Monitoring (Conner) Flashcards
Why monitor?
- To identify problems and intervene early
- prevent complications
- avoid/catch mistakes
- adjust therapy
No point in monitoring if….
result not associated with an action
Kirby’s rule of 20
- Albumin concentration
- Blood pressure and perfusion
- Coagulation
- Drug dosages and metabolism
- Electrolyte and acid-base
- Fluid balance
- GI motility and integrity
- Heart rate, rhythm, and contractility
- Immune status, abx, leukogram
- Joint motility and nursing care
- Kidney function
- Love
- Mentation
- Nutrition
- Oxygenation and ventilation
- Pain control
- Protein/osmotic pull
- Red blood cell and hemoglobin concentration
- Sugar (glucose) concentration
- Wound care and bandage changes
Hypoalbuminemia
Causes
COnsequences
- Causes
- liver failure
- protein-losing enteropathy/nephropathy
- malnutrition
- systemic inflammation
- Consequences
- altered pharmacokinetics
- delayed wound healing
- reduced oncotic pressure
*hyperalbuminemia almost always dehydration
Albumin drug binding
- Change in volume of distribution
- Short term inc in free drug, but
- higher volume distribution
- more rapid clearance
Blood pressure and Perfusion
- BP = CO x VR
- CO = HR x SV => preload + afterload + contractility
- preload is dependant on blood volume (I believe)
- VR = something weird => vasodilation/constriction
- CO = HR x SV => preload + afterload + contractility
*VR: vascular resistance
Cardiac output
- Half of the blood pressure equation
- Determined by heart rate and stroke volume
- after dertain inc in HR, no more inc CO
- from dec SV
- after dertain inc in HR, no more inc CO
Vascular resistance
- Other half of BP equation
- Resistance to flow is directly proportional to viscosit of fluid and length of tube
- Resistance is inversely proportional to radius of tube to fourth power
Pulse quality
- sense of blood perfusion and pressure
Coagulation
- Always monitor patient
- patechiae, ecchymoses
- gums, pinnae, ventral abdomen
- Often monitor
- plately count
- clotting times
- antithrombin
- fibrin degradation products (D-dimers)
- Thromboelastography
*Beware of thrombosis
Drugs and Metabolism
- Double check dosage every day
- Have someone else double check
- Evaluate need for change
- renal excretion
- hepatic metabolism/excretion
- degree protein-bound
- Assess if drugs still needed
- double check IV drug compatibility
Electrolytes and acid-base
- Hypokalemia, hypocalcemia common
- refeeding syndrome
- hypoglycemia
- hypokalemia
- hypophosphatemia
- hypomagnesemia
- diabetic ketoacidosis
- hypokalemia
- hypophosphatemia
- renal failure
- hyperphosphatemia
- hyper/hypokalemia
- rapid Na changes
Fluid balance
- One of the most difficult parameters to monitor accurately
- Encompasses both hydration and vascular volume
- these are not the same thing
- Most accurately monitored via serial, consistent body weight measurements
- often we don’t know patient’s ideal body weight
GI Motility & Integrity
- Ileus is common
- primary
- secondary - opioids
- Compromised GI barrier
- bacterial translocation
- altered drug uptake (PO meds)
- vomiting
- diarrhea
- Enteral feeding whenever possible
Heart rate, Rhythm, contractility
- Heart rate
- Check often
- feel pulses
- Auscult while feeling pulse
- tachycardia in a dog is bad => investigate
- bradycardia in a cat is bad => investigate
Indirect Measures of hydration
- Elevated hematocrit and total solids
- Hyperalbuminemia
- Hypersthenuric urine
- azotemia
- hypernatremia
True/False: Normal resting heart rate for a dog is dependent upon size of the dog
False
Normal heart rates
- Dogs: 60-100
- Cats:
- 180-220 (in hospital)
- 140-160 (at home)
*cat in hospital < 180 in hospital probs not good!
Arrhythmias
- Monitor progression
- Treat if Clinical Signs
- weakness
- collapse
- hypotension
Contractility
Decreased with
treated with
- Decreased with
- Sepsis
- SIRS
- primary heart dz
- Treated with
- positive inotropes
- Dobutamine (sepsis, SIRS)
- Pimobendan or digoxin (heart dz)
- positive inotropes
Oxygenation
- Hypoxemia
- dec partial pressure of oxygen/ saturation of oxygen in the blood
- Hypoxia
- dec oxygen tension in tissues
*Hypoxemia leads to hypoxia but hypoxia can be present without hypoxemia
Oxygen content
- 98% of blood oxygen carried by hemoglobin
- 1.5% of oxygen from dissolved oxygen
*Anemic animals don’t need oxygen, they need blood!
Immune status
- Infectious dz common
- not all infections are bacterial
- not all sick patients need antibiotics
Antimicrobial therapy
- evaluate on a daily basis
- empiric therapy should be based on
- sources of infection
- tissues infected
- likely pathogen
- whenever possible obtain cultures