Exam 4: Anesthesia

Vanessa was able to restore the patient's normal respirations and monitored her closely as she emerged from the propofol.The patient stated that her mouth,lips,and tongue were numb and prickly feeling and she had a metallic taste.Vanessa suspected that the patient had _ and responded by ___.

Vanessa Cavelle,an experienced CRNA,administered MAC to a 29-year-old female undergoing local scar revision surgery for an old abdominal incision.She titrated midazolam and propofol to dull the patient's level of consciousness.She was alerted by the dropping SpO₂ reading and the patient's loss of chest movement.The patient did not respond to a head tilt-chin lift maneuver.Vanessa's next response to this event is to:

Two monitoring devices that are commonly used to determine ventilatory status are required by some insurance providers as reflective of high-quality care and by anesthesia provider professional organizations as a recommended standard of care.These two devices are:

Rebecca Wheeler,a 2-year-old scheduled for bilateral myringotomy with tube placement,was calm and giggling as her mother stood by her side stroking her cheek.OR policy permitted parents to be present during the initial administration of anesthetic.The anesthesia provider explained her actions,and what Rebecca would experience,to the mother as she gently placed the mask over Rebecca's nose and mouth and turned on the flow of sevoflurane and oxygen.Rebecca calmly slid into unconsciousness.The anesthesia provider told the mother that Rebecca would soon begin to squirm and possibly thrash around a bit restlessly,but it is a normal effect and Rebecca would soon be in a quiet sleep.What phase of anesthesia is Rebecca in and what stage is she about to enter?

Sherry Ames is an endoscopy nurse in a busy free-standing ambulatory surgery center.She is an RN with additional documented competency in providing an anesthesia modality to healthy patients having screening colonoscopies,bronchoscopies,and upper GI endoscopies.This modality will allow this patient population to tolerate potentially uncomfortable procedures while maintaining their own airway and be easily aroused from light sleep.Sherry is competent and legally qualified to provide which modality of anesthesia?

Malignant hyperthermia (MH)is a rare,multifaceted syndrome with an increased incidence in individuals with central core diseases such as:

Emma Clements,a frail 92-year-old,was positioned in lithotomy for a 90-minute rectal procedure under spinal anesthesia block (SAB).At the end of the procedure,when the circulating nurse and surgeon gently removed her legs from position and placed her in supine position,she experienced a common side effect of spinal anesthesia,.

Which inhalational anesthetic agent(s)has the fastest onset of induction,emergence,and recovery?

Whenever regional anesthesia is used,resuscitative equipment and drugs must be immediately available and the patient monitored for any substantial change in vital signs or untoward reactions.An example of an untoward reaction or risk with regional anesthesia is:

Multiple studies have found that intraoperative awareness (IOA)occurs in 0.1% to 0.2% of patients undergoing general anesthesia.These studies also determined that even under seemingly adequate general anesthesia,implicit memory may be retained along with the ability to process auditory stimuli subconsciously.Based on these studies,it was determined that anesthesia techniques that rely solely on receptor-based drugs are a risk factor for IOA.Which classification of drugs should be avoided for patients at risk for IOA?

Postoperative nausea and vomiting (PONV)is often a side effect of the inhalational anesthetic _ and the analgesic ___.

As a member of the surgical team,the perioperative nurse advocates for the surgical patient during the surgical experience.Identify the nursing activities,from the list below,that positively influence patient safety and desired patient outcomes.

Rigo Vegas,a 24-year-old tennis coach,was scheduled for an arthroscopy for recurrent knee pain.This was his first surgical experience and he was determined to optimize his chances for a successful outcome by complying with all his preoperative orders.He has a family history of anesthesia and surgery complications and did his best to provide a thorough preanesthetic assessment history.He denied any history of allergies,musculoskeletal abnormalities,obstructive sleep apnea,or reflux disease.He admitted to eating a cheese steak and drinking 2 cans of beer the night before at 11:30 PM,but promised that he finished food and fluid intake before midnight and did not eat or drink anything else.He stated that he felt calm even without preoperative sedation.The induction was smooth.On attempt at intubation,it was evident that total muscle relaxation had not been achieved.The circulating nurse gently restrained Rigo's arms as he began to move and gag on the laryngoscope.Rigo vomited undigested stomach contents.His nasopharynx was suctioned and cleared,intubation was achieved,and a nasogastric tube was inserted and connected to suction.Rigo experienced respiratory distress on extubation and was transferred to ICU with acute respiratory distress syndrome.Based on his preanesthetic history,aspiration could have been prevented by which measure?

Which statement best explains the mechanism of action of general anesthetic agents?

Pediatric,geriatric,and physiologically compromised patients have impaired thermal regulatory mechanisms that place them at risk for hypothermia.The perioperative nurse should prepare the OR bed before patient arrival by placing:

The potential for intraoperative awareness (IOA)can exist for patients in all modes of anesthesia.Select the anesthesia modality that presents the least likely opportunity for IOA.

Number the correct sequence of events in a well-managed intraoperative MH crisis. a.Lavage the stomach,bladder,rectum,and open body cavities as feasible. b.Give dantrolene sodium (Dantrium) 2.5 mg/kg. c.Discontinue triggering anesthetic agents. d.Counsel patient and family about MH. e.Hyperventilate with 100% O₂ at highest flow rate. f.If the patient is hyperthermic (>39° C),begin active cooling. g.Monitor the temperature to avoid hypothermia.Stop cooling at 38° C. h.Transfer to ICU. i.Monitor and correct for dysrhythmias,hyperkalemia,metabolic acidosis,and urine output.

In the past,MH mortality ranged up to 80%,but the immediate infusion of dantrolene (Dantrium)and proper treatment have reduced the death rate to about 7%.What is dantrolene's mechanism of action that reverses the hypermetabolic state and crisis?

Justin,a 4-year-old preschool student,was telling his friend Jacob about his operation.He had a hernia fixed and told Jacob that the nurse put "magic cream on his hand before she stuck the ivy in" and then the doctor "gave him surgery sleep medicine that was like milk in his ivy" and "another doctor put a little needle stick in his back near his butt after he was asleep so he would not hurt when he woke up." Based on Justin's self-report of his surgery experience,what three types of anesthesia,in the correct order to his story,did Justin receive?

Local anesthetic medications,such as lidocaine hydrochloride,have more than one indication for use as an anesthetic.Which three anesthesia modalities use local anesthesia?