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ECC > Monitoring (Conner) > Flashcards

Monitoring (Conner) Flashcards

1
Q

Why monitor?

A
  • To identify problems and intervene early
  • prevent complications
  • avoid/catch mistakes
  • adjust therapy
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2
Q

No point in monitoring if….

A

result not associated with an action

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3
Q

Kirby’s rule of 20

A
  • 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
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4
Q

Hypoalbuminemia

Causes

COnsequences

A
  • Causes
    • liver failure
    • protein-losing enteropathy/nephropathy
    • malnutrition
    • systemic inflammation
  • Consequences
    • altered pharmacokinetics
    • delayed wound healing
    • reduced oncotic pressure

*hyperalbuminemia almost always dehydration

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5
Q

Albumin drug binding

A
  • Change in volume of distribution
  • Short term inc in free drug, but
  • higher volume distribution
  • more rapid clearance
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6
Q

Blood pressure and Perfusion

A
  • BP = CO x VR
    • CO = HR x SV => preload + afterload + contractility
      • preload is dependant on blood volume (I believe)
    • VR = something weird => vasodilation/constriction

*VR: vascular resistance

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7
Q

Cardiac output

A
  • 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
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8
Q

Vascular resistance

A
  • 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
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9
Q

Pulse quality

A
  • sense of blood perfusion and pressure
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10
Q

Coagulation

A
  • 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

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11
Q

Drugs and Metabolism

A
  • 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
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12
Q

Electrolytes and acid-base

A
  • Hypokalemia, hypocalcemia common
  • refeeding syndrome
    • hypoglycemia
    • hypokalemia
    • hypophosphatemia
    • hypomagnesemia
  • diabetic ketoacidosis
    • hypokalemia
    • hypophosphatemia
  • renal failure
    • hyperphosphatemia
    • hyper/hypokalemia
  • rapid Na changes
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13
Q

Fluid balance

A
  • 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
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14
Q

GI Motility & Integrity

A
  • Ileus is common
    • primary
    • secondary - opioids
  • Compromised GI barrier
    • bacterial translocation
    • altered drug uptake (PO meds)
    • vomiting
    • diarrhea
  • Enteral feeding whenever possible
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15
Q

Heart rate, Rhythm, contractility

A
  • Heart rate
  • Check often
  • feel pulses
  • Auscult while feeling pulse
  • tachycardia in a dog is bad => investigate
  • bradycardia in a cat is bad => investigate
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16
Q

Indirect Measures of hydration

A
  • Elevated hematocrit and total solids
  • Hyperalbuminemia
  • Hypersthenuric urine
  • azotemia
  • hypernatremia
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17
Q

True/False: Normal resting heart rate for a dog is dependent upon size of the dog

A

False

18
Q

Normal heart rates

A
  • Dogs: 60-100
  • Cats:
    • 180-220 (in hospital)
    • 140-160 (at home)

*cat in hospital < 180 in hospital probs not good!

19
Q

Arrhythmias

A
  • Monitor progression
  • Treat if Clinical Signs
    • weakness
    • collapse
    • hypotension
20
Q

Contractility

Decreased with

treated with

A
  • Decreased with
    • Sepsis
    • SIRS
      • primary heart dz
  • Treated with
    • positive inotropes
      • Dobutamine (sepsis, SIRS)
      • Pimobendan or digoxin (heart dz)
21
Q

Oxygenation

A
  • 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

22
Q

Oxygen content

A
  • 98% of blood oxygen carried by hemoglobin
  • 1.5% of oxygen from dissolved oxygen

*Anemic animals don’t need oxygen, they need blood!

23
Q

Immune status

A
  • Infectious dz common
  • not all infections are bacterial
  • not all sick patients need antibiotics
24
Q

Antimicrobial therapy

A
  • evaluate on a daily basis
  • empiric therapy should be based on
    • sources of infection
    • tissues infected
    • likely pathogen
  • whenever possible obtain cultures
25
Q

Leukogram analysis

A
  • monitor in patients with known/suspected infection
  • immature neutrophilia to mature
    • suggests patient is not overwhelmed
  • left shift neutrophilia to degenerative left shift
    • suggests patient may become overwhelmed

*inflammation DOES NOT EQUAL infection

26
Q

ELevated temperature

Hyperthermia

A
  • Hyperthermia
    • temp elevated from external heat source
      • imbalance heat production and heat loss
      • radiation
      • convection
      • evaporation
      • conduction
    • patient wants to be cooler
27
Q

ELevated temperature

Fever

A
  • Temp elevated from within
  • Stimulation of pyrogens
  • inc set point in hypothalamus
28
Q

TPLO patient coming out from blankets and temp is 97.9 and panting. What do you do?

A

Take off blankets

-opioids mess up set point

29
Q

Joint and nursing care

A
  • recumbent animals prone to complications
    • decubital ulcers (bed sores)
    • venous stasis => thrombosis
    • muscle atrophy and weakness (disuse atrophy)
    • urine and fecal soiling
      • promotes decubital ulcers
30
Q

Preventing recumbency complications

A
  • Lots of soft, padded bedding
  • turn patient
    • keep sternal as much as possible
    • turn hips when sternal
  • check bedding frequently for soiling
  • passive range of motion for joints
  • tissue massage
31
Q

Kidney function

A
  • Primary dz
  • complication of primary dz
  • complication of therapy
  • Frequent monitoring of creatinine
    • +/- urea concentrations
    • urine output necessary in some patients
32
Q

Love

A
  • encourage visits from owners
33
Q

Mentation

A
  • Investigate sudden changes
  • may not be primary neuro prob
    • oxygen
    • glucose
34
Q

Nutrition

A
  • Often overlooked
  • causes mal/undernourishment
    • altered immune function
    • poor wound healing
    • increased risk of infection
    • weaknessness and recumbency
35
Q

Pain

A
  • Look for it
  • Treat it

*pain is physiologically harmful

36
Q

Red blood cells and hemoglobin

A
  • Hematocrit or PCV
    • should be measured frequently (once daily) if on fluid therapy
      • check more frequently in patients with anemia
    • measure total solids every time PCV is checked
37
Q

PCV and things that affect it

A
  • Fluids => hemodilution => lowers PCV
  • Acute bleeding => lose whole blood => no change in PCV
  • Hemolysis => normal volume, loss of RBCs => lowers PCV
  • Dehydration => lowers volume => inc PCV
38
Q

Sugar (glucose)

A
  • Sever hypoglyclemia can be immediately life threatening
    • anorexic kittens and puppies (esp small breeds)
    • patients with sepsis
    • patient w/ escessive insulin
      • insulinoma
      • diabetes mellitus
      • iatrogenic diabetes
39
Q

Wound Care

A
  • Inspect all wounds/holes at least daily
    • inc cath sites
  • Eval bandages frequently and change if wet/soiled
40
Q

Writing treatment orders

A
  • Consider which parameters most imp for THIS patient
  • Consider pros and cons of each monitoring parameter
  • Choose actions for parameters outside of range

ECC (18 decks)

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