Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

ONCOLOGY & CC > CCU: Monitoring > Flashcards

CCU: Monitoring Flashcards

1
Q

Dehydration is a deficit in

A

extracellular fluid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the 6 perfusion parameters that are important to monitor for shock

A

1) Heart Rate
2) Pulse quality
3) Mucous membrane color
4) Capillary refill time
5) Extremities temperature
6) Mentation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

T/F: compensated shock has normal blood pressure

A

true- blood pressure is highly preserved by the compensatory response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the indications for measuring arterial blood pressure

A

1) Routine monitoring
2) Anesthetized patients
3) Classification of compensated / decompensated shock
4) Monitoring resuscitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is normal blood pressure

A

Systolic: 120-140mmHg
Diastolic: 70-90mmHg
Mean: 90-110mmHg

140/80 with a mean of 100 *

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the limitations of arterial blood pressure measurements

A

-Dont indicated if patient is in shock or not
-Not a measure of perfusion
-Insensitive- highly preserved by compensatory response. Arterial BP is the last thing to go
-Variability in measurement, especially indirect BP: obtain repeated 3-5 measurements and average
-Can be affected by other factors (pain, stress, etc)

*Must correlate findings to physical exam/clinical picture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How should you obtain a reliable blood pressure when indirect BP often has variability

A

obtain repeated 3-5 measurements and average

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the gold standard for arterial blood pressure measurement

A

direct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the pros of arterial blood pressure

A

Systolic, diastolic and mean pressure
arterial waveform for further analysis
continuous monitoring allows close monitoring of changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the cons of direct arterial blood pressure measurement

A

-Requires placement of arterial catheter
-Invasive, technically challenging
-Requires monitor and pressure transducer for measurements
-Pressure tracings can be distorted: clots, kinks, inappropriate tubing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the two main devices of indirect blood pressure measurement

A

1) Doppler with Sphygmomanometer
2) Oscillometry

noninvasive
readily invasive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

In most studies does Osc vs Doppler vs Direct perform better in dogs and is more accurate

A

Oscillometry

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Pros and Cons of Doppler

A

Pros:
-Inexpensive
-Readily available
-Auditory signal generated
-Better in cats

Cons:
-Less accurate in dogs
-Measures systolic BP only
-May not actually measure SBP
-Requires patient manipulation
-People/time consuming
-Operator dependency
-Auditory signal generated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Pros and Cons of Oscillometric

A

Pros
-Accurate
-Readily available
-Systolic, diastolic and mean BP
-Measures HR
-Not operator dependent
-Hands off measurement
-Automatically cycle for repeated measurements

Cons:
-More expensive
-May be affected by motion, variable heart rate, and pulse deficits
-Black box effect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Dopper measures ___________
Oscillometric measures_______

A

Doppler: Systolic BP only

Oscillometric: Systolic, diastolic, and mean BP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What values define hypotension

A

MBP <60-65mmHg
SBP <90mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Hypotension is more commonly seen in

A

ER/Urgent care due to decompensated shock secondary to severe dehydration, acute hemorrhage, trauma, sepsis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

T/F: blood pressure is necessary to diagnose shock

A

False- it is not necessary but it does help to classify it between compensated and decompensated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What aspect of blood pressure do mot ECC clinicians worry about most

A

CPP = MBP - ICP

depends on the MBP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What values define hypertension

A

MAP> 160mmHg or SBP >200mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Hypertension might be secondary to

A

1) Pain, stress = physiological response
2) cardiac disease
3) renal disease
4) Cushing’s disease
5) Pheochromocytoma
6) Toxin injection (ie chocolate)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How do you treat hypertension

A

target the cause and/or vasodilators, ACE-inhibitors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the indications for measuring ECG

A

-Unstable patients- heart rate is an early indicator of CV instability
-Presence of brady or tachyarrhthmias
-pulse deficits
-guide shock resuscitation
-guide anti-arrhthmic therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How do you do apply ECG

A

3 leads (LF,RF, LH)
most commonly interpreted in lead II (RF, LH)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

represents the summed electrical activity in the heart

A

Electrocardiogram (ECG)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

produced with anaerobic metabolism
marker for perfusion, O2 delivery or utilization

