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final exam principles of nurse anesthesia > miscellaneous anesthesia equipment > Flashcards

miscellaneous anesthesia equipment Flashcards

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1
Q

list the components of the SPDD model?

A

supply

processing

delivery

disposal

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2
Q

list the 5 tasks of oxygen?

A

02 pressure failure alarm

o2 pressure failure device (failsafe)

o2 flowmeter

02 flush valve

ventilator drive gas

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3
Q

what is the location of the supply component of the SPDD model?

A

pipeline to the back of the anesthesia machine

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4
Q

what is the location of the processing component of the SPDD model?

A

inside the machine up to the common gas outlet

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5
Q

what is the component of the delivery component of the SPDD model?

A

breathing circuit

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6
Q

what is the location of the disposal component of the SPDD model?

A

scavenging system

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7
Q

1 kPa equals how many mbar?

A

10 mbar

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8
Q

1 mbar is equal to how many mm HG?

A

.76 mm Hg

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9
Q

100 kPa is equal to how many mBar?

A

1000

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10
Q

1000 mbar is equal to how many mmHg?

A

760 mmHg

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11
Q

760 mmHg is equal to how may cm H2O?

A

1030 cm H20

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12
Q

1030 cm H2O is equal to how many psi?

A

14.7 psi

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13
Q

14.7 psi is equal to how many atomsphere?

A

1

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14
Q

who is responsible for the purity of the medical gases? and who enforces it?

A

united states pharmacopoeia

food and drug administration (FDA)

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15
Q

who has published requirements for the manufacturing, marketing, labeling, filling, qualification, transportation, storage, handling, maintenance, requalification, and disposition of medical gas cylinders and containers?

A

Department of Transportation (DOT)

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16
Q

Who is responsible with the regulation of occupational trace gas exposure in the workplace setting?

A

occupational safety health administration (OSHA)

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17
Q

what are the components of a medical gas cyclinder?

A

body

valve

port

stem

handle

pressure relief device

conical depression

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18
Q

wha tis the most easily damaged portion on the cylinder?

A

the valve

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19
Q

what are the two different type of cylinder valves?

A

diaphragm valve

packed valve

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20
Q

what type of cylinder should be used for MRI?

A

aluminum

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21
Q

cylinders are filled and discharged through a ______.

A

valve

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22
Q

the valve on a cylinder attaches to the ______ of the cylinder

A

neck

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23
Q

describe a packed valve?

A

stem is sealed by a resilient packing such as teflon, which prevents leaks around the threads

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24
Q

packed valves are also called ______ acting, because turning the stem causes the seat to turn.

A

direct

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25
Q

what type of pressures is a packed valve meant for?

A

high pressures

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26
Q

what type of pressures is a diaphragm valve mean for?

A

low pressures

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27
Q

describe a diaphragm valve?

A

closure between the cylinder interior and the atmosphere is accomplished by using a seal usually metal to metal, and a bonnet nut that clamps one or more circular disks in place

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28
Q

what are the advantages of a diaphragm valve?

A

can be opened fully by using a one-half to three quarter turn, compared to the packed valve requires two or three full turns

the seat does not turn and therefore less likely to leak

no stem leakage can occur because of the diagphragm

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29
Q

what is the disadvantage of a diaphragm valve?

A

expensive compared to the packed valve

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30
Q

what is the port on a cylinder?

A

the point of exit for the gas

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31
Q

what should happen to the port during transit?

A

a covering be placed on it

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32
Q

what is the purpose of the stem?

A

is rotated during valve opening or closing

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33
Q

to close the valve, the stem seals againt the seat is part of the valve body.

when the valve is opened, the stem moves _____ , allowing gas to flow to the port

A

upward

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34
Q

what is the purpose of the handle on the cylinder?

A

used to open or close a cylinder valve

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35
Q

which way do you turn the handle to open the valve?

A

turn counterclockwise

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36
Q

which way to turn the handle to close the valve?

A

turn clockwise

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37
Q

purpose of the pressure relief device?

A

purpose is to vent the cylinder’s contents to the atmosphere if the pressure of the enclosed gas increases to a dangerous level

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38
Q

where is the conical depression found?

