Monitoring (Conner) Flashcards
1
Q
Why monitor?
A
- To identify problems and intervene early
- prevent complications
- avoid/catch mistakes
- adjust therapy
2
Q
No point in monitoring if….
A
result not associated with an action
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
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
5
Q
Albumin drug binding
A
- Change in volume of distribution
- Short term inc in free drug, but
- higher volume distribution
- more rapid clearance
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
- CO = HR x SV => preload + afterload + contractility
*VR: vascular resistance
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
- after dertain inc in HR, no more inc CO
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
9
Q
Pulse quality
A
- sense of blood perfusion and pressure
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
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
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
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
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
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
16
Q
Indirect Measures of hydration
A
- Elevated hematocrit and total solids
- Hyperalbuminemia
- Hypersthenuric urine
- azotemia
- hypernatremia
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)
- positive inotropes
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
Leukogram analysis
* 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
ELevated temperature
Hyperthermia
* Hyperthermia
* temp elevated from external heat source
* imbalance heat production and heat loss
* radiation
* convection
* evaporation
* conduction
* patient wants to be cooler
27
ELevated temperature
Fever
* Temp elevated from within
* Stimulation of pyrogens
* inc set point in hypothalamus
28
TPLO patient coming out from blankets and temp is 97.9 and panting. What do you do?
Take off blankets
-opioids mess up set point
29
Joint and nursing care
* 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
Preventing recumbency complications
* 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
Kidney function
* Primary dz
* complication of primary dz
* complication of therapy
* Frequent monitoring of creatinine
* +/- urea concentrations
* urine output necessary in some patients
32
Love
* encourage visits from owners
33
Mentation
* Investigate sudden changes
* may not be primary neuro prob
* oxygen
* glucose
34
Nutrition
* Often overlooked
* causes mal/undernourishment
* altered immune function
* poor wound healing
* increased risk of infection
* weaknessness and recumbency
35
Pain
* Look for it
* Treat it
\*pain is physiologically harmful
36
Red blood cells and hemoglobin
* 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
PCV and things that affect it
* 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
Sugar (glucose)
* 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
Wound Care
* Inspect all wounds/holes at least daily
* inc cath sites
* Eval bandages frequently and change if wet/soiled
40
Writing treatment orders
* Consider which parameters most imp for THIS patient
* Consider pros and cons of each monitoring parameter
* Choose actions for parameters outside of range
