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Prodigy Quick Review > Monitoring Devices > Flashcards

Monitoring Devices Flashcards

1
Q

How will placing a blood pressure cuff too loosely

affect the estimate of the actual blood pressure?

A

Placing a blood pressure cuff that is too loose, too small, or
positioned below the level of the heart will result in a blood
pressure that overestimates the actual blood pressure.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 306

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2
Q

What is an auscultatory gap and in what patients is it

most common

A

While checking a blood pressure by means of auscultation, there
is occasionally a gap where sounds cannot be heard. This is an
auscultatory gap. It is more common in hypertensive patients and
may lead to inaccuracies in the diastolic measurement.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 90.

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3
Q

What risks are associated with the placement of an

intra-arterial catheter?

A

Infection, vasospasm, hematoma, ischemia of the extremity or
digit distal to the catheter, thrombus formation, and nerve
damage. Potential iatrogenic risks include air embolism,
inadvertant intra-arterial injection of a drug, and hemorrhage due
to a break or disconnection in the system tubing.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 307.

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4
Q

How will an arterial pressure transducer that is placed
below the level of the heart affect the estimate of the
actual blood pressure?

A

Placement of the transducer below the level of the heart will
overestimate the actual blood pressure and vice-versa.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 307.

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5
Q

How would the arterial waveform in the foot compare to

the arterial waveform in the aorta?

A

As you move peripherally away from the aorta, the arterial
waveform becomes distorted by wave reflections resulting in
increased systolic pressures and a larger pulse pressure. For
example, the systolic pressure in the radial artery will be evaluated
as higher than that in the aorta because it is more distal.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 87-88.

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6
Q

After hypothermic cardiopulmonary bypass, would you
expect an arterial waveform monitor to overestimate or
underestimate the aortic blood pressure? Why?

A

The hypothermic conditions reduce the vascular resistance in the
hand compared to the aorta and the radial arterial line will
underestimate the aortic pressure. This effect is even more
dramatic with the use of vasodilating drugs.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 88.

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7
Q

During craniotomy for tumor removal, with what should

the arterial pressure transducer be level?

A

The arterial transducer should be level with the patient’s ear to
more accurately facilitate calculation of the cerebral perfusion
pressure.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 97

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8
Q

What conditions are associated with an increased

central venous pressure

A

Right ventricular failure, tamponade, tricuspid stenosis, tricuspid
regurgitation, pericarditis, pulmonary hypertension, chronic left
ventricular failure, and hypervolemia.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 302.

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9
Q

What conditions are associated with large v waves on

the CVP waveform?

A

Tricuspid regurgitation, mitral regurgitation, or a sudden, dramatic
increase in intravascular volume.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 302.

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10
Q

What conditions are associated with the loss of the a

wave on a CVP waveform?

A

Atrial fibrillation, ventricular pacing, and asystole.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 301.

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11
Q

What conditions are associated with extremely large a
waves (also called cannon a waves) on a CVP
waveform?

A

Dysrhythmias such as junctional rhythms, complete AV block, or
PVCs, triscupid or mitral stenosis, myocardial ischemia, diastolic
dysfunction, ventricular pacing, and ventricular hypertrophy.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 302.

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12
Q

What are the three descents that follow the a, c, and v
waves on a central venous pressure waveform and
what do they represent?

A

The x wave follows the a wave and represents the start of atrial
diastole. The x1 descent occurs as a result of the downward pull
of the ventricular septum during systole. The y descent
represents the opening of the tricuspid valve.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 300-301.

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13
Q

Where should a precordial doppler be placed to best
detect signs of a venous air embolism? What can
mimic the signs of a venous air embolism?

A

The doppler should be positioned over the right sternal border
between the 3rd and 6th intercostal spaces. The injection of
mannitol through a central venous line may mimic the signal of a
venous air embolism.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 713

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14
Q

What is the most sensitive device for detecting a
venous air embolism? What is the most sensitive noninvasive
device for this purpose?

A

The transesophageal echocardiogram is the most sensitive device
for detecting venous air embolism. The doppler is, however, the
most sensitive non-invasive device for this purpose.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 713.

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15
Q

What West lung zone is considered ideal for

placement of a pulmonary artery catheter and why?

A

Ideally, it should be placed in an area within West lung zone III
because the pulmonary artery pressure is greater than the
pulmonary venous pressure which is in turn greater than the
alveolar pressure in this position.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 302-303.

