10. Electrolytes and Metabolism II

Questions and Answers

All of the following may cause arterial hypotension in a surgical patient except:

Malignant hyperthermia

Hypervolemia (correct)

Hypoxia

Transfusion reaction

The anesthesiologist evaluates the patient's oxygenation and carbon dioxide removal by measuring arterial:

Only 3

All but 3 (correct)

Only 2 and 4

1, 2, 3

Which statement is not true about fluids?

Lab report of a dehydrated patient shows a decrease in packed cell volume and hemoglobin (correct)

Extracellular fluids consist of interstitial fluid and blood plasma

Hypovolemia is a deficit of both water and electrolytes

Extracellular fluid volume is proportionately larger in infants than in adults

The center which regulates the rhythm of respirations is located in the:

Pons Signup and view all the answers

In surgical patients, the most common cause of shock is oligemia which is a/an:

Deficient circulating blood volume Signup and view all the answers

Which of the following may cause apnea?

All of the above Signup and view all the answers

Which statement is not true about the sino-atrial node?

Impulses pass from it to the bundle of His Signup and view all the answers

Oxygen is carried in the blood:

Only A and C Signup and view all the answers

After cardiovascular surgery, hypocalcemia may result from and hyperkalemia may result from .

multiple transfusions of citrated blood, red cell breakdown from pump perfusion Signup and view all the answers

The basic approach to the treatment of postoperative shock is to:

Determine the cause Signup and view all the answers

An accurate index of cardiac performance is:

Central venous pressure Signup and view all the answers

Solutions whose volumes and pressures remain the same if the two solutions are separated by a membrane are:

Isotonic solutions Signup and view all the answers

To produce inspiration, pressure must be lower than pressure; it must be __ to produce expiration.

intrathoracic, atmospheric, higher Signup and view all the answers

In a two-bottle water seal suction setup for chest drainage, the first bottle provides and the second provides the .

water seal and collects drainage, suction control Signup and view all the answers

Operating for empyema include:

Thoracoplasty and decortication of the lung Signup and view all the answers

Following open heart surgery, drainage catheters may be inserted into:

The pericardium and anterior mediastinum Signup and view all the answers

The blood component administered to patient with a clotting problem is:

Fresh Frozen Plasma Signup and view all the answers

Which of the following statements concerning erythrocytes (RBC) is not true?

Produced only after birth in bone marrow Signup and view all the answers

Which of the following statements concerning the lymphatic system is not true?

Lymph nodes act as absorbers and diffusers Signup and view all the answers

The continuous rhythmic lavage of the bladder to stimulate reflex control is:

Tidal drainage Signup and view all the answers

Edema can result from:

All of the above Signup and view all the answers

Which of the following methods are not used to control blood loss in the OR?

Deoxydized cellulose and cotton pledgets Signup and view all the answers

The main indication for dialysis in renal failure is a high . The methods of dialysis are and __.

serum potassium, hemodialysis, peritoneal dialysis Signup and view all the answers

A patient receiving IV therapy develops shortness of breath with increased respiratory rate and blood pressure. The diagnosis is and the nurse should .

circulatory overload, slow the IV Signup and view all the answers

All of the following are function of the spleen except:

Stabilize arterial flow Signup and view all the answers

Study Notes

Arterial Hypotension in Surgical Patients

Hypoxia, transfusion reaction, and malignant hyperthermia can lead to arterial hypotension, while hypervolemia typically increases blood pressure.

Evaluation of Oxygenation and CO2 Removal

Anesthesiologists assess oxygenation and carbon dioxide removal through arterial pH, pCO2, and pO2 measurements; H2CO3 is calculated, not measured.

Fluid and Electrolyte Management

Extracellular fluids include interstitial fluid and blood plasma.
Hypovolemia indicates a deficit in both water and electrolytes; dehydration results in increased packed cell volume and hemoglobin.

Respiratory Regulation

The pons regulates the rhythm of respirations alongside the medulla oblongata.

Causes of Shock in Surgical Patients

Oligemia, or a deficiency in circulating blood volume, is the most common cause of shock in surgical patients.

Triggers for Apnea

Apnea can result from pharyngeal irritation, sudden cold stimulation, or sudden painful stimuli.

Sino-Atrial Node Function

The sino-atrial (SA) node, located in the right atrium, is the heart's pacemaker that initiates atrial contractions. Impulses from the SA node go to the atrioventricular (AV) node, not directly to the bundle of His.

Oxygen Transport in Blood

Oxygen is carried in the blood as both dissolved in plasma and bound to hemoglobin.

Postoperative Electrolyte Imbalances

Hypocalcemia post-cardiovascular surgery arises from multiple transfusions of citrated blood; hyperkalemia can result from red cell breakdown during pump perfusion.

Treatment of Postoperative Shock

The primary approach to treating postoperative shock involves determining the cause, followed by targeted interventions.

Cardiac Performance Assessment

Central venous pressure (CVP) serves as an accurate index of cardiac performance and reflects the filling pressure of the right heart.

Isotonic Solutions

Isotonic solutions maintain equal volumes and pressures when separated by a membrane due to equivalent osmotic pressure.

Mechanics of Breathing

Inspiration occurs when intrathoracic pressure is lower than atmospheric pressure; expiration requires a higher intrathoracic pressure.

Chest Drainage Systems

In a two-bottle chest drainage setup, the first bottle provides water seal and collects drainage; the second regulates suction control.

Surgical Management of Empyema

Thoracoplasty and decortication of the lung are surgical options for treating empyema by addressing the fibrous tissue and allowing lung expansion.

Drainage Catheter Placement After Surgery

After open-heart surgery, drainage catheters are commonly placed in the pericardium and anterior mediastinum to prevent complications.

Clotting Problems and Blood Components

Fresh Frozen Plasma (FFP) is administered to patients with clotting problems, as it contains essential coagulation factors.

Erythrocyte Production

Erythrocytes are produced prior to birth in the liver and spleen, and not solely in the bone marrow after birth.

Lymphatic System Function

Lymph nodes filter lymph fluid, play a key immune role, and do not act as absorbers and diffusers.

Bladder Control Techniques

Tidal drainage serves as a method for continuous rhythmic lavage of the bladder to stimulate reflex control.

Causes of Edema

Edema can arise from kidney disease, severe burns, and lymphatic or venous blockages due to fluid imbalance and increased hydrostatic pressure.

OR Blood Loss Control Methods

Deoxydized cellulose and cotton pledgets are utilized in the OR for controlling blood loss, alongside other methods like electrocoagulation.

Indications for Dialysis

High serum potassium levels indicate the need for urgent dialysis, employing methods like hemodialysis and peritoneal dialysis.

IV Therapy Complications

Symptoms like shortness of breath and increased respiratory rate may indicate circulatory overload, necessitating a reduction in IV flow rate.

Spleen Functions

The spleen acts as a blood reservoir, participates in hemopoiesis, and helps in the destruction of damaged red blood cells, but does not stabilize arterial flow.

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Study for the ABSA Surgical Assistant Exam