clinical monitoring part 1

Question 1

what are mandatory oxygenation monitoring

Answer 1

clinical observation
pulse oximetry

Question 2

how often do you assess ventilation and CV

Answer 2

every 3-5 minutes

Question 3

when should you initially auscultate your patient

Answer 3

preop

Question 4

according to beer lambert a low concentration results in

Answer 4

low absorption

Question 5

according to beer lambert a high concentration results in

Answer 5

high absorption

Question 6

according to beer lambert less light path length results in

Answer 6

less absorption

Question 7

according to beer lambert more light path length results in

Answer 7

more absorption

Question 8

what is the gold standard is oximetry not accurate

Answer 8

Co-oximetry
4 wavelengths

Question 9

which hemoglobin absorbs more red light

Answer 9

deoxyhemoglobin

Question 10

which hemoglobin absorbs more infrared light

Answer 10

oxyhemoglobin

Question 11

what does the pulsatility of arterial blood flow estimates

Answer 11

SaO2

Question 12

what is the light transmitted through

Answer 12

skin
soft tissue
venous blood
arterial blood
capillary blood

Question 13

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

Answer 13

increases
increases

Question 14

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

Answer 14

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

Question 15

Korotkoff sounds are produced by

Answer 15

turbulent flow beyond that partially occluded cuff

Question 16

phase 1 korotkoff sounds

Answer 16

the most turbulent/audible (SBP)

Question 17

phase II korotkoff sounds

Answer 17

softer and longer sounds

Question 18

phase III korotkoff sounds

Answer 18

crisper and louder sounds

Question 19

phase IV korotkoff sounds

Answer 19

softer and muffled sounds

Question 20

phase V korotkoff sounds

Answer 20

sounds disappear (DBP)

Question 21

what is the equation for MAP

Answer 21

DP+ 1/3 (SP-DP)

Question 22

what are 4 limitations to auscultation discussed in lecture

Answer 22

decreased peripheral flow
changes in vessel compliance
incorrect cuff size
obesity

Question 23

cuff bladder should be

Answer 23

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

Question 24

the maximal amplitude of oscillations equals

Answer 24

MAP

Question 25

what is the least agreement with invasive BP

Answer 25

SBP

Question 26

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

Answer 26

atherosclerosis, edema, obesity and chronic HTN

Question 27

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

Answer 27

low high

Question 28

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

Answer 28

<+/- 5mmHg 20mmHg

Question 29

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

Answer 29

overestimating underestimating

Question 30

advantages of automatic cuff

Answer 30

eliminate clinician subjectivity improved quality and accuracy automaticity noninvasive

Question 31

disadvantages in automatic cuff

Answer 31

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

Question 32

caution use of automatic BP cuff in

Answer 32

severe coagulapathies peripheral neuropathies arterial/venous insufficiency recent thrombolytic therapy

Question 33

indications for invasive blood pressure monitoring

Answer 33

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

Question 34

radial site for invasive BP monitoring

Answer 34

most common site easy to access complications uncommon

Question 35

other monitoring sites for invasive BP besides radial

Answer 35

ulnar brachial axillary femoral posterior tibial dorsalis pedis

Question 36

what is the allens test

Answer 36

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

Question 37

transfixion technique of arterial line placement

Answer 37

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

Question 38

ID waveforms

Answer 38

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

Question 39

as pressure wave moves to periphery

Answer 39

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

Question 40

square wave test

Answer 40

fast flush no more than 2 oscillations following the flush

Question 41

underdamped art line results in __________ systolic pressure

Answer 41

elevated

Question 42

over damped art line results in

Answer 42

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

Question 43

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

Answer 43

under-multiple oscillations over-no oscillations

Question 44

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

Answer 44

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

Question 45

arterial line complications

Answer 45

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

Question 46

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

Answer 46

decrease

Question 47

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

Answer 47

increase

Question 48

RV stroke volume drops during

Answer 48

early phase of inspiration

Question 49

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

Answer 49

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

Question 50

what is a possible indicator of hypovolemia

Answer 50

dramatic increase SPV

Question 51

normal pulse pressure variation

Answer 51

<13-17%

Question 52

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

Answer 52

positive response to volume expansion

Question 53

what does the stoke volume variation correlate

Answer 53

resistance and compliance based on age, gender computes SV

Question 54

normal SVV and equation

Answer 54

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

Question 55

what does a >10-13% SVV indicate

Answer 55

positive response to volume expansion

Question 56

predicting accurate results requires what 6 things

Answer 56

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