pain control exam 3
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58 terms
Terms | Definitions |
|---|---|
 inhalation sedation advantages | -Onset rapid -Equal to IV sedation -Rapid peak clinical actions -Permits titration -Depth of sedation may be altered-moment to moment -Duration of action not fixed -Rapid recovery 3-5 mins -Patient may be discharge w/not prohibition on activities -No injection -Safe |
| inhalation sedation disadvantages | -Initial costs -Equipment -Continuing costs -Space for equipment -Not a potent agent -Can not go over 20% -Patient cooperation necessary -All staff must be trained -Unscavaged trace N2O may be harmful |
| indications for inhalation sedation | -Management of fear and anxiety -Medically compromised patients -Management of gagging |
| cardiovascular disease | Any sedation that decreases myocardial O2 requirments decreases patient risk |
| O2 content of air | -20.9% |
| copd | Relative contraindication-possible apnea |
| asthma | -Safe- nonirritating to lungs like other anesthetic gases -Frequently warranted to relieve stress |
| chronic nasal obsturction | -Anatomic or pathologic(allergies) -Difficult to sedate |
| stroke | -O2 levels increases risk of seizure or additional neuronal damage -Deep sedation contraindicated -N2O2 highly recommneded |
| epilepsy and seizure disorders | -More sensitive to hypoxia -Does not cause seizures |
| contraindications | -Few absolute as long as O2 percentage is more than 20% -Patients w/compulsive personality -Claustrophobic patients -Severe behavior problems -Severe personality disorders -Upper resp infections -COPD |
| properties of N2O | -Non irritiating, sweet smelling, colorless gas -Relatively insoluble in blood, does not combine w/any blood elements -Low blood solubility |
| potency of N2O | -Least potent of anesthetic gases -Surgical depth anesthesia usually not obtainable unless combined w/ a more potent anesthetic |
| pharmacology of N2O | -Rapidly absorbed from alveolar sacs inot the pulmonary circulation -Displaces N2 from the alveoli and blood -Occurs w/in 3-5 mins of administration -Majority exhaled thru lungs w/in 3-5 mins |
| diffusion hypoxia | -Rapid diffusion of N2O into alveoli from blood produces a signficant dilution of O2 in the lungs -From 14% normal to as little as 10% -Headache nausea and lethargy -More CO2 is removed from the blood than usual, lowering CO2 tension of the blood -Stimulus for breathing is lost and respiration is depressed |
| prevention of diffusion hypoxia | Administration of 100% O2 for 3-5 mins |
| affects on central nervous system | -Mechanism of action unknown -Almost all froms of sensation are depressed -Memory, concentration, cognitive acts are minimally affected -CNS, primarily the cortex, mildly depressed at O2 levels less more than 20% |
| affects on cardiovascular system | -Depression of mycardial contraction slighlty depressed at a raio of 80% N2O; 20% O2 |
| hematopoises from long term chronic exposure | -Bone marrow suppression |
| hematopoises from short term exposure | -Neuropathy (dentists, etc) -Increased evidence of miscarriage -Decreased fertility |
| oxygen affects on cns | -Minimal to no effect -Possible slight constriction of cerebral vessels |
| oxygen affects on cardiovascular system | -Slight fall in heart rate (3 to 4 beats/min) and cardiac output (10-20%) reduction w/ a lsight increase in diastolic blood pressure (increased peripheral resistance) |
| oxygen affects on respiratory system | -Minute volume slightly depressed (3%) -Abolishes chemoreceptors located in cartoid and aorta -Loss of reflex stimulation |
| -nose functions | -Primary warm and humidify air -Rich blood supply of the mucous membranes -Defend against organisms and foreign materials -Cilia and mucous membranes (submucosal glands and globlet cells) -Conduit for air travel from the external environment -Vocal resonance -Smell |
| respiration | -Diffusion of gases across membranes controlled by te partial pressure of gases on either side of the alveolar membrane -Pulmonary capillaries form the most dense capillary network in the entire body -Gases move from a zone of higher pressure to one of lower pressure |
| continuous flow sedation | -Contain flowmeters -Delivers a continous flow of gases regardless of the patient's respiratory pattern-even during expiration -Significantly greater accuracy and safety of gas flow -Accuracy of 2-5% |
| demand flow sedation | -Gases are delivered only upon respiration -Volume of gases per minute is not registered or visible -Mixer valve not accurate -Not used in dentistry |
| continuous flow units contain | -Compressed gas cylinders -Reducing valves (regulators) -Pressure gauges -Flowmeters -Reservoir bag -Conducting tubing -Full face mask, nasal hood, or nasal cannula |
| continuous flow three subgroups | -Portable system -Central storage system -Central storage system w/ moblie heads |
| compressed gas cylindars safety features | -Color coded -Pin index safety system -Physically impossible for an N2O cylindar to be inadvertently attached to an O2 yoke of the delivery system |
| oxygen gas cylinder | -Pressure is from 1900 to 2200 psig -A full E tank containiing 660 liters of gas wold empty in 110 mins at a flow rate of 6L/min |
| nitrous gas cylinder | -Filled to 90-95% w/liquid N2O gas; a full E cylinder produces 1600 L of gaseous N2O -Pressure gauge will record "full" as long as any liquid remains in cylinder -Once all liquid is gone, the pressure gauge will start to fall -Approx 2.5 cylinders of O2 are used for each cylinder of N2O |
| regulators | -Also called reducing valves -Located between the compressed gas cylinders and the flometer -Reduces the high pressure gas in the cylinder to a pressure safe for the patient and the sedation unit -40-55 psig |
| yokes | -On portable systems -Manifolds w/ a similar function are used to multiple cylinders on central units -Holds cylinders of compressed gases tightly to the nipples of the portable sedation unit |
| early to ideal sedation symptoms | -Light headedness -Tingling of hands and feet -Wave of warmth -Vibration thruout body -Numbness hands and feet -Numbness soft tissue -Euphoria -Lightness or heaviness of extremities -Analgesia |
| heavier sedation/slight oversedation symptoms | -Hearing, esp of distant sounds, becoming more acute -Visual images become confused -Sleepiness -Sweating increases -Laughing, crying -Dreaming -Nausea |
| oversedation symptoms | Nausea |
| early to ideal sedation signs | -Blood pressure, heart rate elevates slightly early in procedure -Respirations are normal, smooth -Peripheral vasodilation -Flushing of extremities, face -Decreased muscle tonus as anxiety decreases (arms and legs relax) -Eyes glazed over |
| heavier sedation/ slight oversedation signs | -Increased movement -Increased heart rate, blood pressure -Increased rate of respiration -Increased sweating -Possibly lacrimation |
| replace oxygen tank | When O2 gets down to 300 |
| a full tank of nitrogen | Will be at 750 psg |
| fastest form of sedation | Inhalation |
| bare min amount of o2 | -20% worldwide -30% in US |
| amount of o2 in air | 20.9-21% |
| comes out of circulation to allow NO2 to go in | Nitrogen |
| to prevent hypoxia | Give patient O2 to patient for 3-5 mins |
| cylinders used of o2 compared to N2O | 2 1/2 tanks oxygen to one tank N2o |
| start oxygen at | 6 or half resp rate |
| bag too full means | -Too much gas -Vaccuum not set high enough |
| first symptom of N2O | Lightheadness |
| n20 biotransformed | Thru lungs |
| usual cause of complications | Didn't train patient correctly |
| signs/ symptoms vomitting | -Sweating -Pallor |
| reservoir bag | -Provides reservoir from which additional gas may be drawn should patient demand exceed gas flow -Under normal use patient recieves gases delivered from the delivery unit -If patient takes dep breath, the delivery unit unable to accomodate the demand -W/o patient will feel like suffocating |
| when patient vomits | -Turn off nitrous -Turn O2 where had it -Turn to side -Take mask off -Let vomit/suction -Give O2 |
| toothache feeling occurs | When O2 goes to sinuses and causing pressure change |
| optimum vaccuum flow | 45 L |
| biggest cause of office contamination | Patient talking |
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