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60 Cards in this Set
- Front
- Back
What are some cardiac considerations of prone position?
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pooling of blood in extremities
compression of abd muscles (pt should have TEDS/SCDs) pooling can --> decreased preload, decr CO, decreased BP increased SVR and PVR |
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What are some cardiac considerations of sitting position?
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minimal effects on CV
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What are some cardiac considerations with reverse t-burg?
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decr CO, preload, BP
baroreceptor reflexes incr SNS tone, HR, PVR |
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What are some cardiac considerations with Trendelenburg?
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activation of baroreceptors --> decr in CO, PVR, HR, and BP
research suggests t-burg does not improve CO in hypotension and hypovolemia |
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What does cardiogenic oscillations on ETCO2 waveform indicate?
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interference from heart or aorta pulsation
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What does a cleft on alveolar plateau on ETCO2 waveform indicate?
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spontaneous respiration
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Common injury with lithotomy position?
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peroneal nerve injury from fibula pressing against candy canes
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5 Complications of lateral decub positions
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1. backache/neck pain
2. compartment syndrome 3. contusion "folding" ear 4. Inc IOP, ischemia to dependent eye 5. stretch injury to suprascapular nerve (too much rotation of non-dep arm) |
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3 complications of lithotomy position
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1. peroneal nerve injury
2. compartment syndrome 3. digit amputation |
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5 complications of prone position
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1. ischemic optic neuropathy
2. central retinal artery occulsion 3. periorbital, conjunctival edema (keep HOB at lvl of heart of higher) 4. brachial plexus injury 5. impaired cerebral perf |
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Deoxyhemoglobin looks dark b/c of the _______ absorption of red light
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increased
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Does Hb absorb more infrared or red light?
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red (660nm)
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Does HbO2 absorb more infrared or red light?
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infrared (960nm)
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How does the mass spectrometer work?
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analyzes inspired (FI) and end tital (ET)
o2, no2, co2, anesthetic gases compares the mass:charge ratio & places into specturm |
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explain the 1st phase of exhalation
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deadspace gas leaving the lung (no CO2)
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explain the 2nd phase of exhalation
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includes deadspace gas and gas from the alveoli mixing, which causes a rapid rise in CO2
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explain the 3rd phase of exhalation
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all deadspace gas is out.
CO2 slowly rises (dependant on V/Q ratio) |
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explain the 4th phase of exhalation
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peak ETCO2 which is the highest level exhaled CO2 during respiration (plateau)
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AANA: standard of care for nurse anesthesia practice (Standard V)
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Monitor ventilation continuously. Verify intubation by auscultation, chest excursion, and confirmation of CO2 in expired gas. Monitor ETCO2 during ventilation incl. anesthesia or sedation req. artificial airway support. Use spirometry and vent pressure monitors
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Capnogram
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Actual waveform generated by capnometer
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Capnography
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Graphic record of CO2 concentration on screen or paper
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Raman spectrometry
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Laser interacts with gas molecule and measures the fraction of energy absorbed at different light wavelengths called “scattering”
Advantages – multi-gas/agent, fast, no scavenging, accurate Disadvantages - costly |
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What are the advantages and disadvantages of Mass Spectometry?
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Advantages - Multigas, multiagent, fast, reliable, low cost
Disadvantages - Measures only preprogrammed gases, must be scavenged, warm-up time, space |
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What are the advantages and disadvantages of Mainstream Sampling?
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Measures gas directly in the breathing system
Advantages – fast, good waveform, water & secretions not issue Disadvantages – heavy in circuit, incr dead space, opport for disconnect, gas options limited |
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What are the advantages and disadvantages of Sidestream Sampling?
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Advantages – Accurate < 40 Resp/min, lightweight, less chance of disconnect
Disadvantages – water/secretions may clog line, flexible tube can be easily obstructed |
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What is mainstream sampling?
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Measures gas directly in the breathing system
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What is sidestream sampling?
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Pump in the monitor aspirates a sample of gas through a thin, flexible sampling line
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What is a Galvanic cell?
