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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
What does line A-B represent on capnography?
A-B represents baseline inspiration to beginning of expiration.
26
What should the CO2 value be for line A-B?
Zero/baseline
27
What does line C-D represent on capnography?
C-D represents exhalation upstroke. Mixture of deadspace and exhaled TV.
28
What does D represent on capnography?
End-tidal waveform
29
What would a shark-fin capnograph waveform represent?
Asthma, COPD, bronchospasm
30
What does the curare cleft tell you?
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.
31
Will ETCO2 increase or decrease with better CO?
It will increase
32
What must the anesthetist do when changing agents and using a monochromatic infrared spectrometry?
Monitor must be re-programmed with the agent selected.
33
What is mass spectrometry?
Early form. Usually a separate room that multiple samples were sent to, then sent back to the OR room.
34
On an old AGM, where was the respirometer/ventimeter located?
On the expiratory limb to measure TV and MV
35
How often is blood pressure and HR recorded?
At least every 5 minutes
36
Normal Right atrial pressure?
1-8 (2-10)
37
Normal Right Ventricular pressure?
25/0(5)
38
Normal Pulmonary artery pressure?
25/10
39
Normal Pulmonary Artery Wedge Pressure?
6-12
40
Name three contraindications for TEE?
Recent gastric bypass Esophageal varices Esophageal masses
41
What is the primary way to avoid post op hypothermia?
Prevention
42
What type of medications are at highest risk for altering thermoregulation?
Anesthetic gases
43
What are the three main branches of thermoregulation?
Afferent sensing Central regulation Efferent response
44
Which part of the brain loses its thermoregulatory ability under general anesthesia?
Hypothalamus
45
In aortic stenosis, which factor is mostly effected- preload, afterload, heart rate, or contractility?
Afterload
46
Out of the following, which one does not cause decrease in SVR: hypethermia, hypovolemia, sepsis, anaphylactic shock
Hypovolemia
47
How big should a blood pressure cuff be in relation to extremity circumference?
40%
48
What is the name of the initial long upstroke in an arterial line waveform?
Anacrotic limb
49
Formula for SVR
[(MAP-CVP)/CO] x 80
50
What is the most common cause of an overdampened arterial waveform?
Bent arm/positioning
51
Which patients ALWAYS must have body temp monitored continuously during GA?
Pediatric patients and when indicated on all other patients.
52
Which types of surgery will have the most profound effect on thermoregulation?
Open abdomen/ bowel surgery
53
What thermoregulatory function is inhibited during GA?
Hypothalamus
54
How is thermoregulation impaired during spinal/epidural anesthesia?
Sympathetic blockade causes vasodilation with peripheral pooling of blood
55
Peripheral nerve stimulator has two electrodes, what are they?
Positive (red) proximal aspect of nerve. and Negative (Black) distal aspect of nerve
56
When should you obtain your first peripheral nerve stimulation assessment?
Prior to NMBA administration in order to have a baseline and watch for changes.
57
Which muscle is stimulated by the ulnar nerve?
Adductor pollicis muscle
58
Which muscle is stimulated by the facial nerve?
Orbicularis oculi
59
Name a depolarizing NMBA;
succinylcholine
60
Name a non-depolarizing NMBA:
all the -oniums
61
Which type of NMBA "sticks" open the receptor so that it cannot be repolarized?
Depolarizing NMBA | Ex: succinylcholine
62
Which type of NMBA stops depolarization from occuring?
Non-depolarizing NMBA. | Ex; -oniums
63
What is a train-of-four assessment?
4 individual twitches. 0.2msec long. 500msec apart.
64
What is considered a more accurate assessment than TOF, but isn't commonly used?
Double-burst stimulation
65
What is post-tetanic stimulation?
TOF after tetany assessment
66
What is the biggest difference seen with TOF between Non-depolarizing and depolarizing NMBA?
Depolarizing NMBA you will NOT see Fade
67
What is a TOF ratio?
Gives the difference between the 1st twitch and the 4th twitch
68
With non-depolarizing NMBA, at what % receptor occupancy can there still be an intact TOF?
At 75% receptor occupancy
69
At what % is twitch height effected with non-depolarizing NMBA?
At 75%
70
What are Visual Evoked Potentials (VEP)?
Bright lights via glasses
71
What are Auditory Evoked Potentials (AEP)?
Headphones with loud/high pitched noises
72
Somatosensory Evoked Potentials (SSEP)?
Looking at the sensory side (afferent)
73
What are Motor Evoked Potential (MEP)?
Looking at the motor side (efferent)
74
Where do SSEPs stimulate?
At the extremity
75
Where do MEPs stimulate?
At the head/brain
76
What is optimal BIS value during anesthesia?
BIS near 60
77
What does a BIS value of 100 represent?
Awake
78
What does a BIS value of 0 represent?
Dead (not awake)
79
What does a BIS value of 20 represent?
Patient is in Burst suppression
80
What information does a NIRS monitor provide?
Measures oxygen supply vs oxygen demand within a specific region. Measures tissue oxygen index as a ratio
81
What is important to do with NIRS monitor prior to GA?
Get a baseline NIRS value

APA Fundamentals (10 decks)

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