Special Populations Chapter 4 - (Nicola)

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1

The first 28 days outside the uterus

Neonate

2

1-18 months

Infant

3

18-30 months

Toddler

4

30 months to 5 years

Pre-schooler

5

6-12 years

School age

6

13-18 years

Adolescence

7

What is the pediatric surgical team more focused on for the patient
in terms of needs

Physiological

8

A child less than 6 months cannot ....

Shiver

9

A child less than 6 months is prone to which issues (in surgery) due
to lack of temperature regulation

Hypothermia, bradycardia (slow), and acidosis

10

Which sinuses are present at birth

Ethmoid and maxillary

11

What age does the frontal sinus develop

7 years

12

When does the sphenoid sinus develop

After pubity

13

Normal heart rate for infant to 2 years

80-30 with average heart rate of 110

14

Normal heart rate for 2-6 year old

70-120 with average heart rate of 100

15

Normal heart rate for 6-10 year old

70-110 with average heart rate of 90

16

Normal heart rate for 10-16 year old

60-100 with average heart rate of 85

17

Normal respiratory rate for 1 year old

10-40 rr per min

18

Normal respiratory rate for 3 year old

20-30 rr per min

19

Normal respiratory rate for 6 year old

16-22 rr per min

20

Normal respiratory rate for 10 year old

16-20 rr per min

21

Normal respiratory rate for 17 year old

12-20 rr per min

22

Patients who are ...... are usually held by the anesthesia provider
during induction

2 and under

23

What is the appropriate out put of urine

1 to 2mL/kg/hr

24

A method of ECG monitoring in which the intra-arterial catheter is
inserted directly into the artery

Intra-arterial measurement

25

A catheter passed through a peripheral vein and ending in the
thoracic vena cava; it is used to measure venous pressure or to infuse
concentrated solutions

Central venous catheter

26

The standard method of monitoring blood oxygenation levels for all
age levels

Arterial blood gases

27

The two common types of shock seen in all age groups are

Septic and hypovolemic

28

A state of shock when the body is overwhelmed by the pathogenic
microorganisms and cannot adequately fight the infection. GRAM
negative within the blood.
Other causes are UTI UTI and contaminated intravascular cathetar.
Presents with reduced circulating blood volume

Septic shock

29

Result in decreased venous return that lowers cardiac output and
leads to poor tissue perfusion with eventual lactic acidosis.

Hypovolemic shock

30

What is the most common cause of hypovolemic shock in pediatric
patients and how can it be treated

Dehydration - quick fluid and blood replacement
Emergency
treatment is hypotonic solution of sodium chloride

31

Practically every antibiotic has been associated with the development

Pseudomembranous enterocolitis

32

Inflammation of the small intestine and colon

enterocolitis

33

What is the number one cause of death in children aged 1–15

Accidents

34

The most common bone fracture is of the ......., usually as a result
of shoulder dystocia

clavicle

35

What is the term used for difficult labor or delivery of a baby

Dystocia

36

Abnormal accumulation of air in the pleural cavity

Pneumothorax

37

What refers to patients whose body weight is 100 pounds greater than
ideal body weight

Morbid obesity

38

Enlargement of the heart due to the increased demands placed on the
heart, leading to congestive heart failure

Myocardial hypertrophy

39

What is delayed due to the poor blood supply to the adipose tissue

Healing

40

Obese patients are prone to an increased incidence of ......

postoperative wound infections

41

What is a surgical complication in which a wound ruptures along a
surgical suture

Dehiscence

42

What significantly improves pulmonary function in an obese patient in surgery

Reverse Trendelenburg position (Head up feet down)

43

What must be used with obese patients to reduce the incidence of DVT

Intermittent venous compression boots

44

What are the three most common complications after gastric bypass or
gastroplasty surgery

Abdominal catastrophes, internal hernia, and acute gastric distention

45

Often acute respiratory failure indicates peritonitis. If visceral
perforation is suspected, an exploratory laparotomy will be performed.
These can be described as ......

