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N928 Basic Principles of Anesthesia > Post Anesthesia Care > Flashcards

Post Anesthesia Care Flashcards

(100 cards)

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1
Q

The PACU was first suggested by

A

Florence Nightingale in the 1860s

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2
Q

The first recovery rooms were established across the US in the

A

1960s & 1970s

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3
Q

The PACU operates under the

A

anesthesia department

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4
Q

Phase 1 of PACU is

A

immediate intensive care level recovery
cares for patients during emergence and awakening
continues until standard discharge criteria is met

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5
Q

Phase 2 of PACU is

A

less intense than phase 1
ensures patient is ready for discharge
“Fast-tracking” directly to phase 2 PACU care is appropriate for some patients (dependent on surgical procedure & patient comorbidities)

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6
Q

Prior to the patient leaving the OR:

A

patent, stable airway
adequate ventilation and oxygenation
hemodynamic stability

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7
Q

The appropriate position to transport patients to the PACU includes

A

adults- supine with HOB elevated
children- side lying position
transport with supplemental oxygen if needed

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8
Q

Essential steps to arrival and admission to the PACU include

A 
assess
attach to monitors
provide oxygen 
measure/record vital signs
Report to PACU nurse
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9
Q

The report given to the PACU nurse is this AANA standard of care.

A

Standard 11: transfer of care

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10
Q

Included in the handoff report is:

A

Patient’s name, age, comprehension limits
diagnosis, surgical procedure & surgeon
Review pre-anesthetic assessment, VS, allergies, medical/surgical history, daily medications
anesthetic technique, anesthetic course, complications, agents used, intraoperative fluids
preoperative laboratory data
timing/dosage of medications- antibiotics, antiemetics, narcotics
Post anesthesia orders

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11
Q

With the emergence from general anesthesia, we frequently see:

A 
airway obstruction
hypothermia/shivering
agitation/delirium
pain
Nausea/vomiting
autonomic lability
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12
Q

Recovery from inhalation anesthetics is based upon:

A
  • speed of emergence directly proportional to alveolar ventilation but inversely proportional to agent’s blood solubility
  • Speed of emergence is dependent on total tissue uptake: degree of metabolism, agent solubility, duration of exposure to the agent
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13
Q

The speed of emergence is dependent on total tissue uptake:

A

degree of metabolism, agent solubility, duration of exposure to the agent

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14
Q

Recovery from IV anesthetics is based upon

A

the function of the pharmacokinetic profile of the drug:
routes for metabolism and excretion, elimination half-life, redistribution profile, degree of lipid solubility, time and quantity of last dose

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15
Q

Delayed emergence is defined as

A

failure to regain consciousness 30-60 minutes after general anesthesia is discontinued

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16
Q

Delayed emergence is MOST commonly due to

A

residual drug effects

Consider treatment: Narcan, flumazenil, neuromuscular blocking agent reversal

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17
Q

Other less common causes of delayed emergence include:

A

hypothermia, hypoxia, hypercarbia, marked metabolic disturbances, perioperative stroke

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18
Q

Postoperative complications include:

A

Pain, PONV, agitation, emergence delirium, hemodynamic complications, respiratory complications, fluid & electrolyte imbalance, neurologic deficits, drug interactions

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19
Q

Postoperative hemodynamic complications include

A

hypotension, hypertension, & arrhythmias

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20
Q

Postoperative respiratory complications include:

A

airway obstruction, hypo/hyperventilation, hypoxemia, bronchospasm, pulmonary edema, & aspiration

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21
Q

The most common postoperative issue is

A

pain

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22
Q

Methods of pain management include

A

opioids, non-opioids, regional, and alternative methods

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23
Q

Alternative methods for pain relief include

A

distraction, ice/heat, massage, acupuncture, immobilize, TENS unit

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24
Q

Postoperative nausea and vomiting significantly contribute to:

A

delayed discharge

unanticipated postsurgical admissions

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25
The etiology of PONV is
multifactorial and reasons include anesthetic agents, type of procedure, patient factors
26
Patient factors for PONV risk factors include:
``` female (3x > risk than males) young age large body habitus history of PONV or motion sickness non-smokers ```
27
Anesthetic technique risk factors for PONV include:
general anesthesia | medications: volatiles, N2O, opioids, anticholinesterase
28
Surgical procedures that increase the risk for PONV include
laryngoscopy, gyn, eye, ENT, breast, neurosurgery
29
Postoperative risk factors for PONV include
hypotension and postoperative pain
30
Receptor types that contribute to PONV include:
dopaminergic, histaminic, cholinergic muscarinic, 5-HT (serotonin)
31
The vomiting center in the brain
receives afferent inputs from many areas of the body
32
The vomiting center is also known as the
nucleus tractus solitarius
33
PONV management includes
adequate hydration, P6 acupuncture point on the wrist, antiemetics
34
Classes of antiemetics include
``` 5 HT-3 receptor antagonists benzamides phenothiazines butyrophenones antihistamines anticholinergics others ```
35
The 5 HT-3 receptor antagonists include
ondansetron, dolasetron, and granisetron
36
The benzamides include
metoclopramide, cisapride
37
Phenothiazines include
chloropromazine, promethazine
38
Butyrophenones include
droperidol, haloperidol
39
Antihistamines include
diphenhydramine
40
anticholinergics include
scopolamine, atropine
41
Other drugs that help with PONV include
steroids, ginger root
42
Postoperative delirium and dysfunction is inclusive of
emergence delirium or agitation postoperative delirium postoperative cognitive dysfunction
43
Emergence delirium or agitation occurs in
10-20% of patients | more common among- younger populations, patients with preoperative anxiety, patients with psychological disturbances
44
Emergence delirium or agitation is often a manifestation of
pain
45
Other contributing factors to agitation that must be ruled out include
hypoxemia, acidosis, hypotension, bladder distension/ foley catheter, occult bleeding
46
Causes of postoperative delirium include
withdrawal psychosis, toxic psychosis, circulatory psychosis, & functional pscyhosis
47
Postoperative delirium is costly because
it increases ICU length of stay, hospital length of stay, functional decline, number of days mechanically ventilated
48
Predisposing factors for delirium include
reduced cognitive reserve: dementia, depression & advanced age Reduced physical reserve & sensory impairment
49
Reduced physical reserve as it relates to delirium includes
atherosclerotic disease, renal impairment, pulmonary disease, advanced age, and preoperative beta blockade
50
Sensory impairment as it relates to delirium includes
alcohol abuse, malnutrition, dehydration, and apolipoprotein E4 genotype
51
Precipitating medication risk factors for delirium include:
medications or medication withdrawal- anticholinergics, muscle relaxants, antihistamines, GI antispasmodics, opioid analgesics, antiarrhythmics, corticosteroids, >6 total medications, >3 new inpatient medications
52
Additional precipitating risk factors for delirium include:
pain, hypoxemia, electrolyte abnormalities, malnutrition, dehydration, environmental change (ICU admission)
53
Postoperative cognitive dysfunction is
a decline in memory and executive function after surgery and anesthesia can last days to months after surgery
54
Risk factors for postoperative cognitive decline include
patients >65 years or have pre-existing cognitive impairment type of surgery, re-operation, inflammation, depression, sleep deprivation, anesthetic technique
55
Postoperative cognitive dysfunction can be caused by
``` cerebral microemboli inflammatory mechanisms hypotension decreased cerebral blood flow hyperventilation resulting in significant hypercapnia/cerebral vasoconstriction & extreme hypocapnia ```
56
Deleterious effects of decreased temperature include:
impaired immune system, increased incidence of infection, increased blood loss and need for transfusion, increased myocardial risks, prolonged need for mechanical ventilation, decreased drug metabolism
57
Methods to warm patients include
increase room temperature, body warming blankets, fluid warmers, warm irrigation fluid, humidified gases
58
Hypothermia symptoms include:
shivering, clumsiness, slurred speech, & confusion | drowsiness, shallow breathing, and a weak pulse
59
Shivering in the absence of hypothermia may be related to
pain it increases O2 consumption, increases CO2 production, increases cardiac output, & predisposes at risk patients to cardiac morbidity
60
Shivering is concerning because it increases
oxygen consumption
61
Shivering may be treated with
Demerol 25 mg IV in the PACU
62
Causes of airway obstruction include
tongue falling back against posterior pharynx, glottic edema, secretions vomitus or blood in the airway, laryngospasm, external pressure on trachea (hematoma)
63
A partial obstruction will result in
snoring
64
A complete obstruction will result in
cessation of airflow, absent breath sounds, & paradoxical chest movements
65
Hypoventilation is defined as
PaCO2 >45 mmHg
66
Signs and symptoms of hypoventilation include
excessive or prolonged somnolence, airway obstruction, slow RR or tachypnea with shallow breathing, labored breathing
67
Causes of respiratory complications can be due to
residual depressant effects of anesthetic agents, inadequate neuromuscular blockade reversal, hypothermia, splinting secondary to pain Treat the underlying cause
68
Respiratory complications can lead to
hypoxemia- mild to moderate PaO2 50-60 mmHg
69
Hypoxemia is initially well-tolerated by the healthy but
acidosis and CV depression occurs as it worsens
70
Early indication of hypoxemia include
restlessness, tachycardia, and cardiac irritability | tachypnea, dyspnea, diaphoresis, retractions, altered LOC, HA
71
Late indications of hypoxemia include
obtundation, bradycardia, hypotension, and cardiac arrest | dyspnea, decreased respirations, & cyanosis
72
Hypoxemia symptoms in pediatrics are different and include
nasal flaring, stridor, grunting, and feeding problems
73
Causes of hypoxemia include
hypoventilation, increased intra-pulmonary shunting, decrease in cardiac output, increase in O2 consumption (shivering)
74
The treatment for hypoxemia is
O2 therapy with or without positive airway pressure
75
Respiratory complications can include
bronchospasm, pulmonary edema, pulmonary embolism, & aspiration
76
Hypotension is defined as
BP 25% below pre-op baseline
77
Causes of hypotension include
hypovolemia (most common cause), pain medications (cause venodilation), volatiles (decreased venous return), postoperative MI, hypoxia, cardiac tamponade, pneumothorax, LV dysfunction
78
Treatment for hypotension includes
fluid challenge, vasopressors, consider/treat underlying cause
79
Causes of hypertension include
pain (most common cause), hypoxemia/hypercarbia, bladder distension, fluid overload, hypervolemia, not taking routine antihypertensives
80
The treatment for hypertension includes
adequate pain relief, bladder catheterization, beta blockers, & vasodilators
81
Possible causes of cardiac dysrhythmias in the PACU include
bradycardia- opioids, beta blockers tachycardia- anticholinergics, antisialogogues, albuterol, pain, hypovolemia PACs or PVCs
82
Populations most commonly affected by fluid and electrolyte imbalance include
elderly, debilitated patients, hypertensive patients pretreated with diuretics, diabetic patients, neurosurgical patients
83
Fluid and electrolytes abnormalities include:
hyponatremia (water intoxication) hypocalcemia hypermagnesemia
84
Hypermagnesemia may result from patients treated with
magnesium sulfate for pre-eclampsia or ESRD
85
S/S of hypermagnesemia include
N/V, sedation, decreased reflexes, weakness, hypotension, bradycardia, respiratory paralysis, cardiac arrest
86
Hypocalcemia may be a result of
hepatic failure, massive volume replacement, acute pancreatitis, hypoparathyroidism, ESRD
87
S/S of hypocalcemia include
irritability & anxiety, paresthesia, seizures, laryngospasm, bronchospasm, HF, and muscle cramps
88
S/S of hyponatremia include
``` stupor/coma anorexia lethargy tendon reflexes decreased limp muscles orthostatic hypotension seizures/HA ```
89
Neurologic deficits include
peripheral nerve injuries post-dural puncture HAs transient focal deficits postoperative vision loss
90
Drug interactions should be suspected when
unexpected changes in neurologic status or vital signs occur
91
Drug interactions are more common due to
increased use of non-FDA regulated herbal supplements
92
Minimal criteria for discharge from the PACU includes:
easily arousable, fully oriented (return to baseline), maintains and protects airway, VS stable for minimum of 15-30 minutes, able to call for help if necessary, no obvious surgical complications such as active bleeding
93
Patients must be observed for a minimum of
20-30 minutes after last dose of parenteral narcotic
94
Neuromuscular blocking affects of some
antibiotics are potentiated by calcium channel blockers
95
Hypokalemia from diuresis or rapid fluid replacement may precipiate
digitalis toxicity
96
dopamine effects are reduced by
phenothiazines and antipsychotic drugs
97
Ketamine enhances the
dysrythmogenicity of ephedrine
98
Clearance of steroids is reduced by
phenytoin
99
The _____ score is used to determine PACU discharge
Aldrete score based on respiration, O2 saturation, consciousness, circulation, and activity
100
The Aldrete score must be
>/= 9 prior to PACU discharge; 10 is recommended

N928 Basic Principles of Anesthesia (16 decks)

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