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16
Q

What measurements can a pulmonary artery catheter

make directly? Indirectly?

A

The pulmonary artery catheter allows for direct measurement of
pulmonary artery pressures and indirect measurement of the left
ventricular filling pressure and right-sided cardiac output.
Measurements such as pulmonary vascular resistance and
systemic vascular resistance are calculations made on data
observed directly and indirectly.
Longnecker DE, Newman MF, Brown DL, Zapol WM.
Anesthesiology. 2nd ed. New York: McGraw-Hill; 2012: 413

17
Q

What are the general indications for using EEG

monitoring during anesthesia?

A

Monitoring cerebral perfusion during controlled hypotension,
carotid endarterectomy, and for monitoring anesthetic depth.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 588.

18
Q

What conditions would make monitoring core body
temperature via a pulmonary artery catheter
inaccurate?

A

Thoracotomy and cardiopulmonary bypass can render pulmonary
artery temperatures unreliable.
Dorsch JA, Dorsch SE. A Practical Approach to Anesthesia
Equipment. Philadelphia, PA: Lippincott Williams and Wilkins,
2011: 552.

19
Q

How would EEG data appear during periods of light

anesthesia?

A

Surgical stimulation or light anesthesia would display high
frequency, low voltage activity on the EEG monitor.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 588.

20
Q

What are the only intravenous anesthetic agents

capable of producing burst-suppression on an EEG?

A

Barbiturates, etomidate, and propofol
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 588.

21
Q

What is the only volatile anesthetic that can produce

an isoelectric EEG at clinical levels?

A

Isoflurane, which is capable of producing an isoelectric EEG at 1-
2 MAC.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 588.

22
Q

How does hypercapnia affect the EEG during

anesthesia?

A

Mild hypercapnia will produce an increase in EEG activity. Severe
hypercapnia, however, will decrease the activity on the EEG.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 588.

23
Q

How do the EEG changes seen with early hypoxia

differ from that seen in late hypoxia?

A

Early hypoxia will produce an increase in EEG activity while late
hypoxia and cerebrovascular ischemia will show a decline in EEG
activity.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 588.

24
Q

What anesthetic medications can produce an increase

in EEG activity?

A

Subanesthetic doses of inhalation agents, and small doses of
barbiturates, etomidate, and benzodiazepines produce an increase
in EEG activity. Nitrous oxide and ketamine also produce an
increase in EEG activity.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 588.

25
Q

How would an EEG appear during periods of

cerebrovascular compromise?

A

Cerebral compromise and deep anesthesia would typically display
low frequency, high voltage EEG activity.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 588.

26
Q

What are the three different methods of defining

hypoxemia?

A

A 5% drop in O2 saturation, an O2 saturation < 90%, and a PaO2
< 60 mmHg are all definitions of hypoxemia.
Gaba DM, Fish KJ, Howard SK. Crisis Management in
Anesthesiology. Philadelphia, PA: Churchill Livingstone; 1994:
79.

27
Q

Can infrared gas analyzers measure oxygen content

directly?

A

A disadvantage of infrared monitors is that they cannot directly
measure oxygen content because O2 doesn’t absorb infrared light.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 127.

28
Q

How does a chemical carbon dioxide detector work?

A

A chemical carbon dioxide detector contains a pH-sensitive
indicator that changes color when exposed to carbonic acid.
Carbonic acid is formed as the byproduct of the exposure of water
to carbon dioxide.
Dorsch JA, Dorsch SE. A Practical Approach to Anesthesia
Equipment. Philadelphia, PA: Lippincott Williams and Wilkins,
2011: 426-427

29
Q

Which pulse oximetry site would respond the slowest

to changes in oxygen saturation?

A

Although it the most commonly used, the fingers respond slower
to changes in oxygen saturation than more centrally placed
locations such as the ear, nose, or forehead. The more central
locations are also more resistant to vasoconstriction from cold or
reduced perfusion.
Dorsch JA, Dorsch SE. A Practical Approach to Anesthesia
Equipment. Philadelphia, PA: Lippincott Williams and Wilkins,
2011: 486.

30
Q

How can hypovolemia affect pulse oximetry monitoring?

A

Hypovolemia has been cited as a cause of the pulse oximeter
waveform to skip beats, perform erratically, and cause variation in
the pulse waveform during positive-pressure ventilation. If
pausing ventilation causes the waveform to return to normal, then
fluid bolus trial should be attempted to see if hypovolemia is the
underlying cause.
Dorsch JA, Dorsch SE. A Practical Approach to Anesthesia
Equipment. Philadelphia, PA: Lippincott Williams and Wilkins,
2011: 492.

