Shared Flashcard Set

Details

Principles test 1
Principles test 1
69
Nursing
Graduate
08/05/2009

Additional Nursing Flashcards

 


 

Cards

Term

True or False:

 

The scrubbed person is only sterile from the chest down to the waist level and just above the elbows to the gloves.

Definition

 

 

 

True

Term

 

NIOSHA recommeds no more than ______ppm exposure to volatiles and ______ppm to nitrous oxide

Definition

 

 

2; 25

Term

 

 

What is the cellular impact of nitrous oxide exposure?

Definition

-Inhibits Vit. B12 dependent enzymes including methionine synthestase (responsible for myelin formation) and thymidylate sythetase (necessary for DNA synthesis)

 

-Prolonged exposure can lead to bone marrow depression

 

-Teratogenic

Term

 

The number one reason for anesthesia related morbidity and mortality

Definition

 

 

Lack of proper airway management

Term

 

The division between the upper airway and lower airway is:

Definition

 

 

cricoid cartilage

Term

 

Upper airway structures

Definition

 

 

Nose

Mouth

Pharynx

Larynx

Term

 

What is the function of the nasal passage?

 

What arteries supply the nasal mucosa?

Definition

- provides large surface area to WARM/HUMIDIFY air; turbinates FILTER air

 

-Maxillary (sphenopalantine branch); opthalmic and facial (septal)

Term

 

What is contraindicated in a cribiform plate disruption?

Definition

 

Positive pressure ventilation, nasal airways, nasal intubation, NG tubes

Term

Describe innervation of the nasal passage.

 

What does sympathetic innervation result in?

 

How does anesthesia affect sympathetic innervation?

Definition

- The trigeminal nerve supplies the nasal passage; specifically the anterior 1/3 of septum and lateral wall supplied by anterior ethmoidal nerve branch and the posterior 2/3 supplied by maxillary branch via sphenoplatine ganglion.

 

-vasoconstriction and tissue shrinkage

 

- inhibits

Term

What is the #1 cause of airway obstruction?

 

What is a close second and how does it cause obstruction?

Definition

Tongue

 

Soft palate; falls back against nasal passage and blocks air movement

Term

Where do the following structures lie:

Nasopharynx

Oropharynx

Cricoid cartilage

Definition

C1

C2-3

C5-6

Term
Where does the upper esophageal sphincter sit and why is it important?
Definition
At the junction of the esophageal opening and lower edge of the hypopharynx; arises from cricopharyngeal muscle and acts as barrier to regurgitation/aspiration
Term

Name the 3 paired and 3 unpaired cartilages of the larynx

 

What is the largest unpaired?

 

What is the function of the arytenoids?

Definition

Paired: arytenoids, cuneiform, corniculate

Unpaired: epiglottis, thryroid, cricoid

 

Thyroid

 

Point of attachement of vocal cords, allow open/closing of cords necessary for respiration and voice

Term

 

 

 

Describe sensory and motor innervation of larynx

Definition

 

Sensory: internal superior laryngeal (laryngeal tissue from vocal cords up) and recurrent laryngeal (mucosa inferior to vocal cords

 

Motor: External superior laryngeal (cricothyroid) and recurrent laryngeal

Term

 

 

What does the right and left recurrent nerves loop around?

Definition

 

Right: subclavian artery

 

Left: aortic arch

Term

Name the muscle that correlates with the following vocal cord actions:

1. abduction of vocal cords, opens glottis

2. adducts glottis

3. produces tension and elongates cords

4. shortens and relaxes cords

5. closes glottis and adducts

Definition

1. posterior cricoarytenoid

2. lateral cricoarytenoid

3. cricothyroid

4. thyroarytenoid

5. arytenoids

Term

 

Describe the trachea

Definition

originates at inferior border of cricoid cartilage

extends to carina

10-20cm long

cricoid is only complete ring

16-20 C shaped rings

 

Term
You are doing an airway assessment on a patient.  What history information would you want to know?
Definition
History of: previous airway surgery, difficult airway, co-morbidities, change in body habitus, facial anomalies
Term

 

The five predictors of a difficult mask ventilation:

OBESE

Definition

Obese

Bearded

Elderly

Snorers

Edentulous

Term
Some assessment factors to determine difficult airway:
Definition

Long upper incisiors

Overbite/underbite

visibility of uvula

shape of palate

mandibular compliance

thyromental distance

length/thickness of neck

range of motion of neck/head

Term

 

what are some considerations to using face masks?

