NURS 581 - Exam 2 Study Guide Latest Update 2024-2025 with Questions and Verified Correct, Exams of Nursing

Download NURS 581 - Exam 2 Study Guide Latest Update 2024-2025 with Questions and Verified Correct and more Exams Nursing in PDF only on Docsity! NURS 581 - Exam 2 Study Guide Latest Update 2024-2025 with Questions and Verified Correct Answers Guaranteed Success 1. What is SCIP?: Surgical Care Improvement Project: publishes guidelines that are meant to improve surgical outcomes For example: - BG levels pre/post-op - meds to hold/continue during preop - stress hormone management - abx to incision (1 hour) - electric clippers for hair removal 2. What is the prevelance of current anesthesia-related deaths? How many of those are preventable? Name some common causes of preventable deaths (4 total): 1: 26,000 (in the 1940s, used to be 1: 650) 1/3 of these deaths are preventable; caused by: 1) inadequate IV access 2) improper airway 3) wrong anesthetic technique 4) inadequate crisis management Preparation and vigilence is key every case 3. What type of hospital would you expect to use preanesthesia clinics vs. phone call the night before?: Preanesthesia clinic - larger, urban hospitals Phone call the night before - small rural hospitals (usually done by preop nurse) 4. When assessing for difficult airway history, what is something you should ask every patient?: Did a previous anesthesia provider ever say you were a difficult airway? If so, did they right a letter explaining this in more detail? 5. When asking about family history, what are two syndromes should alert anesthesia providers?: From anesthesia, did any of your family members die or have any serious ADR such as fever? 1) Malignant hyperthermia 2) A-typical acetylcholinesterase 6. How long before surgery should patients quit smoking? What are some associated risks with smokers? (3 total): 12-48 hours - reduces HR, BP, carbon monoxide levels, and circulating catecholamines (Reality: patients usually smoke right before surgery) Associated risk with smokers: - irritable airway - delayed wound healing - 6-8 weeks after quitting => copious secretions from the return of cilia function7. When should you get a urine pregnancy test prior to surgery?: All females of childbearing age with a functioning uterus 8. Give an example of each functional level within the Metabolic Equivalents of Functional Capacity (MET).: 1 kilocalorie per kg per hour 1 kcal/kg/hr (would be equivalent to sitting on the couch for one hour) ***e4 MET indicates better surgical outcomes (can they climb a flight of stairs without dyspnea, chest discomfort?) 9. More examples of MET from power point for reference *great test questions here*: 10. What are some basic allergies that could cause problems during any 15. In general, instruct patients to stop taking herbs/supplements 2 weeks prior to sx; especially for what supplements?: St John's Wort - many medication interactions Garlic - interferes with platlet aggregation => bleeding risk 16. What are factors that could make intubation difficult? (I have listed 18): 1) hx of difficult intubation 2) brittle/missing teeth 3) large tongue 4) high mallampti class (uvula not visible) 5) extensive facial hair (use KY jelly) 6) Oral/neck/tharacic masses (beware of tracheal deviation) 7) hx of oral/neck cancer requiring radiation 8) tonsillar disease 9) C-spine issues (limited ROM) 10) raised hard palate 11) Maxillary protrusion (overbite) 12) Mandibular hypoplasia (underbite) 13) Short, thick neck 14) hx of prolonged intubation => stenotic larynx (NICU as a baby, prolonged ICU visit on vent) 15) obesity/large breasts 16) OSA ***have patient bring home-CPAP to have in PACU for recovery 17) pregnancy 18) angioedema 17. What is the 3-3-2 airway exam?: Predicts a difficult airway - 3 fingers should fit between incisors - 3 fingers should fit between mandible and anterior neck (less fingers indicate less room to displace tongue) - 2 fingers should fit between the mandible thyroid notch/hyoid bone (less than two makes direct visualization of larynx nearly impossible) ***One or more predictors => 34% difficult intubation 18. Mallampti Classification: -> Direct visualization of hypopharynx; 50% predictibility = high incident of false positive. Do not use as only oral assessment method. I - soft palate, fauces, uvula, pillars II - soft palate, fauces, uvula III - soft palate, base of uvula IV - soft palate not visible III and IV will be difficult 19. Calculate Ideal Body Weight (IBW) for the