A

found above the safety relief device on small cylinder is the conical depression that recieves the retaining screw of the yoke.

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39
Q

if the retaining screw is tightened into the safety relieve device, what may happen?

A

the device may be damaged and the cylinder contents escape.

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40
Q

what is the purpose of the PISS?

A

inadvertent misconnections of gas cylinders.

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41
Q

PISS configuration air?

A

1,5

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42
Q

PISS configurations oxygen?

A

2,5

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43
Q

PISS configurations nitrous oxide?

A

3,5

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44
Q

USA color for oxygen

A

green

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45
Q

international standard color for oxygen

A

white

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46
Q

what is the usa standard color for nitrous oxide

A

blue

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47
Q

what is the international standard color for nitrous oxide

A

blue

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48
Q

what is the usa standard color for carbon dioxide?

A

grey

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49
Q

what is the international standard color for carbon dioxide?

A

grey

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50
Q

what is the usa standard color for air?

A

yellow

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51
Q

what is the international standard color for air?

A

white and black

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52
Q

the presence of more than one washer between the hanger yoke assembly and tem of the tank may do what?

A

may allow the PISS to be bypassed

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53
Q

what is the air capacity in Liters and PSIG for a E cylinder?

A

625 L

1900 PSIG

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54
Q

what is the oxygen capacity in Liters and PSIG for a E cylinder?

A

660 L

1900 PSIG

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55
Q

what is the nitrous oxide capacity in Liters and PSIG for a E cylinder?

A

1590 L

745 psi

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56
Q

name the two gases that come in a liquid or a gas?

A

nitrous oxide or carbon dioxide

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57
Q

when do we typically change the oxygen cylinder?

A

if the oxygen is less than 500 PSI

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58
Q

what percent oxygen is found in 1 liter of air?

A

21%

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59
Q

the only time cylinders on the back of an anesthesia machine should be turned on is?

A

during the daily machine check or when you are not able to use the pipeline supply.

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60
Q

what would happen if you lose pipeline pressure and the oxygen cylinder was left open, what would happen?

A

you would use the cylinder oxygen without knowing it, by the time the failsafe alarms, your backup oxygen supply would be empty

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61
Q

the only way of determining cylinder content is by?

A

the label not its color

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62
Q

what is the weight of a full nitrous oxide cylinder?

A

20.7 pounds

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63
Q

what is the weight of an empty cylinder?

A

14.1 pounds

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64
Q

what is gas volume for nitrous oxide?

A

250 L to 1590 L

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65
Q

list the 15 possible hazards with cylinders

A

inccorcet cylinder attached

incorrect contents

incorrect valve

incorrect color

incorrect labeling

inoperable valve

damaged valve

contaminated cylinder contents

nitrous oxide theft

asphyxia

fires

explosion

projectile damage

thermal injury

overfilled cylinder

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66
Q

oxygen exists as a gas inside the cylinder, because why?

A

its critical temperature is below room temperature (-119 C).

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67
Q

what is the equation to calculate the amount of time left on cylinders?

A
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68
Q

which oxygen analyzer must be calibrated daily

A

galvanic fuel cell

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69
Q

what are the two types of oxygen analyzers

A

Galvanic Fuel cell

Paramagnetic device

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70
Q

which oxygen anayzer increases oxygen tension by creating an increase in magnetic attraction

A

paramagnetic device

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71
Q

which oxygen anayzer increases oxygen tension by creating a current across two electrodes

A

galvanic fuel cell

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72
Q

which oxygen analyzer automatically calibrates itself

A

paramagnetic device

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73
Q

which oxygen analyzer has a quicker response time

A

paramagnetic over the galvanic fuel cell

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74
Q

what do oxygen analyzers monitor

A

oxygen concentration, not pressure

75
Q

Oxygen analyzers can detect what two things

A

oxygen pipline crossover

leak in the breathing circuit (tupically Y-piece and CO2 canister)

76
Q

nitrous oxide exists as a liquid inside the cylinder why?

A

because its critical temperature is above room temperature (36.5 C).

