Acute Care - Quiz 2

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gecrouch88
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181963
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Acute Care - Quiz 2
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2012-11-11 20:26:45
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Surgery Anesthesia Wounds Debridement
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Surgery, Anesthesia, Wounds, Debridement
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  1. What are the goals of anesthesia?
    • controlled, reversible state of unconsciousness
    • maintenance of physiologica homeostais
    • --function of all systems during peri-operative period to minimize adverse outcomes
    • amnesia - result of general anasthesia
    • analgesia
    • neruomuscular blockade
    • --allows muscle relaxation for proglonged period of time
  2. What are the two types of anestesia?
    • general
    • regional
  3. What are the 4 components of general anasthesia?
    • amneisa
    • analgesia
    • inhibition of noxious reflexes (keep from gaging on trach tube)
    • skeletal muscle relaxation
  4. What are the three phases of general anasthesia?
    • induction
    • used to relax and start process
    • IV meds used
    • --propotol is most common
    • --less common - sodium pentothal, ketamine, etomidate (risk of adrenal insufficiency)
    • maintenance
    • vilitile gases - sevoflurane, desflurane, nitrous oxide
    • TIVA (total IV anesthesia) - meds released on a timer based on HR and BP
    • emergence
    • autonomic hyper-responsivencess may result in:
    • --HTN, tachycardia, broncho/laryngospasm
    • --can be blunted with short acting narcotics, beta blockers, lidocaine
    • coming out of anesthesia
  5. What are the advantages of general anasthesia?
    • total control
    • reduced intra-operative patient awareness and recall
    • control of airway, breathing, and circulation
    • can be used in cases of sensitivity to local anesthetic sites
    • adapted easily to procedures of unpredictable duration
    • --can extened if something goes wrong
  6. What are the disadvantages of general anesthesia?
    • complexity of care and costs
    • physiological fluctuations (HR, RR, BP)
    • less serious complications:
    • --vomitting
    • --sore throat
    • --HA
    • -- shivering
    • --delayed return to normal functioning
  7. What are the general effects of general anesthesia?
    • neurological
    • cortical
    • --brain
    • --"paralysis" - relaxation of the muscles
    • autonomic
    • --decreased in HR, BP, hot/cold temperatures
    • metabolic
    • hypothermia
    • cardiovascular
    • decreased cardiac output
    • arrythmia
    • peripheral vascular
    • decreased BP - less blood returns to the brain
    • respiratory
    • decreased of altered:
    • --arterial oxygenation
    • --hypoxia
    • --respiratory patter
    • --residual capacity (can't expell air completely)
    • potential atelectasis or pneumothorax
    • pneumonia
    • PMH could play a role
  8. What are the risk factors of general anesthesia?
    • COPD, emphysema, Hx smoking, obesity
    • prolonged time = increased risk for complications
    • los of blood = decreased blood count
  9. What is regional anesthesia used for?
    • used for specific site surgical procedures
    • --lower abdominal
    • --UE and LE
  10. What are the different types of regional anesthesia?
    • spinal (subarachnoid)
    • epidural (thoracic and lumbar)
    • peripheral nerve blocks
  11. Describe spinal anesthesia
    • small-gauge needle inserted into L3-L4 or L4-L5
    • reaches subarachnoid space
    • local anestheisa is injected (temporary numbness and relaxation)
    • most common for LE procedures
    • doesn't affect body and doesn't have same body effects
    • effects C-fibers which control pain
  12. Describe epidural anesthesia
    • small-gauge flexible catheter into epidural space
    • may remain in place during and post-op
    • can be used in combo with GA to decrease peri-op stress
    • used with IV like method
    • can control more "going in/out"
  13. Complications of regional anesthesia
    • post-dural puncture headache (PDPH)
    • --more common with large needles (epidural)
    • --less common with spinal anesthesia
    • spinal hematoma
    • --anti-platelet medication considerations
    • --prevent clotting
    • epidural abscess
    • --infection, wound can spread
    • hypotension
    • --8-11% (especially hypovalemia)
    • motor impairment
  14. What is a nerve block?
    • commonly used when involving LE or UE
    • most common sites:¬†femoral, brachial plexus, sciatic
    • major advantage: avoid hemodynamic instability associated with GA and neuraxial blockade
    • localized
    • --feel pressure, not pain
    • --less blood loss
  15. What are the complications of a nerve block?
    • local effects: pain, weakness, echymosis, hematomy, infection and numbness
    • systemic tocicity (CNS, CV)
    • allergic reactions
    • pneumothoras (supraclavicular)
    • phrenic nerve paralysis: diaphragm, unable to breathe properly
  16. Other types of regional anesthesia
    • monitored anesthesia care
    • no complete LOC
    • need adequate local anesthesia
    • sedation
    • should be able to maintain airway integrity
    • conscious sedation "twilight state"
    • multimodal analgesia
    • one modality of pain control while avoiding side effects of opoid
  17. Complications of endotracheal intubation
    • after anesthesia induction, endotracheal tube placed in mouth and trachea using laryngoscopre
    • most commone side effect: post-op soar throat
    • dislocation arytenoid cartilage
    • damage to teeth or tracheal mucosa
  18. Other side effects of anesthesia
    • GI issues: nausea/vomitting
    • incisional pain
    • neurological complications (mental status)
    • cardivascular/hematologic (cardiac arrythmias, MI, CVA)
    • respiratory (aspirating gastric contents)
    • integumentary (wound infection)
    • musculoskeletal (secondary to positioning)
  19. What are the medications used for sedation in the ICU?
    • lorazapam: usually used if sedated > 24 hours
    • midazoiam: rapid reliable anesthesia
    • minimal CV complicationshypotension and hypovelemic pts can occur
    • psychotic rreactions are rare
    • dexamedetomidine: easily arousable to participate in PT without irritation, low HR
    • propofol: deeper levels of sedation, more rapid awakening
  20. What are some behaviors due to disorientation in the ICU
    • not as much psychotic because they aren't there as long
    • aggressiveness due to
    • medications
    • sepsis
    • fever
    • encephalopathy
    • paranoia
    • withdrawl syndrome
    • pain
  21. What is a thoracentesis
    • therapeutic or diagnostic removal of the pleural fluid via percuaneous needle aspiration
    • "pleural tap"
    • post procedure CXR
    • bronchiopulmonary hygeine
    • mobility/ambulation
  22. Complications of thoracentesis
    • pneumothorax
    • (air pushed in before removing fluid)
    • can be painful and not want to breath on that side
  23. What is a thoracotemy?
    • removal of part of the lung
    • wedge resection, segmentectomy, lobectomy
    • --peripheral bronchial or parenchymal lesion
    • pneumonectomy: removal of total lung
    • --bronchial carcinoma, emphysema, multipule lung abscesses, bronchiectasis, or TB
    • incision through thoracotemy (into chest)
    • many different possible approches
  24. Complications with a thoracotemy?
    • atelectasis
    • pneumonia
    • excess bleeding
    • infection
    • rib Fx
  25. What are the PT implications for a thoracotemy?
    • pulmonary hygiene
    • deep breathing
    • mobilization
    • ROM/positioning
    • manual techniques
    • relaxations techniques
  26. Who is considered a candidate for a lung transplantation?
    • end stage lung disease < 1year to live
    • most commonly COPD and cystic fibrosis
    • single or double lung
  27. Pre-operative measures for a lung transplant
    • medical
    • PTF, V/Q scan (checks for PE), BiPAP, pulmonary hygiene
  28. Physical therapy for lung transplantation
    • comprehensive evaluation
    • 6MWT
    • pulmonary hygiene
    • conditioning as able
  29. Post-operative measures for a lung transplant
    • infection:
    • open thoracic procedure
    • immunosuppression
    • S/S consistant with pulmonary infection
    • rejection:
    • decreased SaO2 at rest
    • CXR changes demonstrate inflammation
    • PT role for rejection:
    • continue pulmonary hygiene if needed
    • defer activity progression until rejection resolves
    • PT Implications:
    • strict standard precaustions
    • pulmonary hygiene
    • functional activity progression/edurance training
  30. Idications for a living donor lobar transplant
    • cystic fibrosis
    • bronchiopulmonary dysplasia
    • primary pulmonary HTN
    • pulmonary fibrosis
  31. Procedure and outcomes of a living donor lobar transplantation
    • procedure:
    • bilateral implantation of lower lobes from two blood-group compatible living donors into one recepient
    • donors must be 3-6" taller than recepiant
    • outcome:
    • comparable to cadaveric double lung transplant
    • --78% survival 1 year after
    • --48% survivale 5 years after
  32. What do you document after a lung transplant?
    • RPE/dyspnea scale
    • pt education
    • need and duration of seated rest
    • bitals pre, during, and post
    • O2 amount
    • positioning of comfort
    • level of inceptive spirometry
    • response to exercise
    • productive cough/sputum
  33. What is a laparoscopy?
    • fiber-optic tube inserted into abdominal cavity through small incision
    • diagnostic procedures:
    • vizualization
    • biopsy
    • gluid aspiration
    • therapeutic procedures:
    • lysis of adhesions
    • laser ablation
    • cholycystectomy
    • appendectomy
    • hernia repair
    • gastrectomy
    • colectomy
    • reproductive procedures
  34. Colectomy - indications, procedure, PT implications
    • indications:
    • cancer
    • diverticulitis
    • chronic ulcerative colitis
    • chronic constipation
    • procedure:
    • a portion or all of color is removed
    • may or may not need colostomy or ileostomy
    • open procedure vs. laparoscopic
    • PT implications:
    • splinting
    • sit at angle to prevent from stretching
    • avoid valsalva
    • log roll
    • malabsorption
    • huffing - forced expiration
    • abdominal binder
    • protein levels
    • medication
  35. Gastric Bypass
    • NIH criteria:
    • BMI > 40+
    • BMI > 35 with one or more related comorbid conditions
    • post-op nutrition concerns:
    • weight los of 65-80% excess weight typical
    • roux-en-y procedure:
    • small puch created at top of stomach using surgical staples and/or plastic band
    • "new stomach connected directly to middle portion of jejunum bypassing rest of stomach and upper portion of small intestine
  36. What is a whipple procedure?
    • indication:
    • severe or urremitting chronic pancreatitis or cancer
    • procedure:
    • remove duodenum, portion of stomach and jejunum, gallbladder, common bile duct, and regional lymph nodes
    • followed by anastomosis of remaining components
    • NO PT UNLESS COMPLETELY NECESSARY
  37. After a surgical procedure, when is PT not appropriate?
    • nausea/vomitting
    • bed rest
    • complications
    • contraindications
    • pain

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