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CPAN Mega set 1
Dantrolene is diluted with... - 60 ml of sterile water without preservatives Describe the stages of anesthesia - Stage I begins with initiation then loss of consciousness. The patient can follow simple commands and the REFLEXES are IN TACT Stage II begins with loss of consciousness and ends with the disappearance of the LID REFLEX. Respirations are Irregular and the risk of laryngospasm, bronchospasm and aspiration is high Stage III begins with CESSATION of RESPIRATION. Reflexes are GONE Stage IV: Overdose. Anesthesia to circulatory collapse. Naloxone Dosing - 0.1-0.2 every 3-5 minutes spinal cord lesions above which point contribute to autonomic hyperreflexia? - Lesions above T6 contribute to autonomic hyperreflexia. treat diabetes insipidus - with vasopressin and fluid replacement mnemonic for cranial nerves - On I Olfactory Old II Optic Olympus III Oculomotor Towering IV Trochlear Tops V Trigeminal
A VI Abducens Finn VII Facial And VIII Auditory German IX Glossopharyngeal Viewed X Vagus Some XI Spinal Accessory Hops XII Hypoglossal tonic phase of a seizureq - stiff; loss of consciousness; may cry out Which are the longest acting spinal anesthesia blocks? - Tetracaine With epinephrine is the longest. But bulimic ain't beats tetra ain't. Adding dextrose to a spinal anesthesia so,union increases its density relative to the CAF and therefore prolongs its effects. Lidocaine toxicity symptoms - Dizziness, tinnitus, circumoral numbness clonic phase of a seizure - urinary incontinence shaking frothing of mouth Symptoms of autonomic dysreflexia - Flushing HA HTN BRADYcardia Triggers of autonomic dysreflexia - Fecal impact ion
smell and vision oculomotor, trochlear, abducens - eye movement (make the eyes do tricks) Trigeminal - face sensation, mastication, jaw movement facial nerve - Facial motor, taste and salivation acoustic - hearing and equilibrium Glossopharyngeal - Swallowing, gag reflux, taste on posterior tongue, Vagus - Swallowing, gag, abdominal viscera and phonation Spinal Accessory - Head and shoulder movement Hypoglossal - tongue movement Non-depolarizing neuromuscular blockers - what do atracurium, cisatracurium, pancuronium, rocuronium, and vecuronium function as Depolarizing neuromuscular blocking agents - Succinylcholine
Depolarizing neuromuscular blocking agents - A skeletal muscle relaxant that after administration produces skeletal muscle twitches by stimulating the nicotinic receptors on the neuromuscular end plat. They remain on the end plate x3- minutes which leads to paralysis. Skeletal muscle function does return as the psuedocholinesterace metabolizes the succs which typically takes 3-5 minutes. Non-depolarizing neuromuscular blockers - Cause paralysis of skeletal muscles by blocking the neural muscular transmission at the myoneural junction. What drugs are used to reverse the effects of the non depolarizing neuromuscular blocking agents? - Anticholinesterace drugs Why do you use anticholinergic drugs with anticholenesterace? - To reduce the side effects of anticholinesterace drugs used to reverse the neuromuscular blockade. What side effects occur when giving anticholinesterace drugs to reverse non depolarizing neuromuscular blocking agents? - Bradycardia, salivating, miosis, hyperperistalsis. What narcotic is enhanced by beta blockers? - Dilaudid Sevoflurane - Emergence time 7-8 minutes (shorter than propofol) Can trigger MH. Desflurane - Pungent inhaled anesthetic which leads to high incidence of coughing and vasospasm Emergence in 8-9 minutes
Relationship: family Is it okay for me to do, move and act? Events: exploring, using tools, making art Erickson middle childhood 7-12 - Virtue: competence Psychosocial: industry vs inferiority Relationship: neighbors/school Can I make it in the world of people and things? Events: school, sports Erickson adolescence 13-19 - Virtue: fidelity Psychosocial: identity vs role confusion Relationship: peers/ role model Who am I/ who can I be? Events: Social relationships Erickson Early Adulthood 20-39 - Virtue: love Psychosocial: intimacy vs isolation Relationships : friends/partners Can I love Events: romantic relationships Erickson middle adulthood 40-59 - Virtue: care Psychosocial: generativity vs stagnation Relationships: household/coworkers
