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Pharm II > (2-08-17) Patient Monitoring and Procedure Recovery > Flashcards

(2-08-17) Patient Monitoring and Procedure Recovery Flashcards

1
Q

what is the ADA standard 1 of IV sedation?

A

-qualified ppl shall be present in the room throughout the conduct of all GA, regional anesthetics, and monitored anesthesia

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2
Q

what is the ADA standard 2 of sedation?

A 
during all anesthetics, the pt's:
-oxygenation
-ventilation
-circulation
-temperature
shall be continually evaluated
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3
Q

for GA, is a breathing tube required?

A

no, although it is commonly practiced

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4
Q

what does enteral mean?

A

oral

*parenteral means IV

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5
Q

what levels of anesthesia does conscious sedations cover?

A

minimal and moderate

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6
Q

what are the 5 things to monitor according to the ADA?

A
  • consciousness
  • oxygenation
  • ventilation
  • circulation
  • temp
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7
Q

what type of sedation has normal response to verbal stiulation

A

minimal

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8
Q

what type of sedation has *purposeful response to verbal or tactile sensation?

A

moderate (conscious) sedation

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9
Q

what type of sedation has **purposeful response following repeated or painful stimulation

A

deep sedation

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10
Q

what type of sedation has unarousal even with painful stimulus

A

general A

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11
Q

what is a Bispectral index monitor used for? (EEG)

A

used to determine where a pt is on the spectrum of sedation

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12
Q

what is the % of atmospheric O2?

A

21%

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13
Q

how do you monitor oxygenation?

A

arterial blood gas (ABG)

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14
Q

what is the normal pH range for a person?

A

7.35-7.45

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15
Q

what is the normal PaCO2 for a person?

A

35-45 mmHg

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16
Q

what is the normal HCO3- for a person?

A

22-26 mEq/L

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17
Q

what is the normal PaO2 for a person?

A

70-100 mmHg

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18
Q

in what order on an EEG do the readings appear?

A

pH / PaCO2 / HCO3- / PaO2

*normal reading = 7.40 / 40 / 24 / 90

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19
Q

how is respiratory alkylosis caused?

A

when you HYPERventilate

7.46 / 34 / 24 / 84

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20
Q

what is cyanosis and what are the clinical signs?

A
  • a lot of deoxygenated hemoglobin build up

- blue fingers … “chin-lift” to open airways

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21
Q

how is respiratory acidosis caused?

A

when you HYPOventilate
hypoxemia - low O2 (PaO2 less than 60%)

7.34 / 46 / 24 / 59

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22
Q

what is the primary driver of ventilation?

A

HCO2- !!!!!!!

this means that you can hold air as long as you want but it will not effect % O2 saturation

But, this can be overcome by CNS during sedation

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23
Q

what respiratory volume determines how long a person has until they desaturate their oxygen?

A

residual volume (how much air is left in the lungs after she has forced out as much as she can)

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24
Q

what are we attempting to do with supplemental O2?

A

affect the A-a gradient (alveolar/atriolar)

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25
Q

in zone 1 of the lungs, what are the partial pressures seen?

A

PA > Pa > Pv

A = alveolar
a = atriole
v = vein
26
Q

in zone 2 of the lungs, what are the partial pressures seen?

A

Pa > PA > Pv

A = alveolar
a = atriole
v = vein
27
Q

in zone 3 of the lungs, what are the partial pressures seen?

A

Pa > Pv >PA

A = alveolar
a = atriole
v = vein
28
Q

what is hypoxic pulmonary vasoconstriciton?

A

helps to avoid shunt/ mix of oxygenated and deoxygenated blood

*low alveolar O2 tension causes vasoconstriction

29
Q

when pulse oximetry is employed, what should be audible to the anesthesia care team personell?

A
  • variable pitch tone

- low threshold alarm

30
Q

how should oxygen saturation continuously be evaluated?

A

pulse oximetry

31
Q

what are the primary determinants of the O2 available for tissue metabolism?

A
  • hemoglobin concentration
  • oxygen saturation of hemoglobin

*this is bc dissoved O2 volume is negligible

32
Q

what is the oxygen carrying capacity of hemoglobin?

A

-1.34

1 gram of hb can carry 1.34 mL of O2

33
Q

On the O2 dissociation curve, what dec P50 (what inc affinity to hb)

A

dec temp
dec Pco2
dec 2,3 - DPG
inc pH

34
Q

on the O2 dissociaiton curve, what inc p50 (what dec affinity to hb)

A

inc temp
inc Pco2
Inc 2,3 - DPG
dec pH

35
Q

getting rid of CO2 gas

A

ventilation

36
Q

what is the equation for minute ventilation?

A

RR (respiratory rate) x TV (tidal volume)

37
Q

what is the normal minute ventilation?

A

5-6 L/min

38
Q

when do we have respiratory alkylosis?

A

HYPERventilation

39
Q

what is a precordial stethoscope used for?

A

to monitor breathing

40
Q

according to the ADA, how should you monitor ventilation?

A
  • observe chest excursions
  • “should” auscultate (stethascope) breath sounds OR monitor end-tidal CO2

*can also be measured by capnography

41
Q

the process of moving air into and out of the lungs

A

ventilation

*this is when CO2 is eliminated from the body

42
Q

Using infared light absorption patterns to generate a wave that is displayed on a monitor to measure ventilation

A

capnography

43
Q

what is the PaCO2 of the arterial blood

A

40 mmHg

44
Q

what is phase 0 of ventilation?

A

inspiration

45
Q

what is phase 1 of ventilation?

A

expiration begins, but CO2 free gas is expelled

46
Q

what is phase 2 of ventilation?

A

mixing of the dead space gas and alveolar gas

47
Q

what is phase 3 of ventilation

A

(expiratory plateau) as exhalation continues, remaining gas expelled is almost entirely alveolar

48
Q

what drug can be given to inc RR?

A

Naloxone

*same one they give to help heroin overdose

49
Q

what is a sign that there is low blood flow going to tissues (poor perfusion) (reduced CO) (hypoventilation)

A

pallor

50
Q

way of inflating to occlude artery and then slowly letting air out to measure the pressure coming through

A

ocillometry (blood pressure)

51
Q

how do you calculate MAP?

A

2/3 diastolic + 1/3 systolic

its all relatively unique and specific to each pt

52
Q

what is the equation for BP

A

BP = SVR x CO

53
Q

what does the P wave mean on an EKG?

A

-SA node in walls of the atria

54
Q

what does the Q wave mean on an EKG?

A

impulse reached AV node which delays it by about .01 second

55
Q

what does the RS wave mean on an EKG?

A

bundle branches carry signals from the AV node to the heart apex

56
Q

what does the T wave mean on an EKG?

A

signal spreads through the ventricle walls

57
Q

what does the ASA recommend for monitoring circulation?

A

every pt should have BP and HR evaluated and documented every 5 minutes

*consider continuous EKG monitoring if the pt has significant CV disease

58
Q

what is the average body temp in celcius?

A

37

59
Q

why is it important to monitor for temp during sedation?

A

malignant hyperthermia

60
Q

is measuring temp on the skin a good choice?

A

no bc heat is lost across epidermis

Pharm II (16 decks)

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