Abdominal catastrophes

46

What occur when there is protrusion of an internal organ into a
retroperitoneal fossa or a foramen

internal hernia

47

What occurs when substances, such as air (gas) or fluid, accumulate
in the abdomen causing its outward expansion beyond the normal girth
of the stomach and waist

acute gastric distention

48

What are often found during abdominal procedures on obese patients

gall stones

49

The pancreas produces little or no insulin, and the individual must
have daily, regular doses of insulin.

Type 1—insulin-dependent diabetes mellitus (IDDM)

50

The pancreas produces different amounts of insulin. The individual is
not required to take insulin and blood glucose levels are usually
controlled by diet.

Type 2—non–insulin-dependent diabetes mellitus (NIDDM)

51

Complications associated with diabetes

Infection
Dehydration
Poor circulation
Hypertension
and myocardial infarction
Retinopathy resulting in blindness

52

Medical term, commonly known as a heart attack

Myocardial infarction

53

The normal dosage of preoperative medication is decreased since
narcotics can induce vomiting, which predisposes the patient to fluid
and electrolyte imbalance, causing a hypoglycemic reaction

Preoperative care of a diabetic patient

54

Monitoring is necessary to determine the patient’s needs for insulin,
glucose, or both. A glucometer is used to measure the blood glucose
level. Urine specimens are monitored for the presence of ketones.

Intraoperative care of a diabetic patient

55

What is one of the most common postoperative complications of
diabetes, primarily due to diminished levels of blood flow to the
affected area

Increased rate of infection

56

What substances are made when the body breaks down fat for energy.

Ketones

57

Performing surgery in the third trimester can lead to a .......

40% risk of premature labor

58

What can be hard to locate in a late term uterus

Anatomical landmarks

59

In pregnant patients, the three important items to remember are
..............when general anesthesia must be used

Increase in preterm labor, fetal death, and low birth weight

60

The surgical technologist should aid the surgeon by
..............during the surgical procedure to detect contractions.

palpating the uterus

61

When positioning a pregnant patient in the .... position, a small
rolled sheet or pad should be placed under the right hip to slightly
laterally shift the uterus to the left.

supine

62

For a pregnant patient the operating room table may be ...... to the
left and placed in slight ..... to aid with venous return

tilted 30 degrees, Trendelenburg position

63

Relief of pressure: (A) pressure on aorta and vena cava caused by
gravid uterus; (B) pressure is relieved by placing a wedge under right hip

card image

See opposite

64

Degree of function of an immune system that is designed to keep a
patient from infection by pathogens

Immunocompetence

65

Auto immune diseases include

Multiple sclerosis (debilitating - nervous system)
Lupus
erythematosus(inflammation, pain,)
Rheumatoid arthritis (chronic
joint inflammation)

66

What drugs are also administered to recipients of organ transplants
to prevent the recipient’s immune system from rejecting the newly
transplanted organ.

Immunosuppressant

67

Patients who are receiving antineoplastic agents to combat cancer are .......

Immunosuppressed.

68

A cancer that produces painful external and internal lesions;
internally, the lesions can cause complications, such as difficulty in
swallowing (if present in the esophagus) or bowel obstruction (when
present in the intestine)

Kaposi’s sarcoma (opportunistic in AIDS patients)

69

Which surgical patient may present with multiple opportunistic
infections by parasites, fungi, viruses, or bacteria; overall, the
general poor health demands special care of the patient

AIDS

70

For which patient should the parent(s) or legal guardian should be
present while transporting to the surgery department, and allowed in
preoperative holding and brought into PACU as soon as feasible

Patient with Down’s Syndrome

71

What physical traits must be taken into consideration by the
anesthesia provider and PACU personnel for a Down syndrome patient

Microgenia, muscle hypotonia, a flat nasal bridge, macroglossia, a
short neck, and excessive joint laxity.

