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APA Fundamentals > Clinical Monitoring > Flashcards

Clinical Monitoring Flashcards

1
Q

When is thermoregulation required?

A

It is not required for every patient, but if a change is anticipated, normothermia must be facilitated.

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2
Q

When is neuromuscular response assessment required?

A

When an NMBA has been given

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3
Q

Which AANA standard of care number deals with monitoring, evaluating, and documenting?

A

Standard IX (9)

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4
Q

What is the main difference between a technician and a clinician?

A

A clinician does not simply react. A clinician thinks proactively and uses all the monitors and skills in harmony to provide care.

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5
Q

What might be happening if your patient is turning red?

A

Increased CO2

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6
Q

What are the three assessment tools under Fundamental basis of monitoring?

A
  1. Inspection
  2. Auscultation
  3. Palpation
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7
Q

What are the Six items under Monitoring according to AANA?

A
  1. Ventilation
  2. Oxygenation.
  3. Cardiovascular Status
  4. Body temp.
  5. Neuromuscular Function/Status.
  6. Patient Positioning.
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8
Q

What MUST be monitored under oxygenation?

A

Continuous pulse oximetry and via clinical observation.

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9
Q

Which law of physics is the pulse oximeter based off of?

A

Beer Lambert’s Law

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10
Q

What are the basics of Beer Lambert’s Law?

A

Relates the absorption of light by a solute to its concentration and optical properties at a given light wavelength.

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11
Q

How does a pulse oximeter work?

A

Send two wavelengths:
660(red)
and
940(infrared). Passes through arterial bed. Wavelengths are received on the other side with a preprogrammed calibration curve to give a % concentration of oxyhemoglobin.

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12
Q

Which hemoglobin absorbs 940nm (infrared) light?

A

Oxyhemoglobin

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13
Q

Which hemoglobin absorbs 660nm (red) light?

A

Deoxyhemoglobin.

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14
Q

What are some reasons the SpO2 could give an inaccurate measurement?

A 
Motion artifact.
Cautery interference.
Abnormal Hgb.
Anemia.
Methylene blue.
Vasoconstriction.
Hypothermia.
Hypotension.
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15
Q

What is a good rule of thumb for estimating PaO2 at a given SpO2?

A

SpO2 of 70, 80, 90 is roughly a PaO2 of 40, 50, 60

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16
Q

When do you use Cont ETCO2 monitoring?

A

During controlled or assisted ventilation requiring airway support.
During moderate and deep sedation.

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17
Q

What could suprasternal retractions tell you about the patient?

A

If there is an upper airway blockage.

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18
Q

What is the indication for precordial/esophageal stethoscopes?

A

Provides cont auditory confirmation of ventilation

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19
Q

Which patient population do precordial stethoscopes primary get used?

A

Pediatrics

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20
Q

What does ETCO2 monitoring provide for intubated versus non-intubated patients?

A

Intubated= quality of ventilation.

Non-intubated= simply the presence of ventilation

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21
Q

What is pCO2 compared to ETCO2?

A

Arterial CO2 is normally 2-5 higher than ETCO2.

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22
Q

What are the two types of ETCO2 sampling designs?

A

Mainstream/non-diverting

and

Sidestream/diverting

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23
Q

How does sidestream/diverting ETCO2 sampling work?

A

Extra little tubing coming off circuit. Has constant suction to draw a continuous sample.

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24
Q

ETCO2 waveform has 4 or 5 different phases, what are they?

A 
A- Inhalation.
B- Inhalation stops and beginning of exhalation.
C-Exhalation
D-END TIDAL CO2 Measurmenet.
E-beginning of next breath.
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25
Q

What does line A-B represent on capnography?

A

A-B represents baseline inspiration to beginning of expiration.

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26
Q

What should the CO2 value be for line A-B?

A

Zero/baseline

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27
Q

What does line C-D represent on capnography?

A

C-D represents exhalation upstroke. Mixture of deadspace and exhaled TV.

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28
Q

What does D represent on capnography?

A

End-tidal waveform

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29
Q

What would a shark-fin capnograph waveform represent?

A

Asthma, COPD, bronchospasm

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30
Q

What does the curare cleft tell you?

A

Curare cleft is a slight dip in the C-D line that represents the diaphragm “flopping”. Deeper the NMBA blockade, the more pronounced the cleft.

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31
Q

Will ETCO2 increase or decrease with better CO?

A

It will increase

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32
Q

What must the anesthetist do when changing agents and using a monochromatic infrared spectrometry?

A

Monitor must be re-programmed with the agent selected.

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33
Q

What is mass spectrometry?

A

Early form. Usually a separate room that multiple samples were sent to, then sent back to the OR room.

34
Q

On an old AGM, where was the respirometer/ventimeter located?

A

On the expiratory limb to measure TV and MV

35
Q

How often is blood pressure and HR recorded?