77
Q

______ joins two or more similar components

A

connector

78
Q

___ establishes functional continuity between otherwise disparate or incompatible components

A

adapter

79
Q

The pressure will begin to decrease from 745 psi for nitrous oxide only after what? at this point the cylinder is about _____ empty.

A

all the liquid is gone and only gas remains.

3/4 empty

80
Q

what are the three disadvantages of connectors and adaptors

A

increase dead space

increase resistance

increase the number of sites that disconnections can occur

81
Q

when the nitrous cylinder is 3/4 empty approximately ____ L of nitrous oxide remains in the tank.

A

250 L to 400 L

82
Q

_____ are used to protect the patient from microorganisms and airborne particulate mater and to protect anesthsia equpitment and the environement from exhaled components

A

filters

83
Q

Filters: increase or decrease

_____ resistance to gas flow

_____ PIP

______resistance leading to _____ for spontaneously breathing patients

A
  1. increase
  2. increase
  3. increased resistance causes problems during spontanous ventilation
84
Q

gas delivered from anesthsia machines is ___ and at ___ remperature

A

dry and room temperature

85
Q

what are the effects of inhaling dry gases

A
  1. Damages Respiratory tract
  2. Body temperature is lowered
  3. tracheal tube obstructions may occur
86
Q

what are the damages that occur to the respiratory tract when inhaling dry gases from an anesthsia machine

A

– As mucosa dries, the temperature drops, secretions thickens, ciliary function is reduced, surfactant activity is imparied, musoca becomes more susceptible to injury and may result in atelectasis and obstructions

–dry gases can cause bronchospasms

87
Q

what are the four sources of humidity

A
  1. carbon dioxide absorbents
  2. exhales gases
  3. low fresh gas flow
  4. coaxial breathign systems
88
Q

how do carbon dioxide absorbents increase humidity

A

the reaction of an absorbent and CO2 liberates water

89
Q

In exhales gases, what are ways that humidity is contained

A

tracheal tube and LMA premits some rebreathing which preserves expired humidity

90
Q

How does fresh gas flow conserve moisture

A

low FGF will conserve moisture

91
Q

what coaxial breathing system permits humidity

A

Bain

92
Q

_____ conserves some exhaled water and heat and returns them to the patient in the inspired gas

A

HME (heat and moisture exchanges)

93
Q

what are the two types of HMEs

A

hydrophobic or hygroscopic

94
Q

what are some contraindications for using an HME

A

thick, copious, bloody secretions

HEM should be used with caution for weaning patient

**should not be used with an HUMIDIFIER**

95
Q

what are the two types of HMEs

A

Hydrophobic and Hygroscopic

96
Q

the only reliable method to determine the volume of nitrous oxide that remains in the the tank?

A

weigh it

97
Q

what is the most delicate part of the cylinder?

A

the cylinder valve

98
Q

gas cylinders must be stored in the _______ position.

A

upright

99
Q

the cylinder must be stored in the upright position and ______.

A

secured.

100
Q

when changing the cylinder on the anesthesia machine, it is appropriate to temporarily place the old cylinder on it _____ until it can be moved to its appropriate storage receptacle.

A

side

101
Q

if you do not have cylinder to use as a replacement be sure to insert a ?

A

yoke plug

102
Q

a yoke plug is inserted to prevent?

A

if a check valve fails, gas that should be going to the patient will exit the anesthesia machine

103
Q

Failure to remove the plastic cover from the port before installing the cylinder will cause what?

A

an obstruction of gas flow when the cylinder turned on

104
Q

A hydrophobic membrane consists of _____ pores and the membrane is _____ for ____ surface area

A

small pores

pleated membrane

increase surface area

105
Q

performance of the hydrophobic HME may be impaired from

A

high ambient temperatures

106
Q

which HME filter is efficient for bacterial and vital filtering

A

Hydrophobic

107
Q

which filter allows for the passage of water vapor but not liquid water

A

hydrophobic

108
Q

which filter is associated with small increases in resistance when wet

A

hydrophobic

109
Q

_____ HME contains a wool, foam or peperlike material coated with moisture retaining chemicals,

A

hygroscopic

110
Q

Hygroscopic HMEs also contain a thin fiber membrane that has been subjected to electrical field to _____