31
Q

What are the advantages of an infrared gas monitor?

Disadvantages?

A

Infrared gas monitors are small and portable, they have a quick
response time, a short warm-up time, and do not need to be
connected to a scavenger because the analyzed gases can be
returned to the circuit. Argon and nitric oxide don’t interfere with
readings, but other substances such as ethanol, ether,
paraldehyde, and acetone can be incorrectly detected as volatile
agents. Although the response time is fast, it may not be fast
enough to accurately analyze volatile agent levels if the respiratory
rate is very high. Handheld two-way radios may interfere with the
analyzer causing CO2 readings to be falsely elevated.
Dorsch JA, Dorsch SE. A Practical Approach to Anesthesia
Equipment. Philadelphia, PA: Lippincott Williams and Wilkins,
2011: 422-423.

32
Q

What potential problems can be detected by
capnography? By the gas analyzer? How is hypoxia
detected?

A

Capnography is capable of detecting or aiding in the detection of
errors in gas delivery, circuit disconnection, circuit leaks,
endotracheal cuff leaks, poor mask or LMA fit, hypoventilation,
malignant hyperthermia, airway obstruction, and air embolism.
Vaporizer overdose or malfunction is detected by the agent
analyzer. Circuit hypoxia is detected by the oxygen analyzer.
Sandberg WS, Urman RD, Ehrenfield JM. The MGH Textbook of
Anesthetic Equipment. Philadelphia, PA: Elsevier Saunders;
2011: 137

33
Q

What is a nondiverting gas monitor? How does this

differ from a diverting gas monitor?

A

A nondiverting gas monitor measures the concentration of a gas
using sensors located directly within the gas stream. A
nondiverting gas monitor can only analyze oxygen and carbon
dioxide. A diverting gas monitor uses a pump to aspirate a gas
sample from the circuit to the sensor contained within the monitor.
Dorsch JA, Dorsch SE. A Practical Approach to Anesthesia
Equipment. Philadelphia, PA: Lippincott Williams and Wilkins,
2011: 416-417.

34
Q

What is Raman spectroscopy?

A

Raman spectroscopy determines the anesthesia gas
concentration by analyzing the intensity of light emitted after the
gas sample returns to the unexcited state after being energized by
a laser.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 127.

35
Q

Where in the anesthesia circuit would you find a

Wright respirometer?

A

A Wright respirometer is located in the expiratory limb and
contains vanes that cause it to rotate when exhaled gas passes
across it. The rotations are measured electronically,
mechanically, or through photoelectrics to indicate the exhaled
tidal volume.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 67.

36
Q

What factors can result in inaccurate tidal volume

readings when using a Wright respirometer?

A

High flow rates will cause the respirometer to register falsely
elevated tidal volumes and low flow rates will register falsely
decreased tidal volumes. Nitrous oxide will also cause the tidal
volume to register falsely high.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 67.

37
Q

What is the low peak pressure alarm on an anesthesia

machine?

A

The low peak pressure alarm is activated when the ventilator is
turned on. It is designed to help detect disconnects in the
anesthesia circuit. In order to prevent the alarm from triggering
the airway pressure must exceed a preset minimum within a set
amount of time (usually about 15 seconds).
Dorsch JA, Dorsch SE. Understanding Anesthesia Equipment.
5th ed. Philadelphia, PA: Lippincott Williams and Wilkins, 2008:
743.

38
Q

What is train-of-four stimulation and how is it used?

A

A train-of-four stimulus consists of four single pulses of equal
intensity at intervals of 0.5 seconds. When a partial depolarizing
block is present, all four contractions will be diminished; while in a
partial nondepolarizing block, there will be a fade in intensity of the
contraction over the course of the stimulations, with the potential
absence of some or all of the contractions depending on the
intensity of the block.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 161.

39
Q

What is double-burst stimulation and what are the

advantages to its use?

A

Double-burst stimulation (DBS) is characterized by two short
sequences of 50 H electrical impulses separated by 750
milliseconds. The primary use for DBS is the detection of residual
blockade by a nondepolarizing neuromuscular relaxant. Fade on
the second burst of DBS is easier to detect than fade on a train of
four.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 161.

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