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86 Cards in this Set
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- Back
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What criteria must be included in admitting orders?
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Adca Vanndimls
Admit to the service of Dr. X of ___ service. Diagnosis Condition (Stable, Guarded, Critical, Terminal) Allergies Vitals Activity Nursing Nutrition Drains IV Meds Labs Special Tests |
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Tracheal Tube size for women
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8-8.5
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Tracheal Tube size for men
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8.5-9
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Cirgulating Nurse job and education?
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Oversees pt, entire team, supplies, and paperwork. Non-sterile person.
RN |
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Scrub Nurse education?
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RN
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OR Tech or Anesthesia Tech education?
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LPN
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MacCantosh laryngoscope
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curved
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Miller Larygoscope
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straight to lift epiglotis
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Airway size possibilities.
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0-4
measure from ear to corner of mouth |
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Laryngeal Mask Airway (LMA) placement instructions?
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lay against roof of mouth and slide in --> swoop down --> add air
http://www.youtube.com/watch?v=sBps7rxYVg8 |
http://www.youtube.com/watch?v=sBps7rxYVg8
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How much air do you add to an LMA?
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if it is size 3 add 20cc
size 4 = 30 cc size 5 = 40 cc http://www.youtube.com/watch?v=sBps7rxYVg8 |
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What are some of the cardiac risks for surgery?
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known vascular disease - PVD or Post MI as seen on Q wave or Critical aortic stenosis
smoking diabetes age >65 HTN |
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What is the drug for chemical stress testing?
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Dobutamine
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What are the different surgical risks for...
Aortic cross clamp surgery vascular orthopoedic intrathoracic and abdominal cataract surgery |
Aortic cross clamp surgery = highest
vascular = high orthopoedic = orthopoedic intrathoracic and abdominal = intermediate cataract surgery = low |
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How is risk in surgery assessed?
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patient disease x surgical stress
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How is surgical risk graded?
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1 = no risk
4 = serious but will die without |
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During surgery monitor the heart, temperature, provide steroids if adrenals are insufficient, and continue with statins. What specific measures are taken to protect the CV system?
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Use Beta blockers if they have high diastolic BP or risks of cardiac morbid events AND HR is >50. This will decrease demand, prevent tachycardia, lower preload (LVEDP) and improve short and long term outcomes.
Watch lead II for starting or ongoing ischemia in the Right coronary or LAD and the P wave (rhythm). Watch lead V5 for the LAd |
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Preoperative evaluation of the patient includes?
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HX of drugs, surgeries...will give idea of risks
PE for CAD, heart failure (ST gallop and edema) ECG anyone >50 with risk factor Labs: kidney, liver, diabetes, adrenal insufficiency (supplement during surgery if they are insufficient) |
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What Hbg level is risky for those actively bleeding and those not actively bleeding?
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Active bleed <10
Non-actively bleeding <7-8 |
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What do we evaluate in an emergent situation?
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Airway (NG tube unless there is a cribiform fracture)
Breathing Circulation (2 large lines before hypovolemic) Disability/neurologic Exposure/Eyes (undress the patient) Foley catheter (double check for high prostate) |
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What percentage of blood loss leads to:
BP changes change in consciousness white color lost femoral or carotid pulse |
BP changes >30%
change in consciousness >50% white color >30% lost femoral or carotid pulse >50% |
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What is shock?
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abnormally circulating system --> inadequate tissue perfusion
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How do you estimate blood volume in adults and kids?
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Adults 70cc/kg
Kids 80-90/kg |
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What are the classes of hypovolemic shock and the quality/quantity of replacement fluid?
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15-25% 3:1 crystalid:cc lost
30-50% 1:1 blood:cc lost remember adults 70cc/kg |
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What is the #1 used fluid replacement?
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LR
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In hopyvolemic shock, how do you administer LR to youth?
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bolus of 20cc/kg up to 3 times
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When is Normal Saline administered?
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with blood transfusions
never administer more than 10L |
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What volume is considered a massive transfusion?
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1.5 times the blood volume or >10 units
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How much does 1 unit of platelets raise the platelet level?
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10,000
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At what point are platelets administered?
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<50,000
(at that point bleeding will occur following all surgeries) |
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What are the consequences of hypothermia?
metabolism acid/base levels electrolytes O2 usage |
increased O2 consumption (shivering can increase it 100%)
increases affinity of Hbg for O2 impairs platlet function acidosis increases intracellular K - hence older blood increasing K levels decreases citrate and other drug metabolism (citrate is in blood products) |
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What is an alternative to blood for transfusion?
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HES (Hydroxyethyl Starch)
albumin 1cc/1cc blood lost again: adults 70cc blood/kg |
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What maximum quantity of HES should be administered?
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500cc or 1 L top max
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In emergent situations, what is the minimum fluid output we look for?
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adults 50cc/h
kids 1cc/h |
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How do you treat acidosis?
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warm fluids
<7.2 also give bicarbinate with acidosis and hypothermia, coagulopathy is inevitable |
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What anesthesia induction drug is soy and egg based?
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propothol
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What are the would cleanliness classifications?