Can I make my life count Events: work/children Late adulthood 60 and older - Virtue: wisdom Psychosocial: ego integrity vs despair Relationship: mankind, my kind Is it okay to have been me? Events: reflecting on life Halothane (Fluothane) - Doesn't increase saliva production Sweet Cardiac problems Hypocalcemia S/S - Diarrhea, Numbness, Tingling of extremities and around mouth, Convulsions, Positive Chvostek sign, Positive Trousseau sign, *Pt at risk for tetany. central venous pressure - venous blood pressure within the right atrium that influences the pressure in the large peripheral veins 0-8 mm hg Right ventricular systolic /diastolic (rvs/rvd norm - 15-25 and 0-8 mm hg Pulmonary artery s/d norm - 15-25 and 8- Pulmonary artery wedge pressure norm - 6-12 mm hg
1-2 grams exophthalmos - abnormal protrusion of the eyeball Causes dryness and increased risk of corneal abrasions metabolic alkalosis causes - severe vomiting, excessive GI suctioning, diuretics, excessive NaHCO thyrotoxic crisis - toxic condition characterized by hyperthermia, tachycardia, nervous symptoms, and rapid metabolism; also known as thyroid storm. Malignant hyperthermia - Autosomal-dominant trait characterized by often fatal hyperthermia in affected people exposed to certain anesthetic agents. Hyperthermia, muscle rigidity, tachycardia, hypercarbia causes diabetes insipidus - hyposecretion of ADH (vasopressin) D/t head trauma, tumors or surgery Signs dilute unconcetrated sugar free urine, dehydration and c/o thirst. Treatment for diabetes insipidus - vasopressin(ADH), desmopressin, dilutional hyponatremia how much saline given Sodium less than 120 - 3-5% saline solution Sodium bicarbonate can be used in cardiac arrest for what and dosage for children is what? - Hyperkalemia, od on tricyclics or sodium channel blockers,
Dose 1 meq/kg slow bolus Hypothyroidism can cause what that makes intubation more difficult - Enlarged tongue They also have slower metabolism of meds and airway incompetence d/t neurologic weakness and overall decreased metabolic states Addison's disease - a condition that occurs when the adrenal glands do not produce enough cortisol or aldosterone Requires steroid therapy S/s muscle weakness fever dehydration n/v hypotension followed by hyponatremia and hyperkalemia Fluid bolus for cardiogenic shock? In kids - 5-10 ml/kg over 10-20 minutes Mannitol - osmotic diuretic Pulls fluid from brain cells into bloodstream to decrease icp Syndrome of Inappropriate Antidiuretic Hormone (SIADH) -
- secretion includes excessive ADH secretion from the pituitary gland Fluid overload, hyponatremia, Thirst HA, decreased loc, decreased urine output, elevated bp and HR, n/v/d seizures and heart failure anesthetic medication cause what to happen to ecf - Cause vascular dilation and expand extra cellular fluid capacity. Important for easing fluid overload and improving cardiovascular function diabetes insipidus congenital/acquired treated with - ADH/vasopressin
Hypothyroidism can make more prone to what and why? - Hypothermia d/t lowered metabolic state Mag levels greater than 2.5 result in? - 1.3-2. Decreased reflexes, decreased bp, and decreased HR mag toxicity antedote - calcium gluconate hyperparathyroidism - hypersecretion of the parathyroid glands, usually caused by a tumor Htn, dysthymia, somnolent, lethargic, polyuria and polydipsia, osteoporosis, muscle weakness, myalgia, constpation, hypercalcmia which can deplete bones of calcium transphenoidal surgery - Removal of Pituitary gland through nasal passage. Assess airway is priority. Call doctor of halo sign is present on the nasal dressing, indicates cerebrospinal fluid. Also cough, excessive seaport c/o postnasal drainage This approach decreases risk of blood loss and infection rate hypophysectomy - removal of the pituitary gland SIADH prone to what which is a risk for what when muscle relaxant used - Hyponatremia snd reparalysis Addison's disease - occurs when the adrenal glands do not produce enough of the hormones cortisol or aldosterone They require steroids for surgery
Keep glucose level below what for glucose control after surgery - 180 Increased risk for aspiration - Morbid obesity, renal or hepatic failure, as cites, brain injury, increased icp, decreased loc, delayed gastric emptying, diff swallowing, cp, trauma, pain, overdose, diff airway, gi obstruction, anorexia, esophagus d/o, diabetes Paxil can be effective for what in diabetes - Diabetic neuropathy Hypothermia can cause shivering which can lead to - Metabolic acidosis chest tube - decreased drainage =assess for kinks or dependant loops -do not clamp off Sevoflurane (Ultane) - Inhalation anesthetic/common ERCP (endoscopic retrograde cholangiopancreatography) - a specialized technique used to study the bile ducts, pancreatic duct and gallbladder. EGD (esophagogastroduodenoscopy) - An upper GI endoscopy that investigates the esophagus, stomach and duodenum for abnormalities like bleeding ulcers. EVAR - endovascular abdominal aortic aneurysm repair dermatome -