A

increase its polarity- which improves filtration efficency and hydrophobicity

111
Q

A hygroscopic HME is more efficient at what two things

A

moisture and temperature conservation

112
Q

in what HME can resistance can increase greatly when HME becomes wet

A

Hygroscopic

113
Q

what are the factors that affect moisture output

A
  1. types of HME used
  2. humidity of fresh gas (increased humidity of gas entering HME will increase inspired humidity)
  3. inspiratory and expiraotry flow
  4. circuit leaks
114
Q

if you open the cylinder and hear a hissing sound, what does that mean?

what is you first step?

if the first step doesnt work?

if the second step doesnt work, what do you do?

A

there is a leak

  1. tighten the connection

then replace the washer between the cylinder and the hanger yoke assembly

replace the cylinder

115
Q

for factors affecting moisture output, for the inspiratory and expiraotry flow, the faster the gas flows through HME the ____

A

less time there is to evaporate or deposit moisture so a larger tidal volume may cause humidity of inspired gas to fall

116
Q

if the yoke retaining screw punctures the safety relief valve, what can happen?

A

it may damage the cylinder causing it to leak

117
Q

an mri cylinder will have two colors which are?

A

majority of the tank will be silver, and only the top is the color that signifies the gas it contains.

118
Q

what are the advantages of HMEs

A

inexpensive, easy to use, reliable, low resistance when dry, no danger in overhydration

119
Q

what are the disadvantages of using HMEs

A

limited humidification

contribution to temperature preservations is not significant

increases dead space (needs to be as close to patient as possible)

120
Q

list some of the hazards of HMEs

A

– heavy, viscous secretions can greatly increase resistance of HME use

– do not use with external heated humidifier

– nebulized medication can increase resistance with hygroscopic HMEs

– HME can become obstructed with blood, fluid, secretions

– liquid can break through hygroscopic HME, causing poor filtration

– HMEs can contribute to rebreathing (pediatric patients)

121
Q

ionic reactions take place on the surface of granuales in

A

aqueous medium

122
Q

_____ granules becomes exhaused more quickly than ___ granuels which indicates what % of water needs to be present

A

dry granules quicker than moist

10-20% of water

123
Q

when beginning an anesthetic using the anesthesia machine, a provider must check for the presence of what supply components?

A

full E cylinder and alternative means of ventilation (ambu bag).

124
Q

KOH is used less frequently as an activator due to

A

the ability to produce Compound A and Carbon monoxide

125
Q

if the pipeline pressure fials or fraction of inspired oxygen drops what are the steps a provider should take?

A
  1. do not attempt to fix the oxygen analyzer- it must be trusted until it can be proven wrong
  2. turn on backup oxygen cylinder on machine fully, and disconnect pipeline. Ensure that the measured fraction of inspired oxygen (FIO2) begins to rise. If the FIO2 does not increase (with fresh gas flow adequate to wash in the O2 quickly), ventilate the patient by Ambu bag with room air.
  3. use low flows of oxygen. maintain anesthesia with a volatile agent. ensure that FIO2 and agent concentration are appropriate
  4. turn off the ventilator and ventilate manually through the circle system.
  5. call for help if needed; calculate the time remaining for the current cylinder; call for additional oxygen cylinders, and install them on the machine if needed.
  6. find out how long the problem is expected to last; participate in the hospital disaster plan, which may require prioritzing oxygen for those pateitns who need it most
  7. do not reconnect the patient to pipeline gas until the gas supply is tested
  8. if unable to use the circle, ventilate with an oxygen source (freestanding cylinder) or with room air via a bag-valve-mask device, adn institute toal intravenous anesthesia.
126
Q

1 mole of CO2 produces

A

13,000 kcal of heat energy

127
Q

absorbents contain _____ as an indicator of absorbent pH

A

ethyl violet

128
Q

_______ does not regenerate to any extent, indicating it does not regain capacity to absorb CO2 during period that it is not in use

A

soda lime

129
Q

During a rest period, soda lime changes from ____ to _____

A

from purple to white during a rest period

130
Q

what is the first step in the reaction of CO2 with soda lime

A

Carbon dioxide + water - - carbonic acid

131
Q

what is the second step for CO2 reaction with soda lime

A

Carbonic acid + 2 sodium Hydroxide — sodium carbonate + 2 water + heat

132
Q

what is the third step for CO2 and soda lime reaction

A

sodium carbonate + calcium Hydroxide - - - calcium carbonate + 2 sodium hydroxide

133
Q

what are the pipeline components?

