NURSE ANESTHESIA NCE BOARD
REVIEW PART 2
what is the best way to monitor temperature in the OR with combing safety and
accuracy? - Correct Answers -Esophageal temp monitoring offers best combo of
accuracy and safety over an extended period of time
good estimation of core temp
what are consequences of hypothermia? - Correct Answers -SNS stimulation
Oxygen hgb curve shift to left
Vasoconstriction and decreased tissue PO2
Coagulopathy and plt dysfunction
Sicking of hgb S
Slowed drug metabolism
Increased vol agent solubility
MI and arrhythmia
Surgical site infection
Increased blood loss
Risk of sickle cell crisis
Prolonged emergence
Shivering increases VO2 by _____% - Correct Answers -Shivering increases VO2 by
400%
Benefits of perioperative hypothermia
,Oxygen consumption decreased by _____% for every 1 degree C reduction in core
body temp
what procedures/circumstances is hypothermia good for? - Correct Answers -Oxygen
consumption decreased by 5% for every 1 degree C reduction in core body temp
Good for cerebral ischemia, cerebral aneurysm clipping, TBI, CPB, CA, aortic cross
clamping, carotid endarterectomy
what 3 ingredients are needed to produce a fire?
give examples of each - Correct Answers -Ignition source - bovie, laser
Oxidizer - oxygen N2O
Fuel - ETT, drapes, surgical supplies
Describe a first degree burn - Correct Answers -First degree burn = superficial
Epidermis only
Stinging, tender, sore
describe a second degree burn - Correct Answers -Second degree burn = partial
thickness
Superficial dermis to upper dermis... considered a deep dermal burn if lose to lower
dermis
Very painful
describe a third degree burn - Correct Answers -Third degree burn = full thickness
Complete destruction of epidermis and dermis
No sensation - nerve endings are obliterated
describe a fourth degree burn - Correct Answers -Fourth degree burn = full thickness
Extends To muscle and bone
No sensation - nerve endings are obliterated
Immediately after a burn, microvascular permeability increases and causes capillary
leak
,what are consequences of this? - Correct Answers -capillary leak immediately after a
burn causes...
Edema formation
Decreased plasma oncotic pressure
Loss of intravascular volume = hypovolemia and shock
Hemoconcentration
After a burn, fluid shifts are the greatest in the first ____ hrs and stabilized by _____ hrs
what type of fluid should be avoided in the first 24 h and why? - Correct Answers -After
a burn, fluid shifts are the greatest in the first 12 hrs and stabilized by 24 hrs
Fluid requirements are highest in first 24 hrs
Albumin should be avoided in first 24 hrs because its lost to interstitial space
Hemolysis can occur
Increasing hgb in first few days signifies inadequate resuscitation
Modified brooke formula - Correct Answers -2 ml x %TBSA burned x kg
Half in first 8 hrs, half in next 16 hrs
Parkland formula - Correct Answers -4 ml x %TBSA burned x kg
Half in first 8 hrs, half in next 16 hrs
compare parkland formula and modified brooke formula - Correct Answers -modified
brook = 2 ml x %TBSA burned x kg
parkland formula = 4 ml x %TBSA burned x kg
both give half in first 8 hrs and half in next 16 hrs
Clinical end points of burn resuscitation - Correct Answers -UO 0.5-1 ml/kg/kg
MAP > 60
HR 80 -100
Base def < 2
, what is the kind of burn the will leave little visible damage on skin but can cause great
visceral damage?
what is a sign of extensive muscle damage? - Correct Answers -Electrical burns
Myoglobinemia is result of extensive muscle damage
CO poisoning
- CO binds to hgb _____x more than oxygen?
- which way does oxyhgb curve shift?
-what does the blood look like?
- what kind of acid/base abnormality occurs?
- what happens to pulse ox?
