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60 Cards in this Set

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  • Back
What are some cardiac considerations of prone position?
pooling of blood in extremities
compression of abd muscles (pt should have TEDS/SCDs)
pooling can --> decreased preload, decr CO, decreased BP
increased SVR and PVR
What are some cardiac considerations of sitting position?
minimal effects on CV
What are some cardiac considerations with reverse t-burg?
decr CO, preload, BP
baroreceptor reflexes incr SNS tone, HR, PVR
What are some cardiac considerations with Trendelenburg?
activation of baroreceptors --> decr in CO, PVR, HR, and BP
research suggests t-burg does not improve CO in hypotension and hypovolemia
What does cardiogenic oscillations on ETCO2 waveform indicate?
interference from heart or aorta pulsation
What does a cleft on alveolar plateau on ETCO2 waveform indicate?
spontaneous respiration
Common injury with lithotomy position?
peroneal nerve injury from fibula pressing against candy canes
5 Complications of lateral decub positions
1. backache/neck pain
2. compartment syndrome
3. contusion "folding" ear
4. Inc IOP, ischemia to dependent eye
5. stretch injury to suprascapular nerve (too much rotation of non-dep arm)
3 complications of lithotomy position
1. peroneal nerve injury
2. compartment syndrome
3. digit amputation
5 complications of prone position
1. ischemic optic neuropathy
2. central retinal artery occulsion
3. periorbital, conjunctival edema (keep HOB at lvl of heart of higher)
4. brachial plexus injury
5. impaired cerebral perf
Deoxyhemoglobin looks dark b/c of the _______ absorption of red light
Does Hb absorb more infrared or red light?
red (660nm)
Does HbO2 absorb more infrared or red light?
infrared (960nm)
How does the mass spectrometer work?
analyzes inspired (FI) and end tital (ET)
o2, no2, co2, anesthetic gases
compares the mass:charge ratio & places into specturm
explain the 1st phase of exhalation
deadspace gas leaving the lung (no CO2)
explain the 2nd phase of exhalation
includes deadspace gas and gas from the alveoli mixing, which causes a rapid rise in CO2
explain the 3rd phase of exhalation
all deadspace gas is out.
CO2 slowly rises (dependant on V/Q ratio)
explain the 4th phase of exhalation
peak ETCO2 which is the highest level exhaled CO2 during respiration (plateau)
AANA: standard of care for nurse anesthesia practice (Standard V)
Monitor ventilation continuously. Verify intubation by auscultation, chest excursion, and confirmation of CO2 in expired gas. Monitor ETCO2 during ventilation incl. anesthesia or sedation req. artificial airway support. Use spirometry and vent pressure monitors
Actual waveform generated by capnometer
Graphic record of CO2 concentration on screen or paper
Raman spectrometry
Laser interacts with gas molecule and measures the fraction of energy absorbed at different light wavelengths called “scattering”
Advantages – multi-gas/agent, fast, no scavenging, accurate
Disadvantages - costly
What are the advantages and disadvantages of Mass Spectometry?
Advantages - Multigas, multiagent, fast, reliable, low cost

Disadvantages - Measures only preprogrammed gases, must be scavenged, warm-up time, space
What are the advantages and disadvantages of Mainstream Sampling?
Measures gas directly in the breathing system
Advantages – fast, good waveform, water & secretions not issue
Disadvantages – heavy in circuit, incr dead space, opport for disconnect, gas options limited
What are the advantages and disadvantages of Sidestream Sampling?
Advantages – Accurate < 40 Resp/min, lightweight, less chance of disconnect
Disadvantages – water/secretions may clog line, flexible tube can be easily obstructed
What is mainstream sampling?
Measures gas directly in the breathing system
What is sidestream sampling?
Pump in the monitor aspirates a sample of gas through a thin, flexible sampling line
What is a Galvanic cell?
Fuel or microfuel cell sensor used for O2 analysis
Calibrated daily to room air (21% O2)
What are the principles behind O2 sat monitoring?
Measures pulsatile signals across perfused tissue at 2 wavelengths where absorption is compared as a ratio of oxyhemoglobin to all functional hemoglobins (algorithms used)
What does the pulse ox probe contain?
light source (light-emitting diodes - red and infrared)
light detector (photodiode)
What are the principles of O2 sat monitoring? (simplified answer)
the absorption of radiation (light) is proportional to the concentration of the substance
Oxyhemaglobin looks red b/c of the _______ absorption of red light
Name 7 factors that influence accuracy of pulse ox reading.
1. excessive ambient light
2. motion
3. methylene blue
4. low CO, hypothermia
5. profound anemia
6. nail polish
7. bovie
When are Pulse Ox (sats) not very accurate?
When is the esophageal steth C/I?
esophageal varices or strictures
Describe how air embolism/PE affects ETCO2
Decreased CO2
Describe how circuit disconnect affects ETCO2
Decreased CO2
Describe how CO2 insufflation during laproscopic procedure affects ETCO2
Increased CO2
Describe how hyperventilation affects ETCO2
Decreased CO2
Describe how hypothermia affects ETCO2
Decreased CO2
Describe how hyperthermia affects ETCO2
Increased CO2
Describe how hypoventilation affects ETCO2
Increased CO2
Describe how improved blood flow (CO) affects ETCO2
Increased CO2
Describe how release of clamp/tourniquet during vascular surgery affects ETCO2
Increased CO2
What are some limitations & proper application of esophageal steth?
Limited to use with intubated patients
Placed in nasally or orally & rest in lower 1/3 of esophagus
What is a Precordial stethoscope?
Special stethoscope that is placed on various locations of a pts chest
Wenger chest piece is large (heavy/adult) or small (lightweight/pedi)
Improper prone positioning can cause abdominal pressure.. why does this matter?
increased abdominal pressure can cause
decreased preload
cephalad movement of the diaphragm
decreased FRC and compliance
increased peak airway pressure
In standard lithotomy position how is pt positioned?
thighs flexed approx 90 deg.
knees bent parallel to floor
legs well padded
arms tucked or on armboards <90 angle
what is the maximum angle armboards and arms should be in the supine position? what is the desirable angle?
<90degrees (max)
60 degrees (optimal)
what nerve can be injured by the anesthetist's fingers on the patient's mandible during masking?
Facial Nerve
What surgical access is possible with prone position?
posterior fossa of skull
posterior spine
perirectal area
posterior lower extremities
Which position increase pressure in cerebral veins, inc ICP/CVP/IOP, inc preload, and causes nasal congestion?
Who is ulnar neuropathy more common in?
Older males
Why use an axillary roll in lateral decub position?
to raise the thorax and prevent shoulder compression and brachial plexus injury
Wrist drop, weakness of abduction of thumb, loss of sensation b/w thumb and index finger, inability to extend the distal phalanx of the thumb
Radial Nerve Injury
how should you place the patient's palms when the pt is in the supine position? why?
palms up (supination)
relieves pressure on the ulnar nerve as it passes through the humeral notch at the elbow
Trendelenburg positon causes swelling where?
possible airway obstruction
What is lateral jackknife position?
-intended to widen intercostal spaces
-pt down-side iliac crest over the hinge
-table is flexed so the thighs become lateral to the trunk
-chassis of table re-oriented so that flank and thorax become horizontal
inability to completely extend elbow, numbness over dorsal and palmar areas of the distal phalanges of the 1 and 2nd fingers. caused by AC trauma s/p IV attempt.
Median nerve dysfunction
What was found when ASA close claim analysis was done b/w 1990-1999 of 2 separate studies.
Both studies - 16% of settlements were related to peripheral nerve injuries but no MOI could be found