Flipped Classroom - temperature monitoring Flashcards
As a general principle, the comfort of operating room personnel must be balanced with patient care. For adult patients, what is the recommended ambient room temperature range in the operating room?
A) 68°F to 75°F (20°C to 24°C)
B) 60°F to 65°F (15°C to 18°C)
C) 75°F to 80°F (24°C to 27°C)
D) 80°F to 85°F (27°C to 29°C)
Correct Answer:
A) 68°F to 75°F (20°C to 24°C)
Rationale:
Maintaining an appropriate operating room temperature is essential for both patient safety and the comfort of the surgical team. The recommended temperature range of 68°F to 75°F (20°C to 24°C) helps prevent patient hypothermia while ensuring a suitable working environment for personnel. Too low of a temperature increases the risk of perioperative hypothermia in patients, leading to complications such as increased infection rates, delayed wound healing, and coagulopathy. Conversely, excessively high temperatures can cause discomfort for the surgical team, impairing performance. (Butterworth et al., 2022)
Which of the following statements about hypothermia in the operating room is correct? ( Select 3 choose)
A) Hypothermia is defined as a core body temperature of less than 36°C.
B) General and regional anesthesia is a potential cause of intraoperative hypothermia.
C) Conductive heat loss is the primary mechanism of heat loss in the operating room.
D) Radiant heat loss is considered the greatest source of heat loss in preoperative and operative settings.
Correct Answers:
A) Hypothermia is defined as a core body temperature of less than 36°C.
B) Epidural anesthesia is a potential cause of intraoperative hypothermia.
D) Radiant heat loss is considered the greatest source of heat loss in preoperative and operative settings.
Rationale:
Hypothermia is a common issue in the operating room and is defined as a core body temperature below 36°C (Elisha et al., 2023). General and regional anesthesia contributes to hypothermia by causing vasodilation and impairing thermoregulation (Elisha et al., 2023). Radiant heat loss, the transfer of body heat to a cooler environment, is identified as the greatest contributor to heat loss in perioperative settings (Elisha et al., 2023). Option C is incorrect because conductive heat loss in is not the primary mechanism in the operating room; it is, radiant heat loss dominates.
Elisha, S., Heiner, J. S., & Nagelhout, J. J. (2023). Nurse Anesthesia (7th ed. p. 321). Elsevier.
Which of the following statements about malignant hyperthermia is correct?
A) Hyperthermia is always the first sign of malignant hyperthermia.
B) When hyperthermia occurs in malignant hyperthermia, core temperature can increase by 1°C every 5 minutes.
C) Malignant hyperthermia typically develops slowly over several hours.
D) Core temperature changes in malignant hyperthermia are minor and rarely significant.
Correct Answer:
B) When hyperthermia occurs in malignant hyperthermia, core temperature can increase by 1°C every 5 minutes.
Rationale:
Malignant hyperthermia is a life-threatening condition triggered by certain anesthetic agents, causing a rapid and extreme metabolic reaction. Hyperthermia is an early symptom, not the first sign (Butterworth et al., 2022. Early signs may include tachycardia, muscle rigidity, and increased CO2 production. When hyperthermia does manifest, core temperature can rise quickly, as much as 1°C every 5 minutes, emphasizing the urgency of immediate intervention (Butterworth et al., 2022). Malignant hyperthermia is a rapidly progressing condition, not a slow-developing making option C is incorrect. Core temperature changes are severe, not minor making option D incorrect.
Which of the following statements about preoperative warming is correct?
A) Prewarming the patient for 30 minutes with convective, forced-air warming blankets helps reduce the initial drop in core temperature.
B) Preoperative warming is ineffective in preventing perioperative hypothermia.
C) Prewarming works by increasing metabolic heat production.
D) The central-peripheral temperature gradient increases after prewarming.
A) Prewarming the patient for 30 minutes with convective, forced-air warming blankets helps reduce the initial drop in core temperature.
Rationale:
Preoperative forced-air warming is an effective strategy to reduce the phase one decline in core temperature by minimizing the central-peripheral temperature gradient before anesthesia is induced (Butterworth et al., 2022). This process helps prevent redistribution hypothermia, a common cause of perioperative hypothermia (Butterworth et al., 2022). Option B is incorrect because prewarming is an effective measure in preventing temperature drops. Option C is incorrect because prewarming does not significantly increase metabolic heat production; rather, it helps maintain existing heat distribution. Option D is incorrect because the central-peripheral temperature gradient actually decreases, not increases, after prewarming.
