• Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key

image

Play button

image

Play button

image

Progress

1/58

Click to flip

58 Cards in this Set

  • Front
  • Back
WHAT DO YOU NEED TO MAKE SURE OF WHEN POSITIONING A PATIENT?
you must have adequate access to the airway, medication, and iv access and be able to monitor the patient
WHAT SHOULD YOU DO IF THE PATIENT IS MOVED?
you must listen and document breath sounds, check bp
WHAT IS THE BIGGEST PHYSIOLOGIC CONSEQUENCE OF POSITION CHANGES?
Hypotension, b/c anesthesia blunts the compensatory SNS relexes that would normally minimize the changes associated with postion changes.
PRE OP CONSIDERATIONS?
extremes of any: age, body habitus, pre-existing neuro issues, DM, PVD, arthritis, smoking/alcohol, and pre-existing lesions/ injuries.
TIDAL VOLUME
amount of gas inspired, or expired with each normal breath
INSPIRATORY RESERVE VOLUME
maximum amount of additional air that can be inspired from the end of normal inspiration
EXPIRATORY RESERVE VOLUME
maximum volume of additional air that can be expired from the end of normal expiration
RESIDUAL VOLUME
volume of air remaining in the lung after maximal expiration.
***this is the only lung volume which cannot be measured with a spirometer
LUNG CAPACITIES
subdivisions of total volume that include two or more of the 4 basic lung volumes
FRC
functional residual capacity
amount of air remaining in lungs after quiet expiration
FRC
volume that we can replace with 100% O2
TLC
total lung capacity
volume of air in lungs at the end of maximal inspiration
Called a capacity b/c it is the sum of all 4 basic lung volumes (TLC = RV + IRV + TV + ERV)
VITAL CAPACITY
maximum volume of air that can be forcefully expelled from the lungs following a maximal inspiration (VC = IRV + TV + ERV) or (VC = TLC - RV)
FRC
volume of air remaining in the lung at the end of normal expiration. called a capacity because it equals residual volume plus expiratory reserve volume (FRC = RV + ERV)
INSPIRATORY CAPACITY
Maximum volume of air that can be inspired from end expiratory position (of less importance than the other capacities)
(IC = TV + IRV)
SUPINE POSTION
-FRC decreased by 20% (abdominal contents limit mvmt of diaphragm, decreased muscle tone from GA) - small airways close sooner --> hypoxia - VQ changes cause shunting --> hypoxia - gravity increases blood flow (perfusion) to lung zone III (dorsal) - decreased pulmonary compliance - minimal CV changes - obese people (compression of IVC supine hypotension syndrome) - pressure on occiput (alopecia * pad the head)
SUPINE POSITION
keep hips and knees slightly flexed, blanket pillow under knees, legs uncrossed, heels padded, correct anatomical spinal placement, arms (if on side must be padded and tucked) (if on arm boards * padded palms up supinated less than 90 degrees)
ULNAR NERVE INJURY
#1 in anesthesia related nerve injuries
*manifested by inability to abduct the 5th finger * weakness / atrophy of hand muscles "claw hand" *
prevented by supination, and avoid hypotension and hypoperfusion, pad arms properly
MOST SUPERFICIAL NERVE
BRACHIAL PLEXUS INJURY
excessive external rotation or abduction of the arm
*avoid > 90 degree abduction
* avoid arm falling off the table
* watch lateral head rotation
* if prone watch flexion and abduction of arms overhead
* lateral position requires an axillary roll which avoids the compression of humerus into the axilla
***manifestation of general weakness of the upper arm
TRENDELENBURG
*causes further pressure upwards on the diaphragm, from abdominal contents and further decreases lung expansion
* Increases ICP by decreasing venous drainage
* IOP increased with glaucoma
* increased risk of aspiration
head down feet up
ACTIVATION OF BARORECEPTORS INCREASE IN BP ?
increase in baroreceptor discharge
**inhibits SNS (vasoconstriction) and enhances vagal tone (bradycardia)
MENDELSON SYNDROME?
aspiration of > 25cc of gastric contents with a pH of < 2.5
SHOULDER BRACES?
can inhibit venous and carotid
LITHOTOMY
**can autotransfuse 500cc blood to core
can impair ventilation due to upward pressure
Most common nerve injury **common peroneal
but also- sciatic, femoral, saphenous, and obturator
