Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

6902 > Monitoring > Flashcards

Monitoring Flashcards

1
Q

Scope and Standards for Nurse Anesthesia Practice

A

Standard V

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Standard V

A

Monitor the patient’s physiologic condition as appropriate for the type of anesthesia and specific patient needs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Requirements/Monitoring Parameters

A 
VOTC
-Ventilation
-Oxygenation
-Temperature 
-Circulation
Neuromuscular
Patient Positioning
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Ventilation

A
  • Verify intubation by auscultation, chest rise, EtCo2
  • Continuously monitor EtCO2
  • Use spirometry and pressure monitors as indicated
  • Inspired anesthesia gases
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Oxygenation

A
  • Clinical observation
  • Pulse ox
  • ABGs
  • Inspired O2
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Temperature

A
  • Continuously on all pediatric patients under GA

- When indicated on adult pts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Circulation

A
  • ECG and heart sounds
  • HR
  • BP every 5 minutes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Neuromuscular

A

when neuromuscular blockade agents are used

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Patient positioning

A

Assess and institute protective measures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Cardiac surgery monitors

A 
invasive BP
CVP
TEE
UOP
ABGs
cerebral oximetry
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Preload definition

A

Tension on LV after diastole

End diastolic volume

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Increased preload = ?

A

Increased SV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Components of preload

A

Volume (intravascular, extravascular, total body sodium)
Venous tone
Compliance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

End Systolic Volume

A

Contractility

Afterload

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Contractility

A

Heart’s ability to generate force

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Afterload

A

Tension on LV when aortic valve opens

-Indirectly measure by SVR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Increased afterload = ?

A

Decreased SV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

CO

A

HR x SV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Arterial Pressure Monitoring

A

Radial most common

  • easy, superficial
  • ulnar nerves supply 90% of flow
  • Allen’s test
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Optimally damped art line

A

Baseline is re-established after 1 oscillation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Under-damped art line

A

Baseline is re-established after several oscillations (SBP is overestimated, DBP is underestimated, and MAP is accurate)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Over-damped art line

A

Baseline is re-established with no oscillations (SBP is underestimated, DBP is overestimated, and MAP is accurate). Causes include an air bubble or clot in the pressure tubing or low flush bag pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Invasive BP measures BP where?

A

At level of transducer. Should be at RA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Reasons to have art line

A 
Major surgery with blood loss or fluid shifts
CPB
Aortic surgery
Need for frequent ABGs
Recent MI, unstable angina, severe CAD
Shock
Permissive hypotension
Hypothermic procedures
Trauma
COPD, PHTN, PE
Inotropic support needed
Inability to measure noninvasively
Asymptomatic AS, MS, AR, MR
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Reasons NOT to have art line

A

Local infection
Coagulopathy
Vaso-occlusive or spastic disease (Raynaud’s)
Interferes with surgical field

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Complications from art line

A 
Infection
Hemorrhage
Hematoma
Arterial spasm
Thrombosis
Embolization
Miscalibration
Injury to adjacent vessels
Ischemia
Blood loss
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Arterial BP Waveform

PEAK OF WAVEFORM

A

Systolic BP (contractility is the upstroke of the peak)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Arterial BP Waveform

TROUGH OF WAVFORM

A

Diastolic BP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Arterial BP Waveform

PULSE PRESSURE

A

Peak - Trough

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Arterial BP Waveform

CONTRACTILITY

A

Upstroke

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Arterial BP Waveform

STROKE VOLUME

A

Picture entire area under the “hill” shaded

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Arterial BP Waveform

DICROTIC NOTCH

A

Closure of AV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

CVP/RA Waveforms

A

Waves - a,c,v

Descents - X, X1, Y

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

A waveform

A
  • 1st wave
  • Produced by contraction of the RA
  • Just after P wave (atrial depolarization)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

C waveform

A
  • 2nd wave
  • Produced from closure of the triCuspid valve
  • Right ventricular contraction
  • Just after QRS (ventricular depolarization)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

V waveform

A
  • 3rd wave
  • Produced from passiVe filling of RA (encompasses portion of RV systole)
  • Just after T wave begins (ventricular repolarization)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

X descent

A

start of atrial diastole (btwn a and c waves)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

X1 descent

A

Produced by downward pulling of the septum during ventricular systole (btwn c and v waves)

  • RA relaxation
  • ST segment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Y descent

A

opening of the tricuspid valve (after v wave)

Just after T wave ends

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

RA/CVP

A

5 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Elevations of CVP due to:

