed ST seg

Hypokalemia: U waves, wide QRS, slow reflexes (ileus)

Question 15

Fasting

Answer 15

-clears 2 hrs
-breast milk 4 hrs
-formula/light meal 6 hrs
-high fat/protein meal 8 hrs

Question 16

Esophageal surgery

Answer 16

Airway concern
-HOB elevated
-low cont suction

Question 17

Gastric surgery considerations

Answer 17

-pulm toilet, assess for hypovolemia, risk for aspiration
-do not manipulate ngt.

Question 18

Small bowel surgery considerations

Answer 18

Assess for Na and Bicarbonate loss, electrolyte imbalances, stoma care

Question 19

Rectum/Anus surgery considerations

Answer 19

Assess for retention

Question 20

Thyroidectomy or parathyroidectomy considerations

Answer 20

Assess for hypocalcemia (muscle twitches, tingling, weakness)
-pharyngeal nerve damage- say “e”

Question 21

ENT & Dental procedure considerations

Answer 21

Ice for swelling
-irritation can inc secretions 4x

Question 22

Vocal cord surgery considerations

Answer 22

Provide materials for pt to write with

Question 23

Fluid requirements

Answer 23

-Adult KG + 40 = ml/hr
-Pediatric 0-10kg. 4ml/kg/hr
-ped 10-20kg. 40+ 2ml/kg/hr for each kg over 10
-ped >20kg 60+ 1ml/kg/hr per kg over 20

Question 24

Pediatric hypotension

Answer 24

SBP 70 + (age x 2)

Question 25

Adequate UOP

Answer 25

Adults 1ml/kg/hr Pediatrics 2-3ml/kg/hr

Question 26

Pediatric ACLS medications

Answer 26

-epi 0.01mg/kg -amio 5mg/kg -adenosine 0.1mg/kg first, second 0.2mg/kg -atropine 0.02mg/kg

Question 27

More herbal supplement info

Answer 27

Question 28

Epi anaphylaxis

Answer 28

1: 1,000 Tx for CPR 1:10,000

Question 29

Halothane

Answer 29

Bronchodilating effects

Question 30

Diuretics

Answer 30

Potassium Wasting: bumex, lasix, -thiazides Potassium sparing: aldactone, spirinolactone

Question 31

ICD implantable debfibrillator

Answer 31

-driving restricted 6 mo -limited movement on affected side -bed rest 6-18 hrs -no MRIs

Question 32

ESWL shock wave lithotripsy

Answer 32

-monitor for dec UOP from large calculi blocking ureter -pain, bruising, hematuria common (2-3days) -encourage fluids!

Question 33

Von Willebrand disease

Answer 33

-common hematologic disorder- easily bruises, epistaxis DDAVP desmopressin is synthetic vasopressin to help minimialize bleeding

Question 34

Skin graft

Answer 34

Elevation promotes venous return

Question 35

Posterior hip arthroplasty

Answer 35

-lower extremities in neurotransmitter alignment -avoid hip flexi on >90 Avoid internal rotation -if anterolateral approach- avoid external rotation

Question 36

HELLP

Answer 36

LDH is first enzyme to inc

Question 37

Pituitary procedure considerations

Answer 37

-monitor temp: hyper then hypothalamic issues. Hypo then Dec thyroid stem hormone levels

Question 38

MH susceptible pts

Answer 38

1+ hrs phase 1 1.5+ hrs phase 2

Question 39

Myasthenia gravis

Answer 39

-associated with prolonged blockade -rapid fatigue of voluntary muscles

Question 40

Ethmoidectomy (sinus surgery) considerations

Answer 40

-cocaine for vasoconstriction- CV effects -change mustache dressing 2-3x in first 4 hrs is normal. Do not swallow secretions… leads to n/v. ice preferred. Assess vision

Question 41

Ketamine

Answer 41

-bronchodilator effects -inc HR, BP -inc secretions -inc ICP, inc cerebral flow

Question 42

Blephartoplasty (eyelid surgery)

Answer 42

Avoid heavy lifting and bending -ice ok, no hot liquids for 24 hrs

Question 43

Sickle cell pt goal

Answer 43

Avoid acidosis, hypothermia, dehydration,