following patients: 1) Male, 140 lbs, 5'9'' 2) Female, 172 lbs, 5'4'' 3) Male, 89 kg, 183 cm 4) Female, 50 kg, 155 cm: 1) 105 + (8 x 6) 105 + (48) IBW = 153 lbs 2) 100 + (3 x 5) 105 + (15) IBW = 120 lbs 3) 89 x 2.2 = 196lbs 183 / 2.54 = 72 inch 105 + (12 x 6) 105 + (72) IBW = 177 lbs 4) 50 x 2.2 = 110lbs 155 / 2.54 = 61 inch 100 + (1 x 5) 100 + (5) IBW = 105 lbs 20. Calculate Body Mass Index for the following patients: 1) Male, 140 lbs, 5'9'' 2) Female, 172 lbs, 5'4'' 3) Male, 89 kg, 183 cm 4) Female, 50 kg, 155 cm: BMI = Kg / (Ht in meters)^2 1 inch = 0.0254 meters 1 cm = 0.01 meters 1) 140 / 2.2 = 63.63kg An increase in these cases are linked to the anti-vaccine movement 29. Laryngealmalacia: Over-softening of the tissue of the larynx = collapse of airway ***premature babies and older adults with muscle-weakness syndromes; associated with: - aortic arch anomalies - tracheal-esophageal fistulas - mechanical intubation 30. ASA 1: ASA 1 - no health history -> age is not a factor -> nonsmoker -> normal BMI 31. ASA 2: ASA 2 - mild/moderate systemic disturbance that may not be related to the reason for surgery -> 1 PMH -> smoker -> overweight - > pregnant 32. ASA 3: ASA 3 - Severe systemic disturbance that may or may not be related to the reason for surgery ***most people are in this category -> 2 or more PMH -> still functional 33. ASA 4: ASA 4 - severe systemic disturbance that is life-threatening with or without surgery -> ESRD, severe aortic stenosis, actively having an MI, stroke, or DKA 34. ASA 5: ASA 5 - Moribund patient who has small chance of survival; surgery is last resort (resuscitative effort) -> ischemic bowel, grade 5 liver laceration, AAA rupture 35. ASA 6 "E": ASA 6 - patient is brain dead and surgery is for organ harvest E (emergency surgery) - can be added on to any ASA class 36. STOP - BANG: - every "yes" answer is 1 point. - less than or equal to 3 is low risk for OSA ***Any patient with diagnosed OSA should be encouraged to bring their CPAP machine to be used for post-op recovery 37. What would constitute a cardiology consult during preop assessment? (3 total): - Severe angina or MI in the last 30 days - Symptomatic arrythmia - Aortic stenosis *patients with pacemakers/AICDs should undergo interrogation to assess settings; consider turning off, especially when using cautery -> magnet. 38. Preop B/P goals for: 30-59 years of age >60 years of age: 30-59 years of age < 140/90 >60 years of age < 150/90 39. Special anesthesia considerations for chronic HTN: - be cautious to suddenly drop blood pressure; may become symptomatic - may need to treat with a BB during induction to counteract the catecholamine surge; however BBs can cause refractory bradycardia which can be difficult to treat 40. Risk of re-infarct during surgery due to a previous ischemic episode: - general risk of MI with anesthesia under normal circumstances is 0.3% -> MI within 3-6 months = 6% risk -> MI within 1-2 months = 19% -> MI within the last 30 days = 33% ***If they do re-infarct, there is 50% probability of mortality 41. Special considerations in preop preperation of patient with LV dysfunction: -> HFrREF/CHF associated with gallop (S3), SOB at rest ***Will start an ACEI ***High narcotic technique (cardiac-stable; lower risk of vasodilation) 42. High risk procedures: 5% cardiac risk Aortic sx Major vascular sx Peripheral vascular sx 43. Intermediate risk procedures: 1-5% cardiac risk - Intraperitoneal - Transplant (more risk with soft tissue transplant) - Carotid Endarterectomy - Peripheral arterial anioplasty - Endovascular aneurysm repair - head/neck surgery - Major neurologic/orthopedic (spine/hip) ***For all of these risk factors, EKG 1-3 months prior to surgery is ideal 50. What must be checked before proceding with any procedure? (4 total): - Right Patient and Procedure (check armband; ask patient name, surgeon, procedure) - Right site marked by MD - Informed Consent is signed and in the chart - Perform Time-Out (usually by the circulating nurse; always engage in this process. Perfect time to address any concerns found during your preop assessment to the team) 51. What entity sets standards of monitoring for CRNAs, and when were these standards first introduced?: AANA via Professional Practice Manual; 1974 - you must always be up-to-date on AANA standards; they are proven to reduce mortality/morbidity - If you are ever called to court, these standards will protect your practice 52. Name some basic standards of monitoring that must be used on every