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NU 568
Exam 1 - Principles of Nurse Anesthesia - Pre-op Assessment
| Question | Answer |
|---|---|
| The extent of the pre-op work-up depends on what 3 things? | 1) Medical condition of the Pt 2) Type of surgery being performed 3) Type of anesthesia required for the surgery |
| Name the 3 assessment areas in the pre-op: | 1) Review of medical records 2) Pt interview 3) Physical exam |
| The preanesthesia assessment clinic benefits patients by allowing them to complete what 5 things prior to surgery? | 1) Registration 2) H & P 3) Teaching 4) Consults 5) Dx testing |
| How soon before surgery should a patient with a complex medical history be evaluated for surgery? | 1 week |
| What are the 8 categories of health conditions whereby a patient would benefit from an early preop assessment? | 1) General 2) CV 3) Respiratory 4) Endocrinologic 5) Hepatic 6) Musculoskeletal 7) Oncologic 8) GI |
| What 4 General Health conditions benefit from an early preop? | 1) Inability to engage in normal ADLs 2) Conditions necessitating continual assistance or at-home monitoring w/in the past 6mos. 3) Acute episodes or exacerbations of chronic conditions w/in the past 2mos. 4) Meds that will require schedule modificatio |
| A patient with a history of what 6 CV conditions would benefit from an early pre-op anesthesia assessment? | 1) Angina 2) CAD 3) MI 4) Symptomatic arrhythmias 5) Poorly controlled HTN (dia >110, sys >160) 6) CHF |
| What 3 respiratory conditions necessitate an early pre-op? | 1) Asthma or COPD req'ing chronic meds; acute exac. or progression of these dx's w/in past 6mos. 2) H/o major airway sx, unusual airway anatomy, upper/lower airway tumor or obstruction 3) Chronic resp. distress req'ing home vent assistance or monitoring |
| What 3 endocrinologic factors would benefit from an early pre-op assessment? | 1) Diabetes treated with insulin or oral antidiabetics 2) Adrenal d/o 3) Active thyroid dx |
| What hepatic condition would benefit from an early preop assessment? | Active hepatobiliary disease |
| What musculoskeletal factors benefit from an early preop assessment? | 1) Kyphosis/scoliosis w/functional compromise 2) TMJ w/restricted mobility 3) Cervical or thoracic injury |
| What 2 oncologic conditions benefit from an early preop assessment? | 1) Pt receiving chemotherapy 2) Oncologic process w/significant physiologic residua or compromise |
| Patients with what GI symptoms would benefit from an early pre-op anesthesia assessment? | 1) Massive obesity (>140% IBW) 2) Hiatal hernia 3) GERD |
| What can provide a basic direction of the patient interview and assessment? | Patient chart |
| The "current medical information" in a patient chart contains key pieces of information for surgery. What are the 7 key pieces of information noted in the current medical history? | 1) Surgical consent 2) Surgeon's name/date/proposed surgery 3) Baseline data (Ht/Wt, VS) 4) Progress notes and consults 5) Medical treatments w/drug doses and schedules 6) Diagnostics (XR, labs) 7) Social factors (cultural factors, coping mech |
| The pt interview is designed to reduce ______ and increase _______. | anxiety, patient satisfaction |
| What does plasma cholinesterase break down and what can a deficiency of this enzyme lead to? | Acetylcholine; prolonged paralysis w/paralytics |
| Patients that are reported as latex ______ should be treated as latex ______. | Sensitive; allergic |
| Where should latex allergic patients be placed in the OR schedule? | 1st case |
| What exam diagnoses a genetic predisposition for latex allergy? | Caffeine muscle biopsy |
| Who is at risk for latex allergies? | 1) Spina bifida pts 2) Healthcare workers 3) Individuals w/frequent exposure to latex |
| Nicotine is a toxic _____ that produces a _____ effect in the cardiovascular system. | alkaloid, ganglionic |
| What are the ganglionic effects of nicotine? (6) | Increased: 1 - HR 2 - BP 3 - Myocardial contractility 4 - Myocardial O2 consumption 5 - Myocardial excitement 6 - PVR |
| CO has an affinity for HGB that is _______X greater than O2. | 250-300 |
| Preop smoking cessation for at least ______ weeks may greatly improve pulm. mechanics. | 8 |
| What are 3 anesthetic complications noted in children exposed to second-hand smoke? | 1) laryngospasm 2) coughing on induction or emergence 3) post-op desats |
| Chronic alcoholism creates resistance/tolerance to CNS depressants such as _________, ________, and __________. | hypnotics, opioids, inhaled gases |
| Increased morbidity and mortality is associated with ETOH abuse due to what 4 effects? | 1) poor wound healing 2) infx 3) bleeding 4) hepatic injury |
| What are the 2 most popular illicit drugs? | cocaine, MJ |
| What are s/s of illicit drug use? (6) | 1) evidence of injections 2) pupil constriction 3) lymphadenopathy 4) malnutrition 5) poor dentition 6) nasal perforation |