A 
RV disease
PHTN
Pulmonic stenosis
L-R shunts
TV disease
Tamponade
Constrictive pericardial disease
Restrictive cardiomyopathies
Systolic HF
Hypervolemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

High RA and High PA =

A

PHTN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

High RA and Normal PA =

A

Pulmonic stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Insertion sites for CVP

A 
IJ
EJ
SC
Basilic/cephalic
Femoral
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

IJ

A

short, straight course and accessible at HOB

  • just under medial border of SCM (carotid deeper and more medial to IJ)
  • Now mandate to use US guidance
  • Right better than left bc it is straighter, the right lung apex is lower, and larger vessel
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

EJ

A

must go through valves
more difficult
neck maneuvering

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

SC

A

increased risk of pneumothorax
non-compressible site
Can cause aortic injury, cardiac tamponade, hemothorax, mediastinal hematoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Basilic/cephalic

A

easy to access
difficult to stay in RA
migrates with arm movement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Femoral

A

Higher infection rates
easiest
no US guidance needed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Reasons to have CVP

A 
Major surgery with blood loss or fluid shifts
Procedures with high risk of VAE
Chronic drug or TPN 
Poor peripheral IV access
Rapid infusion of fluids
Trauma
Inotropic support needed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Reasons NOT to have CVP

A

Superior vena cava syndrome
Coagulopathy
New pacemaker or AICD within 2 months
Surgical site access

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Complications from CVP

A 
Infection
Hemorrhage
Thrombosis
Embolization
Chylothorax, hemothorax, pneumothorax
Major nerve injury
Pericardial effusion/tamponade
Arrhythmias
PFO
Puncture of thoracic duct
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

PAC Contraindications

A 
Severe tricuspid or pulmonic disease
RA or RV mass
Tetralogy of Fallot
Severe arrhythmias
LBBB
New PM
Severe coagulopathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

PAC Complications

A 
Complete HB
Endobronchial hemorrhage
Pulmonary infarct
Catheter knotting
Valve damage
Thrombocytopenia
Thrombus formation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

CI

A

CO/BSA

2.6-4.2 L/min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

SV

A

CO * 1000/HR

50-110 mL per beat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Stroke Index

A

SV/CI

30-65 mL per beat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

SVR

A

(MAP-CVP)*80/CO

900-1400

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

SVRI

A

(MAP-CVP)*80/CI

1500-2400

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Pulmonary vascular resistance

A

(MPAP-Wedge)*80/CO

150-250

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Pulmonary vascular resistance index

A

(MPAP-Wedge)*80/CI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

SVR

A

estimate of LV afterload
increased SVR = LV wall stress (shock states)
determinant of O2 consumption

63
Q

PVR

A

estimate of RV afterload
limited d/t pulmonary vasculature
elevated in PHTN

64
Q

CO determination

A

thermodilution
continuous
dyes

65
Q

PAC Placement

Subclavian to RA

A

10 cm

66
Q

RIJ to Vena cava

A

15 cm

67
Q

LIJ to Vena cava

A

20 cm

68
Q

Femoral to Vena cava

A

40 cm

69
Q

Right median basilic to Vena cava

A

40 cm

70
Q

Left median basilic to Vena cava

A

50 cm

71
Q

Distance from RIJ to RA

A

25-35 cm

72
Q

Distance from RIJ to RV

A

35-45 cm

73
Q

Distance from RIJ to PA

A

45-55 cm

74
Q

Distance from RIJ to PA wedge

A

50-60 cm

75
Q

Goal of PAC placement

A

West Zone III

  • bulk of pulmonary blood flow
  • continuous column of blood btwn tip of PAC and LV
  • provides most accurate estimate of LVEDP
76
Q

Zone III

A

arterial pressure > venous pressure > alveolus pressure

77
Q

Where is Zone III

A 
Dependent region of lung
physiologically not anatomically defined
Base when sitting
towards back when supine
Towards chest when prone
towards dependent lung in lateral position
78
Q

What contributes to state of Zone III?

A

PEEP
diuresis
hemorrhage
change in position

79
Q

PAC in Zone I or II will produce?