patient, every case.: - Continuous presence of a dedicated anesthesia provider - HR and BP measured every 5 minutes - Continuous ECG - Ventilation continuously monitored - Disconnect detecting device for mechanical ventilation - O2 analyzer in breathing circuit - Pulse oximetry - Never turn off alarms; only silence as needed 53. AANA standards for verifying intubation: - auscultation - positive chest excursion (bil chest rise) - expired CO2 54. What leads are most commonly used during ECG monitoring?: II (inferior, RCA, largest voltage projection) V (majority of LV) ***Can detect ischemia on most portions of the heart 55. When is tempurature monitoring mandatory?: - children < 10 years old - all pts receiving general anesthesia -> all other patients as indicated by discretion of the CRNA 56. Why are patients at risk for hypothermia in the OR?: 1) Volatile gases > vasodilation = cold 2) Birthday suit 3) Cold IVFs ***Patients with vascular disease more at risk 57. When is it mandatory to continuously monitor neuromuscular function?: When using neuromuscular depolarizing and nondepolarizing agents ("blocks") 58. How often should CRNAs assess patient position?: Every 15 minutes! ***This is due to a peak of lawsuits associated with post-op pressure injuries 59. Esophageal Stethoscope: -> excellent quality breath/heart sounds -> accurate core body temp ***only used on anesthetized patients; placed in distal 1/3 of esophagus 60. FEF end-tidal detector: Also called 'Easy Cap II CO2 Detector' -> pH sensitive paper that changes from purple to yellow in the presence of CO2 ***very sensitive, small amounts of CO2 in the stomach can produce a false positive. 61. How does Capnography technology work?: -> IR (infrared light) absorbed is proportional to the concentration of polyatomic gases (CO2) -> Nitrous Oxide is also a polyatomic gas, so it may slightly influence CO2 readings 62. What monitoring device will most likely detect respiratory problems or hemorrage first?: EtCO2 ***Invaluable tool for measuring adequacy of ventilation -> sampling port at elbow of circuit 63. Will EtCO2 be increased or decreased in the following pathophysiologies? MH Hypothermia PE Apnea Hyperventilation Hypoventilation Low fresh gas flows: Increased EtCO2 Decreased EtCO2 MH Hypothermia PE Apnea - EtCO2 absent Hyperventilation Hypoventilation Low fresh gas flows 64. What is normal correlation of PaCO2 vs EtCO2? - extubation (intentional or nonintentional) - disconnected ventilator or EtCO2 sample tubing - kinked tubing - apnea - loss of circulation (VT/Vfib/asystole) 73. What would make you suspect a CO2 Embolism during a lap case using CO2 sufflation?: Will get increase on EtCO2 initially; then a sharp decrease => cardiovascular collapse 74. What would cause a drastic decrease in EtCO2 but sustains low and does not drop to zero?: - Leak - Mucous plug - Obstruction 75. What would cause a sudden upwards shift in baseline and peaked EtCO2 waveform?: Contamination of CO2 line (moisture) or plugin is faulty 76. What circumstances would cause a gradual increase in EtCO2 baseline and peak?: - MH (refractory hypercapnia) - exausted CO2 absorber 77. 1) What intervention is appropiate if you have a gradual increase in EtCO2, and you are in the middle of a short case? 2) What if you are in a long case?: If you do not suspect MH... 1) Hyperventilate and change CO2 absorber after case 2) Put patient on ambu bag while changing CO2 absorber in the middle of the case78. Curare Cleft: Patient is trying to take a breath; fighting ventilator... <aka> your patient is waking up -> if you are close to the end of a case and see this; giving an IVP of narcotics will transiently depress respirations 79. The case is over and you are wanting to extubate the patient. What is something you can do to easily stimulate spontaneous breathing?: Purposely hypoventilate -> rise in CO2 is a strong stimulator for spontaneous breathing 80. A curare cleft with an elevated baseline?: Sticking Inspiratory Valve 81. What would be suspected with a rippled, pulsatile wave on the plateau and inspiratory downstroke?: Cardiogenic oscillations => indicates pulsatile movements of aorta or heart ***Normal, usually seen in skinny patients. Document. 