A

At least every 5 minutes

36
Q

Normal Right atrial pressure?

A

1-8 (2-10)

37
Q

Normal Right Ventricular pressure?

A

25/0(5)

38
Q

Normal Pulmonary artery pressure?

A

25/10

39
Q

Normal Pulmonary Artery Wedge Pressure?

A

6-12

40
Q

Name three contraindications for TEE?

A

Recent gastric bypass
Esophageal varices
Esophageal masses

41
Q

What is the primary way to avoid post op hypothermia?

A

Prevention

42
Q

What type of medications are at highest risk for altering thermoregulation?

A

Anesthetic gases

43
Q

What are the three main branches of thermoregulation?

A

Afferent sensing
Central regulation
Efferent response

44
Q

Which part of the brain loses its thermoregulatory ability under general anesthesia?

A

Hypothalamus

45
Q

In aortic stenosis, which factor is mostly effected- preload, afterload, heart rate, or contractility?

A

Afterload

46
Q

Out of the following, which one does not cause decrease in SVR: hypethermia, hypovolemia, sepsis, anaphylactic shock

A

Hypovolemia

47
Q

How big should a blood pressure cuff be in relation to extremity circumference?

A

40%

48
Q

What is the name of the initial long upstroke in an arterial line waveform?

A

Anacrotic limb

49
Q

Formula for SVR

A

[(MAP-CVP)/CO] x 80

50
Q

What is the most common cause of an overdampened arterial waveform?

A

Bent arm/positioning

51
Q

Which patients ALWAYS must have body temp monitored continuously during GA?

A

Pediatric patients and when indicated on all other patients.

52
Q

Which types of surgery will have the most profound effect on thermoregulation?

A

Open abdomen/ bowel surgery

53
Q

What thermoregulatory function is inhibited during GA?

A

Hypothalamus

54
Q

How is thermoregulation impaired during spinal/epidural anesthesia?

A

Sympathetic blockade causes vasodilation with peripheral pooling of blood

55
Q

Peripheral nerve stimulator has two electrodes, what are they?

A

Positive (red) proximal aspect of nerve.
and
Negative (Black) distal aspect of nerve

56
Q

When should you obtain your first peripheral nerve stimulation assessment?

A

Prior to NMBA administration in order to have a baseline and watch for changes.

57
Q

Which muscle is stimulated by the ulnar nerve?

A

Adductor pollicis muscle

58
Q

Which muscle is stimulated by the facial nerve?

A

Orbicularis oculi

59
Q

Name a depolarizing NMBA;

A

succinylcholine

60
Q

Name a non-depolarizing NMBA:

A

all the -oniums

61
Q

Which type of NMBA “sticks” open the receptor so that it cannot be repolarized?

A

Depolarizing NMBA

Ex: succinylcholine

62
Q

Which type of NMBA stops depolarization from occuring?

A

Non-depolarizing NMBA.

Ex; -oniums

63
Q

What is a train-of-four assessment?

A

4 individual twitches.
0.2msec long.
500msec apart.

64
Q

What is considered a more accurate assessment than TOF, but isn’t commonly used?

A

Double-burst stimulation

65
Q

What is post-tetanic stimulation?

A

TOF after tetany assessment

66
Q

What is the biggest difference seen with TOF between Non-depolarizing and depolarizing NMBA?

A

Depolarizing NMBA you will NOT see Fade

67
Q

What is a TOF ratio?

A

Gives the difference between the 1st twitch and the 4th twitch

68
Q

With non-depolarizing NMBA, at what % receptor occupancy can there still be an intact TOF?

A

At 75% receptor occupancy

69
Q

At what % is twitch height effected with non-depolarizing NMBA?

A

At 75%

70
Q

What are Visual Evoked Potentials (VEP)?

A

Bright lights via glasses

71
Q

What are Auditory Evoked Potentials (AEP)?

A

Headphones with loud/high pitched noises

72
Q

Somatosensory Evoked Potentials (SSEP)?

A

Looking at the sensory side (afferent)

73
Q

What are Motor Evoked Potential (MEP)?

A

Looking at the motor side (efferent)

74
Q

Where do SSEPs stimulate?

A

At the extremity

75
Q

Where do MEPs stimulate?

A

At the head/brain

76
Q

What is optimal BIS value during anesthesia?

A

BIS near 60

77
Q

What does a BIS value of 100 represent?

A

Awake

78
Q

What does a BIS value of 0 represent?

A

Dead (not awake)

79
Q

What does a BIS value of 20 represent?

A

Patient is in Burst suppression

80
Q

What information does a NIRS monitor provide?

A

Measures oxygen supply vs oxygen demand within a specific region.
Measures tissue oxygen index as a ratio

81
Q

What is important to do with NIRS monitor prior to GA?

A

Get a baseline NIRS value

APA Fundamentals (10 decks)

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