72

Isolation precautions are based on .... guidelines

Center for Disease Control (CDC)

73

The primary routes of transmission of microorganisms

Contact: direct or indirect
Droplet
Airborne
Common
vehicle (food, water, medications, medical devices, and equipment)

Vector-borne (mosquitoes, flies, rats)

74

The wearing of protective attire is mandated by the

OSHA blood borne pathogens final rule

75

Who requires the wearing of a NIOSH-certified respirator through its
tuberculosis standards

CDC

76

What percentage of geriatric patients present with one or more
comorbid condition

80%

77

What pertains to a disease or other pathological process that occurs
simultaneously with another

Comorbid

78

Studies suggest that 30% to 80% of substance abusers suffer from .......

coexisting psychiatric illness

79

The presence of a ......... would benefit the surgical team to
provide assistance to the team and patient.

counselor or social worker

80

How do physicians often refer to the shorter the response time, the
greater is the chance for survival of the trauma patient

The “Golden Hour” and Trauma System

81

Concept that medical treatment of a trauma victim within the first
hour following injury improves patient outcomes

The "golden hour"

82

What should be given the sooner the better for a heart attack victim,
to give a greater chance that the heart rhythm will return to normal
with less damage to the heart muscle.

CPR

83

Can meet all needs required for treating trauma patients, including
qualified personnel and equipment on a 24-hour basis, offering a
comprehensive service and the highest level of surgical care.

Level I trauma center (Good Sam)

84

Can treat seriously injured or ill patients, but does not have all of
the resources that a Level I facility would have

Level II trauma center (CDH & Edward)

85

Most often a community or rural hospital in an area that does not
have a Level I or II facility. These centers offer limited care and
have resources for immediate care until the trauma patient is
stabilized and then transported to a Level I or II hospital.

Level III trauma center (Bolingbrook)

86

Available in some states, the center can provide advanced trauma life
support to stabilize the patient before the patient is transported to
a Level I or II hospital. It provides initial evaluation,
stabilization, diagnostic capabilities, and transfer to a higher level
of care.

Level IV trauma center

87

An attempt to understand the mechanism of injury and the action and
effect of a particular type of force on the human body, for instance a
bullet wound and knife wound will have different effects on the body

kinematics

88

What results from forces such as deceleration, acceleration,
compression, and shearing

Blunt trauma

89

Examples in which blunt trauma is sustained include

motor vehicle accidents (MVAs)
falls
assaults (hit with a
fist or blunt object)
sports injuries

90

What are classified as low velocity or high velocity

Bullet injuries
(bullet travels 1,000 feet per second or
slower) or high velocity (3,000 feet per second; commonly seen with
military weapons

91

A scoring system used to assess the severity of a traumatic wound and
to determine the condition of a patient

Revised Trauma Score

92

What involves the Glasgow Coma Scale, Neuro 3-15 scale, as well as
other physiological factors.

RTS

93

Hair, tissue, and gunpowder residue may be found on the hands of the ....

victim

94

What should be placed in a bag, and taped, if they do not require
surgery to preserve evidence

Hands

95

Vietnam veterans who have PTSD (1980) symptoms were at the time of
the war said to have

post-Vietnam syndrome

96

Epiphyses not closed until age 20

Bone growth plate

97

Male genitals

testes do not descend until 1 year old

98

Bodily fluid

75% water first post natal week
60% 1-2 year

99

Caloric requirements for pediatrics

Much higher than an adult

100

Physical priorities in OR/ER

Open and maintain airway
Stabilize spine
IV catheter & fluids

101

Obesity issues/complications

varicose veins, edema in lower extremities, liver issues, pituitary issues

102

Grounding pad placement on obese patient

Abdomen, thighs, buttocks

103

Insulin =

breakdown of sugar

104

Diabetic positioning priority

Pad all bony prominences

105

Pregnancy and surgery

2nd trimester "golden window"

106

Asymptomatic

No symptoms

107

Hearing impaired patient will need

an interpreter

108

Mycobacterium tuberculosis

TB

109

Collection of bullets for evidence

Do not use serrated instruments or powdered gloves

110

Hypothermia

Below 35 degrees