What part of our brain is impaired during anesthesia that allows heat loss due to altered perception of temperature in the anesthetized dermatomes?
A. Pons
B. Hypothalamus
C. Frontal lobe
D. Occipital lobe
Correct answer:
B) Hypothalamus
Rationale:
The thermoregulatory impairment caused by conduction anesthesia results in continued heat loss due to the altered perception of temperature by the hypothalamus in the anesthetized dermatomes.
Which of the following temperature monitoring techniques are not recommended for patients that are getting open heart surgery?
A) Pulmonary artery and esophageal probe
B) Tympanic temperature monitoring
C) Oral temperature monitoring
D) Temporal temperature monitoring
Correct answer:
A) Pulmonary artery and esophageal probe
Rationale:
Esophageal and pulmonary artery temperature monitoring is less accurate and less reflective to core temperature during open heart surgery (Elisha et al., 2023). Tympanic membranes are considered an ideal site of core temperature because it reflects brain temperature (Elisha et al., 2023). Oral and temporal temperature monitoring is considered noninvasive and does not reflect core body temperature (Elisha et al., 2023).
__________defines the thermal state of an object?What defines the thermal state of an object?
The thermal state
(Elisha et al., 2023. p. 227)
How does the body regulate temperature?
The body regulates temperature through thermoregulatory mechanisms, including Radiation, Convection, Conduction, and Evaporation.
How do humans exchange heat ?
Humans exchange heat from high concentration to lower concentration.
__________ is most significant mechanism of which humans loose heat
Radiation
What is considered normal core body temperature?
37 degrees Celsius
(Elisha et al., 2023. p. 321)
What is hypothermia?
core body temperature of less than 36 degrees Celsius.Cause by:
* general and regional anesthesia by inhibiting
thermoregulation and vasodilation
* Radiant heat loss or transfer of body heat to cooler
environment in ambient operating room temperature.
Considered to be greatest amount of heat lost for patients
undergoing surgery
What is hyperthermia?
core body temperature raises above 38 degrees Celsius. Could be normal for some ppl. could be caused by recreational drug or atropine
What can cause hyperthermia during surgery?
Hyperthermia can be caused by general and regional anesthesia, which inhibit thermoregulation and vasodilation (ether, halothane, methoxyflurane,
enflurane, isoflurane, desflurane, and sevoflurane) or succinylcholine
What causes heat lost for patients undergoing surgery?
Radiant heat loss or transfer of body heat to a cooler environment in ambient operating room temperature.
What effect can atropine have on body temperature?
Atropine can inhibit the sweating response and impair regulatory temperature response, raising core body temperature.
What happens during malignant hyperthermia?
- There is an uncontrolled increase in the release of intracellular calcium in skeletal muscle –> sustained muscle contraction.
- Increased ATP results in uncontrolled hypermetabolic state
that requires increase oxygen consumption, increase CO2 production, LA, and hyperthermia
What is an early sign of malignant hyperthermia?
Hyperthermia is an early sign, with core temperature potentially rising 1 degree C every 5 minutes.
What are the rare incidence rates of malignant hyperthermia?
The incidence is 1 in 15,000 in pediatrics and 1 in 40,000 in adult patients.
What is the treatment for malignant hyperthermia?
- Discontinue anesthetic
- call for help
- mix dantrolene
- bicarbonate
- cooling blanket with temperature monitoring hooked up to core temperature probe (i.e esophageal or bladder probe)
- cooling lavage with temperature monitoring hooked up to core temperature probe,
- cold IV solution
- ice packs over major arteries
- treat hyperkalemia
- treat arrhythmia
_______ monitoring of patients during surgery is critical for patient safety and standard of care.
(Elisha et al., 2023. p. 1325)
What is the purpose of temperature monitoring?
Prevents hypothermia and hyperthermia.
What are the effects of hypothermia?
Increased surgical site infection risk, postoperative shivering with tachycardia and hypertension, impaired coagulation, cardiac arrhythmias, and decreased drug metabolism.
(Butterworth et al., 2022. p. 1238)
What are the effects of hyperthermia?
Can lead to tachycardia, vasodilation, and neurological injury.
