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NUAN 701- NA Practice Principles > Patient Positioning > Flashcards

Patient Positioning Flashcards

exam 2 (94 cards)

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1
Q

Positioning affects physiologic ____ and helps maintain ___ throughout the body

A

integrity
Perfusion

Positioning can impact various body systems and lead to complications.

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2
Q

Which factors can lead to physiologic changes in patients during surgery?

A
  • Surgical position
  • Length of procedure
  • Padding and positioning devices
  • Type of anesthetic

Each of these factors can influence patient comfort and safety.

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3
Q

What systems are most affected by positioning during surgery?

A
  • Cardiovascular
  • Respiratory
  • Nervous

Protecting skin, eyes, breasts, and genitalia is crucial to prevent injuries.

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4
Q

What are the consequences of pressure on sensitive areas during surgery?

A

Can cause skin breakdown or nerve injury that can be permanent

Special care must be taken to avoid pressure injuries.

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5
Q

What did studies on awake patients in the prone position reveal?

A

Subjects experienced severe pain and numbness within 5-10 minutes

Indicates the importance of comfortable positioning.

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6
Q

What are compensatory reflexes, and why are they important?

A

They maintain blood pressure and regulate flow to vital organs

especially in vessel rich organs (heart, lungs, kidney, liver, brain

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7
Q

Where are the receptors that mediate changes in systemic blood pressure located?

A
  • Carotid sinuses
  • Aortic arch

These receptors sense pressure changes and send signals to regulate blood pressure.

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8
Q

causes Impulses to inhibit the medullary vasoconstrictor center and excites the vagus nerve

A

an increase in BP

The vagus nerve is part of the parasympathetic system.

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9
Q

What occurs during a decrease in blood pressure?

A

Sympathetic stimulation increases heart rate and causes vasoconstriction

This helps to increase blood pressure.

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10
Q

What can postural changes cause in anesthetized patients?

A

Significant decrease in blood pressure and tissue perfusion

Examples include sitting or lithotomy positions.

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11
Q

What is the Bezold-Jarisch reflex?

A
  • Hypotension secondary to vasodilation
  • Bradycardia
  • Apnea
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12
Q

How can Zofran administration impact the Bezold-Jarisch reflex?

A

It can cause a less significant impact of this reflex

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13
Q

How much difference in pressure is calculated for each inch of tilt above or below heart level?

A

Plus or minus 2 mm Hg for each inch (2.5 cm) of tilt

Important for accurate blood pressure measurements.

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14
Q

What happens to cardiac output when sitting at 90 degrees?

A

Cardiac output drops 20% due to pooling

This illustrates the importance of positioning.

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15
Q

what positions may have significant impact on myocardial function, especially with CAD

A

lithotomy and Trendelenburg

CVP, PAP, PCWP increase, but CO decreased

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16
Q
A
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17
Q

compared to an awake, spont breathing patient, an anesthetized and spont breathing patient has what?

A

Decreased tidal volume and FRC

This is due to mechanical interference with chest expansion and diaphragm function.

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18
Q

What may help increase tidal volume (TV) but could also lead to hypotension?

A

Adding PEEP

PEEP can increase intrathoracic pressure, affecting hemodynamics.

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19
Q

why do you have an increase in FRC from supine to prone?

A

thought to be related to less pressure on the diaphragm and opening of alveoli segments

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20
Q

How does the prone position affect ventilation-perfusion and oxygenation?

A

Improves oxygenation

This is due to better alveolar opening in the posterior lung regions.

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21
Q

___ is responsible for 60% or more of intrathoracic volume, any intereference with its movment can impact ventilation

A

diagraphm

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22
Q

What is the change in FRC when moving from upright and conscious to supine, anesthetized, and paralyzed?

A

Decrease in FRC by 20%

This has significant implications for preoxygenation and denitrogenation.

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23
Q

What position has the single most significant influence on respiration?

A

Trendelenburg position

This position can impede diaphragm movement.

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24
Q

In the lateral position, which lung is better ventilated in an unanesthetized patient?

A

The dependent or DOWN lung

This occurs due to the weight of viscera and increased hydrostatic pressure.

