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Principles I summer 2024 > clinical monitoring part 1 > Flashcards

clinical monitoring part 1 Flashcards

1
Q

what are mandatory oxygenation monitoring

A

clinical observation
pulse oximetry

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2
Q

how often do you assess ventilation and CV

A

every 3-5 minutes

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3
Q

when should you initially auscultate your patient

A

preop

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4
Q

according to beer lambert a low concentration results in

A

low absorption

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5
Q

according to beer lambert a high concentration results in

A

high absorption

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6
Q

according to beer lambert less light path length results in

A

less absorption

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7
Q

according to beer lambert more light path length results in

A

more absorption

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8
Q

what is the gold standard is oximetry not accurate

A

Co-oximetry
4 wavelengths

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9
Q

which hemoglobin absorbs more red light

A

deoxyhemoglobin

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10
Q

which hemoglobin absorbs more infrared light

A

oxyhemoglobin

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11
Q

what does the pulsatility of arterial blood flow estimates

A

SaO2

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12
Q

what is the light transmitted through

A

skin
soft tissue
venous blood
arterial blood
capillary blood

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13
Q

pulsatile expansion of the artery ___________ then length of light path which ___________ absorbency

A

increases
increases

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14
Q

what are the 6 signal artifacts for pulse ox discussed in lecture

A

ambient light
low perfusion
venous blood pulsations
additional forms of Hb
nail polish

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15
Q

Korotkoff sounds are produced by

A

turbulent flow beyond that partially occluded cuff

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16
Q

phase 1 korotkoff sounds

A

the most turbulent/audible (SBP)

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17
Q

phase II korotkoff sounds

A

softer and longer sounds

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18
Q

phase III korotkoff sounds

A

crisper and louder sounds

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19
Q

phase IV korotkoff sounds

A

softer and muffled sounds

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20
Q

phase V korotkoff sounds

A

sounds disappear (DBP)

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21
Q

what is the equation for MAP

A

DP+ 1/3 (SP-DP)

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22
Q

what are 4 limitations to auscultation discussed in lecture

A

decreased peripheral flow
changes in vessel compliance
incorrect cuff size
obesity

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23
Q

cuff bladder should be

A

40% of arm circumference
80% of length of upper arm
centered over an artery

24
Q

the maximal amplitude of oscillations equals

A

MAP

25
Q

what is the least agreement with invasive BP

A

SBP

26
Q

a low SBP and high DBP error is associated with what 4 disease processes

A

atherosclerosis, edema, obesity and chronic HTN

27
Q

when a cuff is too large BP is _______
when a cuff is too small BP is ______

A

low
high

28
Q

standards state that the average difference must be__________ but deviations up to ___________ are acceptable

A

<+/- 5mmHg
20mmHg

29
Q

placing a cuff on the forearm will ___________ SBP and __________ DBP

A

overestimating
underestimating

30
Q

advantages of automatic cuff

A

eliminate clinician subjectivity
improved quality and accuracy
automaticity
noninvasive

31
Q

disadvantages in automatic cuff

A

unsuitable in rapidly changing situations
patient discomfort
complications: compartment syndrome, pain, petechiae and ecchymoses, limb edema, venous stasis and thrombophelbiitis, peripheral neuropathy

32
Q

caution use of automatic BP cuff in

A

severe coagulapathies
peripheral neuropathies
arterial/venous insufficiency
recent thrombolytic therapy

33
Q

indications for invasive blood pressure monitoring

A

continuous, real time
planned pharmacologic manipulation
repeated blood sampling
determination of volume responsiveness
timing of IABP counter pulsation

34
Q

radial site for invasive BP monitoring

A

most common site
easy to access
complications uncommon

35
Q

other monitoring sites for invasive BP besides radial

A

ulnar
brachial
axillary
femoral
posterior tibial
dorsalis pedis

36
Q

what is the allens test

A

compression of radial and ulnar arteries, patient makes tight fist to exsanguinate the palm, patient opens hand, examiner releases ulnar artery, color return <5 seconds

37
Q

transfixion technique of arterial line placement

A

same positioning and preparation
front and back walls are punctured intentionally
needle removed
catheter withdrawn until pulsatile blood flow appears and then advanced
not associated with more frequent complications

38
Q

ID waveforms

A

1: systolic upstroke
2: systolic peak pressure
3: systolic decline
4:dicrotic notch-aortic valve closing
5: diastolic runoff
6: end-diastolic pressure

39
Q

as pressure wave moves to periphery

A

arterial upstroke steeped
systolic peak higher
dicrotic notch later
end diastolic pressure lower

40
Q

square wave test

A

fast flush
no more than 2 oscillations following the flush

41
Q

underdamped art line results in __________ systolic pressure

A

elevated

42
Q

over damped art line results in

A

systolic pressure decreased
absent dicrotic notch
loss of detail
falsely narrowed pulse pressure
MAP accurate

43
Q

what does the square test look like with under dampened and over dampened

A

under-multiple oscillations
over-no oscillations

44
Q

pressure gradient changes and be due to what 5 things discussed in lecture

A

age (lack of distensibility)
atherosclerosis
peripheral vascular resistance changes
septic shock
hypothermia

45
Q

arterial line complications

A

distal ischemia or pseudo aneurysm
hemorrhage, hematoma
arterial embolization
local infection
peripheral neuropathy

46
Q

an increase in intra-thoracic pressure simultaneously ________ LV after load

A

decrease

47
Q

and increase in Total lung volume will displace pulm venous blood and _______ LV preload

A

increase

48
Q

RV stroke volume drops during

A

early phase of inspiration

49
Q

mechanically ventilated patient normal systolic pressure variation is
normal change up is
normal change down is

A

7-10mmHg
2-4mmHg
5-6mmHg

50
Q

what is a possible indicator of hypovolemia

A

dramatic increase SPV

51
Q

normal pulse pressure variation

A

<13-17%

52
Q

what does a >13-17% of pulse pressure variation indicate

A

positive response to volume expansion

53
Q

what does the stoke volume variation correlate

A

resistance and compliance based on age, gender
computes SV

54
Q

normal SVV and equation

A

10-13%
SVV=(SVmax-SVmin)/SVmean

55
Q

what does a >10-13% SVV indicate

A

positive response to volume expansion

56
Q

predicting accurate results requires what 6 things

A

mechanical ventilation with TV of 8-10mL/kg
PEEP >= 5mmHg
regular cardiac rhythm
normal intra-abdominal pressure
a closed chest
patient positioning (steep trendelenburg)

Principles I summer 2024 (7 decks)

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