A

lactate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

How is lactate measured

A

blood gas analyzer or hand-held lactometer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are the indicators for measuring lactate

A

-Patients with evident or suspected hypoperfusion (objective assessment, guide therapy)
-Can be served as a guide for fluid therapy/resuscitation
-Help decide need for RBC transfusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Does lactate has a prognostic marker or severity of disease

A

failure to improve may have prognostic value

lactate clearance is a better prognosis marker

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What are the limitations of lactate

A

1) May be high with altered cellular utilization of oxygen
2) Cellular energy demand exceeds a normal supply (seizures, physical exertion, etc)
3) Can reflect abnormalities with clearance or overproduction (Type B hyperlactemia, liver disease, drugs, sepsis, etc)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What can abdominal POCUS tell you

A

1) Caudal Vena Cava Collapsibility (Subxyphoid or hepatic or intercostal view)
2) CVC:Ao ratio (Paralumbar view)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What can cardiac POCUS tell you

A

1) Detection of pericardial effusion
2) Subjective assessment of systolic function = contractility
3) Subjective assessment of cardiac underfilling or overloading

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What does a flat Caudal Vena Cava on POCUS mean

A

Hypovolemic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What does a fat Caudal Vena Cava on POCUS mean

A

Fluid overloaded or well fluid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

CVC diameter is larger in inspiration or expiration

A

expiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What is the normal compressibility of the CVC

A

30-50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What does increased CVC compressibility on inspiration mean

A

Hypovolemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

The CVC collapses during inspiration or expiration

A

Inspiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What does decreased CVC compressibility on inspiration mean

A

Hypervolemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Why does the aortic diameter not change in intravascular volume

A

because the aorta has a thicker and more rigid vessel wall than the CVC
-NOT affected by the respiratory cycle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Normal CVC:Ao ratio is

A

1:1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What is a better marker of hypovolemia than CVC measurement

A

CVC: Ao ratio

not affected by breathing cycle, but could be affected by changes in abdominal pressure
Static marker

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What is the preferred view for cardiac POCUS

A

right parasternal short and long axis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What is evaluated when doing cardiac POCUS

A

-Subjective/objective assessment of cardiac contractility
-Left ventricle internal diameter in diastole (LVIDd)
-Ventricular wall thickness/flattening
-Atrial lumen size and LA:Ao rato

Normal LVID depends on weight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What does an increased left ventricle internal diameter in diastole mean

A

patient might be hypervolemic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

a measurement that used pressure to assess volume status
based on the notion that CVP=RAP=RVEDV

considerable debate as to accuracy/utility

A

Central Venous Pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What factors affect central venous pressure relationship to volume

A

1) Venous Return
2) Venomotor tone
3) Intrapleural pressure
4) Right atrium function
5) Cardiac output

considerable debate as to accuracy/utility
-confounding factors, technical issues, repeatability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Methods to assess cardiac output

A

1) PAC thermodilution- gold standard for assessing CO via placement of Swan-Ganz catheter, injection of cold saline from proximal port, temperature measured at tip in PA, speed of temperature depends on CO

2) Transthoracic Doppler- noninvasive CO monitoring, doppler ultrasound probe to detect aortic blood flow, corss-sectional area of vessel predicts stroke volume (SVxHR=CO)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

noninvasive CO monitoring, doppler ultrasound probe to detect aortic blood flow, cross-sectional area of vessel predicts stroke volume (SVxHR=CO)

A

Transthoracic Doppler (USCOM)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

gold standard for assessing CO via placement of Swan-Ganz catheter, injection of cold saline from proximal port, temperature measured at tip in PA, speed of temperature depends on CO

A

PAC thermodilution

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What are the indications to get PCV and total proteins

A

-Abnormal (pale, red, yellow) mucous membranes
-Shock (investigating cause)
-Fluid balance
-Sick animaal

