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Spring 2020 - APA Foundations 1 > Clinical Monitoring - Quiz 2 > Flashcards

Clinical Monitoring - Quiz 2 Flashcards

1
Q

Standard V - Monitoring

A

Oyxgenation

Ventilation

Cardiovascular Status

Thermoregulation

Neuromusdcular Function & Status

Positioning

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2
Q

How does Pulse Ox Work?

A

Two Lights

  • Red - absorbed by dexoyHGB
  • Infrared - absorbed by oxyHGB
  • Lights pass between two diodes through arterial bed
  • Computer does its thing
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3
Q

Beer Lambert’s Law

A

Absorption of light by a solute to its concentration and at a given wavelength.

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4
Q

What can cause inaccurate Pulse Ox readings?

A
  • Hypoperfusion - vasoconstriction, hypothermia, hypotension
  • Motion aritifact
  • Methylene blue
  • Anemia: < 5g/dl
  • Cautery Interference
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5
Q

What does not completely assure adequate gas exchange?

A

Airway Movement

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6
Q

Failure to intubate is ________, Failure to recognize misplacement is __________

A

Problematic

Catastrophic

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7
Q

Value of Precordial/Esophageal Stethoscope

A

Provides continuous assurance that ventilation is happening

Useful to detect changes in breath sounds

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8
Q

Esophageal stethoscope

A

Soft, plastic catheter with a balloon at the end

Only used with Intubated pts.

Can cause bleeding/irritation

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9
Q

What happens if esophageal stethoscope slides into trachea?

A

Gas leak around ETT

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10
Q

What does abscence of ETCO2 waveform indicate?

A

Esophageal Intubation

Accidental d/c from circuit

Cardiac Arrest

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11
Q

Difference between ETCO2 and Arterial CO2

A

ETCO2 is 2-5 torr lower

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12
Q
A
  • A-B: Baseline, End of Inspiration, Beginning of Expiration
  • B-C: Expiratory Upstroke - dead space + alveolar expiration
  • C-D: Alveolar Emptying CO2
  • D: Actual End-Tidal
  • D-E: Rapid return to baseline after exhaling CO2
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13
Q

Gas Analyzer

A

Continual analysis of inhaled & exhaled respiratory and anesthetic gases

  • Mass Spectrometry
  • Infrared Spectrometry
    • Monochromatic
    • Polychromatic
  • Raman Spectroscopy
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14
Q

Mass Spectrometry

A

Measures and reports all of patient’s gas simultaneously

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15
Q

Monochromatic Infrared Spectrometry

A
  • 3.3 micrometer light passed through anesthetic gas sample.
  • Absorption of Halogenated agents is at this wavelength
  • Must set monitor to agent
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16
Q

Polychromatic Infrared Spectrometry

A
  • 7-13 micrometer light pass through anesthesia gas
  • Absorption of halogenated agents are different at this wavelength
  • Monitor automatically identifies inhaled anesthetic
  • Monitor can tell the concentration of gas being given
  • Monitor can measure multiple agents at the same time
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17
Q

Raman Spectroscopy

A

Determines composition and concentration of gas in patient’s airway using the “Raman scattered light”

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18
Q

Peak Inspiratory Pressure Gauge

A

Measures positive pressure created by mechanical vent

  • Low Pressure Disconnect
    • Alarm
    • Circuit Disconnect
    • Leak in System
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19
Q

High Peak Inspiratory Pressure

A
  • Alarm for pressure > 40cm H2O
  • May indicate low pulmonary compliance
  • Check for obstruction in system
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20
Q

Human Senses for Monitoring

A

Hand on Bag

Chest Movement

Listening with Precordial Stethoscope

21
Q

Electrocardiography

A

NOT a measure of heart function - you can have a normal ECG with no cardiac output

LBBB needs to be stress tested if they dont have any history.