**hypotension when the legs are put down
**must put legs up and down simultaneously this avoids stretching of one side of the nerve
> than 4 hours increases risk of injury ischemia, edema
COMMON PERONEAL NERVE INJURY IN LITHOTOMY POSITION?
occurs from compression of lateral aspect of fibula head (improper padding at stirrups)
Manifested by foot drop
FEMORAL NERVE INJURY OF LITHOTOMY POSITION?
excessive angulation of the thigh on the abdomen
MANIFESTED BY - decreased sensation on anterior thigh and inability to flex your hip
FOPSS
Femoral nerve - stressed by excessive angulation of the thigh
Obturator - stretched by excessive flexion of the thigh to the groin
Peroneal - compression of the lateral aspect of the legs at the head of the fibula against the stirrup supports
Saphenous - compression of the medial aspect of the legs against the stirrups
Sciatic nerve - stretched by excessive external rotation of the leg when placing the patient in the lithotomy position
PRONE
-need multiple people to help
- pt is log rolled
- place chest rolls from below clavicles to iliac crest (provide adequate lung expansion and help alleviate pressure on the abdomen)
**protect the genitalia and breasts
-pillows under lower legs and ankles to help flex knees and prevent pressure on the toes
-head positioned to side may impair drainage from the head
-cardiac - compression of abdominal viscera, pooling of blood in extremities, decreased preload, CO, BP, SV
SYSTEMIC ISSUES WITH PRONE
-cardiac - decreased preload, CO, BP, SV, and increased SVR and PVR
-pulm - decreased total lung compliance, increased work of breathing, ET placement
-OTHER- check and document face and eyes are free of pressure Q 15 min
**can cause ION Ischemic optic neuropathy (blindness), corneal abrasions
REVERSE TRENDELENBURG
decrease in CO, preload, and ABP
increased FRC, decreased work of breathing
BARORECEPTOR RESPONSE IN REVERSE TRENDELENBURG
b/c of the decrease in CO, preload, and bp--> baroreceptors sense the decreae in bp and increase SNS tone HR AND SVR
LATERAL DECUBITUS
keep bottom leg flexed
axillary roll placed just below axilla to avoid compression of the neurovascular bundle
**make sure you check the pulse in the dependent arm (put the pulse ox here)
PHYSIOLOGIC CHANGES ASSOCIATED WITH THE LATERAL DECUBITUS
Perfusion is gravity dependent, mechanical ventilation favors the nondependent lung, V/Q mismatch = decreased PaO2
***most important check for hypotension
V/Q MISMATCHING
ventilation without perfusion or the other way around
-ratio normal is 0.8
- normal ventilation is 4L and normal perfusion is 5L and 4/5 is 0.8
V/Q MISMATCHING UNDER ANESTHESIA IN THE LATERAL POSITION
ventilation decreases in dependent lung due to decreased compliance (compression by weight from abdominal contents)
*perfusion increases in the dependent lung due to gravity
clinical sig V/Q mismatching develops
V/Q MISMATCHING CAUSES
can be from 0 to infinity
**infinity (no perfusion) alveolar dead space
** 0 no ventilation intrapulmonary shunt (R-->L)
-dependent lung underventilated and more perfused
-nondependent lung - overventilated and less perfusion
increases in this mismatching will cause hypoxia
SITTING POSITION
used most often for posterior fossa, cervical spine, shoulder or neck surgery
-causes pooling of blood in the lower extremities ***decreased venous return by about 20%
*increased lung volumes and decreased work of breathing
beach chair more common than sitting way upright
SYSTEMIC ISSUES WITH THE SITTING POSITION
CARDIAC - VAE (venous air embolism) caused by open venous system above the level of the heart **atm pressure is greater than venous pressure and air is then sucked in
**If air is greater than pulm clearance, increase pulm pressures, decreased CO r/t increased right ventricular afterload
S/S OF VENOUS AIR EMBOLISM
listen to heart sounds at R second intercostal space by doppler or steth and listen for a milwheel murmur
** sudden decrease in ETCO2, decreased sats, arrythmias, and decrease in bp
Millwheel murmur is usually the first sign
VAE TX
-notify surgeon, flood field with saline or bone wax,
- aspirate air through CVP
- turn off nitrous 100% O2