A

base block

primary and secondary valve

gas specific connection point

quick connectors

face plate

134
Q

why are indicators added to absorbents

A

to signify when the absorbents ability to absorb CO2 is exhausted

135
Q

describe the function of a primary valve for the pipeline component?

A

opens and allows the gas to flow when the male probe is inserted and closes automatically when the connection is broken.

136
Q
A
137
Q

what is the purpose of the secondary valve for the pipeline component?

A

designed so that when the primary valve is removed, the gas flow is shut off. When the primary valve is in place, the secondary valve stays open

138
Q

what is the purpose of the DISS system?

A

prevents inadvertent misconnections of gas hoses. Each gas hose and connector are sized and threaded for each individual gas.

139
Q

what is the purpose of quick connectors for pipeline components?

A

allow apparatuses to be connected or disconnected by a single action

140
Q

does a quick connector or a DISS fitting leak more?

A

quick Connector

141
Q

what is the purpose of the face plate?

A

permanently marked with the name and/or symbol of the gas that it conveys

142
Q

hoses used to connect anesthesia machines and other apparatus to terminal units, must have a permanently attached?

A

noninterchangeable connector

143
Q

the hoses used for a pipeline system must be ____ coded.

A

color

144
Q

hoses should be kept off the _____ and away from ____

A

floor

heat

145
Q

pipeline system problems (6)?

A

pressure loss - most frequent problem

cross connection of gases - most common between nitrous and oxygen

contamination - from particles, bacteria, and liquid water

leaks

theft of nitrous oxide

excessive pressure- regulator failure

146
Q

what component fo a circle system makes rebreathing of exhaled gases?

A

carbon dioxide absorbers

147
Q

what are the benefits of the carbon dioxide absorber?

A

conserve agent, oxygen, nitrous oxide, heat, and humidity

preventing respiratory acidosis that would result from rebreathing CO2

148
Q

FGF of ______ provides near-total rebreathing, and full reliance on absorbent for prevention of rebreathing carbon dioxide

A

0.3 to 0.5 L/min

149
Q

FGF of ____ is associated with little if any reliance on absorbent granules because exhaled carbon dioxide is rapidly diluted and sent to the scavenger with such high fresh gas inflows.

A

greater than 5-8 L/min

150
Q

what do you do if your carbon dioxide absorber goes out what do you do?

A

increases fresh gas flow

151
Q

how many canisters can you have for a carbon dioxide absorber?

A

2

152
Q

double canisters advantages are?

A

permit more complete carbon dioxide absorption

less frequent changes

lower gas flow resistances

153
Q

the 2 canisters you date when the absorbent was last changed where?

A

on the lower canister

154
Q

do indicators affect absorption

A

no

155
Q

What is an additive that serves as an indicator of absorbent pH

A

Ehtyl Violet

156
Q

Fresh CO2 absorbent has a caustic ______ pH due to sodium hydroxide

A

alkaline

157
Q

to ensure complete absorption, a patient’s tidal volume should not exceed what?

A

air space b/t absorbent granules (50% absorber’s capacity)

158
Q

when the pH reaches ____, the ethyl violet changes from what color to what color

A

10.3

white to purple

159
Q

what does a baffle system do?

A

directs gas flow throught the center

160
Q

what does color change indicate in ehtyl blue

A

exhausted soda lime

161
Q

first absorption on a carbon dioxide canister occurs where?

A

at the inlet and along the canister sides.

162
Q

does Ehtyl Violet regain capability to reabsorb

A

no

163
Q

name the three different types of oxygen analyzers?