A

marked variations in PAOP
a & v waves lost
PAOP > PADP

80
Q

RA mean/range

A 
Mean = 5
Range = 1-10 mm Hg
81
Q

RV mean/range

A 
Mean = 25/5
Range = 15-30/0-8 mmHg
82
Q

PA mean/range

A 
Mean = 23/9
Range = 15-30/5-15 mmHg
83
Q

PAOP mean/range

A 
Mean = 10
Range = 65-15 mmHg
84
Q

LA mean/range

A

Mean = 8

Range 4-12

85
Q

LVEDP mean/range

A 
Mean = 8
Range = 4-12
86
Q

No a waves or only v waves

A

A-fib

V- pacing in asystole

87
Q

Giant a-waves or “Cannon” waves

A 
Junctional rhythms
Complete HB
PVCs
V-pacing
Tricuspid or mitral stenosis
Diastolic dysfunction
MI
Ventricular hypertrophy
88
Q

Large V-waves

A

Tricuspid or mitral regurgitation

Acute increase in volume

89
Q

Cause of elevated CVP

A 
RV failure
TS or TR
Cardiac tamponade
Constrictive pericarditis
Volume overload
PHTN
Chronic LV failure
90
Q

Causes of elevated RV

A 
Systolic elevation 
-PHTN
-Pulmonary stenosis
-PE
Diastolic elevation
-Cardiomyopathy
-RV ischemia/infarct
-Tamponade
-RV failure
91
Q

Causes of elevated PAP

A 
LV failure
MS or MR
L-R shunt
ASD or VSD
Volume overload
PHTN
Catheter whip
PE 
COPD
92
Q

Causes of elevated PAOP

A 
LV failure
MS or MR
Tamponade
Pericarditis
Volume overload
Ischemia
AV disease
Hypertrophy cardiomyopathies
R-L shunts
93
Q

Causes of Low PAOP

A

low volume
PE
Pulmonary veno-occlusive disease

94
Q

Where is the correct area on the PAOP to determine preload (LVEDP)

A

Just before upstroke of v-wave

End expiration

95
Q

Data obtained from PAC allows for direct or indirect assessment of CF function?

A

indirect

96
Q

When PAC is not indirect measure:

PADP approximates PAOP

A

PADP does not equal PAOP with PHTN, MR or AR, lung zone I/II, tachycardia , ARDS, RBBB

97
Q

When PAC is not indirect measure:

PAOP approximates LAP

A

PAOP does not equal LAP with PEEP, lung zone I/II, mediastinal fibrosis, RBBB

98
Q

When PAC is not indirect measure:

LAP approximates LVEDP

A

LAP does not equal LVEDP with PEEP, MV disease, change in LV compliance, zone I/II, pulmonary disease

99
Q

When PAC is not indirect measure:

LVEDP approximates LVEDV

A

LVEDP does not equal LVEDV with PEEP, ventricular interdependence, and change in LV compliance (ischemia)

100
Q

When PAC is not indirect measure:

CVP approximates PADP

A

CVP does not equal PADP with change in RV compliance or Tricuspid disease

101
Q

CVP low
PADP low
PAOP Low

A

Hypovolemia, transducer not at phlebostatic axis

102
Q

CVP normal/high
PADP High
PAOP high

A

LV failure

103
Q

CVP high
PADP Normal/low
PAOP Normal/low

A

RV failure, TR, or TS

104
Q

CVP High
PADP High
PAOP Normal/low

A

PE

105
Q

CVP high
PADP high
PAOP Normal

A

PHTN

106
Q

CVP High
PADP high
PAOP high

A

Cardiac tamponade, transducer not at phlebostatic axis

107
Q

CV Normal
PADP normal or high
PAOP High

A

LV myocardial ischemia or MR

108
Q

CVP Low
PADP high
PAOP normal

A

ARDS

109
Q

How does pulse-ox work?

A

Based on Beer-Lambert law which relates the intensity of light transmitted through a solution and the concentration of the solute within the solution. For us, the solution is blood and the solute is hemoglobin.

Oxygen saturation determines color of blood. We compare the ratio of light absorption in arterial and venous blood.

Pulse ox emits 2 wavelengths of light

  • Red light is absorbed by deoxyhemoglobin (venous blood)
  • Near infrared light is absorbed by oxyhemoglobin (arterial blood)
110
Q

At PaO2 <100 mmHg =

A

SpO2 starts to decline

111
Q

At PAO2 < 60 mmHg =

A

sharper/faster decline in SpO2

112
Q

OHDC

A

Right is RIGHT for the patient (O2 offloading

Left LOVES to hold on (greater attachment of O2)

113
Q

SvO2

A

Normal 65-75% and decreases when decreases O2 delivery or increased consumption

114
Q

Coronary perfusion pressure

A

DAP-LVEDP
Most prominent with diastole
-Increase in LVEDP or decrease in DAP = subendocardial tissues at risk

115
Q

CPP

A

MAP-ICP

CVP can be substituted for ICP

116
Q

ECG monitoring

A

Became standard in 1980s

Einthoven created LA/LL/RA leads (bipolar, RL as ground)

117
Q

Ventricular depolarization proceeds from ?

