NURS 581 - Exam 2 Study Guide UPDATED ACTUAL
Questions and CORRECT Answers
What is SCIP? Surgical Care Improvement Project: publishes guidelines that are meant to
improve surgical outcomes
For example:
- BG levels pre/post-op
- meds to hold/continue during preop
- stress hormone management
- abx to incision (1 hour)
- electric clippers for hair removal
What is the prevelance of current anesthesia-related 1: 26,000 (in the 1940s, used to be 1: 650)
deaths?
1/3 of these deaths are preventable; caused by:
How many of those are preventable? 1) inadequate IV access
Name some common causes of preventable deaths (4 2) improper airway
total) 3) wrong anesthetic technique
4) inadequate crisis management
Preparation and vigilence is key every case
What type of hospital would you expect to use Preanesthesia clinic - larger, urban hospitals
preanesthesia clinics vs. phone call the night before?
Phone call the night before - small rural hospitals (usually done by preop nurse)
When assessing for difficult airway history, what is Did a previous anesthesia provider ever say you were a difficult airway? If so, did
something you should ask every patient? they right a letter explaining this in more detail?
When asking about family history, what are two From anesthesia, did any of your family members die or have any serious ADR
syndromes should alert anesthesia providers? such as fever?
1) Malignant hyperthermia
2) A-typical acetylcholinesterase
,How long before surgery should patients quit smoking? 12-48 hours
- reduces HR, BP, carbon monoxide levels, and circulating catecholamines
What are some associated risks with smokers? (3 total)
(Reality: patients usually smoke right before surgery)
Associated risk with smokers:
- irritable airway
- delayed wound healing
- 6-8 weeks after quitting => copious secretions from the return of cilia function
When should you get a urine pregnancy test prior to All females of childbearing age with a functioning uterus
surgery?
Give an example of each functional level within the 1 kilocalorie per kg per hour
Metabolic Equivalents of Functional Capacity (MET).
1 kcal/kg/hr (would be equivalent to sitting on the couch for one hour)
***≥4 MET indicates better surgical outcomes (can they climb a flight of stairs
without dyspnea, chest discomfort?)
More examples of MET from power point for reference
great test questions here
What are some basic allergies that could cause problems Egg white allergy (but egg yolk allergy is ok with propofol)
during any OR procedure?
Iodine
Latex (caution with spina bifida patients)
, What would you instruct your patient during preop if they ACEI - continue
were on the following medications?
BB - continue unless HR < 55 day of sx
ACEI
BB Antiarrythmic - continue
Antiarrythmic
Steroids Steroids - continue + extra stress dose as indicated
Seizure meds
Parkinson meds Seizure meds - continue
Anti-platlets (Aspirin, Plavix)
Insulin (PO vs. Subq) Parkinson meds - continue
Anticoagulants
Antidepressants Anti-platlets - HOLD unless artificial valve, vascular/cardiac sx
Insulin (PO vs. Subq) - hold PO, hold rapid-acting, half other subq insulin doses
Anticoagulants - HOLD
Antidepressants - continue (except MAOIs, d/c 2 weeks prior to sx)
Acute vs Chronic ETOH; how would you modify your Acute: may require less anesthetics
anesthetic plan for either?
Chronic: may require more anesthetics; tx with long-acting benzo's
- barbituate tolerance
- hypnotic tolerance
CAGE Method 1) Do you feel you should Cut down on your alcohol consumption?
2) Have people Annoyed you by criticizing your drinking habits?
3) Have you ever felt Guilty about your drinking?
4) Have you ever had a drink first thing in the morning to steady your nerves or
get rid of a hangover? (Eye-opener)
Special considerations for the following illicit drugs? Cocaine/Meth
- depleted catecholamines; refractory HTN
Cocaine/Meth - dysrhythmias
- increased anesthetics for acute intoxication
Opioids
Opioids
Marijuana - have chronic pain pts take opioids morning of sx
- higher analgesic doses post-op
Marijuana
- labile BP
In general, instruct patients to stop taking St John's Wort
herbs/supplements 2 weeks prior to sx; especially for - many medication interactions
what supplements?