22
Q

Monitoring Body Temperature

A
  • All Pediatric Patients under general
  • Body can’t compensate for hypothermia under general d/t hypothalamic interference
  • Spinal/Epidural hypothermia d/t internal redistribution of heat. Sympathetic system causes vasodilation.
23
Q

Peripheral Nerve Stimulation

A
  • Pulse Generator
  • Two Electrodes
    • (+) Proximal Nerve
    • ( - ) Distal Nerve
24
Q

Common Sites for Monitoring Neuromuscular Function

A

Ulnar Nerve - pollicus muscle

Facial Nerve - orbicularis oculi muscle

25
Q

Types of Nerve Stimulator Tests

A
  • Single Twitch
  • Train of Four (TOF)
  • Tetany: Post Tetanic Potentiation:
  • Double Burst Suppression
26
Q

Electroencephalogram (EEG)

A
  • Monitor cerebral fxn
  • Provides early sign of ischemia
    • Carotid Endartarectomy
    • Cardiopulmonary Bypass
27
Q

Evoked Potentials

A
  • Electrical manifestation of brain’s response to external stimulus
  • Used for procedures with risks of neuro injury
    • Spinal Fusion
    • Craniotomy
  • Visual, Auditory, Somatosensory, and Motor Stimuli
28
Q

Bispectral Index (BIS) Monitoring

A
  • Processed EEG that reflects sedative & hypnotic effects
  • 0 - 100
  • < 60 = high probability of unresponsiveness & low awareness during surgery
  • Goal is to maintain BIS near 60
29
Q

Near Infrared Spectroscopy (NIRS)

A

Measures O2 Supply vs Demand

Ratio of Oxygenated HGB to Total HGB

Used in CV Bypass, Carotid, & Sitting Position

30
Q

In regards to Cerebral Oximetry, what needs to be obtained before giving any medications

A

Obtain Baseline Cerebral Oximetry

31
Q

Single Twitch

A

0.1 - 1 hz for 0.1-0.2 ms

Serves as control twitch

32
Q

Train of Four

A

Four stimuli every 1/2 second at 2 Hz for 2 seconds

Fade - each twitch is smaller

All twitches equal when neuromuscle is free of NMBD

33
Q

Tetanus

A

Continuous electrical stimulation for 5 seconds at 50 or 100 Hz

If no Fade: no signficant paralysis

If Fade: Significant block

34
Q

Double Burst Stimulation

A

2 Short Bursts at 50 Hz separated by 0.75 seconds

Detects residual paralysis during recovery

Fade < 0.6 = significant paralysis?

35
Q

What happens if a patient’s cardiac output if their pacemaker’s rate is inceased from 70 to 140?

A

Stroke volume will fall due to pacemaker stimulation

36
Q

How does cardiac output relate to delivery of anesthetic gas to the brain?

A

Decreased Cardiac Output increases delivery of anesthetic gas

CO is inversely related to brain uptake.

37
Q

The patient is hypotensive with an SVR of 750 dynes after losing blood. What should the nurse do?

A

Give vasopressors, blood products, and IVF

38
Q

What factors increase PVR?

A

Acidemia, Vasoconstriction Drugs, Hypercapnia

39
Q

What should be avoided with mitral stenosis or regurgitation?

A

Hypercarbia

40
Q

How does a temp of 35.5 or hypothermia effect SVO2?

A

Increases mixed venous oxygen saturation

41
Q

Which Lung Zone should the PA catheter tip be placed?

A

Zone III

42
Q

As a PA catheter advances, DBP increases and dicrotic notch forms, where is the tip of the catether?

A

Pulmonary Artery

43
Q

What is the length of the PA cath when it is in the Pulmonary Artery using a Left IJ site?

A

40-50 cm

44
Q

Contraindications to placing a Swan

A

LBBB

RBBB

Triscuspid/Pulmonic Valve Replacements

Presence of Endocardial Pacing Leads

45
Q

When should CVP be measured?

A

End Expiration

46
Q

On an EKG, what is the starting point in measure ST segment?

A

J Point

47
Q

Which electrode acts as the ground?

A

RL Lead - Green

48
Q

Difference between Depolarizing and Non-Depolarizing Medications regarding nerve stimulation

A

Depolarizing (Succinylcholine) will either have twiches or not.

Non-Depolarizing will have fade

49
Q

If patient has new on ST elevation in V3-V4, the most likely culprit is the RCA

A

False

Spring 2020 - APA Foundations 1 (10 decks)

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