A

endocardium to epicardium (reverse for repolarization)

118
Q

Inferior STEMI leads

A

II, III, aVF

119
Q

Inferior STEMI artery

A

RCA

120
Q

Posterior STEMI leads

A

V1-V4 ST DEPRESSION

121
Q

Posterior STEMI artery

A

Left circumflex

122
Q

Lateral STEMI leads

A

I, aVL (High)

V5, V6 (Low)

123
Q

Lateral STEMI artery

A

Left circumflex

124
Q

Anterior STEMI leads

A

V3-V4

125
Q

Anterior STEMI artery

A

LAD

126
Q

Anteroseptal leads

A

V1-V4

127
Q

Anteroseptal artery

A

LAD

128
Q

Which lead selection is not as specific as other 2 lead combinations?

A

II and V5

129
Q

EEG monitoring

A

post-synaptic action potentials of cortical neurons

130
Q

3 Laws of EEG

A
  1. EEG amplitude and frequency are inversely related
  2. Simultaneous decrease indicates hypothermia, ischemia, anoxia, or excessive hypnosis
  3. Simultaneous increase indicates seizure or artifact
131
Q

Beta waves

A

Awake

132
Q

Alpha waves

A

Moderate sedation

133
Q

Theta waves

A

General anesthesia

134
Q

Delta waves

A

Deep anesthesia

135
Q

BIS 40-60

A

anesthesia

reduced recall/awareness

136
Q

BIS <40

A

increased post op M/M

137
Q

BIS >60

A

increased risk of awareness

138
Q

What surgery has higher rates of intra-op awareness

A

cardiac

10x higher

139
Q

Transcranial doppler

A

US waves transmitted through temporal bone

-notice changes in flow = air and calcifications become more noticeable than erythrocytes

140
Q

Jugular Bulb Oximetry

A 
Measures cerebral venous O2 sats via a catheter
-Placed in IJa nd migrated upwards
-Kinking can occur
-55-70% normal
Global measurement
141
Q

Cerebral Oximetry

A
  • Noninvasive
  • Transducers emit infrared light
  • Normal is < 20% of baseline
  • Trends more important
  • Decline > 20% indicative of focal ischemia
  • INVOS at VA = normal is 71% +/- 6% for adults
  • Looks at ACA, MCA, and PCA (watershed zone)
142
Q

Coagulation Monitoring

A

Required in bypass
CPB produces a massive inflammatory response and clotting cascade
Lethal if no anticoagulants are used = unfractionated heparin is choice
Heparin reversed with protamine ( 1 mg Protamine for every 100 units of Heparin)
Protamine can cause anaphylaxis = hypotension, R HF, pulm edema

143
Q

ACT

A

normal 80-120

Desired value during DBP is 300-400

144
Q

Heparin resistance

A

inability to increase ACT with heparin doses

145
Q

Competitive antagonism

A

needs higher disease to overcome (tachyphylaxis)

146
Q

HIIT

A

5% get after 5-14 days of heparin therapy

147
Q

aPTT

A

intrinsic and final common pathways> sensitivity than ACT with lower levels of heparin
Normal is 28-32 seconds

148
Q

PT

A 
extrinsic and final common pathways
12-14 seconds is normal
Used to guide warfarin therapy
increases with vitamin K deficiency
used with INR
149
Q

TEG

A

highly variable
looks at integrity of platelets and the clotting cascade
evaluates clot strength and ability to maintain hemostasis through breakdown

150
Q

TEG

R time

A

time to start forming clot
Normal is 5-10 minutes
Indicates problem with coag factors
treatment = FFP

151
Q

TEG

K Time

A

Time until clot reaches a fixed strength
Normal is 1-3 minutes
indicates problem with fibrinogen
treatment = Cryoprecipitate

152
Q

TEG

Alpha angle

A

Speed of fibrin accumulation
normal is 53-72 degrees
Indicates problem with fibrinogen
treatment = cryoprecipitate

153
Q 
TEG 
Max Amplitude (MA)
A

Highest vertical amplitude of TEG
Normal is 50-70 mm
Indicates problem with platelets
Treatment = platelets and or DDAVP

154
Q

TEG

Lysis at 30 minutes

A

% of amplitude reduction 30 min after MA
Normal is 0-8%
Indicates problem with Excess fibrinolysis
Treatment = TXA or aminocaproic acid

6902 (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions