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Principles 1 > blood pressure monitoring > Flashcards

blood pressure monitoring Flashcards

1
Q

Key indicator of perfusion
• Most important determinant of LV afterload
• Reflects the workload of the heart

A

blood pressure monitoring

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2
Q

rapid systolic estimation, return of flow technique

A

manual indirect bp measurement

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3
Q

The point at which the first turbulent arterial

flow sound returns.

A

systolic bp number

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4
Q

The point at which the sound becomes

muffled/diminished or non longer heard.

A

diastolic bp number

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5
Q

Errors with cuff measurement (4)

A

1) shock or pressors obliterating sound (false low)
2) low compliance (false high)
3) cuff size (large, false low-small, false high)
4) too rapid of cuff deflation (false low)

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6
Q

what is worse: a cuff too wide or too narrow?

A

narrow

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7
Q

the width of the blood pressure cuff should be ___ greater than the diameter of the patient’s extremity

A

20-50%

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8
Q

dynamap/oscillator
data interpretation algorithms utilized
measure systolic, diastolic, mean

A

automated non invasive bp monitoring

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9
Q

Arterial pulsations cause varying amplitudes which are measured along with the rate of change of amplitudes

A

oscillometry (measuring vibrations)

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10
Q

what reading with nibp is most accurate

A

map

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11
Q

what reading of nibp is least accurate

A

diastolic reading

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12
Q

how is systolic pressure determined with nibp

A

amplitude of pulsations
are increasing and are at 25%-50% of
maximum.

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13
Q

how is diastolic pressure measured with nibp

A

amplitude of pulsations
has declined from the peak value
approximately 80%.

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14
Q

map is

A

peak amplitude of pulsations

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15
Q

Invasive BP Clinical Indications (4)

A
  • need for real-time continous pressure monitoring
  • cuff measurement is unreliable
  • waveform diagnostics desired
  • repeated blood sampling needed
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16
Q

sites used for invasive bp (6)

A
  • radial (#1)
  • ulnar (#0)
  • brachial
  • axillary
  • femoral
  • DP/PT
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17
Q

complications of invasive bp (10)

A 
• Ischemia distal to site
• Hematoma-compartmental syndrome
• Arterial trauma
• Infection
• Thrombus formation
• Vasospasm
• Bleeding
• Fistula
• Air embolus
heparin overdose
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18
Q

unit for measuring frequency, number of cycles per

second. 1 cycle per second

A

hertz

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19
Q

back and forth repeated motion. A quantity that

repeatedly and regularly fluctuates above and below some mean value, as the pressure of a sound wave. NORMAL

A

Oscillation

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20
Q

stretch and recoil of spring (bouncing
vibrations/oscillations). a series of oscillations in which each
oscillation has a frequency that is an integral multiple of the same
basic frequency. ABNORMAL OCCURANCE

A

harmonics

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21
Q

exaggerated wave amplitudes occurring when the
monitored frequency matches the systems natural frequency resulting in overshoot or overestimated wave reading. good for the ear, bad for direct bp measurement

A

resonance

22
Q

what makes the electrical signal in the transduer

A

diaphragm displacement/movement

23
Q

explain the process of undamped (overdamped) inside the transducer

A

diaphragm moves too easily it may oscillate too
long. If a second subsequent wave arrives while it’s
still oscillating stacking will occur.

24
Q

explain the process of overdamped in transducer

A

diaphragm is too stiff and fails to oscillate in

response to a pressure wave

25
Q

How easily or rapidly the system oscillates, measured in Hz

A

natural frequency

26
Q

Natural frequency should be at least

A

5 times the frequency of the

waveforms to be monitored.

27
Q

Numerical indicator of the degree of damping.
defines an objects tendency to cease
vibrating/oscillating (how rapidly an object will
return to resting baseline).

A

damping coefficient

28
Q

Completely undamped is a coefficient of

A

0, meaning the object will oscillate forever

29
Q

Completely damped is a coefficient of

A

1, meaning the object will instantly return to baseline resting state as soon as stimulus is withdrawn

30
Q

when one displacement causes

one vibration, damping coeffiecient .4

A

critical damping

31
Q

transducer diaphragm vibrates too long after

being subjected to mechanical displacement

A

underdamped

32
Q

underdamped system is characterized by

A

sbp and dbp overshoot
falsely widened pulse pressure
artifact and other external interference

33
Q

skinny tall waves

sharp exaggerated waveforms

A

underdamped

34
Q

flat long short waves

smooth, no diacrotic notch

A

overdamped

35
Q

overdamping causes (9)

A 
Vasodilation
aortic stenosis
low cardiac output
clots
air bubbles
stopcocks
kinks
blood in transducer
empty or lack of pressure on flush bag
36
Q

underdamping causes (6)

A 
Hypertension
hyperdynamic flow states
catheter whip (excessive catheter movement), atherosclerosis
vasoconstriction
aortic regurgitation
37
Q

Systolic BP will be falsely low and diastolic BP will be
falsely high.
• Mean BP mostly unaffected.

A

overdamped system

38
Q

how do you assess dynamic performance of bp system

A

square wave test

39
Q

optimally damped square wave test

A

1.5-2 oscillations before returning to baseline

40
Q

underdamped square wave test

A

> 2 oscillations: SBP over estimated and DBP may be low or normal

41
Q

overdamped square wave test

A

<1 oscillation: sbp falsely low and dbp may be high or normal

42
Q

optimal tubing length?

A

4 ft

43
Q

how do you optimize dynamic response of system

A
  • NF as high as possible
  • short hard tubing
  • few stopcocks
  • remove air bubbles
  • withdraw blood to remove clots
44
Q

optimal damping number

A

.6-.7

45
Q

where should transducer be leveled

A

5 cm below sternal border and 4th ics

corresponds with aortic root

46
Q

1 cm of transducer height =

A

.75 mmHg

10 cm= 7.5 mmHg

47
Q

what happens to your pressures if pt above the transducer

A

higher pressures

48
Q

what happens when pt is under transducer

A

lower pressure

49
Q

where is neurosurgery placement

A

level of the external auditory meatus of tragus of ear (circle of willis estimates cpp)

50
Q

what will waveform show with aortic stenosis

A

delayed upstroke, narrowed pulse

pressure

51
Q

what will waveform show with aortic regurg

A

sharp rise, double peak

52
Q

what will waveform show with hypertrophic cardiomyopathy

A

spike and dome

due to midsystolic obstruction.

Principles 1 (12 decks)

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