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52 Cards in this Set
- Front
- Back
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Five components of proper positioning |
Knowledge Planning Teamwork Communication Timing |
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Factors that limit positioning |
Pre-existing conditions Rangeof motion (arthirtis/spine stability) Preveious surgeries Prosthetic Joints Fractures Age/Height/Weight |
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Ideal position (for providers) |
Access to Airway At least one arm Optimal exposure of surgical field |
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Ideal position (for patient) |
Position does not exceed physiological limits Best possible body alignment Comfort
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Avoid excesssive ________, ____________, or _________ of body parts |
Flexion, extention or rotation |
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When should eyes be taped shut? |
Prior to intubating (except RSI) |
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What is the most common type of eye injury reported? |
Corneal abrasions |
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5 forces that cause position related injury? |
Pressure Obstruction Compression Shearing Stretching
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________ exerts a parallel force that occludes capillary blood flow |
Shearing |
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_____________ exerts a perpindicular force to soft tissue |
Pressure
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Three things that cause obstruction |
-Flexing an extremity -Retractors -Tourniquets |
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Capillary perfusion pressure is approximately _______ mmHg |
32 mmHg |
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Which forces injure nerves? |
Pressure, obstruction, shearing |
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Which forces injure vessels? |
Pressure and Obstruction
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Which forces injure tissue/skin? |
Pressure and Shearing |
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Describe the mechanisms of nerve injury |
Compression Direct trauma Ischemia (under perfusion/occlusion) Stretching |
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How does stretching injure nerves? |
Dirsrupts vasa nervorium Tears intranerual connective tissue -Leads to hemmorrhage, necrosis, and intra neural edema -blocks signal transport |
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_______ is caused by prolonged compression of hair follicles |
Alopecia |
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When does alopecia occur? |
Alopecia occurs between the 3rd and 28th postoperative day |
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Procedures greater than _____ hours increase the risk of tissue damage by ____ |
2 hours, 35-50 percent |
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____________ is the most common musculoskeletal complication |
Backache |
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How is backache prevented |
Place pillow under patient's knees |
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What makes a patient vulnerable to injury? |
Anything that decreases blood flow or oxygenation? |
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What are some factors that decrease blood flow? |
Cardiac disorders, PVD, atherosclerosis, hypotention |
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What makes a patient vulnerable to hypovolemia? |
-NPO status -Diuretics -Antihypertensives -Bowel preps -Poor nutritional stauts -Nausea and Vomiting
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What makes patients vulnerable to poor oxygenation? |
-Anemia -Respiratory distress -Fever (increased demand) -Infection (increased demand) Obesity (difficult to ventilate) |
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Where are the the baroreceptors located? |
Internal carotids Aortic arch |
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What is the Bainbridge Reflex? |
Increase in heart rate in response to right atrial wall stretch receptors |
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What is the best way to prevent hypotension secondary to position change? |
Change positions slowly |
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What are some interventions to correct position related hypotension? |
Bolus IV fluids Adjust anesthetic depth Administer vasopressors |
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What are the four effects of posture on respiration |
Pulmonary blood flow Lung compliance Intrapulmonary distribution of air Mechanical interference |
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The uneven distribution of pulmonary blood flow is caused by differences in _____________ |
Hydrostatic pressure |
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In zone 1, the _________ pressure is greatest |
Alveolar |
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In zone 2, there is foreword flow during _____________ |
Systole |
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Zone 1 of the lung pressures |
P(alveolar) > P(pulm. art) > P (venous) *vessels held closed |
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Zone 2 lung pressures |
P(arterial) > P (alveolar) > P (venous) |
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Zone 3 lung pressures |
P (arterial) > P (venous) > P (alveolar) |
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Causes of ulnar nerve injury |
-Compression of ulnar nerve against medial epicondyle of humerus |
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Effects of ulnar nerve injury |
-decreased sensation to 4th & 5th fingers -inability to oppose 5th finger -atrophy of intrinsic hand muscles (Claw Hand) |
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Causes of radial nerve injury |
Compressed against musculospiral groove by ether screen
Against arm boards (in lateral position) |
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Effects of radial nerve injury |
Wrist drop |
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Causes of median nerve injury |
AC IV extravasation Arm falls of edge of bed |
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Effects of median nerve injury |
Ape Hand Deformity -inability to pronate forearm -weak wrist flexation -unopposed thumb |
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Causes of brachial plexus injury |
-Head rotated -Arms raised > 90 degrees -Arm extended to one side & head opposite -shoulder rests improperly placed -Alillary roll improperly placed -median sternotomy |
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Causes of common peroneal nerve injury |
-pressure against head of fibula in lateral position -crossed legs in supine (inferior leg) -uprights for stirups (legs inside uprights) |
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Effects of common peroneal nerve injury |
Foot drop -loss of dorsiflexion of ankle/toes -inability to evert foot
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Causes of sural nerve injury |
Crossed legs in supine (superior leg) |
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Causes of saphenous nerve injury |
Stirups in lithotomy (legs outside uprights) |
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Causes of femoral nerve injury |
Extreme angulation of thigh in lithotomy |
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Causes of obturator nerve injury |
Extreme flexion of hip in lithotomy |
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Airway nerve injury |
LMA and recurrent laryngeal nerve |
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Types of POVL |
Ischemic optic neuropathy (ION) Central retinal artery occlusion (CRAO) |
