Monitoring Flashcards
AANA monitoring standard
9
Oxygenation monitoring standards
Clinical observation
Pulse oximetry; continuous
ABG’s as indicated
Ventilation monitoring standards
Auscultation after placement
Chest excursion; rise and fall
ETCO2; MAC case(salter canula)
Pressure monitors as indicated
Monitor RR every 5 minutes
CV monitoring standards
Electrocardiogram
Auscultation as needed
BP and HR every 5 minutes
Thermoregulation monitoring standards
When clinically significant changes in body temp are anticipated or suspected
Peds, elderly
Cases more than 20 min.
Neuromuscular monitoring standards
When neuromuscular blocking agents are administered
Chart q15 min
Chart when administering nm blocker
Chart when redosed
Causes of L shift on oxygb curves
Alkalosis
hypocarbia
hypothermia
decreased COhB
Fetal Hb
L shift = higger affinity for O2
Causes of R shift on oxyhb dissociation curve
acidosis
hypercarbia
hyperthermia
increased 2,3 dpg
Beer-Lambert
Law of absorption
Relates the transmission of light through a solution to the concentration of the solute in the solution
Light absorption must be measured at wavelengths that are proportional to the number of solutes
More concentrated solution absorbs _____ light than a less concentrated solution
more
Pulse ox low concetration
low absorption
Pulse ox high concnetration
high absorption
Pulse ox shorter light path length
Less absorbed = more through the other side
Pulse ox more light path length
more absorption
Co-oximetry
looks at all 4 wave lengths
Gold standard if oximetry is inaccurate
co-oximetry
Red wavelengths of light
660
Infrared wavelengths of light
940 nm
Deoxyhemoglobin (deO2Hb) absorbs more______ light than oxyhb
Red
Oxyhemoglobin (O2Hb) absorbs more——- light than deoxygb
infrared
Pulse ox operating principles
Ratio of AC (alternating current) and DC (direct current) light absorption
AC: Pulsatile expansion of the artery increases length of light path which Increases absorbency
DC looks at non pulsatile
Pulsatile component divided by non-pulsatile component for each wavelength
(AC(660)/DC(660))/ AC(940)/DC(940)
What Absorbs as much light in the 660 nm range as oxyhemoglobin does
carboxyhb
Falsely elevates SpO2
Each 1% increase of COHb will increase SpO2 by …..
1%
Many smokers have >6% COHb
Venous blood pulsations does what to the pulse ox?
Detection of venous O2Hb sat, results in reduction of presumed arterial SpO2