Anesthesia Principles Exam 4 : Emergence & PACU/Infection Control/RiskQuestions plus answers 2024
does postoperative planning begin?: when patient scheduled for surgery
2. Perianesthesia: reflects a continuum of care from the preanesthesia area to the surgery suite and then to the postanesthesia ...
1. when does postoperative planning begin?: when patient scheduled for surgery
2. Perianesthesia: reflects a continuum of care from the preanesthesia area to the surgery suite
and then to the postanesthesia care unit (PACU)
3. Postanesthesia: activities undertaken to manage patient care after completion of a surgical
or nonsurgical procedure in which anesthesia, analgesia, or sedation was administered
4. Purpose of PACU: The primary purpose is the assessment and stabilization of patients after
these procedures, with an emphasis on prevention and detection of complications
5. Do YOU always have to extubate?: NO - always elective and postponement may be necessary
6. Awake technique extubation Advantages/disadvantages: Advantages: Return of airway
reflexes
Decreased aspiration risk Spontaneous
ventilation
Disadvantages:
Increased cardiac stimulation increased
coughing and straining
7. Anesthetized deep technique extubation Advantages/disadvantages: Ad- vantages:
decreased cardiac stimulation
decreased coughing and straining
Disadvantages:
absent/obtunded reflexes
airway obstruction
hypoventilation
8. Steps of Standard Emergence: 1. Reversal of NDMR- after muscle layers closed
2. Remove excess monitors/lines
3. Discontinue anesthetic
4. Untape eyes
5. Asses extubation criteria- spontaneous ventilation, adequate tidal volume, head lifts, full
train of 4 & sustained tetany
6. Suction oropharynx and hypopharynx
7. Extubate-
9. Global criteria for extubation: 1. Acceptable hemodynamics
2. Normothermia
For assistance with assignments (Discussions, research paper , literature review , essays ..) or any revision material contact
informationhimher@gmail.com
3. Ability to maintain airway - return of laryngeal/cough reflexes
- conscious
4. Adequate muscle strength
- Head lift >5 sec
-reversal as indicated by TOF>.9, sustained tetany, dbl burst w/ fade
5. Acceptable metabolics
- acid- base within limits
-electrolytes
6. acceptable hematologic indicators
7. adequate analgesia for optimal respiratory effort
10.Respiratory requirements for extubation: 1. Vital capacity >15 ml/kg
2. Maximal negative inspiratory force> -20cm H20
3. tidal volume of at least 4-5 ml/kg
4. spo2>90%
5. Pao2> 60 mmHg
6. Paco2< 50 mmHg
7. Acceptable spontaneous RR
11.Deep extubation technique indications and contraindications: Indications: risk of adverse
effects of increased ICP or IOP
bleeding into surgical wound wound
dehiscence Contraindications:
previous difficult face masking or ETT Intubation high risk of
aspiration
restricted access to airway
OSA or morbid obesity
Surgical procedure w/ airway edema, bleeding or irritability
12.Deep emergence sequence: 1. Reversal of NDMR- after muscle layers closed
2. Remove excess monitors/lines
3. Suction oropharynx and hypopharynx
4. Extubate- place OPA/NPA, assist ventilations
5. D/C anesthetic agent
6. Untape eye
7. Have emergency supplies available
13.Stages of General Anesthesia: 1. analgesia
2. excitement/delirium
3. surgical anesthesia
4. medullary paralysis
For assistance with assignments (Discussions, research paper , literature review , essays ..) or any revision material contact
informationhimher@gmail.com
14.Complications after extubation: Laryngospasm- oral airway, jaw thrust, apply PPV ( try for 1-2
min.),if not broken yet- prop and succ
Laryngeal edema- caused by excessive cuff pressure. Keep less than <25 Bronchospasm ( small
airways spasming shut)- administer short acting B2 agonist Residual NM Blockade
15.what is the goal in postoperative planning?: provide best care/outcomes while not utilizing
unnecessary resources
16.It's important to consider these things with post-op recovery: ERAS proto- cols
Type of surgery and anesthetic
Comorbidities
Intraoperative events
postoperative monitoring
17. what are the three levels of PACU care?: Phase I, II (outpatient), and Extended care
18.the PACU assess and manages:: 1. respiratory and HD status
2. analgesics and antiemetics
3. preparedness for rapid/optimal recovery
4. common post anesthesia complications (which can be prevented and detected with
specialized care)
19. PACU care focus is on recovery from anesthesia and the return of
baseline VS: Phase I
20.According to the ASPAN Guidelines, how often should you check and doc. vital signs in phase 1:
every 15 min. first hour
then every 30 min until dc from phase 1
21. PACU care focuses on continued recovery based on facil- ity policy and
patient need: phase II
22. PACU care, is when the pt meets criteria to leave phase I, but due to
unavailability, the patient is unable to go to another location: ex- tended care
23.what is PACU "fast track": when you bypass phase I care and move directly from
OR/procedure suite to phase II
24.AANA standards for Post-anesthesia transfer of care: 1. evaluate the pa- tients status and
determine when it is appropriate to transfer the responsibility of care - handoff to another
qualified healthcare provider
2. communicate the patients condition and essential information for continuity of care
25.what is the immediate priority of the CRNA and the PACU RN upon admis- sion to the PACU?:
evaluation of respiratory and circulatory adequacy
For assistance with assignments (Discussions, research paper , literature review , essays ..) or any revision material contact
informationhimher@gmail.com
26.what must be included in the anesthesia verbal handoff to the PACU RN: 1. pt demographic and
hx
2. surgical and anesthetic course
3. PACU tx plan/suggested interventions/and endpoints
4. opportunity for RN to ask questions and for CRNA to respond.
27.what is the purpose of the anesthesia report to the PACU RN: to ensure pt safety and
continuity of care.
28.components of the initial PACU assessment: 1. determine pts physiologic status at time of
admission
2. est pts baseline
3. allow periodic reexamination
4. assess status of surgical site, its effect on preexisting conditions and recovery
5. assess the recovery from anesthesia/residual effects
6. prevent/manage complications
7. provide a safe environment for recovery
8. allow data and trend analysis for discharge or transfer critieria
29.what is the most widely used PACU scoring system: Aldrete scoring system and includes
assessment of
1. level of consciousness
2. physical activity
3. hemodynamic stability
4. respiratory stability
5. Oxygen saturation status
30.aldrete score of is required for discharge: 9-10
31.PACU assessment: Respiratory routine for all pts. and for selected pts.: -
rate, airway patency, breath sounds, Sao2
EtCo2, O2 delivery system, artificial airway
32.PACU assessment: Cardiac routine for all pts. and for selected pts.: PR, BP, single lead EKG,
heart sounds
12 lead ekg, invasive BP, device interrogation
33.PACU assessment: Neuromuscular routine for all pts. and for selected pts.: physical exam
NMB monitoring
34.PACU assessment: Neurologic routine for all pts. and for selected pts.: Loc, orientation, pupils,
sensory/motor function
For assistance with assignments (Discussions, research paper , literature review , essays ..) or any revision material contact
informationhimher@gmail.com
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller smartchoices. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $10.39. You're not tied to anything after your purchase.