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25
in a paralyzed and artificially ventilated patient in the lateral position, which lung is better ventilated
Upper independent lung ## Footnote Compliance is greater due to lower abdominal pressure.
26
What is the effect of steep foot down position (reverse Trendelenburg) on intragastric pressure?
Decreases intragastric pressure ## Footnote This helps prevent regurgitation but increases aspiration risk.
27
What does the steep head down position (Trendelenburg) do to intragastric pressure?
Increases intragastric pressure ## Footnote This encourages gastric contents flow into the oropharynx, but risk of aspiration is minimal
28
What is the most common surgical position used for procedures on the anterior portion of the patient?
Supine position ## Footnote This position distributes weight to occiput, shoulders, spine, hips, and heels.
29
what procedures are typically done in the supine position
face neck/chest abdomen anterior upper/lower extremities
30
What angle should the arms be positioned at when placed on an arm board during supine positioning?
Less than 90 degree angle with palms supinated (up) ## Footnote This prevents brachial plexus injuries.
31
What should be avoided to prevent injury to the subclavian and axillary vessels?
Hyperabduction of the arm ## Footnote This can cause compression and obliteration of the radial pulse.
32
What complications can arise from the supine position?
Lower back pain and nerve injuries
33
What should be done to prevent excessive strain on the lumbar region in supine position?
Use a small pad under the head, back, and knees ## Footnote This maintains normal lumbar curvature.
34
What should be avoided during prolonged mask cases in the supine position?
Pressure on optic and facial nerves ## Footnote Mask pressure or hand compression can cause nerve damage.
35
legs should be parallel and uncrossed to prevent what kind of nerve injuries during prone positiong?
peroneal sural nerve injury
36
What can happen with a supine position and a mediastinal mass?
Compression of tracheobronchial tree, pulmonary artery, and superior vena cava ## Footnote This can lead to dyspnea or coughing during surgery.
37
What is necessary for patients with mediastinal masses in supine position?
Reinforced ETT and awake induction ## Footnote Avoid muscle relaxants to prevent airway compromise.
38
What happens to CO with initial placement in Trendelenburg?
increase cardiac output by 9% in about one minute, but only lasts about 10 min
39
What are the potential complications of the Trendelenburg position?
Increase in CVP, intracranial and intraocular pressures, cardiovascular and respiratory issues ## Footnote It can lead to facial, larynx, and tongue swelling.
40
What should be minimized during a procedure in the Trendelenburg position?
Volume of fluids administered ## Footnote Due to pressure against the diaphragm.
41
What are the concerns of the reverse Trendelenburg position?
Concern of sliding down the table, hypotension, decreased cerebral pressure
42
What is the purpose of the lawn chair position?
To decrease pressure on the lower back
43
What is the prone position used for?
Access to the posterior portion of the body | back, sacral, perianal, post neck, occipital or post cranial procedures
44
What are shoulder rolls used for in the prone position?
Improve circulation and respiration prevents pressure on diaphragm and rib cage ## Footnote They extend from the shoulders to the iliac crest.
45
What can vena cava compression during back surgery lead to?
Increased bleeding from the epidural venous plexus
46
What are the two main causes of postoperative vision loss (POVL)?
* Ischemic optic neuropathy (ION) * Central retinal artery occlusion (CRAO)
47
What factors increase the risk of ischemic optic neuropathy (ION)?
* Males * CPB * Radical neck dissection * Abdominal & hip procedures * Large blood loss (> 1L) * Large amount of fluid administration * Hypotension * Anemia * Prolonged duration in prone position (>5 hrs) * Spine surgery in the prone position
48
thought to be related to direct pressure on the globe, low perfusion pressure in the retina or emboli
Central retinal artery occlusion (CRAO)
49
What measures can minimize the risk of postoperative vision loss (POVL)?
* Proper use of headrests * Proper patient positioning * Maintain BP, fluid status, oxygenation * Limit length of surgery
50
What technique is important for turning a patient to avoid injury?
Log rolling them
51
What is the superman position?
A position with legs propped up on a pillow, arms tucked at the side ## Footnote It is better than flat positioning but can stretch/pull the brachial plexus.
52
What is the Jackson spinal table considered?
The best option for weight distribution compared to rolls or Wilson frames
53
What should be documented during prone positioning?
Head, neck maintained in neutral position, chest rolls in place, arms secured, no pressure on down eye, ear, or nose ## Footnote Document every 15 minutes.
54
What is the lithotomy position primarily used for?
Procedures of the anterior portion of the body: * GYN * Perineal/urology * Abdominal
55
What should be done to prevent joint and spinal injury when using the lithotomy position?
Flex and extend both legs simultaneously ## Footnote This technique helps to minimize the risk of injury during the procedure.
56
How much blood is autotransfused per leg when positioned in lithotomy?
150-250 ml ## Footnote This occurs when the legs are elevated and lowered during the procedure.
57
What is the risk associated with the placement of legs in stirrups during lithotomy?
Compression of obturator, saphenous, and femoral nerves ## Footnote Proper positioning and support are crucial to avoid nerve damage.
58
What is a major complication and MOST COMMON problem associated with the lithotomy position?
Compartment Syndrome ## Footnote This condition is characterized by increased leg compartment pressure, leading to leg ischemia and edema.
59
