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 OR procedure?: Egg white allergy (but egg yolk allergy is ok with propofol) Iodine 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 69 x 0.0254 = 1.7526 meters 63.63 / (1.7526)^2 63.63 / 3.072 BMI = 20.72 (normal) 2) 172 / 2.2 = 78.18kg 64 x 0.0254 = 1.6256 meters 78.18 / (1.6256)^2 78.18 / 2.643 BMI = 29.58 (overweight) -> 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) - Intrathoracic - Major urologic 44. Low risk procedures: <1% cardiac risk - breast - dental - endoscopic - cataract - gynecologic - reconstructive - minor ortho(knee sx) - minor urologic ***most of these can be done with LMA/MAC/local 45. Fasting preop hours for the following: - 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? What would alter this correlation?: EtCO2 always reads slightly lower (2-5 mmHg) than PaCO2 ***Some medications alter this correlation: - methylene blue - indigo carmine ***Incompetent unidirectional valves ***Faulty absorber ***Moisture in sampling tubing 65. Explain the 4 phases of a normal EtCO2 waveform: I - Baseline; 1st portion of exhaled air from dead spaces. Should be zero. II - Upstroke; early exhalation, air is from gas-exchange tissues of the lungs III - Plateau; CO2-rich alveolar air. ***Junction between phase III-IV is where EtCO2 is measured IV - Downstroke; inhalation 66. What would cause an elevated baseline on EtCO2 waveform?: 1) CO2 absorbent exhausted or channeling 2) Incompetent exhalation check valve 3) Bain circuit flows too low 4) MH; increasing flows will have no effect 67. What would cause a prolonged upstroke of phase II on EtCO2 waveform?: ***Mechanical obstruction = slow emptying - COPD - bronchospasm 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 (light- emitting) 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) -> Increases affinity of O2 to HGB resulting in decreased delivery of O2 to the tissues -> PO2 will be lower than correlating SPO2 reading (falsely high SPO2) Example: Point 'A2' on the diagram shows a left shift; where an SPO2 of 90% correlates with PO2 45mmHg (where it would normally correlate to 60mmHg) Right Shift (better) -> decreases affinity of O2 to HGB; so increased amounts of oxygen is being delivered to the tissue -> PO2 will be higher than correlating SPO2 reading (falsely low SPO2) Example: Point 'A1' on diagram 90. Correct size and length of BP cuff: size - 20-50% greater than diameter of patient arm length - should cover 80% of upper arm 91. What is the potential loss of heat for a patient in the OR?: 0.5 - 1 degree celsius per hour; especially during general anesthesia <36 = hypothermia <34 = significant morbidity <32 = fibrillary threshold 92. What is the most significant mechanism of heat loss?: Radiation (60%) loss of heat from vasodilation to cooler room temperatures Evaporation (20%) insensible loss from ventilation Convection (draft over wet skin) Conduction (3-4%) cold bed surface 93. BIS monitoring: Measures brain waves; gives an estimate of conciousness >90 = awake 40-60 = goal for general anesthesia; no memory 0 = absent brain activity ***Do not treat based off of BIS number, look at your patient ***Does not indicate whether or not pt is in pain or will move 94. Patients at high risk for awareness of surgery (3 total): 1) Stat C-section mothers 2) Use of cardio-bypass (filters sedatives) 3) Trauma patients in hemorrhagic shock (B/P too low for proper sedatives) 95. Indications for using cerebral oximetry: - Neurosurgical patients - Hx of stroke - Cardiac patients 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 106. Mapleson A (Magill) System: -> FGF near reservoir bag -> APL near patient -> excessive dead space; considered difficult to use ***Most efficient for spontaneous ventilation ***Least efficient for controlled ventilation Lack's System - co-axial modification; APL further away from patient 107. Mapleson B: -> FGF (distal) and APL (proximal) to patient -> FG and alveolar mixture is inhaled -> differs from C due to corregated tubing ***FGF must be greater than 2 x minute ventilation to avoid rebreathing => wasteful 108. Mapleson C: Known as Water's Circuit, or Ambu Bag ***Same as B, except shorter main tubing (no corregated tubing) ***CO2 builds up slowly over time, not efficient 109. Mapleson D vs Bain System: Mapleson D -> FGF close to patient -> APL valve is placed just before reservoir bag ***most efficient for controlled ventilation, 2nd most efficient for spontaneous ventilation Bain's system - co-axial modification where FGF runs inside corrugated tube through which expired gas is eliminated; warms FGF. High FGF needed. ***used today in vet clinics and for pre-mature neonates 110. Describe the test that is used to evaluate the integrity of a Bain Circuit: The Bain Circuit is susceptible to disconnect or kinking of the inner FGF tubing. If so -> circuit becomes dead space -> respiratory acidosis Pethick Test - occlude patient/APL end and fill FGF inlet by using O2 flush valve; then release occlusion at the elbow. Reservoir should go flat 111. King Circuit: -> inspiratory limb inside expiratory limb -> less bulky than Bain, same disconnection problems as a Bain - > no elbow, cannot perform pethick test ***will not respond to increased FGF if you have a problem. If you have a problem, change entire circuit 112. Mapleson E: Ayre's T-piece -> no reservoir or APL valve -> used to administer to O2 and humidified gas to intubated patient breathing spontaneously 113. Mapleson F: Jackson-Rees System -> bag has a venting mechanism-usually a hole -> APL can be added -> scavenging can be done by enclosing bag in a plastic chamber from which waste gases are suctioned -> can use as a mask or ETT -> can use CO2 absorber to avoid high FGF ***Can be used for long periods 114. Closed vs Mapleson Circuits: Closed - can use on any age - low resistance (less than a tracheal tube, but more than a NRB circuit) - conserve respiratory heat and humidity - low FGF