A

paramagnetic oxygen analyser

electrochemical oxygen analysis

piezoelectric analysis

164
Q

what is the common absorbent known as

A

soda lime

165
Q

describe piezoelectric analysis?

A

uses vibrating crystals that are coated with a layer of lipid to measure volatile anesthetic agents.

When exposed to a volatile anesthetic agent the vapor is absorbed into the lipid

The resulting change in the mass of the lipid alters the vibration frequency.

By using an electronic system consisting of two oscillating circuits, one of which has an uncoated crystal and the other a coated crystal, and electric signal that is proportional to the vapor concentration is generated.

166
Q

explain the importance of mesh size and granules

A

size of the granule must strike a balance btw surface area (absorptive capacity) and airflow resistance (work of breathing)

Small granule= higher surface area with high resistance

large granule= low surface area with low resistance

167
Q

fragmented soda lime granules produce

A

dust hardener

168
Q

describe electrochemical oxygen analysis?

A

consists of a sensor, which is exposed to the gas being analyzed, and the analyzer box, which contains the elctronic circuitry, display, and alarms.

The sensor contains a cathode and anode surrounded by electrolyte.

The gel is held in place by a membrane that is non permeable to ions proteins, and toher such materials, yet is permeable to oxygen.

Sensor is placed in the inspiratory limb of the breathing system.

169
Q

size 4 or 8 mesh size signifies?

A

less resistance with the greatest amount of absorbent

the holes determine the size of particles allowed to get through soda lime resulting in Compoud A and Carbon Monoxide

170
Q

after limited use of CO2 absorption canister, absorption has occured primarily at the ___ and lesser at the ___

A

inlet and lesser along the sides

171
Q

where is the least resistance in a CO2 absorption canister

A

loosely packed granules or smooth inner walls

172
Q

describe paramagnetic oxygen analysers?

A

when introduced into a magnetic field, some substances locate themselves in the strongest portion of the field, gaining themselves the name paramagnetic.

oxygen is the only paramagnetic gas important in anesthesia.

When a gas that contains oxygen is passed through a switched magnetic field the gas will expand and contract, causing a pressure wave that is proportional to the oxygen partial pressure.

To ensure accuracy, the pressure is compared to pressure of air or oxygen.

173
Q

Volitle anesthetics can be further broken down into ___ and _____ when a drier absorber is used

A

compoud A or carbon monixide and not scavenged

174
Q

what are the two ways to respond to a hypercarbia patient with an exhausted absorber

A
  1. increase Fresh Gas Flow (do not increase Minute Ventilation)
  2. change the canister (dont throw away the old canister in case there is something wrong with the new one, you will not be able to ventilate your patient)
175
Q

what are the 2 main problems that can occur with carbon dioxide absorbent

A
  1. exhausted absorbent (no longer able to neutralize CO2)
  2. desiccated absorbent (too dry)
176
Q
A
177
Q

______ may disturbe the paramagnetic oxygen sensor so that it reads higher than expected

A

desflurane

178
Q

list the early signs of carbon dioxide absorber exhaustion

A

increase in partial pressure of end-tidal carbon dioxide, may be accompanied by an increase in inspired carbon dioxid

respiratory acidosis

hyperventilation

signs of SNS activation (flushed, cardiac irregularities, sweating)

increased bleeding at surgical site

color of indicator

179
Q

what is the benefit of adding Silica to absorbent granules

A

provides hardness and minimizes the creation of dusts (less dust means less bronchial irritation and less risk bronchospasms)

180
Q

what are the late signs of carbon dioxide absorber exhaustion?

A

increased (and then later decrease) in heart rate and blood pressure

dysrhythmia

181
Q

you should use carbon dioxide absorbents with lower amounts of strong ________, such as?

A

bases

potassium hydroxide

182
Q

a good recommendation is to change the absorbent regularly, such as _____ mornings. why?

A

monday

incase the absorbent was exhausted due to FGF left on all weekend

183
Q

if you have a double canister, do you have to change both at the same time?

A

yes

184
Q

if you are unsure of an abosrbent state of hydration, such as when the FGF has been left on, what should you do?

A

change the absorbent

final exam principles of nurse anesthesia (12 decks)

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