Flashcards in Exam # 1 Intra-Operative & Post Anesthesia Phases Deck (57)
What are the 4 important points to remember about the "Surgical Suite"?
1) It includes various restricted areas
2) It flows to prevent cross contamination
3) It has a positive air pressure
4) It has restricted inflow and outflow of personnel
(T/F) Laryngospasms can occur from intubation?
What the difference between Induction and Immersion?
1) Induction - Sedation for surgery
2) Immersion - Waking up from surgery
List the 7 different roles generally involved in the OR room.
1) Circulating Nurse - Masked but not sterile like the scrub nurse
2) Scrub Nurse - Counts surgical sponges and equipment
3) Perioperative Nurse
7) First Assistant - Usually a RNFA or PA
In which 4 surgical situations is general anesthesia typically used?
1) Significant skeletal muscle relaxation
2) Long periods of time
3) Awkward positions
4) Procedures with extremely anxious patients
What are the 3 phases of general anesthesia?
What are the 5 general purposes of general anesthesia?
1) Loss of sensation
5) Muscle relaxation
What are the characteristics of Local Anesthesia?
1) Produces loss of sensation without LOC
2) Can be administered topically, SQ, or intracutaneously (Intradermal)
3) Little systemic absorption leading to rapid recovery and little hangover
What are the effects of Local Anesthesia?
1) Autonomic Nervous System blockade
2) Skeletal muscle paralysis
3) Discomfort, hypotension and seizures
What is Regional Anesthesia? Give 2 examples.
Regional Anesthesia - Anesthesia where the patient remains awake but loses sensation and has an absence of pain in a particular body region. I.e.,
What is the difference between a Spinal and an Epidural?
1) Spinal - Includes sensation loss and paralysis from umbilicus to the toes. It is injected into the subarachnoid space (CSF) below the L2 and HOB must be flattened as a spinal precaution.
2) Epidural - Includes a sensation loss from the waist to the thighs. It is injected into the epidural space (does not enter CSF).
Why does Spinal Anesthesia carry a risk of headache (especially when you sit up)?
Because of the loss of CSF
How is the type of anesthesia used in a surgery determined?
By the type of procedure and the patient's complexity (how sick is the patient)
Spinal Anesthesia is usually injected in between which two lumbar vertebrae?
Between L4 and L5
Define Moderate Sedation
Moderate Sedation is also known as "Conscious" or "MAC Sedation. It is a state of drug-induced depression of consciousness caused by administering a combination of anxiolytics (i.e.,versed) and opioids (i.e., fentanyl).
What are the 3 characteristics of Moderate Sedation?
1) The patient maintains their own airway but still achieves pain control
2) Provides analgesia, relieves anxiety, and/or amnesia
3) Patient can still respond to physical or verbal stimuli
Describe Malignant Hyperthermia. What are the characteristics of this disorder?
Malignant Hyperthermia is a rare metabolic disease characterized by extreme hyperthermia and rigidity of the muscles when anesthetic gases (especially halothane & succinylcholine) are administered. Characteristics include:
1) Affects genetically susceptible patients
2) Occurs anytime from anesthesia induction up to 24 hrs post-op
3) Can result in death
Explain the physiology of Malignant Hyperthermia
A spike in Calcium leads ⬆ metabolism which leads to ⬆ temperature which leads to ⬆ lactic acid which leads to ⬆ metabolic acidosis which leads to death if not treated.
Besides the anesthetic gases halothane and succinylcholine, what 3 other things could cause Malignant Hyperthermia?
What are the 6 SxS of Malignant Hyperthermia?
1)Rapid onset on a high temperature (110 F and can rise 1-2 degrees every 5 mins).
2) Muscle rigidity (Jaw tightening)
3) ⬆ CO2 and ⬇ CO
4) Tachypnea & Tachycardia
6) Dark brown urine (myoglobinuria)
What is the function of myoglobin?
Myoglobin stores/carries oxygen in the muscle (same as what hemoglobin does in the blood).
What 6 methods are used to treat and manage Malignant Hyperthermia in the PACU?
1) Reconstitute an administer Dantrolene in large doses (20 vials given by 2 RNs via 2 IV lines).
2) Treat arrhythmias with IV meds
3) Obtain ABGs and serum potassium
4) Give 100% oxygen
5) ⬇ Temperature using ice bags the groin and armpits
6) Maintain urinary output
What are the steps for treating Malignant Hyperthermia treated on the floor?
1) Call for help (code situation)
2) Start icing the patient
3) Start second IV line
4) Administer O2 with non-rebreather mask
5) Transfer patient to ICU
What are the methods used to promote a "Bloodless Surgery"?
2) ⬇ temperature (cold temp causes ⬆ platelet aggregation)
3) Cell saver - Reuse patients blood
4) Maximize blood production using FeSO4, EPO, and Vitamin K
5) Use other blood components such as plasma proteins and fibrinogen
What are the 3 important goals of the post-operative period?
1) Maintain oxygenation and pain control
2) Preventing complications while the body repairs
3) Protecting the patient
What are the 6 impending and imperative tasks to be performed by the PACU nurse when receiving a patient from surgery?
1) Assess the patients airway and apply O2
2) Connect to a cardiac monitor
3) Take VS
4) Attach to SaO2 monitor
5) Receive report from the OR nurse and Anesthesiologist
6) Assess drains, dressings, lines and tubings
When a patient is newly admitted to the PACU, a full head-to-toe assessment is performed and oxygen therapy (if general Anesthesia was used or if the Anesthegiologist orders) is administered. What is the benefit of the oxygen therapy to a post surgical patient?
1) It aids in the elimination of the anesthetic agent
2) It meets ⬆ O2 demands from blood loss or increased metabolism
(T/F) A neuro assessment in the PACU begins with LOC even though most patients will be asleep.
The patient should be outputting at least 30 mL/hr post-op. Is it ok if the patient has a total urinary output of 69 mL for the past 4 and a half hours since she has been out of surgery?
No, (4.5 x 30 = 135) the patient should have had a minimum of at least 135 mL by now.