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Principles Exam II - PathoEndocrine - slides 2-14
creamy
21
Nursing
Graduate
10/15/2009

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Term
Formula for calculating normal weight for males...
Definition

106 lbs. for 1st 5 feet.

 

Add 6 lbs. for every inch over 5 ft.

Term
Formula for normal weight for women...
Definition

100lbs. for 1st 5 ft.

 

5lbs for every inch over 5 ft.

Term
How do I tell if someone is obese? Morbidly obese?
Definition

They weigh 20% more than their predicted normal weight.

 

Twice predicted weight or 100lbs over predicted weight.

 

Their weiner heads are found 6 inches deep to the posterior aspect of their overhanging pannus.

Term
In an obese person, CO2 production is ______that of a normal weight person.
Definition
double
Term
Obesity is a _______lung disease.
Definition
restrictive
Term
What are some respiratory effects of Obesity?
Definition
  1. Decreased reserve (you should pre-oxygenate longer)
  2. Decreased FRC, lung compliance, VC, IRV, ERV
  3. Increase work of breathing
  4. Hypoventilation
  5. Bronchitis and emphysema are common
  6. Increased risk of aspiration pneumonitis
  7. V/Q abnormality leading to shunting
Term
Somnolence, twitching, cyanosis, polycythemia, periodic respiration, RVH, RV failure are all symptoms of what disease state associated with obesity?
Definition
Pickwickian syndrome (aka. hypoventilation syndrome)
Term
Rapid fire some CV changes associated with obesity.
Definition
  1. CO twice normal
  2. HTN
  3. cardiomegaly
  4. increased BV (although their EBV is 50-55 cc/Kg)
  5. CAD and atherosclerosis
  6. increase risk of thromboemboli
  7. aortocaval compression (possible)
Term

T of F: all of the following are true regarding GI changes r/t obesity?

  • increased gastric volumes are also more acidic
  • Hiatal hernia common
  • Fatty liver infiltration, liver dysfunction more common
  • poop smells "poopier" than normal
Definition
True! (last statement was a hilarious joke)
Term
The airways of "plumpkins" can present challenges for even the most experienced anesthesia provider. List some physical attributes that make it harder to get that tube in.
Definition
  1. high chest wall or breast tissue
  2. numerous chins
  3. fleshy cheeks
  4. large tongue
  5. enlarged platal, pharyngeal, and supralaryngeal tissue
  6. prone to soft tissue obstruction (MAC cases)
Term
What are some other considerations that make anesthesia more difficult for tubbies?
Definition
  1. High incidence of diabetes
  2. Difficult IV starts
  3. Regional is more difficult
  4. Positioning - prone to nerve injuries especially brachial plexus.
Term
What were some other anesthetic considerations (for obese pts) that were randomly thrown on a slide?
Definition
  1. Obtain hx of daily activity, exercise tolerance
  2. ABGs and PFTs may be necessary
  3. CXR, EKG, and LFTs should be done
  4. Determine SaO2 on room air (should be on the chart b/c of implications for post-op discharge...they don't need to go home on a 99% SaO2 if they came in at 91%
  5. Calculate doses on lean body mass
  6. Decreased dose requirements for spinal and epidural anesthesia.
  7. May have difficulty lying supine
Term
Is masking an obese patient for an entire case a good idea?
Definition
No. Increased risk of aspiration. Difficult to achieve adequate TVs.
Term
How high should your FiO2 be for super-fatties?
Definition
at least 50%
Term
Should you deep extubate your chunky monkey patients?
Definition
No! They should be completely awake.
Term
Which is more potent: T3 or T4?
Definition
T3 - it's the primary metabolic regulator.
Term
What metabolic disease is characterized by weight loss, muscle weakness, warm moist skin, heat intolerance, nervousness, hypercalcemia, thrombocytopenia, mild anemia, atrial fibrillation, and dysrhythmias?
Definition
Hyperthyoidism
Term
T or F: Grave's disease is more predominate in males?
Definition
False! Females
Term
What thyroid disorder is characterized by an enlarged thyroid gland, exopthalmos, clubbing of the fingers, and occurs more frequently in females?
Definition
Grave's disease
Term
Thyroiditis often follows_______.
Definition
a respiratory illness.
Term
T or F: thyroiditis is characterized by a firm, painfull gland and is treated with anti-inflammatory agents?
Definition
True
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