Anemia (regen or non-regen) or polycythemia vera

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

PCV =

A

PCV= Hct= 3xHb

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

When getting PCV and total proteins, what else should you assess

A

serum color

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

With blood loss, both PCV and TP are decreased but why is PCV >TP

A

because of splenic contraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

With dehydration, will both PCV and TP be increased or decreased

A

increased

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

If you have increased albumin, its because _______ while increased total protein is likely _________

A

albumin: dehydration
TP: hyperglobulinemia

57
Q

Why should we not use the term “total solids”

A

because the total protein level is estimated by refraction produced by combined plasma concentration of its solutes- aka the total solids
Protein does not equal oncotic pressure

58
Q

What are the indications for measuring blood glucose

A

-minimum data base
-shock
-known diabetic patient
-seizuring puppy/kitten
-monitoring hypo/hyperG

59
Q

Where you do sample for a blood gluocse measurement

A

vein
capillary (ear, paw pads, elbow callus and outer lip)

60
Q

What should you consider when measuring blood glucose

A

important to use animal validated for small animals
determine whole BG concentrations so needs erythrocytes (humans contain different amount of glucose compared to animals in RBCS) so use species specific code (GlucoPet, AlphaTrack 2)

61
Q

Why should you never use the term dyspnea

A

because it is a sensation and patients are unable to verbalize they are in respiratory distress

say respiratory distress instead

62
Q

ability of CO2 to exit the body

A

ventilation

63
Q

decreased tissue perfusion of O2

A

hypoxia and perfusion

64
Q

decreased of PaO2

A

hypoxemia

65
Q

physical examination of respiratory distress is

A

increased respiratory rate and effort

66
Q

What constitutes an animal with increased respiratory effort

A

orthopneic posture
-elbow abduction
-neck extension
-open mouth breathing
-nasal flaring *
-cyanosis

67
Q

When a patient is in respiratory distress, what should you start with

A

Pulse oximetry

68
Q

In regards to respiration, what should you be looking for on a physical exam

A

1) Resp rate
2) Resp Efforts (Elbow abduction, neck extension, open mouth breathing, nasal flaring, cyanosis)
3) Respiratory patterns
4) Audible breathing sounds
5) Use of stethoscope for respiratory sounds

69
Q

Used as a non invasive surrogate for PaO2 but not directly related

A

Pulse oximetry

70
Q

Pulse oximetry is accurate at

A

+/- 2/4 percentage points which may be significant at the steeper part of the curve

71
Q

When is pulse oximetry less accurate

A

SaO2 <85% but you still know the patient is hypoxemic

72
Q

What is normal pulse oximetry

A

> 98%

73
Q

SaO2 of 95% = PaO2 of

A

80mmHg

74
Q

SaO2 of 90% = PaO2 of

A

60mmHg

75
Q

How can pulse oximetry be used as threshold for client communication

A

97%-100%: normal, look for look alikes
95-95%: may be able to be treated as outpatient
90-95%: will usually/probably need to be hospitalized
<90% may need to be mechanically ventilated

76
Q

What are the 5 causes of hypoxemia

A

1) Low partial pressure of PiO2 (altitude, empty O2 tank, faulty anesthetic equipment, housefire)

2) Hypoventiliation

3) Low V/Q

4) No V/Q (shunt) - pulmonary or anatomic- no ventilation to perfused lung units

5) Diffusion Impairment - pulmonary fibrosis

77
Q

What might cause low PiO2 leading to hypoxemia

A

altitude
empty O2 tank
fault anesthetic equipment
House fire

78
Q

what might cause a diffusion impairment leading to hypoxemia

A

pulmonary fibrosis

79
Q

What are the 8 places where respiratory distress can arise from

A

1) Upper
2) Lower
3) Parenchyma (water, blood, pus, tissue)
4) Chest wall- including muscular fatigue and neurologic
5) Diaphragm/Abdomen- including muscular fatigue and neurologic
6) Pleural space - air, fluid, tissue
7) Vascular- PTE
8) look alikes- non respiratory causes: anemia, shock, pain sepsis

80
Q

What are some non-respiratory causes of respiratory distress

A

anemia
shock
stress
pain
sepsis

81
Q

occurs due to high PCO2 where the CO2 takes up space in the alveoli and contributes to hypoxemia