Definition

all increase deadspace

has 22mm adaptor for bag to attach

correct size is important for good seal

occular trauma is a big concern

Term

 

What are advantages of ETT intubation

Definition

Patent airway

Protects against blood/aspiration

PPV

Removal of tracheal secretions

Decreases anatomical deadspace

controlled oxygen delivery

route for emergency drugs

Term

 

What are advantages of a MAC blade?

Definition

less dental trauma

more room for ETT

less bruising of epiglottis

less stimulating

Term

 

4 common problems with laryngoscopy

Definition

 

blade inserts too deep/can't see structures

tongue escapes

displacing blade tip to the right in attempt to keep tongue to left

difficulty inserting blade

 

Term

 

 

How much air should be put in ETT cuff?

Definition

 

usually 3-6ml; most importantly, to seal

Term

What grading system is used to describe visualizaiton of larynx?

 

What are the grades?

Definition

cormack & lehane

 

1: entire laryngeal aperture

2. posterior laryngeal aperture

3. epiglottis only

4. nothing

Term

 

How much cricoid pressure should be applied?

Definition
2 kg with increase to 4kg as pt loses consciousness
Term

 

What is objective criteria for ETT extubation?

Definition

1. VC = 10ml/kg

2. Peak NIP = -20cm H2O

3. TV = 6 ml/kg

4. sustained tetanic contraction of 5 seconds

5. T1/T4 ratio of >0.7

6. PaO2-PAO2 gradient <350 torr on 100%

 

Term

 

What are NPO fasting guidelines?

Definition

Clears : 2h

Breast milk: 4h

Formula/non human milk: 6h

Light meal: 6h

Fatty/lg meal: 8h

Term

 

Who was the first nurse to specialize in nurse anesthesia? When?

 

Who is the mother of nurse anesthesia? What were three achievements?

Definition

Sister Mary Bernard - 1877 - St. Vincent's Hospital

 

Alice Magaw - widely published, performed >14,000 anesthetics without complications, mastered open drop ether technique

Term

 

 

Who established the first school of nurse anesthesia?  When?  Where?

Definition

 

Agnes McGee

1909

Portland, OR

 

Term

 

 

Who founded the AANA?

When?

Definition

 

Agatha Hodgins

1931

Term

 

Describe the outcome of Frank v. South

Definition

 

 

1. medicine cannot regulate other professions

2. Hatfield (CRNA) was NOT practicing medicine

3. recognized nurse judgment involved in practice of anesthesia

Term

 

 

Describe the outcome of Dagmar Nelson's court case.

Definition

 

1. She was engaged in giving anesthesia under the license of surgeon

2. She was NOT practicing medicine

Term

 

 

When could men enter the AANA?

Definition

 

 

1947

Term

The first certification exam was offered in ______.

 

 

Certification exams were mandated in:

Definition

1945

 

1978

Term

 

 

Name the functions of the AANA

Definition

Oversees recertification, CEUs, determine recert. criteria

 

Educate public

 

Set up practice standards, guidelines

 

Political action

 

Action alerts

Term

 

 

Where should addendums be placed in the charting?

Definition

 

 

Added as close to the time they occured as possible

Term

 

 

describe informed consent

Definition

 

 

the patient has the right to reasonably informed participation in decisions involving his or her health care - every adult of sound mind has the right to determine what happens with his or her own body

Term

 

 

What was the outcome of Natanson v. Kline in regards to informed consent?

Definition

Physicians must provide:

nature/purpose of proprosed tx

potential risks/benefits

alternative tx's along with their risks/benefits

Term

 

 

What is capacity?

Definition

 

A clinical term refering to the ability to make rational and reasonably well informed decisions by a particular patient in their treatment and/or life decisions

Term

 

 

What is competency?

Definition

 

 

A legal term refering to the ability to make rational and reasonably well informed decisions by a particular person in their treatment/life decisions.

Term
What is assault?  Battery?
Definition

 

Assault is an act that creates fear of imminent battery and battery is unlawful touching

Term

 

 

Who can sign informed consent?

Definition

 

-Adult >18y.

