Focus - Chem + professional issues Flashcards
(93 cards)
1
Q
List the 4 bond strengths
A
Strongest
Covalent
Ionic
Polar covalent
Van der waals
2
Q
Calculate C to F and F to C
A
3
Q
What are the common units of pressure?
A
4
Q
Which bond has a complete transfer of electrons? Which one equally shares?
A
Ionic - Complete transfer
Covalent - Equal sharing
5
Q
Common metals, Acids, and bases are examples of which type of bonds? What about water?
A
Ionic
Water - polar covalent
6
Q
Which type of charges do protons, neutrons, and electrons have?
A
Protons - POSITIVE
Neutrons - NEUTRAL
Electrons - Negative
7
Q
P total = P1 + P2 + P3 is an example of which law?
A
Daltons - the total pressure exerted is the sum of all partial pressures
8
Q
A
2.1%
(16/760) * 100
9
Q
A
760*0.06 = 45.6
10
Q
Which component of oxygen delivery is most affected by Henry’s law?
A
PaO2
Multiple PaO2 by 0.003 (oxygen’s solubility coefficient) will tell you how much oxygen is dissolved in the blood
11
Q
Which law is about gas solubility?
A
Henry’s Law
12
Q
Which law describes the transfer rate of a gas through a tissue medium?
A
Fick’s Law
13
Q
Anesthetic emergence is prolonged by a hypothermic patient is an example of which law?
A
Henry’s
14
Q
An over pressurized vaporizer is an example of which law?
A
Henry’s
15
Q
Increasing FiO2 increases PaO2 is an example of which law?
A
Henry’s
16
Q
Cardiac output calculation is an example of which law?
A
Fick’s
17
Q
Placental drug transfer is example of which law?
A
Henry’s
18
Q
Which law states that the molecular weight determines how fast it can diffuse?
A
Graham’s
Smaller can transfer through a graham cracker faster
19
Q
Is emergence prolonged in the hypothermic patient?
A
Prolonged
20
Q
How does increasing pressure affect solubility?
A
21
Q
How does increasing temperature affect solubility?
A
22
Q
CO2 is how many more times soluble than O2?
A
20 times
23
Q
Which law is shown through the 2nd gas effect?
A
Grahams
24
Q
What is the universal gas law?
A
Pv = nrT
P- pressure
V- volume
n- number of moles
r - constant 0.0821
T- Temperature
25
Increasing the radius by 1,2,3,4 does what to the flow rate?
1 = 1
Doubling = 16x
Tripling = 81x
Quadrupling = 256x
26
Decreasing temperature does what to viscosity and resistance?
Increases
(makes it slower)
27
What is Q when referring to Ohm's law?
Flow
28
What is MAP-CVP when referring to Ohm's law?
Pressure gradient
29
What is SVR and PVR when referring to Ohm's law?
Resistance
30
What is Delta P when referring to Ohm's law?
Pressure Gradient
31
What is Cardiac output when referring to Ohm's law?
Flow
32
When is laminar, transitional, and turbulent flow?
Laminar <2000
Transitional 2000-4000
Turbulent >4000
33
Airflow in the terminal bronchioles is which type of flow?
Laminar
Also blood flow in systemic circulation
34
Airflow in the medium sized bronchioles is which type of flow?
Turbulent
35
Laminar flow is dependent on?
Viscosity (Poiseuille's)
36
Turbulent flow is dependent on?
Density (Graham's)
37
Does helium/oxygen mixture help flow that's already laminar?
NO
38
How does heliox help?
Improves flow with high resistance
Ex: Epiglottis, bronchospasm
39
According to Bernoulli's principle, if fluid velocity is high, is high or low pressure exerted on the walls?
High velocity - low pressure on walls
Low velocity - high pressure on walls
40
Examples of the Venturi effect?
Jet ventilator
Venturi mask
Nebulizer
41
What is the Coanda effect?
Think snake
Flow attaches to the walls
Ex: mitral regurgitation
42
Bernoulli's
Venturi
Coanda
43
Do large alveoli have a higher or smaller concentration of surfactant? What about small alveoli?
Large - smaller concentration
Small - larger concentration
44
Does decreasing radius increase or decrease wall stress?
Decreases
45
Does decreasing intraventricular pressure increase or decrease wall stress?
Decreases
46
Does increasing wall thickness increase or decrease wall stress?
Decreases
47
Does increasing wall stress increase or decrease O2 consumption
Anything that increases wall stress also increases O2 consumption
48
Which law describes why LV thickness increases due to systemic hypertension
Law of LaPlace
49
What are three ways to limit radiation exposure?
Distance
Duration
Shielding
50
Minimum safe distance from radiation source?
