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48 Cards in this Set
- Front
- Back
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How does having red hair affect anesthesia?
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people would read here need more anesthesia
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name four positive effects of doing a thorough preoperative evaluation:
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reduced risk
reduced morbidity efficiency reduced cost |
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what are the three major areas of documentation for the srna?
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preop assessment form
progress note care plan |
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describe the preop assessment form:
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standardized form with checklists that our department specific
can be done at preoperative assessment visit or immediately preop can be done inpatient or outpatient |
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what does the care plan contain?
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"daily evaluation tool"
includes an evaluation of student discuss with staff cRNA or M.D. |
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what is the number one thing that decreases patient anxiety?
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entering the room with someone familiar.
try to do your own preop evals |
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what is the daily form?
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it is a written form we bring to our receptor.
contains plan, care plan (IV fluids, "what if" regarding IV fluids" etc.) |
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what is done with the preop interview?
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history is obtained
physical exam/assess current status order preop tests/consults, medications reassure patient obtain consent document and develop care plan |
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what is the concern with benzodiazepines and consent?
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must obtain consent first, then give benzodiazepines (both anesthesia and surgical consent)
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how comprehensive are surgical notes?
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they are not. They only assess the current problem
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what are the 2 genetic anesthesia disorders?
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malignant hyperthermia
abnormal pseudo cholinesterase (don't give succs, would be paralyzed for a long time) |
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what are some sources of patient information?
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chart review/old record
clinical data consultations patient interview/exam discussion with teams |
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what is the rule of thumb with DNR orders preoperatively?
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they are reversed for the procedure
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what is the concern with history of hiatal hernia or reflux?
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inability to protect airway, added risk for aspiration
start proton pump inhibitors one day ahead of time |
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what is the pneumonic to remember for preoperative systems review?
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CPRNGHEPBAG (see picture seven, write out twice)
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this at what age do we always get a preop EKG?
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45
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for a patient on chronic steroids, what's type of dose may we give during surgery ?
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stress dose
adrenals are suppressed and patient will not adequately respond to stress |
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what are the three components to the anesthetic history?
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previous anesthesia given
complications family history |
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when a regional is planned, what must we pay close attention to in the physical exam?
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the regional anesthesia site
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what is Mallampati classification?
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an airway assessment
mp 1 through 4 (see picture eight) |
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what advantage will you have upon intubation that you do not when assessing Mallampati classification?
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you will be able to move the jaw forward
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what type of intubation would somebody be if they had a short mandibular ramus and a receding jaw?
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difficult
you would not see the larynx with a Miller or Mac you would need a fiber optic, a Bullard, or to do it blindly |
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what is included in the anesthesia plan?
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type of anesthesia
special monitoring preop instructions invasive devices that need consent backup plans explain to the patient (Mac with ga backup) |
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what is covered when you discuss consent with patient?
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plan and type of anesthesia
risks delineated (outlined) all options presented patient signature address all patients questions |
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what is included with your signature when documented?
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signature with title, print if illedgible
beeper number |
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what would we right in the progress notes?
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anything unusual or special circumstances
updates and changes of data since initial preop evaluation anything not included in the standard form assessment immediately preop (per JHAHO) |
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Re: the patient, what two things do we always monitor vigilantly?
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vital signs
response to surgery |
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Re: equipment, what three things do we monitor vigilantly?
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anesthesia machine and circuit
infusion pumps heating devices |
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Re: inspection, palpation, percussion, and auscultation, what are we looking at when observing the patient?
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inspection: skin color, surgical field, EBL, edema, movement, eyes/pupils
palpation: skin temperature, pulse percussion: gastric distention, pneumothorax auscultation: |
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what two ways to we monitor oxygenation?
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inspired oxygen Monitor
pulse oximeter |
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what three ways do we monitor ventilation?
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observation
end tidal CO2 disconnect alarm on vent |
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what three ways do we monitor circulation?
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EKG
heart rate and blood pressure at least every five minutes continuous circulatory monitoring (one of the following: palpation, auscultation, arterial waveform, ultrasound, plethoysmography, oximetry) |
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what is a record deal stethoscope?
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a heavy stethoscope that is placed over the precordium or at the struggle much
it offers continuous monitoring of every breath and heartbeat it can detect changes in respiration, swallowing, etc. before other monitors |
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what is an esophageal stethoscope?
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it is like an ng tube
it can't go nasally or orally can hear rest sounds or heart sounds there is a special earpiece (Chris will get it for us) |
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what are some potential problems with esophageal stethoscope's?
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hypoxia from unintended tracheal bronchial placement
compression of the trachea and small infants detachment of cuff distortion of surgical anatomy of working the neck trauma to esophagus or trachea it is radio opaque |
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what's does the Allen's test assess?
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arterial circulation of the palmar arch
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what are the three parts to an arterial waveform?
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anacrotic limb
dirotic limb dicrotic notch |
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what three things can we assess by looking at the arterial waveform?
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volume status
contractility SVR and SV |
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what is the anacrotic limb?
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the rapid rise.
the philosophy of blood ejected from the left ventricle the peak is systolic blood pressure |
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what does a more vertical anacrotic limb indicate?
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regurgitation
anemia fever and hyperthyroidism |
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what happens at the dicrotic notch?
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aortic valve closes
begin diastole and coronary perfusion |
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with a patient sitting upright, where do you zero the arterial transducer?
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at the level of the brain
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Re: arterial lines, what is a "whip?"
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it is an exaggerated peak or trough.
overestimates systolic and diastolic blood pressure Cather could be too big for artery tubing could be too long or too narrow (anything that increases resistance.) |
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What is the formula for blood pressure, as analogous to ohms law?
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BP = co x svr
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what is the most useful parameter for assessing organ perfusion?
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MAP
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what's does systolic variation during respiratory cycle suggest?
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hypovolemia
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what is central venous pressure used to estimate?
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intravascular fluid status
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in which patients is CVP inaccurate?
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right
sided heart dysfunction |