A

Hypoventilation

82
Q

T/F: PvO2 is a marker of oxygenation

A

False

83
Q

difference between PAO2 and PaO2

A

A-a gradient

84
Q

the A-a gradient should be _________ in an animal with normal lungs, no abnormal anatomic shunts, breathing 21% oxygen at sea level

A

<10 mmHg

85
Q

What is the basis of defining hypoxemia

A

PaO2

86
Q

What do you need to assess hypoxemia

A

arterial blood gas with a known FiO2

87
Q

the ratio of PaO2 to FiO2 with FiO2 expressed as a decimal (400-500)

A

P/F ratio

88
Q

You should only use the P/F ration when there is

A

stable PCO2 and variable FiO2

influenced by PCO2

89
Q

What decreases P/F ratio

A

decreased lung function - useful to assess pulmonary function

90
Q

How do you calculate A-a gradient

A

{[(Pb-Ph20)x FiO2] - PaCO2 (1/RQ)} - PaO2

simplied if room air at sealevel
A-a = 150-1.1xPaCO2 - PaO2

91
Q

The FiO2 should be about

A

400-500

92
Q

What is the simplified A-a gradient if on room air at sea level

A

A-a = 150-1.1xPaCO2 - PaO2

93
Q

Why is PaCO2 slightly lower than at sea level

A

due to compensation for the low PaO2 (to maintain normoxia)

Normal PaCO2 in CO is 30-40mmHg instead of 35-45 mmHg at sea level

94
Q

What allows the movement of air in and out of the respiratory system to properly ventilate

A

1) Diaphragm: main muscle of inspiration- phrenic nerve (C3-C5)
2) Rib cage and related msucles
3) Abdominal muscles- forced expiration
4) Accessory muscles- neck, nares

95
Q

what innervates the diaphragm and allows it to be the main muscle of inspiration

A

Phrenic nerve (C3-C5)

96
Q

What are the indications to use a capnometry/ capnography

A

-Breath by breath surrogate for PaCO2/ PVCO2
-ROSC in CPR

97
Q

What is a normal caponmetry reading

A

PETCO2 = 30-40mmHg

usually 5mmHg difference between
PvCO2 > PaCO2 > PETCO2

98
Q

How much does PvCO2, PaCO2, and PETCO2 differ

A

usually a 5mmHg difference

99
Q

What is the limitation of capnometry and canopgraphy

A

needs the patient to be intubated

100
Q

What are the phases of capnography

A

I: inspiratory baseline
II: Expiratory upstroke
III: Expiratory plateau
EtCO2- end expiration
IV: Expiratory Downstroke

101
Q

What is the alpha angle of the capnograph

A

the angle between phase II (expiratory upstroke) and Phase III (expiratory plateau)

allows you to assess ventilation/perfusion of the lung
V/Q mismatches will have an alpha angle greater than 90 degrees

102
Q

What alpha angle tells you there is a V/Q mismatch

A

when it is greater than 90 degrees

103
Q

What is the beta angle in the capnograph

A

the angle between the end expiration and the expiratory downstroke

used to assess rebreathing, if rebreathing occurs the angle is greater than 90 degrees

104
Q

What beta angle tells you that rebreathing is occuring

A

if the angle is greater than 90 degrees

105
Q

You perform a venous blood gas on a dog. the PvCO2 is 62mmHg. Is the dog hypo or hyperventilating

A

Hypoventilation - CO2 is high

106
Q

You perform a venous blood gas on a dog. the PvCO2 is 62mmHg. Is this dog most likely acidemic or alkalemic

A

Acidemic

107
Q

You perform a venous blood gas on a dog. the PvCO2 is 62mmHg. What is most likely cause of ventilation disorder

