Exam (elaborations)
NSG 529 POSITIONING AND NERVE INJURY EXAM QUESTIONS AND ANSWERS
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NSG 529 POSITIONING AND NERVE INJURY EXAM QUESTIONS AND ANSWERS...
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Which positions shift the Frank-Starling curve to the left?-Sitting, flexed lateral, reverse- Trendelenburg, prone
-Positions where head is above the level of the heart, venous pooling in the LEs
reduces venous return leading to lower CO
Positions that shift the Frank-Starling curve to the right
-Trendelenberg, lithotomy,
-Blood shifts towards the central circulation, increasing venous return and
cardiac output
Adverse effects of Trendelenberg and lithotomy positions
-Increased hydrostatic pressure causes oedema of the face, eye, and airway
-Intracranial HTN
-Patients with poor myocardial function may not be able to tolerate the volume
shift
-Trendelenberg causes the diaphragm to shift cephalad which can cause
endobronchial intubation
What are some of the attenuated effects of general anaesthesia on the body's
compensatory mechanism?
-GA impairs baroreceptor responsiveness and decreases SNS tone
-Neuraxial anaesthesia (sympathectomy)
-PPV (increases intrathoracic pressure and reduces venous return)
-PEEP (same as PPV)
-muscle relaxants (decrease skeletal muscle tone, decreases venous return)
3 interventions to promote CV stability during positioning?
-Move the patient slowly
-Use a lighter plane of anaesthesia
-IV hydration
3 differences in the anesthetized patient respiratory status compared to an awake
and spontaneously breathing patient?
-Decreased Vt
-Decreased FRC
-Increased closing volume
, In the awake and spontaneously breathing patient, which areas of the lungs are
ventilated and perfused more in the lateral position?
Dependent lung
In the anesthetized and paralyzed patient in the lateral position which areas of
the lungs are better ventilated and perfused?
Non-dependent lung is better ventilated, dependent lung is better perfused
Complications from neck flexion?
-Impaired venous drainage, edema
-Endobronchial intubation
Which 2 conditions pose the highest risk of brachial plexus stretch injuries?
When the arms are ABducted >90 degrees and the head is rotated to the other
side
Conditions that cause compression injuries to the brachial plexus?
-Shoulder braces, improperly placed axillary roll, median sternotomy, bean bags
If shoulder braces must be used, how should they be specifically placed?
Distal end of each clavicle (over the acromion)
Precautions for the prone position
-Don't let the shoulders sag forward
-Do NOT extend arms over the head (keep shoulders and elbows at 90 degrees
or less)
-Assess for thoracic outlet syndrome (preop ask patient to clasp hands behind
the head. If they complain of pain then tuck the arms in the prone position)
Considerations for the lateral decubitus position
-Chest support (axillary roll) placed distal (caudad) to axilla
-Neutral neck alignment
-Flex dependent thigh and knee
-Place a pad underneath dependent common perineal nerve
-Place pillow between dependent and non-dependent legs and extend non-
dependent leg
-Minimize circumduction of downside shoulder to prevent injuring the supra-
scapular nerve
-Retaining strap across the hip and flexed to the underbelly of the OR table.
Stap between iliac crest and femur NOT directly over femur head
-2nd strap over thorax or shoulders
-Make sure the bean bag isn't over a pony prominence
Most common injured peripheral nerve?
Ulnar
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