What factors increase the risk of developing Compartment Syndrome in the lithotomy position?
* Surgical time >2-3 hours * Increased BMI * Hypotension ## Footnote Extended surgical times and patient conditions contribute to the risk of this syndrome.
60
What is the sitting position used for?
Posterior fossa craniotomies, posterior cervical procedures, shoulder (beach chair), plastics ## Footnote The sitting position allows for better access to certain surgical sites.
61
What are common complications of the sitting position?
* Hypotension * Decreased cerebral perfusion * Hyperflexion of neck * Brachial plexus injury * Stretch of sciatic nerve * Venous air embolism (VAE) ## Footnote Each of these complications can pose significant risks during surgery.
62
What is a venous air embolism (VAE)?
Occurs when pressure within an open blood vessel is sub atmospheric With negative pressure gradident between operative site and right heart
63
What is the lethal volume of air for VAE per kilogram?
3-5 ml/kg
64
What methods are used for the detection of VAE?
* TEE (Transesophageal Echocardiography) * Precordial Doppler * Transthoracic Doppler (TTD) * Mass Spectrometry * Esophageal stethoscope ## Footnote Different methods have varying sensitivity and costs associated with their use.
65
what is the most sensitive detection method of VAE?
TEE- detects 0.02 ml/kg of air very expensive Requires constant visual attention
66
Which detection method is the most sensitive noninvasive monitoring for VAE?
Transthoracic Doppler (TTD) ## Footnote best for early detection, It can detect as little as 0.05 ml/kg of air
67
What are the signs and symptoms of VAE?
* Sudden hypotension * Decreased cardiac output * RV failure * Impaired LV filling * Decreasing ETCO2 + increasing PaCO2 * Hypoxemia * Presence of nitrogen in exhaled gas ## Footnote Recognizing these symptoms is crucial for prompt intervention.
68
What should be done as a treatment for VAE?
* Stop procedure * Flood field with fluid * Turn off N2O/air * Head down left lateral (Durant maneuver), aspirate from central line * Administer fluids, vasopressors, & inotropes ## Footnote Immediate actions are necessary to manage and mitigate the effects of VAE.
69
What documentation is required for the sitting position?
ETT secured with tegaderm * Arms/elbows padded and secured across chest/on armrests * Positive radial pulses bilateral * Head in neutral position * Breath sounds equal bilateral ## Footnote Thorough documentation helps ensure patient safety and surgical accuracy.
70
What are the common uses for the Lateral Decubitus position?
* Access to thorax * Kidney procedures * ERCP * EGD * Hip procedures
71
How should the upper arm be supported in the Lateral Decubitus position?
In an elevated position with blankets, a double arm board, or on a padded Mayo stand
72
What should be avoided to prevent nerve damage in the Lateral Decubitus position?
Pressure on the brachial artery or median/ulnar nerves
73
In the left lateral position, where should the pulse oximeter be placed?
On the left hand
74
What equipment is used to support the Lateral Decubitus position?
A bean bag covered with a draw sheet
75
What percentage of cases in the ASA Closed Claims Project are nerve injuries?
22% | second to death 26%
76
risk factors for ulnar injury:
* o male >50 o previous ulnar injury o very thin or obese o prolonged bedrest/procedure
77
What are the primary mechanisms of nerve injuries?
* Transection from trauma * Compression * Stretch * Ischemia * Kinking
78
what are the two most common nerve injuries after anesthesia?
ulnar nerve- 28% brachial plexus nerve- 20%
79
what are the increased risk factors of nerve injuries associated with anesthesia and positioning
* o HTN o diabetes o PVD o heavy alcohol/tobacco use o older age/arthritis o extremes of weight (low & obesity) o sex (males higher risk of ulnar nerve injury
80
what the chief etiology of nerve damage from positioning
* stretching or direct compression of a nerve
81
What are the common manifestations of ulnar nerve damage?
Claw hand and sensory deficit of the middle part of the hand, ring finger, and pinky finger
82
What is the common site for radial nerve injury?
Upper arm | secondary to BP cuff being cycled too often for long period of time, ## Footnote or tourniquet
83
What is a characteristic manifestation of radial nerve injury?
Wrist drop and inability to extend metacarpophalangeal joints | secondary to paralysis of extensor muscles in forearm
84
What is the effect of general anesthesia on nerve damage risk?
It creates conditions ideal for nerve damage due to loss of muscle tone and perception
85
What is the relationship between age and risk of nerve injuries?
Risk increases significantly after age 70
86
What is the impact of smoking on postoperative nerve injury risk?
Increases risk and leads to delayed healing
87
What should the arm's position be to avoid brachial plexus injury?
Extended and supinated
88
decreased sensation over palmar surface of thumb, index finger, middle finger & lateral aspect of ring finger „ Referred to as APE HAND
Median nerve injury
89
what can the common peroneal nerve injury cause?
foot drop
90
what nerve can be injured with excessive hip flexion and/or external rotation of legs, straight legs in sitting position o Can See foot drop
sciatic nerve
91
what nerve is damaged when the legs are suspended lateral to the vertical braces or stirrups- and Presents as decreased sensation over anteromedial aspect of leg
saphenous nerve
92
what nerve can be injured with - excessive traction during lower abdominal surgery
femoral
93
* Legs crossed during surgery can injure two nerves:
o Top leg- sural nerve injury- pressure from superior aspect of dependent leg will cause pressure on underside of superior leg o Bottom leg- superficial peroneal injury- pressure from underside of superior leg will damage superficial peroneal nerve of dependent leg
94
what % of all pressure injuries/ulcers occur in the OR
23%

NUAN 701- NA Practice Principles (4 decks)

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