Garlic
- interferes with platlet aggregation => bleeding risk
Questions and CORRECT Answers
What is SCIP? Surgical Care Improvement Project: publishes guidelines that are meant to
improve surgical outcomes
For example:
- BG levels pre/post-op
- meds to hold/continue during preop
- stress hormone management
- abx to incision (1 hour)
- electric clippers for hair removal
What is the prevelance of current anesthesia-related 1: 26,000 (in the 1940s, used to be 1: 650)
deaths?
1/3 of these deaths are preventable; caused by:
How many of those are preventable? 1) inadequate IV access
Name some common causes of preventable deaths (4 2) improper airway
total) 3) wrong anesthetic technique
4) inadequate crisis management
Preparation and vigilence is key every case
What type of hospital would you expect to use Preanesthesia clinic - larger, urban hospitals
preanesthesia clinics vs. phone call the night before?
Phone call the night before - small rural hospitals (usually done by preop nurse)
When assessing for difficult airway history, what is Did a previous anesthesia provider ever say you were a difficult airway? If so, did
something you should ask every patient? they right a letter explaining this in more detail?
When asking about family history, what are two From anesthesia, did any of your family members die or have any serious ADR
syndromes should alert anesthesia providers? such as fever?
1) Malignant hyperthermia
2) A-typical acetylcholinesterase
,How long before surgery should patients quit smoking? 12-48 hours
- reduces HR, BP, carbon monoxide levels, and circulating catecholamines
What are some associated risks with smokers? (3 total)
(Reality: patients usually smoke right before surgery)
Associated risk with smokers:
- irritable airway
- delayed wound healing
- 6-8 weeks after quitting => copious secretions from the return of cilia function
When should you get a urine pregnancy test prior to All females of childbearing age with a functioning uterus
surgery?
Give an example of each functional level within the 1 kilocalorie per kg per hour
Metabolic Equivalents of Functional Capacity (MET).
1 kcal/kg/hr (would be equivalent to sitting on the couch for one hour)
***≥4 MET indicates better surgical outcomes (can they climb a flight of stairs
without dyspnea, chest discomfort?)
More examples of MET from power point for reference
great test questions here
What are some basic allergies that could cause problems Egg white allergy (but egg yolk allergy is ok with propofol)
during any OR procedure?
Iodine
Latex (caution with spina bifida patients)
, What would you instruct your patient during preop if they ACEI - continue
were on the following medications?
BB - continue unless HR < 55 day of sx
ACEI
BB Antiarrythmic - continue
Antiarrythmic
Steroids Steroids - continue + extra stress dose as indicated
Seizure meds
Parkinson meds Seizure meds - continue
Anti-platlets (Aspirin, Plavix)
Insulin (PO vs. Subq) Parkinson meds - continue
Anticoagulants
Antidepressants Anti-platlets - HOLD unless artificial valve, vascular/cardiac sx
Insulin (PO vs. Subq) - hold PO, hold rapid-acting, half other subq insulin doses
Anticoagulants - HOLD
Antidepressants - continue (except MAOIs, d/c 2 weeks prior to sx)
Acute vs Chronic ETOH; how would you modify your Acute: may require less anesthetics
anesthetic plan for either?
Chronic: may require more anesthetics; tx with long-acting benzo's
- barbituate tolerance
- hypnotic tolerance
CAGE Method 1) Do you feel you should Cut down on your alcohol consumption?
2) Have people Annoyed you by criticizing your drinking habits?
3) Have you ever felt Guilty about your drinking?
4) Have you ever had a drink first thing in the morning to steady your nerves or
get rid of a hangover? (Eye-opener)
Special considerations for the following illicit drugs? Cocaine/Meth
- depleted catecholamines; refractory HTN
Cocaine/Meth - dysrhythmias
- increased anesthetics for acute intoxication
Opioids
Opioids
Marijuana - have chronic pain pts take opioids morning of sx
- higher analgesic doses post-op
Marijuana
- labile BP
In general, instruct patients to stop taking St John's Wort
herbs/supplements 2 weeks prior to sx; especially for - many medication interactions
what supplements?
Garlic
- interferes with platlet aggregation => bleeding risk