| What are the s/s of MJ use? | 1) tachycardia 2) labile BP 3) euphoria |
| What are the s/s of cocaine/amphetamine use? | 1) HTN 2) excitement 3) hallucinations |
| What are the s/s of hallucinogenic use? | 1) dissociative reactions 2) hallucinations |
| What two organ systems are negatively affected by anabolic steroid use? | hepatic and endocrine |
| What are 4 supplements that contribute to anticoagulation? | Garlic, gensing, ginko ginger |
| How is the minimum alveolar concentration (MAC) of anesthesia affected with chronic alcoholism? | MAC is increased |
| Ginger can alter serum levels of __________. | glucose |
| Ephedra is a CNS [stimulant/depressant]. | stimulant |
| What two herbal supplements have CNS depressant qualities? | Ginger and kava kava |
| St. John's wort has been used to treat what psychologic malady? | Depression |
| The physical airway exam includes assessments of what features? | 1)Teeth 2)Inside of the mouth 3)Mandible 4)Neck |
| What is the patient asked to do during the Mallampati classification? | Open their mouth as wide as possible and extrude their tongue without phonation. |
| The Mallampati exam is used to assess which features in the airway? | Tonsils, tonsillar fossa, pharynx |
| What is visible in each classification of the Mallampati scoring system? | Class: 1)Entire tonsil clearly visible 2)Upper half of tonsil fossa is visible 3) Soft and hard palates clearly visible 4)Only the hard palate is visible |
| The lower the Mallampati score the __________ the intubation, the higher the Mallampati score the ___________ the intubation. | Easier, harder |
| The thyromental distance is the space between what two features? | Prominence of the thyroid cartilage and bony point of the lower mandibular border |
| What is associated with a difficult endotracheal intubation in regards to the thyromental distance? | <7cm or three finger breadths |
| The [thyromental/sternomental] distance is said to be more predictive of a difficult airway. | sternomental |
| The sternomental distance measures the space between what two features? | The upper border of the manubrium sterni and bony point of the lower mandibular border |
| A sternomental distance of less than _______cm is suggestive of a difficult airway. | 13.5 |
| 4 finger breadths is approximately _______in. | 3 |
| What does the interincisor distance measure? | The degree of mouth opening |
| The degree of mouth opening is controlled by what joint? | temporomandibular joint |
| How far between the upper and lower incisors should an adult be able to open their mouth? | At least 4cm (2 large finger breadths) |
| The antlantooccipital function measures the degree of movement between what two body parts? | Head and neck |
| Moderate flexion of the neck on the chest and full extension of the atlantooccipital joint aligns the axes of what three important airway features? | Oral cavity, pharynx, larynx |
| The McGill position is also known as the ________ position. | "sniff" |
| What types of oral equipment should be removed prior to surgery? | Dentures and partial plates |
| The removal of what object can prevent aspiration during anesthesia? | Loose teeth |
| Obesity is defined as a bodyweight more than _________% above ideal bodyweight (IBW). | 20 |
| Morbid obesity is defined as a bodyweight more than __________% above IBW. | 40 |
| What is the equation used to calculate IBW for men? Women? | Men: 105lbs + 6lbs for each inch > 5ft // Women: 100lbs + 5lbs for each inch > 5ft |
| What is a more specific approach to measure weight in relation to height? | BMI |
| What is the equation to calculate BMI? | Weight in kg divided by height in meters sq. |
| What is the BMI range to be considered overweight? Obese? Morbidly obese? | 1)25-29.9 2)30-35 3)>35 |
| What are illnesses associated with obesity? (8) | 1)HTN 2)Dysplipidemia 3)CHF 4)Gallstones 5)Hernias 6)OSA 7)OA 8)Respiratory disorders |
| What possibility needs to be considered with the obese patient? | Difficult intubation |
| What type of intubation needs to be considered with the difficult airway? | Fiberoptic |
| What two types of medications should be considered in preparation for a fiberoptic intubation? | Anticholinergics and antisialagogues |
| What inflammatory arthropathy causes severely compromised upper airway management of the cervical spine? | Ankylosing spondylitis |
| What pharmacologic considerations should be made for patients with ankylosing spondylitis? | NSAIDs, corticosteroids |
| Patients who have been on steroids must be considered for a ______________ dose of steroids. | Pre-op |
| Rheumatoid arthritis affects the mobility of __________. | Joints |
| In what three ways does rheumatoid arthritis affect the airway? | 1)Limited ROM of the TMJ 2)Restrictions in vocal cord movement 3)Tracheal stenosis |