(Butterworth et al., 2022. p. 126)
What is the recommended operating room temperature range?
68-75°F (20-24°C).
(Butterworth et al., 2022. p. 15)
How does temporal temperature monitoring work?
Infrared technology measures blood temperature close to the surface via swipe across the forehead and down the temporal artery.
(Elisha et al., 2023. p. 322)
What are the advantages of temporal temperature monitoring?
Safe, quick, and easy for awake patients.
What is a disadvantage of temporal temperature monitoring?
Nonreliable as it does not measure core temperature.
Where is axillary temperature monitoring placed?
Between the armpit.
How reliable is axillary temperature monitoring?
Close to core temperature but not actual core temperature.
What factors influence axillary temperature readings?
IV fluids and ease of dislodgment.
Is oral temperature monitoring an accurate reflection of core temperature?
No, sources suggest it is not accurate.
(Elisha et al., 2023. p. 322)
What are the advantages of tympanic temperature monitoring?
Considered to be core temperature and accurate if a contact probe is used. Easy to measure by inserting it gently into the ear. Most ideal site with the aural probe due to close proximity to the brain, reflecting brain temperature.
(Elisha et al., 2023. p. 322)
What are the disadvantages of tympanic temperature monitoring?
Possible trauma to the eardrum if pushed in too far. Can push more earwax into the canal. Infrared devices are less accurate.
What are the advantages of nasopharyngeal temperature monitoring?
Reflects core temperature. More useful in intubated patients.
(Elisha et al., 2023. p. 322)
What are the disadvantages of nasopharyngeal temperature monitoring?
Not usable if trauma has occurred to the head or neck area. Bleeding can occur if the probe is inserted. Less useful in awake patients.
What are the advantages of esophageal temperature monitoring?
Considered to reflect core temperature. Easy to insert if the patient is intubated.
(Elisha et al., 2023. p. 322)
What are the disadvantages of esophageal temperature monitoring?
Can cause oral or esophageal trauma and bleeding. Not useful in awake patients. Inaccurate if the patient is humidified. Must avoid inserting too far down to prevent inaccurate readings from the stomach. Not reliable during open-heart surgery due to exposed chest.
(Elisha et al., 2023. p. 322)
What is the primary advantage of bladder and rectal temperature monitoring?
Provides a definite reflection of core temperature.
(Elisha et al., 2023. p. 322)
What are the disadvantages of bladder and rectal temperature monitoring?
Invasive and requires urinary catheter placement. Risk of urinary tract infection (UTI). Possible trauma to the rectum and urethra. Bladder temperature probe is not useful in liver transplant surgery.
(Elisha et al., 2023. p. 322)
What is the primary advantage of pulmonary artery temperature monitoring?
Provides a definite reflection of core temperature.
(Elisha et al., 2023. p. 322)
What are the disadvantages of pulmonary artery temperature monitoring?
Invasive. Possible risk of infection and introduction to pathogens. Requires PA catheter. Not reliable during open chest procedures.
(Elisha et al., 2023. p. 322)
What is prewarming in the preoperative setting?
Warming patients preoperatively using warm blankets and forced-air warming devices.
What is the benefit of prewarming patients?
Reduces phase one decline in core temperature by minimizing body heat loss to the environment.
(Butterworth et al., 2022. p. 1239)
Which patients are more vulnerable to temperature fluctuations?
Patients with specific comorbidities (e.g., hypothyroidism, burns) and pediatric patients.
What are intraop considers for temp control?
- Cool ambient temperature in the operatingroom
- Prolonged exposure of large wound Intravenous fluids
- High flow of unhumidified gases can
contribute to hypothermia or hyperthermia
What are intraop prevention for complications caused by temp cntrol
- Warming blankets or bear hugger
(depending on what type of surgery) - Heated humidification of inspired gases
- Warming of IV fluids
- Administer Dantrolene for MH
How to prevent postop shivering?
- Occurs in PACU due to hypothermia or neurological after effects of general anesthetic agent
- Occurs after use of greater concentration of volatileanesthetic
- Can cause hyperthermia and metabolic acidosis if it sustained for long periods of time
- Increase oxygen consumption, decrease arterial oxygen saturation, and associated with increase risk of myocardial ischemia
- Treatment for shivering include IV dose of meperidine 12.5-25 mg in adults, warming blankets and forced-air warming device (bear hugger)