- what is the treatment? - Correct Answers -CO binds to hgb with an affinity 200x that of
oxygen
CO shifts oxygen hgb curve to left and impairs oxygen unloading to tissues
Oxidative phosphorylation also impaired
Causes metabolic acidosis
Cherry red blood
Pulse ox NOT accurate - unable to distinguish between carboxy and oxyhgb
Treatment = 100% fio2 or hyperbaric oxygen
how does hyper and hypocarbia affect seizure duration? - Correct Answers -Hypocarbia
increases seizure duration, making it a useful modality prior to the ECT procedure
The seizure caused by ECT results in a profound HD response
Initially there is a surge in ______ activity followed by ______ activity
what are the s/sx of the SNS/PNS activity? - Correct Answers -Initially there is a surge
in PNS activity followed by SNS activity
PNS → brady, decr BP, increased oral secretions, increased gastric secretion
REVIEW PART 2
what is the best way to monitor temperature in the OR with combing safety and
accuracy? - Correct Answers -Esophageal temp monitoring offers best combo of
accuracy and safety over an extended period of time
good estimation of core temp
what are consequences of hypothermia? - Correct Answers -SNS stimulation
Oxygen hgb curve shift to left
Vasoconstriction and decreased tissue PO2
Coagulopathy and plt dysfunction
Sicking of hgb S
Slowed drug metabolism
Increased vol agent solubility
MI and arrhythmia
Surgical site infection
Increased blood loss
Risk of sickle cell crisis
Prolonged emergence
Shivering increases VO2 by _____% - Correct Answers -Shivering increases VO2 by
400%
Benefits of perioperative hypothermia
,Oxygen consumption decreased by _____% for every 1 degree C reduction in core
body temp
what procedures/circumstances is hypothermia good for? - Correct Answers -Oxygen
consumption decreased by 5% for every 1 degree C reduction in core body temp
Good for cerebral ischemia, cerebral aneurysm clipping, TBI, CPB, CA, aortic cross
clamping, carotid endarterectomy
what 3 ingredients are needed to produce a fire?
give examples of each - Correct Answers -Ignition source - bovie, laser
Oxidizer - oxygen N2O
Fuel - ETT, drapes, surgical supplies
Describe a first degree burn - Correct Answers -First degree burn = superficial
Epidermis only
Stinging, tender, sore
describe a second degree burn - Correct Answers -Second degree burn = partial
thickness
Superficial dermis to upper dermis... considered a deep dermal burn if lose to lower
dermis
Very painful
describe a third degree burn - Correct Answers -Third degree burn = full thickness
Complete destruction of epidermis and dermis
No sensation - nerve endings are obliterated
describe a fourth degree burn - Correct Answers -Fourth degree burn = full thickness
Extends To muscle and bone
No sensation - nerve endings are obliterated
Immediately after a burn, microvascular permeability increases and causes capillary
leak
,what are consequences of this? - Correct Answers -capillary leak immediately after a
burn causes...
Edema formation
Decreased plasma oncotic pressure
Loss of intravascular volume = hypovolemia and shock
Hemoconcentration
After a burn, fluid shifts are the greatest in the first ____ hrs and stabilized by _____ hrs
what type of fluid should be avoided in the first 24 h and why? - Correct Answers -After
a burn, fluid shifts are the greatest in the first 12 hrs and stabilized by 24 hrs
Fluid requirements are highest in first 24 hrs
Albumin should be avoided in first 24 hrs because its lost to interstitial space
Hemolysis can occur
Increasing hgb in first few days signifies inadequate resuscitation
Modified brooke formula - Correct Answers -2 ml x %TBSA burned x kg
Half in first 8 hrs, half in next 16 hrs
Parkland formula - Correct Answers -4 ml x %TBSA burned x kg
Half in first 8 hrs, half in next 16 hrs
compare parkland formula and modified brooke formula - Correct Answers -modified
brook = 2 ml x %TBSA burned x kg
parkland formula = 4 ml x %TBSA burned x kg
both give half in first 8 hrs and half in next 16 hrs
Clinical end points of burn resuscitation - Correct Answers -UO 0.5-1 ml/kg/kg
MAP > 60
HR 80 -100
Base def < 2
, what is the kind of burn the will leave little visible damage on skin but can cause great
visceral damage?
what is a sign of extensive muscle damage? - Correct Answers -Electrical burns
Myoglobinemia is result of extensive muscle damage
CO poisoning
- CO binds to hgb _____x more than oxygen?
- which way does oxyhgb curve shift?
-what does the blood look like?
- what kind of acid/base abnormality occurs?
- what happens to pulse ox?
- what is the treatment? - Correct Answers -CO binds to hgb with an affinity 200x that of
oxygen
CO shifts oxygen hgb curve to left and impairs oxygen unloading to tissues
Oxidative phosphorylation also impaired
Causes metabolic acidosis
Cherry red blood
Pulse ox NOT accurate - unable to distinguish between carboxy and oxyhgb
Treatment = 100% fio2 or hyperbaric oxygen
how does hyper and hypocarbia affect seizure duration? - Correct Answers -Hypocarbia
increases seizure duration, making it a useful modality prior to the ECT procedure
The seizure caused by ECT results in a profound HD response
Initially there is a surge in ______ activity followed by ______ activity
what are the s/sx of the SNS/PNS activity? - Correct Answers -Initially there is a surge
in PNS activity followed by SNS activity
PNS → brady, decr BP, increased oral secretions, increased gastric secretion
