(2-08-17) Patient Monitoring and Procedure Recovery Flashcards
what is the ADA standard 1 of IV sedation?
-qualified ppl shall be present in the room throughout the conduct of all GA, regional anesthetics, and monitored anesthesia
what is the ADA standard 2 of sedation?
during all anesthetics, the pt's: -oxygenation -ventilation -circulation -temperature shall be continually evaluated
for GA, is a breathing tube required?
no, although it is commonly practiced
what does enteral mean?
oral
*parenteral means IV
what levels of anesthesia does conscious sedations cover?
minimal and moderate
what are the 5 things to monitor according to the ADA?
- consciousness
- oxygenation
- ventilation
- circulation
- temp
what type of sedation has normal response to verbal stiulation
minimal
what type of sedation has *purposeful response to verbal or tactile sensation?
moderate (conscious) sedation
what type of sedation has **purposeful response following repeated or painful stimulation
deep sedation
what type of sedation has unarousal even with painful stimulus
general A
what is a Bispectral index monitor used for? (EEG)
used to determine where a pt is on the spectrum of sedation
what is the % of atmospheric O2?
21%
how do you monitor oxygenation?
arterial blood gas (ABG)
what is the normal pH range for a person?
7.35-7.45
what is the normal PaCO2 for a person?
35-45 mmHg
what is the normal HCO3- for a person?
22-26 mEq/L
what is the normal PaO2 for a person?
70-100 mmHg
in what order on an EEG do the readings appear?
pH / PaCO2 / HCO3- / PaO2
*normal reading = 7.40 / 40 / 24 / 90
how is respiratory alkylosis caused?
when you HYPERventilate
7.46 / 34 / 24 / 84
what is cyanosis and what are the clinical signs?
- a lot of deoxygenated hemoglobin build up
- blue fingers … “chin-lift” to open airways
how is respiratory acidosis caused?
when you HYPOventilate
hypoxemia - low O2 (PaO2 less than 60%)
7.34 / 46 / 24 / 59
what is the primary driver of ventilation?
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
what respiratory volume determines how long a person has until they desaturate their oxygen?
residual volume (how much air is left in the lungs after she has forced out as much as she can)
what are we attempting to do with supplemental O2?
affect the A-a gradient (alveolar/atriolar)
in zone 1 of the lungs, what are the partial pressures seen?
PA > Pa > Pv
A = alveolar a = atriole v = vein
in zone 2 of the lungs, what are the partial pressures seen?
Pa > PA > Pv
A = alveolar a = atriole v = vein
in zone 3 of the lungs, what are the partial pressures seen?
Pa > Pv >PA
A = alveolar a = atriole v = vein
what is hypoxic pulmonary vasoconstriciton?
helps to avoid shunt/ mix of oxygenated and deoxygenated blood
*low alveolar O2 tension causes vasoconstriction
when pulse oximetry is employed, what should be audible to the anesthesia care team personell?
- variable pitch tone
- low threshold alarm
how should oxygen saturation continuously be evaluated?
pulse oximetry
what are the primary determinants of the O2 available for tissue metabolism?
- hemoglobin concentration
- oxygen saturation of hemoglobin
*this is bc dissoved O2 volume is negligible
what is the oxygen carrying capacity of hemoglobin?
-1.34
1 gram of hb can carry 1.34 mL of O2
On the O2 dissociation curve, what dec P50 (what inc affinity to hb)
dec temp
dec Pco2
dec 2,3 - DPG
inc pH
on the O2 dissociaiton curve, what inc p50 (what dec affinity to hb)
inc temp
inc Pco2
Inc 2,3 - DPG
dec pH
getting rid of CO2 gas
ventilation
what is the equation for minute ventilation?
RR (respiratory rate) x TV (tidal volume)
what is the normal minute ventilation?
5-6 L/min
when do we have respiratory alkylosis?
HYPERventilation
what is a precordial stethoscope used for?
to monitor breathing
according to the ADA, how should you monitor ventilation?
- observe chest excursions
- “should” auscultate (stethascope) breath sounds OR monitor end-tidal CO2
*can also be measured by capnography
the process of moving air into and out of the lungs
ventilation
*this is when CO2 is eliminated from the body
Using infared light absorption patterns to generate a wave that is displayed on a monitor to measure ventilation
capnography
what is the PaCO2 of the arterial blood
40 mmHg
what is phase 0 of ventilation?
inspiration
what is phase 1 of ventilation?
expiration begins, but CO2 free gas is expelled
what is phase 2 of ventilation?
mixing of the dead space gas and alveolar gas
what is phase 3 of ventilation
(expiratory plateau) as exhalation continues, remaining gas expelled is almost entirely alveolar
what drug can be given to inc RR?
Naloxone
*same one they give to help heroin overdose
what is a sign that there is low blood flow going to tissues (poor perfusion) (reduced CO) (hypoventilation)
pallor
way of inflating to occlude artery and then slowly letting air out to measure the pressure coming through
ocillometry (blood pressure)
how do you calculate MAP?
2/3 diastolic + 1/3 systolic
its all relatively unique and specific to each pt
what is the equation for BP
BP = SVR x CO
what does the P wave mean on an EKG?
-SA node in walls of the atria
what does the Q wave mean on an EKG?
impulse reached AV node which delays it by about .01 second
what does the RS wave mean on an EKG?
bundle branches carry signals from the AV node to the heart apex
what does the T wave mean on an EKG?
signal spreads through the ventricle walls
what does the ASA recommend for monitoring circulation?
every pt should have BP and HR evaluated and documented every 5 minutes
*consider continuous EKG monitoring if the pt has significant CV disease
what is the average body temp in celcius?
37
why is it important to monitor for temp during sedation?
malignant hyperthermia
is measuring temp on the skin a good choice?
no bc heat is lost across epidermis