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clean
clean contaminated contaminated dirty |
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What is the incidence of infection with the following wound classifications?
clean clean contaminated contaminated dirty |
clean 3%
clean contaminated 5-15% contaminated 15-40% dirty >40% |
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How are dirty wounds treated?
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only close fascia
pack with 4x4's drain deep to fascia close suction/wound vaccume |
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Treatment for choliosystitis?
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C. dif
metronidazole or Vancomycin |
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Treatment for soft tissue injuries?
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Nafcillin or Oxacillin (for G+)
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Treatment for abdominal injuries?
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(for G-) aminoglycoside or cephalosporin plus metronidazole
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Treatment for MRSA?
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Vanc or Linezolid
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Treatment for H Pylori
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Prevpac (amox, clarithromycin, or lansoprazole)
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Td
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regular, delayed immunity, Tetanus
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TID
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immediate immunity, Immunoglobulin
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Felon
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hand infection (pulp space of hand)
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Paronychia
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infection in lateral nail folds and over mantle of nail
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Treatment for peptic ulcers
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1st H2 antagonists: Cimetadine (Tagamet), Ranitadine (Zantac), and Famotidine (Pepsid)
PPI's Lansoprazole (prevacid), Omeprazole (Prilosec), Kapidex (Dexlansoprazole), Aciplex (Rabeprazole) |
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What is Cimetadine?
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Tagamet is first line H2 antagonist, treatment for peptic ulcers
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What is Ranitadine?
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Zantac is the first line H2 antagonist treatment for peptic ulcers
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What is Famotidine?
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Pepsid is a first line, H2 antagonist, treatment for Peptic ulcers.
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What is Lansoprazole
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Prevacid is a PPI for peptic ulcers
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What is Omeprazole?
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Prilosec is a PPI for peptic ulcers
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What is Dexlansoprazole/Kapidex?
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Kapidex is a PPI for peptic ulcers
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What is Robeprazole?
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Aciplex is a PPI for peptic ulcers
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What are the types of ulcers?
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I - 1 ulcer
II - 1 gastric and 1 peptic III - prepyloric IV - gastroesphogeal V - any caused by NSAIDs or steroids |
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What is unique about a heating probe for treating bleeding peptic ulcers?
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deep penetration and a high risk of perpheration
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What is unique about a multipolar probe for treating bleeding peptic ulcers?
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not as deeply penetrating as a heating probe tissue desiccation prevents lower layer damage
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what is the benefit of an argon probe to treat bleeding ulcers?
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even spray, used when there is water in the area, not as deep as the heater probe
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What is a Graham patch?
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omenum used to seal or block acid from leaking in resections and ulcers.
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What is a Heineke-Mikulica Pyloroplasty?
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lateral suturing of the pyloric ulcer rather than horizontal
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What is a Billroth I repair?
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Removing part of antrum to remove an area rich in parietal cells.
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What is a Billroth II repair?
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The jejunum is sutured to the stomach. The duadenum is kept for the secretions but nothing flows through it.
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Where does the Vagus run?
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Left anterior
Right posterior LARP |
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What is the difference between late and early dumping?
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Early dumping occurs 15 minutes after eating b/c the patient either eats too fast or too much --> hyperosmolar environment --> fluids leave circulation --> cause hypovolemic state --> anxiety, tachycardia, diaphoresis, diarrhea
Late dumping is 3 hours after eating and the same symptoms without diarrhea. Due to too much sugar in small intestine. |
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What is the treatment for early and late dumping?
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small fatty meals
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What is afferent limb syndrome?
Sx Tx |
Billroth II thatgets kinked
Sx: Nonbilious vomiting Tx: convert to Roux-en-Y |
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What are the layers of the intestines/stomach?
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Mucosa
submucosa 2 muscularis layers serosa |
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T1 cancer penetrates what layers of the intestines/stomach?
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mucosa and submucosa
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T2 staging cancer penetrates what layers of the intestines/stomach?
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mucosa, submucosa, and muscularis layer.
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T3 penetrates what layers of the stomach?
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mucosa, submucosa, and second muscularis layer.
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T4 penetrates what layers of the stomach?
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mucosa, submucosa, muscularis, and through the serosa
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What is a Sister Mary Joseph node?
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periumbilical palpable node
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what is the name of a periumbilical palpable node?
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Sister Mary Joseph node
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What is a Blumer's shelf
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Peritoneal mets palpable by rectal Pe
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What are the mets palpable by rectal PE?
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Blumer's shelf
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What is Virchow's node?
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palpable left supraclavicular lymph node
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What is a palpable supraventricular lymph node called?
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Virchow's node
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What is Krunkenberg's tumor?
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palpable ovarian mass
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What is a palpable ovarian mass?
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Krunkenberg's tumor
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What is GIST?
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tumor that doesn't penetrate the mucosa,
fast growing therefore highly vascular with a necrotic center |
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What type of cancer does H. pylori cause?
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B-cell lymphoma (low grade)
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What is the most common stomach cancer?
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B-cell lymphoma
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How do you treat low grade B-cell lymphoma?
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treat the H. pylori with Prevpac
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Where does B-cell lymphoma usually occur?
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in the antrum (unlike Burkitt's)
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