-Emanicpated minor who is legally married, in the military, in law enforcement custody, has court documents,

-Legal guardians

-Pregnant teen for procedures/tests related to unborn child/pregnancy only; or if teen with baby, only for procedures/tests for her child

Term

 

If family is signing for patient, what is the order of priority?

Definition

 

spouse, adult child (usu. all must agree/sign), parent, adult sibling, adult relative, close friend

Term

 

 

What is the TBW fluid distribution of:

males

females

elderly

infants

Definition

-60%

-55%

-46-52%

-70-80%

Term

 

Differentiate osmolarity from osmolality

Definition

Osmolarity is the # of osmoles per liter of solvent

 

Osmolality is the # of osmoles per kg of solvent

Term

 

 

Crystalloid replacement of blood loss is:

Definition

 

3 ml crystalloid for every 1 ml blood loss

Term

 

 

How much crystalloid should be given before blood?  What if patient is actively bleeding?

Definition
3 L; if actively bleeding, consider blood not just massive crystalloids
Term

 

Differenetiate insensible v. sensible fluid loss

Definition

Insensible (no solutes): water loss via skin, respiratory tract, incisions

 

Sensible (solutes): mucous, tears, urine, stool, sweat

Term

 

 

What is the insensible water loss in the neonate?

Definition

 

 

40 ml/kg/day

Term

 

 

Your patient has a temperature >37C.  What is the fluid loss related to the temperature?  Is it sensible or insensible?

Definition

- 100-150ml/h for every degree >37C

 

-Sensible

Term

What is the osmolality of:

D5W?

LR?

0.9NS?

Plasma?

Definition

-253 mosmol/kg

-273

-308

-290-300

Term

 

What type of patient may receive D5W in OR?

Definition

 

Patients prone to hypoglycemia (DM, took insulin) and neonates who have limited glycogen stores

Term

 

 

How is lactate metabolized?

Definition

 

1. 70% via gluconeogenesis in the liver to create glucose

 

2. 30% via oxidation to create bicarbonate

Term

 

What is the intravascular 1/2 life of LR?

Definition

 

20-30 minutes

 

Term

 

 

Why should LR not be used on a diabetic patient?

Definition

 

The Cori Cycle causes most of the lactate in the LR to be converted to glucose and the diabetic patient will have post-op hyperglycemia

Term

 

 

What is the formula for a fluid bolus and what general type of fluid should be used?

Definition

 

10-20ml/kg of isotonic fluid

Term

 

 

What is the average intravascular volume of colloids?

 

How do colloids affect crystalloids?

Definition

>3-4 hours

 

improves the intravascular 1/2 life of crystalloids

Term

 

 

What can large amounts of colloids cause (because they are mixed in normal saline)?

Definition

 

 

Hyperchloremic acidosis

Term

 

 

Your patient has a low albumin level.  How does this affect your medications?

Definition

 

If albumin levels are low, there will be more free drug as opposed to bound drug - it is the free drug that creates the effect.

Term

 

 

Why has albumin fallen out of favor?

Definition

-Pooled product

-2X more expensive than hespan

-10X more expensive than crystalloids

-No increased benefits

-Creutzfeldt-Jakobs disease

Term

 

Describe the reaction that can occur with dextran and what can be done to prevent it?

Definition

 

Anaphylactoid and anaphylactic reactions.

 

Dextran 1 (promit) can be given to bind circulating dextran antibodies

Term

 

What is the hemotological risk of dextran?

Definition

 

Doses greater than >20ml/kg/d can interfere with blood typing and prolong bleeding time

 

decreases blood viscosity

Term

 

 

What type of surgery is dextran useful for?

Definition

 

 

microvascular

Term

Estimate blood loss for:

fully soaked 4x4

fully soaked lap pad

dripping lap pad

 

Definition

 

10 ml

100 ml

150 ml

Term

What parameters are used to calculate total blood volume for the following patients?

Premie

Infant

child

Adult Male

Adult Female

Obese adult

Definition

90 ml/kg

85 ml/kg

80 ml/kg

75 ml/kg

65 ml/kg

55 ml/kg

Term

 

How do you determine allowable blood loss for a healthy patient who does not have a hemoglobin or hematocrit on the chart?

Definition

 

Estimated blood volume x 20%

Supporting users have an ad free experience!