| Hoarseness, stridor, painful speech, and dysphagia are all signs and symptoms that can occur with exacerbations of what inflammatory disease? | Rheumatoid arthritis |
| What cardiopulmonary complications may occur with ankylosing spondylitis and rheumatoid arthritis? (5) | 1)Restrictive lung disease 2)Pleural effusions 3)Pericardial effusions 4)Polychodritis 5)Cardiac conduction abnormalities |
| The initial neuro exam consists of assessment of what 4 areas? | 1)Musculoskeletal 2)Sensory system 3)Cranial nerves 4)Mental status |
| What are clinical manifestations of neurological disease? | 1)Increased ICP 2)Sympathetic overactivity 3)Fever and leukocytosis 4)Coma and obtundation |
| A glasgow coma scale of less than _______ is considered comatose. | 8 |
| A Glasgow coma scale of less than _______ requires mechanical ventilation support. | 7 |
| If indicated, a neuro preop assessment should be followed by what 5 things? | 1)review of diagnostic results 2)neurology consult 3)interpretation of CT scans 4)review of the degree of cerebral vascular occlusion 5)12-lead ECG and cardiology consult |
| Anesthetic management of a patient with a neurological disorder should include monitoring levels of what two things? | Anticonvulsants (if presently taking) and glucose |
| In relation to anesthesia, what medications should be avoided in patients with neurological disorders? | Sedatives |
| In relation to anesthesia, what medications should be given to patients with neurological disorders? | Corticosteroids |
| Evaluation of the CV system should include what key points? (3) | 1) Pre-existing cardiac disease 2)Disease severity, stability, and prior treatment modalities 3)Type of indicated surgery |
| What are the MAJOR CV risk factors for anesthesia? (8) | 1)Unstable coronary syndrome 2)Recent MI 3)Unstable/severe angina 4)CHF 5)High grade AV block (3rd degree) 6)Symptomatic ventricular arrhythmias 7)Supraventricular arrhythmias 8)Severe valvular disease |
| What are 4 INTERMEDIATE CV risk factors for anesthesia? | 1)Mild angina 2)Prior MI 3)Compensated or prior CHF 4)Renal insufficiency |
| What are the 6 MINOR CV risk factors for anesthesia? | 1)Advanced age 2)Abnormal ECG 3)Rhythm other than sinus 4)Low functional capacity 5)History of stroke 6)Uncontrolled systemic HTN |
| The New York Heart Association (NYHA) divides patients into categories that assess what factor? | Degree of heart failure with CV disease |
| What is stable angina characterized by? | Substernal discomfort w/exertion but relieved with rest or SL NTG |
| What is unstable angina characterized by? | Angina is progressive with increases in frequency, intensity, and duration that is less responsive to medications or rest. |
| Which patients are at prominent and great risks for a peri-operative MI? | Patient with left ventricular failure and especially ischemic cardiomyopathy |
| What are pertinent signs and symptoms of LVH or ischemic cardiomyopathy? | Rales, resting tachycardia, S3 heart sounds, JVD |
| In the presence of CHF, surgery should _____________. | Postponed |
| Cardiac valve incompetence is also known as cardiac valve _______________. | regurgitation |
| What are the two most common valves of stenosis and/or regurgitation? | Aortic, mitral |
| What is the most common cause of valvular disease? | Rheumatic fever |
| It is imperative to obtain a pre-op _________ for patients with a history of cardiac valve disease or arrhythmias. | EKG |
| What significant pre-op labs should be collected in a patient with a history of cardiac disease or valvular disease? | Potassium, magnesium, serum levels of antiarrhythmics |
| What are the three categories of ventricular arrhythmias? | Benign ventricular, potentially malignant, malignant |
| Describe each category of ventricular arrhythmias. | Benign: unifocal PVCs w/low periop risk. Potentially malignant: known heart disease on antiarrhythmic Rx. Malignant: Heart disease w/hemodynamic compromise and family h/o sudden death. |
| When is the DOO/VOO mode necessary for a patient with an intrinsic pacemaker? | When electrocautery of cardiac muscle is involved |
| True/False: Pacemakers can mask toxic effects. | True |
| Succinylcholine is associated with an increased release of what electrolyte? | Potassium |
| What are two indications for pacemaker placement? | Persistent bradycardia, bi-fascicular block |
| When should pre-op cardiac testing not be performed? | When results will not influence the patient management |
| What are the two types of chemical stress tests? | Adenosine and dobutamine |
| Which stress test involves coronary steal syndrom? | adenosine |
| What occurs in the adenosine stress test in relation to coronary blood flow? | Blood flow is redestributed without negative inotropic effects |
| What three values indicate poor ventricular function? | CI <2.2, LVEDP > 18mmHg, EF <40% |
Created by:
philip.truong
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