Adv Principles Week 2: Gyn Procedures

Front 1

For hysteroscopy procedures, what type of anesthetic techniques may be used?

a. regional
b. general
c. local
d.all of the above.

Back 1

D.

Front 2

When using regional anesthesia for a hysteroscopy procedure what level of spinal block is required?

Back 2

T 10 so that blockade of the hypogastric nerve is achieved.
T 10= umbilicus

Front 3

Paracervical block may otherwise be known as what type of block?

Back 3

Pudendal nerve block

Front 4

What type of airway device is usually sufficient for hysteroscopy procedures if general anesthesia is used?

Back 4

LMA if warranted by patient health history. Do not need muscle relaxation for these cases.

Front 5

Post operative pain from hysteroscopy is generally minimal but patients may complain of pain radiating where?

Back 5

To the shoulder......from CO2 insufflation used during the procedure.

Front 6

True or False: Hysteroscopy patients will likely need anti-emetic prophylaxis?

Back 6

True as this is a GYN procedure. I like to remember the 5 receptor sites for PONV by the pneumonic DASH. Dopamine, antichoinergic, serotonin, and histamine- Marcy

Front 7

During hysteroscopy Toradol may be used for what reason?

Back 7

To provide relaxation of the fallopian tube openings (os) in the uterus.

Front 8

Toradol is an NSAID that works by inhibiting prostaglandins and COX pathways but you must be cautious of what complication that can result from this medicine in hysteroscopy procedures?

Back 8

Bleeding.

Front 9

Potential complications resulting from Hysteroscopy procedures include which of the following? ( more than 1 answer)

a. PONV
b.lithotomy position (compartment syndrome, nerve damage etc.)
c. uterine perforation
d. reaction to distention medium
e. bowel rupture
f. increased FRC

Back 9

A-E True
F false- FRC is reduced due to diaphragm being pushed cephalad.

Front 10

Statement: Reactions to distention medium used for hysteroscopy include anaphylaxis to hyskon (rare), fluid embolus, pulmonay edema, bleeding issues (DIC, platelet dysfunction)

Back 10

.

Front 11

Signs of a fluid embolus during hysteroscopy include which of the following: Choose all that apply.
a. gradual increase in ETCO2
b.gradual decrease in ETCO2
c. more output than input of fluid
d. more input than output of fluid
e. fluid that is ran in without pressure
f. fluid that is ran in under pressure.

Back 11

B, F, D

Front 12

True or False: Uterine perforation or bowel rupture may result if the patient coughs while the surgeon is working in this area and the signs are often immediate

Back 12

False: The first part of the statement is true....however the signs of perforation may not occur until later when there is blood loss into the abdomen or intrabdominal free air present on radiography,

Front 13

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Front 21

What 3 sympathetic nerves innervate the following Organs?

What spinal level do they originate from?

-distal fallopian tube
-Upper Ureter
-Ovaries

Back 21

Aortic plexus
superior mesenteric plexus
renal plexus

T9-T10

Front 22

What nerves innervate the following organs?

And, what spinal level do the nerves originate from?

-Perineum
-Vulva
-Lower and upper vagina
-Cervix and Low uterus
-Posterior urethra
-Trigone
-Lower ureter
-Rectosigmoid colon

Back 22

Pudendal nerve
inguinal nerve
gentiofemoral nerve
posterior femoral nerve
pelvic and parasympathetic nerves

S2-S4

Front 23

The following organs are innervated by?

Where do they originate from?

-uterine fundus
-proximal third fallopian tube
-broad ligament
-upper bladder
-cecum, appendix and terminal large bowel

Back 23

sympathetic nerves via hypogastric plexus

T11-T12

Front 24

The cause of compartmetn syndrome in lithotomy position is?

Back 24

decreased blood flow leads to swelling of tissue in enclosed space

Front 25

What is the formula for determining flow gradient in lithotomy position?

Back 25

0.7 mmHg per every 1 cm elevation above level of BP measurement

Front 26

What can we do to reduce leg compartment pressures?

Back 26

use SCDs

Front 27

True OR False: All the following anesthesia types can be used for GYN laparoscopy procedures:
1. GETA with muscle relaxant
2. LMA (in short cases)
3. Neuraxial

Back 27

True

Front 28

In GYN laparoscopic procedures and the use of LMA technique, nurse anesthetists should use caution and select patient carefully due to ____________

Back 28

the risk of aspiration with this technique.

Front 29

In neuraxial anesthesia, shoulder pain is related to irritation of the _____________and the _________ ___________

Back 29

diaphragm and the phrenic nerve

Front 30

Examination of the endometrial cavity usually for abnormal bleeding and lesions is called:

Back 30

Hysteroscopy

Front 31

what is the purpose of the distention media used during a hysteroscopic procedure?

Back 31

To enable a better view.

Front 32

Name examples of distention media that can be used in hysteroscopy.

Back 32

-CO2
-Sorbitol in water
-LR/NS
-Dextran 70 (Hyskon)

Front 33

T/F: Uterine perforation is a complication assoc with hysteroscopy.

Back 33

TRUE

Front 34

Which of the following is not an indication for a laparotomy?
a. abd hysterectomy
b. pelvic exoneration
c. fertility procedures
d. emergent surg for bleeding
e. D&C

Back 34

E is not an indication

Front 35

Why is neuraxial anesthesia contraindicated for a laparotomy in an unstable pt?
a. b/c sympathetic blockade of neuraxial
b. b/c of need to control airway
c. b/c risk for aspiration
d. takes too long to do

Back 35

A

Front 36

Statement: The pregnant female is considered to have a full stomach beginning at 10-14wks gestation.

Back 36

.

Front 37

Back 37

Hypogastric plexus

Front 38

GYN surgical approaches:
A. Lapraroscopy
B. Hysteroscopy
C. Laparotomy
D. Perineal Abcess

Back 38

GYN surgical approaches:
A. Lapraroscopy
B. Hysteroscopy
C. Laparotomy
D. Perineal Abcess

Front 39

GYN Laparoscopy surgery Types
A. Diagnostic
B. Endometriosis
C. Ectopic Pregnancy
D. Myomectomy
E. Hysterectomy
F. Orchiectomy

Back 39

A. Diagnostic
B. Endometriosis
C. Ectopic Pregnancy
D. Myomectomy
E. Hysterectomy

Front 40

T/F - GYN Laparoscopy usually elective cases in old sick females

Back 40

F - GYN Laparoscopy usually elective cases in YOUNG HEALTHY females

Front 41

T/F - GYN laparoscopy will have CO insufflation.

Back 41

F - GYN laparoscopy will have CO2 insufflation.

Front 42

T/F - GYN laparoscopy may be done in lithotomy position.

Back 42

T

Front 43

T/F - GYN Laparoscopy requires muscle relaxation reversal after induction.

Back 43

F - Usually requires muscle relaxation for abdominal insufflation.