Shared Flashcard Set

Details

Principles 2, test 2, ortho lecture, slides 20-29
--
15
Nursing
Graduate
10/17/2009

Additional Nursing Flashcards

 


 

Cards

Term

What are the overall considerations associated with ortho surgeries?

 

Definition

1.  Pt comorbidities

2.  Positioning challenges

3.  Temperature in room is cold, cold, cold!

4.  Xray exposure

5.  Bleeding (cold can lead to additional coagulopathies)

6.  Pain!!

Term
Pts with CAD undergoing ortho surgery are usually considered what risk?  Why are they difficult to assess?
Definition

"Intermediate" risk--and surgery places patients under enough stress that they may have a cardiac event intra-op.

The patients are difficult to assess because they can't do exercise tolerance tests

Term

What type of tests may be necessary to determine cardiac risk for a patient with CAD?

 

What drugs might be useful?

Definition

Nuclear testing

 

Beta blockers

Term
A patient with rheumatoid arthritis may have atlantoaxial instability.  What does that mean to me?
Definition
This may lead to subluxation of the odontoid process, and normal intubation with neck extension can result in spinal cord injury
Term
What other problems associated with intubation might patients with rheumatoid arthritis present?
Definition

TMJ problems with limited movement of the mouth

Larynx--lack of mobility

Term
What drugs might patients with rheumatoid arthritis be on?  How does this impact us?
Definition
NSAIDS or steroids.  Emergent surgeries may need platelets, steroid replacement is likely going to be necessary.
Term
What are some of the respiratory effects of scoliosis?
Definition

1.  Respiratory failure and death can occur by the age of 45

2.  Decreased vital capacity

3.  V/Q mismatch with hypoxia

4.  Hypercapnia develops with age (and worsening of compensatory mechanisms)

5.  Frequently requires post-op ventilation

Term

What determines the severity of scoliosis?  What does this not account for?

 

How do you determine the probability of post-op ventilation?

Definition

COBBS angle--the more severe the angle, the worse the progression.  This does NOT account for the twisting of the spine.

 

Vital capacity--those with a VC less than 40% predicted will often require post-op vent

Term
What typically happens with pulmonary function after surgery for scoliosis?
Definition
Pulmonary function often deteriorates for 7-10 days post-op before it gets better!
Term

The chronic hypoxia/lack of ventilation which leads to V/Q mismatching, will also eventually lead to what other problems?

 

What other anomalies are often present?

Definition

Chronic pulmonary vasoconstriction, increased pulmonary vascular resistance, increased pulmonary pressures, and right ventricular hypertrophy.

 

MVP, coarctation, and cyanotic heart disease

Term

Concerning positioning, how would you position the pts head if one arm was abducted?

 

What can happen with rotation of the neck?

Definition

Turn towards the abducted arm

 

Compromised circulation of carotid or vertebral artery, leading to neurological or spinal cord ischemia

Term

What anesthetic technique might be necessary with a lateral approach to spinal surgery?

 

How does the approach of the surgery affect fluid management?

Definition

A double lumen ETT and dropping a lung

 

Potential for large or small evaporative loss, need to be aware of the exposure!

Term
Anterior cervical spine surgery utilizes an incision near the SCM muscle.  What structures could potentially be affected?
Definition

Carotid artery, interrupting blood flow, stimulating baroreceptors

Recurrent laryngeal nerve paralysis

Term
What position is usually used for anterior cervical spine surgery?
Definition
Supine, usually with extensive flexion of the neck by the surgeon.  May utilize Mayfield pins.
Term

What type of anesthetic plan is usually used for anterior cervical spine surgery?

 

How much blood loss usually occurs?

Definition

GETA, but if a trauma with unstable neck, be prepared for stabilization and difficult intubation

 

Minimal EBL

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