S1, 2, L5 -
Posterior and outer surfaces of lower limbs S1 - Lateral margin of foot and little toe S2,3,4 - perineum Reversal for precedex (dexmedetomidine - Atipamezol (antisedan) Adductor canal-femoral block - Fem block decreases quad strength. Adductor canal becoming #1. Usually combined in our pacu. Last 10-12 hours mainly but can be 24 hours. fluoroscopy - radiographic procedure that uses a fluorescent screen instead of a photographic plate to produce a visual image from x-rays that pass through the patient, resulting in continuous imaging of the motion of internal structures and immediate serial images litholapaxy - Procedure involving crushing of a bladder stone and immediate washing out of the fragments through a catheter TURBT) - transurethral resection of bladder tumor Gemcitabine - Bladder radiation drug
Facetectomy - (a decompression procedure) surgical removal of all or part of the vertebral facet plasty (suffix) - surgical repair or reconstruction ileal conduit - use of a small piece of intestine to convey urine to the ureters and to a stoma in the abdomen TEE - transesophageal echocardiogram neuraxial analgesia/anesthesia - Analgesia medications instilled into the central nervous system via the spinal cord (intrathecal/epidural) intrathecal - Also known as subarachnoid space. CSF circulates within the intrathecal space. Also known as spinal analgesia Contraindications for intrathecal and epidurals - Infection near site, abnormal clotting, sepsis, cardiovascular issues, sepsis, increased ICP, allergies to the medication, uncontrolled hypovolemia, neurological disease, hx of severe headaches neuraxial analgesia can do what to cardiac workload and myocardial oxygen demand? - Decrease Risks of neuraxial anesthesia - Reap depression, neurotoxicity, epidural hematoma, symptomatic hypotension, urinate retention, infection Anesthesia toxicity )Caine's -
Patient safety What is the preferred position to facilitate drainage of chest fluids and to support optimal chest expansion? - Semi Fowler's Providing translation services for non English speakers is required under what? - The civil rights act To minimize intracranial pressure changes do what? - Head of bed 30-45 degrees and head in neutral position. Space nursing care to allow frequent rest periods NO prone or valsalva Cardiovascular systems of LAST - Begins with htn leading hypotension, pvc's, prolonged pr intervals and qrs on ekg. Followed by cardiovascular collapse if untreated. In neuraxial block what is lost first and what will return first? - Sensation (ice or alcohol swab) Additional assessments for pediatric patients that are more than adults? - Gestational age, birth history, cognitive functioning, developmental milestones, patient:/child interactions When does the posterior fontanelle usually close - 4 months Right shoulder pain after laparoscopic procedure? - D/t retained gases. Can last several days. Managed with analgesics and sleeping with 15 degree elevation of head and shoulders The specialty of pacu nurse regulated by what? -
Policies and procedures of hospital, state and federal regulation agencies , and national accreditation organizations Marking of correct site must be done by - Md or pa but is standard hospital mark for each pt not their signature Safe transportation by rn is determined by? - Mode, number and competency level of accompanying personnel based on pt needs. Not dispo. That is determined by provider Aspan core values for a culture of safety? - Communication, advocacy, competency, timeliness, efficiency, teamwork Emergency readiness requires plans for what? - Medical emergency, severe weather, fire and evacuation, code amber, code silver According to aspan patients are at greatest risk for adverse events of sedation when? - PeAk of medication, first 24 hours, after opioid dose is increased, within first 6 hours after anesthesia, and during hours of 11 pm to 7 am Who provides standards for all clinical lab testing to ensure quality? - Clia provides standards and cms regulate testing to ensure quality Advantages of ambulatory surgery for elderly? - Eliminates unfamiliar inpatient routine, reduces respiratory or intubation events, decrease in ponv, pain, post op complications Toddlers response to pain - Opening eyes wide, rocking, rubbing, clenching teeth or lips, trying to run away, grimacing Prepare pt hours or min prior to surgery to decrease anxiety to far out. Adolescent preop guidelines -
