monitoring Flashcards
stage 1 premed
decreases need for induction agents and anesthetics, place IV during this stage, we monitor HR, RR, perfusion, pulse, drooling/ vomit, sedation, reactions
stage 2 induction
injectable anesthetic to yield unconscious state, can be masked with inhalant anesthetic, intubate prior to this, we monitor HR, RR, MM, CRT, pulse, CNS reflex
stage 3 maintenance
pain free, iso or sevo for inhalant, IV fluids, and pain management, we monitor HR, RR, perfusion, MM, CRT, CO2 and O2, BP, CNS reflexes, temp
stage 4 recovery
inhalant turned off to extubation, vitals monitored until fully awake, quiet warm area, highest morbidity, we monitor HR, RR, CRT, MM, pulses, temp, CNS signs, BP
no equipment can replace…
human observation
eye position
start central then move rostroventral and then back to center as they get deeper
eye position is ineffective if P receives…
dissociative drug (ketamine)
four planes of anesthesia are
induction, excitement, operative, and danger
induction stage
pupils react to light, pulse is irregular but bp is normal
excitement stage
pupil has more reaction to light, pulse is irregular and fast, BP is high
operative stage
pupil has no reaction to light, pulse is steady and slow, BP is normal
danger stage
pupils are extremely large, no reaction to light, pulse is weak and thready, BP is low
suitable depth of anesthesia for surgery
Stage III plane II; regular shallow resp., BP and Hr mildly decreased, relaxed muscle tone, pedal and swallowing absent, ventromedial eye rotation, moderate pupil size
plane I (light)
not suitable for surgery, involuntary limb movement, eyes rotate ventrally, pupils constrict, reflexes present but decreased response
Stage III plane III (deep)
deep anesthesia, excessive for most procedures, low HR and RR, reduced pulse, increased CRT, poor light reflex, dilated pupils, reflexes absent
Stage III plane 4
early anesthesia overdose, abdominal breathing, fully dilated pupils, dry eyes, all reflexes absent, depression of CVS, pale MM, flaccid muscle tone
stage 5
overdose, cessation of RR, circulatory collapse, death, resuscitate immediately
sinus arrhythmias
HR coordination with respiratory, decrease during expiration, increase during inspiration, abnormal in cats
sinus bradycardia
abnormally slow heart rate, common during anesthesia, reverse with anticholinergics
sinus tachycardia
abnormally fast heart rate, inadequate anesthesia, drug reaction, Sx stim, treat according to cause
atrial fibrillation
fine, undulating baseline, absence of P wave, tachycardia, irregular QRS intervals
ventricular fibrillation
undulating baseline, absence of QRS (very squiggly curvy lines)
pulseless electrical activity
cessation of heart contractions or pulse with normal EKG, associated with cardiac arrest
mean arterial pressure (MAP)
average pressure through cardiac cycle, indicator of perfusion to organs (> 60 mmHg)
pale MM
poor perfusion, anemia, blood loss
blue MM
resp arrest, O2 deprivation, pulmonary disease
adequate O2 is necessary for…
metabolic process
oxygen is carried by…
hemoglobin
100% O2 saturation means
all available Hgb binding sites are filled with oxygen
O2 saturation is _____ in arterial blood and _____ in venous blood
highest, lowest
patient with low Hgb (anemia) will give…
inaccurate indication of O2 availability
when a patient is given pure oxygen…
amount of dissolved O2 will increase, but not percent saturation
blood gas analyzers measure…
partial pressure, mostly used in large animals, measures dissolved O2 and CO2 in arterial and venous blood
PaO2 and SaO2 are ______ during anesthetized patients breathing pure oxygen
increased
low PaO2 and SaO2 indicate….
hypoxia and need for O2 supplementation
> 95% saturation indicates…
normal saturation
<85% saturation indicates…
emergency
2 types of pulse ox probes
transmission or reflective
where to put pulse ox
tongue, pinna, lip, vulvar fold, achilles tendon
reflective probe pulse ox can be placed
hollow organ, esophagus, or rectum
ventilation
movement of gas in and out of alveoli
respiration
process of which oxygen is supplied and used in tissues and CO2 is eliminated from tissue
tachypnea
hypercapnia, pulmonary disease, mild surgical stimulus
Tidal volume
amount of air inhaled during one breath, monitored by chest movement or reservoir bag or respirometer
hypoventilation
subnormal tidal volume, shallow breathing, can cause atelectasis, reversed by gentle bagging
hyperventilation
elevated tidal volume, can be caused by hypercapnia and sx stim
dyspnea
labored/ difficult breathing
apneustic resp pattern
prolonged pause between inspiration and expiration
apnea monitor
monitors respirations, warns if patient takes preset breath, detects temp differences inspired and expired air, sensor placed between ET tube and breathing circuit
end-tidal carbon dioxide monitor
measure CO2 in air inhaled and exhaled
CO2 measurement on inspiration
0 mmHg
CO2 measurement on expiration
35-45 mmHg
cardiac arrest
rapid loss of wave form that returns if CPCR is successful
hypothermia
gradual decrease in ETCO2
hyperthermia
gradual increase in ETCO2
CO2 bound to Hgb
20-30 %
CO2 dissolved in plasma
5-10%
CO2 transformed into bicarbonate and hydrogen ions
60-70%
normal PaCO2 in awake patient
<45 mmHg
acidotic
higher CO2 levels produce higher hydrogen ion concentration, blood pH will be lower (7.2-7.3)
PaO2
partial pressure of dissolved oxygen in arterial blood, should be 5x inspired oxygen concentration