- give volume to increase CVP
- vasopressors
- ?peep?
- turn on their left side to try to keep the air in the right atrium
increase the CVP so they suck in less air
-
CONTINUED COMPLICATIONS OF THE SITTING POSITIONS
hypotension, pneumocephalus, paraplegia/quadraplegia, ocular compression, edema of the face, tongue, and neck
- sciatic nerve damage
WHAT FACE MASKS CAN DO
can cause pressure damage over the nose, facial nerve damage from fingers, face straps can cause injury or even necrosis to face, ears, and eyes
RISKS RELATED TO NERVE INJURY
-nutritional status
- body habitus outside of normal
- history of previous nerve injury
- relative significance of the nerve injury
- Res Ipsa Locuitor makes defense challenging (it speaks for itself)
MOST IMPORTANT THING DURING POSITIONING
maintain control of the patients airway, IV access, and monitoring
BRACHIAL PLEXUS NERVE
HOW INJURED: * excessive abduction (> 90degrees) of arm * in prone positon when arm is used as a lever during turning * In supine/trendelenburg when shoulder braces are placed medially against the root of the neck
HOW MANIFESTED: weak arm function
RADIAL NERVE INJURY
HOW INJURED: compression against underlying humerus when lateral upper arm is compressed on the OR table
MANIFESTED BY: *inability to extend the wrist * Inability to abduct the thumb * wrist drop * decreased sensation over the dorsal surface of the lateral three and one half fingers
ULNAR NERVE INJURY
HOW INJURED: compression between medial epicondyle of the humerus and the sharp edge of the bed or frame
MANIFESTED: Sensory loss in fifth digit * claw hand
MEDIAN NERVE INJURY
HOW INJURED: indiscriminate probing (fishing) in the antecubital fossa during venipuncture
MANIFESTED: loss of sensation in finger tips from thumb to mid point of ring finger * Inability to oppose the first and fifth digits * decreased sensation on palmar surface of the lateral three and one half fingers
MUSCULOCUTANEOUS
HOW INJURED: compression nerve injury which is rare b/c of depth of nerve
MANIFESTED; inability to flex forearm
INTERCOSTOBRACHIAL
HOW INJURED: surgery in the axillary region
MANIFESTED: numbness or dysthesia of the upper inner arm
MEDIAL CUTANEOUS
HOW INJURED: compression at the cubital fossa
MANIFESTED: loss of sensation over the medial arm
SCIATIC
HOW INJURED: in sitting position compression of the on the ischial tuberosities * in lithotomy position thigh and nerves are externally rotated and knees are extended * excessive hip flexion resulting in nerve stretch * intramuscular injections
MANIFESTED: weakness of all skeletal muscles below the knee and diminished sensation over lateral half of the leg and almost all of the foot * foot drop * pain or numbness of lower leg, thigh, or foot
FEMORAL NERVE INJURY
HOW INJURED: in lithotomy extreme abduction of the thighs with external rotation of the hip * compression at pelvic brim by retractor or excessive angulation of the thigh
MANIFESTED: decreased or absent knee jerk, and loss of flexion of hip and extension of the knee * decreased sensation over superior aspect of the thigh and medial and anteromedial side of the leg
SAPHENOUS NERVE INJURY
HOW INJURED: Lithotomy position damage occurs when medial aspect of lower leg is suspended outside an unpadded support
MANIFESTED: parasthesis along the medial and anteromedial side of the calf
COMMON PERONEAL NERVE INJURY
HOW INJURED: lithotomy position pressure of vertical support pole for the leg or inadequate padding of metal knee supports which impact the popliteal fossa * in supine prolonged pressure in popliteal fossa by pillows or leg
MANIFESTED: foot drop * loss of dorsal extension of toes * inability to evert the foot
OBTURATOR NERVE INJURY
HOW INJURED: damaged during difficult forceps delivery or by excessive flexion of the thigh to the groin
MANIFESTED: inability to adduct the leg * diminished sensation over the medial side of the thigh
ANTERIOR TIBIAL NERVE INJURY
HOW INJURED: plantar flexion of the feet for extended periods of time
MANIFESTED: foot drop
LATERAL FEMORAL CUTANEOUS NERVE INJURY
HOW INJURED: nerve entrapment at inguinal ligament due to expanding abdominal girth
MANIFESTED: pain and dysthesia over lateral thigh