82. What waveform would you expect to see in an awake, agitated patient fighting the ventilator?: 83. Where is the O2 analyzer in the circuit, and what would happen if you calibrated incorrectly during a routine machine check?: It is located in the inspiratory limb; you could administer a hypoxic mixture if calibrated incorrectly 84. Explain how pulse oximetry works: Sensor contains 2 diodes (lightemitting) and 1 photodiode (light-detector); Uses Lambert-Beer Law of Spectrophotometry which states: 2 different wavelengths of light are used, one is visible red (660nm) and the other is infrared (950nm). Infrared light is absorbed by oxyhemoglobin, red light is absorbed by deoxyhemoglobin. The differences in absorption are used to calculate oxygen saturation Summary Deoxyhgb - red light; 660nm wavelength Oxyhgb - IR light; 950nm wavelength 85. What factors would affect the accuracy of SPO2%?: - high intensity light - ambient light - patient movement - electrocautery - peri vasoconstriction - dyshemoglobinemias - cardiac bypass - IV dyes - nail polish - CO poisoning - hypotension - SPO2 <80% - hypothermia 86. O2 saturation is directly proportional to the amount of ______ _______ in the plasma: O2 saturation is directly proportional to the amount of oxygen dissolved in the plasma 87. Penumbra Effect: -> Pulse ox is loose on the patient's finger and patient's true SPO2 <85% = patient's SPO2 will read falsely high on the monitor -> Pulse ox is loose on the patient's finger and patient's true SPO2 >85% = patient's SPO2 will read falsely low on the monitor 88. Oxyhemoglobin Dissociation Curve: SaO2 90 = PO2 60 SaO2 75 = PO2 40 SaO2 60 = PO2 30 -> There are 4 binding sites for O2 on each HGB molecule; when PO2 decreases to a certain point (60 mmHg) it changes the conformation of HGB, decreasing affinity to O2. -> This is why SPO2 decreases rapidly once under 90% 89. Which shift of the oxyhemoglobin dissociation curve is worse; left or right?: Left Shift (worse) Expiratory Reserve Volume Residual Volume Inspiratory Capacity Vital Capacity Functional Residual Capacity Total Lung Capacity Minute Ventilation: ***Numbers are based on a 70kg male*** Tidal Volume - normal inhale/exhale (500cc) Inspiratory Reserve - maximum inhalation (3000cc) Expiratory Reserve - maximum exhalation (1100cc) Residual Volume - what is left in lungs after expiratory reserve exhaled (1200cc) Inspiratory Capacity - TV + IRV (3500cc) Vital Capacity - TV + IRV + ERV (4600cc) Functional Residual Capacity - ERV + RV (2300cc) Total Lung Capacity - TV+RV+ERV+IRV (5800cc) Minute Ventilation (VE) - TV * RR 98. What is the difference between PaCO2 and PACO2?: PaCO2 = partial pressure of CO2 in arterial blood PACO2 = partial pressure of CO2 in alveolar gas 99. All anesthesia breathing systems have what 2 fundamental purposes?: 1) Delivery of O2 and anesthesia gases 2) Elimination of CO2 100. How does Hagen-Poiseuille Law apply to breathing systems?: Resistance is inversely proportional to diameter (Example, increasing diameter of ETT drastically decreases resistance of flow 101. What are some ways to decreases resistance within a breathing circuit?: - choose appropriate sized tubing (as large as possible) - reduce circuit length - be aware of gas density - avoid unnecessary sharp bends (turbulent flow) - eliminate unnecessary valves 102. Differentiate the following classes of anesthesia breathing circuits: Open Semi-open Semi-closed Closed: Open - directly dropping liquid anesthetic onto a cloth over patient's mouth (Schimmelbusch mask) Semi-open - no rebreathing; reservoir present; FGF greater than minute ventilation Semi-closed (most common) - partial rebreathing/CO2 absorber/reservoir/APV open/ FGF less than minute ventilation (semi open vs semi closed depends on FGF) Closed - total rebreathing/ modern/ CO2 absorber/reservoir **APV closed ***FGF = Minute Ventilation; once steady state is reached, you only add FGF to the circuit what is lost from patient metabolism or what is leaked to reservoir. Cost efficient. CO2 is the only gases that is not rebreathed. 103. Breathing/Reservoir bags: - ellipsoid shape - different sizes; not color coded to specific size - can serve as manual ventilation bag, or reservoir of waste (although 4L size is for reservoir only) - provide means for visual assessment of the existence/rough estimate of ventilation104. Place the 6 Mapleson systems in order from most -> least efficient for spontaneous and controlled ventilation: Preventing rebreathing during spontaneous ventilation: A Donkey Fell Eating Crispy Bacon Preventing rebreathing during controlled ventilation: Donkeys Fall Eating Bacon Clapping Aloud 105. Name three benefits of a low FGF system: 1) cost efficient; recycle anesthetics 2) high flows can dehydrate 4) prevents hypothermia