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Fuel or microfuel cell sensor used for O2 analysis
Calibrated daily to room air (21% O2) |
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What are the principles behind O2 sat monitoring?
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Measures pulsatile signals across perfused tissue at 2 wavelengths where absorption is compared as a ratio of oxyhemoglobin to all functional hemoglobins (algorithms used)
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What does the pulse ox probe contain?
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light source (light-emitting diodes - red and infrared)
light detector (photodiode) |
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What are the principles of O2 sat monitoring? (simplified answer)
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the absorption of radiation (light) is proportional to the concentration of the substance
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Oxyhemaglobin looks red b/c of the _______ absorption of red light
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decreased
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Name 7 factors that influence accuracy of pulse ox reading.
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1. excessive ambient light
2. motion 3. methylene blue 4. low CO, hypothermia 5. profound anemia 6. nail polish 7. bovie |
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When are Pulse Ox (sats) not very accurate?
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<70%
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When is the esophageal steth C/I?
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esophageal varices or strictures
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Describe how air embolism/PE affects ETCO2
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Decreased CO2
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Describe how circuit disconnect affects ETCO2
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Decreased CO2
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Describe how CO2 insufflation during laproscopic procedure affects ETCO2
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Increased CO2
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Describe how hyperventilation affects ETCO2
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Decreased CO2
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Describe how hypothermia affects ETCO2
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Decreased CO2
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Describe how hyperthermia affects ETCO2
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Increased CO2
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Describe how hypoventilation affects ETCO2
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Increased CO2
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Describe how improved blood flow (CO) affects ETCO2
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Increased CO2
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Describe how release of clamp/tourniquet during vascular surgery affects ETCO2
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Increased CO2
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What are some limitations & proper application of esophageal steth?
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Limited to use with intubated patients
Placed in nasally or orally & rest in lower 1/3 of esophagus |
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What is a Precordial stethoscope?
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Special stethoscope that is placed on various locations of a pts chest
Wenger chest piece is large (heavy/adult) or small (lightweight/pedi) |
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Improper prone positioning can cause abdominal pressure.. why does this matter?
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increased abdominal pressure can cause
decreased preload cephalad movement of the diaphragm decreased FRC and compliance increased peak airway pressure |
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In standard lithotomy position how is pt positioned?
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thighs flexed approx 90 deg.
knees bent parallel to floor legs well padded arms tucked or on armboards <90 angle |
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what is the maximum angle armboards and arms should be in the supine position? what is the desirable angle?
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<90degrees (max)
60 degrees (optimal) |
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what nerve can be injured by the anesthetist's fingers on the patient's mandible during masking?
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Facial Nerve
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What surgical access is possible with prone position?
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posterior fossa of skull
posterior spine buttocks perirectal area posterior lower extremities |
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Which position increase pressure in cerebral veins, inc ICP/CVP/IOP, inc preload, and causes nasal congestion?
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Trendelenburg
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Who is ulnar neuropathy more common in?
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Older males
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Why use an axillary roll in lateral decub position?
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to raise the thorax and prevent shoulder compression and brachial plexus injury
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Wrist drop, weakness of abduction of thumb, loss of sensation b/w thumb and index finger, inability to extend the distal phalanx of the thumb
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Radial Nerve Injury
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how should you place the patient's palms when the pt is in the supine position? why?
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palms up (supination)
relieves pressure on the ulnar nerve as it passes through the humeral notch at the elbow |
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Trendelenburg positon causes swelling where?
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head
neck possible airway obstruction |
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What is lateral jackknife position?
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-intended to widen intercostal spaces
-pt down-side iliac crest over the hinge -table is flexed so the thighs become lateral to the trunk -chassis of table re-oriented so that flank and thorax become horizontal |
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inability to completely extend elbow, numbness over dorsal and palmar areas of the distal phalanges of the 1 and 2nd fingers. caused by AC trauma s/p IV attempt.
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Median nerve dysfunction
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What was found when ASA close claim analysis was done b/w 1990-1999 of 2 separate studies.
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Both studies - 16% of settlements were related to peripheral nerve injuries but no MOI could be found
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