A

Upper-Airway Obstruction

108
Q

What are the 3 main reasons for respiratory acidosis

A

1) Brain doesnt work
2) Muscle doesnt work
3) Upper-Airway obstruction

109
Q

You should calculate the anion gap if there is

A

a metabolic acidosis

110
Q

Decreased pH and increased PCO2

A

Respiratory acidosis

111
Q

Increased pH and decreased pCO2

A

Respiratory alkalosis

112
Q

Decrease pH and HCO3

A

metabolic acidosis- do an anion gap

113
Q

Increased pH and HCO3

A

metabolic alkalosis

114
Q

What is the rule of 4s for normal blood gas values

A

pH= 7.4 +/- 0.04
HCO3= 24 +/- 4
base exess/deficit= 0 +/- 4
PCO2= 40 +/- 4
Anion gap = 14 +/- 4
Na = 144 +/- 4
K= 4 +/- 0.4

115
Q

loss of ECF = ______ while loss of ICF=_______

A

ECF: dehydration
ICF: free water loss

116
Q

What factors can you use to evaluate fluid balance

A

1) Physical Exam
2) Body weight
3) Urine specific gravity
4) Urine output
5) PCV-TP

117
Q

Hydrated/volume repleted animals have a USG of

A

1.008-1.012 (isostenuric)

if unreliable with impaired concentrating ability the kidney disease or renal injury

118
Q

What should urine output be? Used as an indicator of renal perfusion/volume status

A

minimum of 1-2ml/kg/hr

*may not be indicative of perfusion in other tissues

119
Q

Increased albumin has one rule out which is

A

dehydration … but it can be influenced by anemia, protein losss, etc.

120
Q

If both PCV-TP are elevated then

A

its usually a marker of dehydration/hemoconcentration

121
Q

Causes of hyperthermia

A

1) Fever (pyrexia)
-Infectious
-Inflammatory
-Neoplasia
-Drug induced (opioids, ketamine in cats)

2) Exposure/failure to dissipate
-airway obstruction
-external heat source

122
Q

What are causes of hypothermia

A

-Shock
-Anesthesia
-Exposure (ie cold)
-Renal failure
-Hypothyroidism

123
Q

What might cause hyperkalemia

A

urinary obstruction
AKI
Addisons
reperfusion injury

124
Q

What electrolyte disturbance is common in ICU, especially on IV fluids

A

Hypokalemia- secondary to diuresis and/or decreased intake

125
Q

What is the main goal of focused ultrasound

A

find free fluid

126
Q

What are the 4 quadrants of abdominal POCUS

A

1) SubXyphoid
-Liver and between liver lobes
-Gallbladder
-Pleural/pericardial space thru diaphragm
-Caudal vena cava distension

2) Bladder- and neck, beware of colon shadow

3) Right kidney- most ocmmon fluid location

4) Left kidney- spleen

127
Q

What can you see in the sub-xyphoid view when doing abdominal POCUS

A

-Liver and between liver lobes
-Gallbladder
-Pleural/pericardial space thru diaphragm
-Caudal vena cava distension

128
Q

What are the indications for focused abdominal US

A

trauma
shock
collapse
acute abdomen
non-invasive
rapid
repeatable

129
Q

What is the primary goal of thoracic ultrasound **

A

best to rule out pneumothorax

130
Q

When doing thoracic POC ultrasounds, what is the best view to ruling out pneumothorax

A

caudo-dorsal- highest point on the thoracic wall

131
Q

When doing thoracic POC ultrasounds, what does the caudo-dorsal view assess

A

rules out pneumothorax

132
Q

When doing thoracic POC ultrasounds, what does the cranioventral view assess

A

the cardiac site
1) Pleural or pericardic fluid
-Subjective volume assessment
2) LA and Ao ratio quick peak
3) Check the heart and pericardial space

133
Q

When doing thoracic POC ultrasounds, what does the subxiphoid view assess

A

may be superior for the detection of pericardial (and pleural effusion) fluid

134
Q

What can you see when doing focused thoracic ultrasounds

A

Gator sign
Glide sign
A-line

135
Q

Lack of glide signs on thoracic POCUS indicate

A

pneumothorax

136
Q

What do shred/Clines on thoracic POCUS indicate

A

consolidation of lung tissue

137
Q

What do B-lines indicate

A

wet lungs

138
Q

How do you calculate the anion gap

A

AG = UA - UC = (Na+K) - (Cl + HCO3)

Normal in dogs = 18 +/-6 and 20 +/-7 cats

139
Q
A

ONCOLOGY & CC (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions