Week 7 Gyn Flashcards
(16 cards)
What changes to blood pressure, cardiac output, & venous return might be expected while a patient is in the lithotomy position?
- Normal or elevated
Gravity dependent autotransfusion
Nagelhout Ch. 23, pg. 411
Torabi PPT, Slide 4
What are common complications of lithotomy position?
- nerve injuries
- compartment syndrome
- hypoperfusion/ischemia
- edema
- rhabdo
particularly if hypotension occurs
Nagelhout Ch. 23, pg. 411
Torabi PPT, Slide 5
What changes to ventilation can occur with extreme flexion of the thighs in the exaggerated lithotomy position?
- Compression of the abdomen limits diaphragmatic movement and decreases lung volumes
Nagelhout Ch. 23 pg. 413
Torabi PPT, Slide 4
Surgical duration greater than __________ with the patient in lithotomy position is the distinguishing characteristic of surgeries where patients develop lower extremity compartment syndrome - name several other risk factors:
- 2-3 hrs
- high BMI
- hypotension, decreased CO, PVD
- tight leg straps
- dorsiflexion of ankle
legs should be periodically lowered if surgery is longer than this
Nagelhout Ch. 23, pg. 420
Torabi PPT, Slide 6 - BOLD
For a surgical procedure where a patient is in lithotomy position, legs should be periodically lowered to the level of the body if the procedure lasts beyond _________
- 2-3 hours
legs should be periodically lowered if surgery is longer than this
Nagelhout Ch. 23, pg. 420
Extreme flexion of the hips more than 90 degrees in the lithotomy position can cause stretching and injury to the ___________ nerve - how does this manifest?
- obturator
- inability to aDDuct leg
- reduced sensation to medial aspect of thigh
NH says the femoral nerve to but ok whatever Dr. Torabi
Nagelhout Ch. 23, pg. 424
Torabi PPT, Slide 11
This nerve is at risk of injury in lithotomy position and is often due to compression betwen the lateral head of the fibula and the bar holding the legs
- common peroneal
Nagelhout Ch. 23, pg. 424
Torabi PPT, Slide 9 - BOLD
How does peroneal nerve injury present?
- loss of dorsiflexion/footdrop
Torabi PPT, Slide 10 - BOLD
What effect may occur when legs are lowered from the lithotomy position to supine? Why?
- hypotension
- relative decrease in venous return
Torabi PPT, Slide 13
What is the most common reason for diagnostic laparoscopy in pregnant patients?
- pelvic pain
Torabi PPT, Slide 14
What are several considerations for obtaining consent for a postpartum tubal ligation?
- patient must be greater than 21 years old
- must be obtained >30 days before delivery
Torabi PPT, Slide 14
Oophorectomy for an ectopic pregnancy may result in ___________ if rupture occurs
- increased blood loss
____________ is the gold standard used as a marker dye to check the integrity of ureters/bladder during abdominal surgery in the parturient
- indigo carmine - 40 mg IV
Torabi PPT, Slide 29 - BOLD
__________ injury may occur if shoulder braces are placed improperly (i.e. ___________) while in steep trendelenburg
- brachial plexus
- medially
Torabi PPT, Slide 32 - BOLD
If at all possible, shoulder braces should be avoided, but if they are used, how should they be placed to prevent nerve injury?
- laterally over the acromioclavicular joint
Torabi PPT, Slide 32 - BOLD
You’ve administered methylene blue to monitor for bladder perforation, what might you see?
Decrease in SpO2