6 feet
51
Maximum radiation exposure for adults? Pregnant?
Adult - 5 rem
Pregnant - 0.5 rem
52
What is the critical temperature?
The highest temperature where a gas can exist as a liquid
53
What is Avogadro's number?
1 mole of ANY gas is made up of 6.023x10 to the 23rd atoms
54
What is the AANA code of ethics?
Principles of conduct and professional integrity that guide-decision making and behavior of CRNAs
55
What are practice standards? Can you deviate from them?
Standards that describe the minimum rules and responsibilities of CRNAs
No must be adhered to
56
What are practice guidelines? Must they be adhered to?
Statements that assist providers in clinical decision making
they "should" be adhered to
57
What are position statements?
Statements that express the AANA on official positions
58
What is nonmaleficence?
The provider has an obligation to not inflict hurt or harm
Ex: unnecessary testing
59
What is beneficence?
Providers should act for the benefit of others
60
What is justice?
Treat everyone the same
61
What are the 6 elements of informed consent?
- Competence
- Decision making capacity
-Disclosure of information
-Understanding of disclosed information
-Voluntary consent
-Documentation
62
Define assent
including children in the decision-making process
63
Do written materials take the place of a face-to-face conversation?
No
64
What four things must be proven by the patient in a lawsuit?
1. Duty - the CNRA had duty to the patient
2. Breach of duty - the CRNA failed their duty
3. Causation - The CRNA caused patient injury
4. Damage - Harm was caused to the patient
65
What is Res Ipsa Loquitur?
'the thing speaks for itself'
Burden of proof can shift from the plaintiff to the defendant
Ex; Leaving a lap sponge in the patient
66
What is battery?
physical contact
Ex: placing an epidural without consent
67
What is assault? Can it happen to an unconscious patient?
Making the person feel that battery is imminent
Can not occur in unconscious patient
Ex: the patient FEELS like you are going to place the catheter without consent
68
Does harm need to be proven with assault or battery charges?
No
69
What is Vicarious Liability?
One person is responsible for another's actions
Ex: Hospital being held for the actions of the nurse
70
What is the emergency in medical treatment and active labor act? (EMTALA)
Must provide services to anyone in the ED
71
What does the affordable care act provide?
Mandated that everyone has health insurance
Must provide preventative care
patients cannot be subject to annual or lifetime dollar limits
72
Which schedule drug classification are opioids?
2 - along with cocaine, meth, and barbiturates
73
Which schedule drug classification is ketamine, steroids, and codeine?
3
74
Which schedule drug classification are benzo's?
4
75
When a patient experiences serious anesthetic outcomes, what information is appropriate to offer to the patient's family?
Facts while also expressing regret
* this creates trust and also lowers the risk of a lawsuit
76
What is the first step if being named in a lawsuit?
Contact insurance carrier immediately
DO NOT DISCUSS THE CASE
77
What are the most common lawsuits for?
1. Death - 30%
2. Nerve injury - 22%
3. Permanent brain damage - 10%
4. Airway injury - 6%
5. Awareness - 1%
78
What are usually the causes for a lawsuit regarding death or permanent brain damage?
1. Inadequate ventilation
2. Esophageal intubation - unrecognized
3. Difficult intubation
79
What is essential to try to avoid a lawsuit?
Establish rapport with the family and patient
80
What 4 things increase the risk of dying within 7 days of surgery?
1. High ASA
2. Emergency
3. Major surgery
4. Old age
81
Which procedures are increasing for malpractice claims?
Chronic pain injections - especially cervical
82
What is legal age for consent? What is an emancipated minor?
18
Emancipated minor - someone under 18 given rights of an adult by the court
83
How can someone become a emancipated minor?
1. Married
2. Parent or pregnant
3. Military
4. Economically independent
84
Do medical providers have to disclose medical errors that cause no harm?
No - but is strongly encouraged under ethics
85
When should exercise and caffeine be avoided before bed?
Caffeine at least 4 hours
Workout at least 3 hours
86
What signs and symptoms may develop from MRI?
Dizziness, light headedness, nausea
87
What is the recovery time for an addict before coming back to work? How long should they be monitored for?
1 year
Probation for 5 years
88
Should you call the police for suspected drug abuse?
Only as a last resort
89
The CRNA charts no issues during airway management after they encountered a difficult airway, The CRNA has committed what?
Medical malpractice
90
What group sets the highest standards that must be followed?
AANA
91
What is an example of an intentional tort?
Battery
92
How much higher do anesthesia alarms need to be set over OR noise?
At least 20 dB higher
93
What is the peak allowable dB set by OSHA?
115 dB
