Brainscape's Knowledge GenomeTM

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


See full index

APA 1 > Monitoring - Quiz 2 > Flashcards

Monitoring - Quiz 2 Flashcards

1
Q

In the AANA standard of care, what does it say in regards to the alarm sounds in the OR?

A

When any physiological monitoring device is used, variable pitch and threshold alarms shall be turned on and audible.

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

Is a pulse ox a standard of care?

A

YES

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

Is EtCO2 mandatory?

A

Yes in the hospital, not mandatory in office based settings

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

Is an EKG a standard of care?

A

YES

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

Is temperature measurement a standard of care?

A

NO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Is checking twitches a standard of care?

A

Yes if using neuromuscular blocking agents

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

Name some things you can see with inspection

A 
Adequacy of oxygenation 
CO2 high – pt turns red/cherry red lips
Fluid requirements
Positioning/alignments of body structures
IV infiltrations 
Arms/legs off table
Surgeon leaning of pt
Blood in suction canaster
Edema
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are some things you can monitor with auscultation

A 
Placement of airway devices
Heart sounds
Blood pressure
You can hear the monitor for changes in heart rate and pulse Ox
Surgeon “oh shit”
Listen to suction
Know where you are in the procedure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are some things you can monitor with palpation?

A

Quality of pulse
Degree of skeletal relaxation
Locate vascular structures and anatomic structures with line placement

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

Pulse ox is a reliable monitor that provides early

A

warning of arterial hypoxia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Despite adequate oxygenation on the pulse ox, what could still be happening?

A

Hypoventilation, hypercapnia and impending respiratory arrest can occur despite adequate oxygenation

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

What is something you can do to help flow to improve pulse ox reading?

A

Nerve block - blocks sympathetic constriction and allows for vasodilation and better blood flow

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

What are the 2 wavelengths that flow though a pulse ox?

A

Red light - 660nm - deoxygenated blood absorbs more

Infrared light - 940nm - oxygenated blood absorbs more

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

What law is the pulse ox based off of?

A

Beer Lambert law

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

What are some reasons for inaccurate pulse Ox readings

A

Hypo perfusion (vasoconstriction, hypothermia, hypotension)
Artifact motion artifact
Methalyne blue and indigo carmen
Anemia
Cautery interference
Abnormal HGB (sickle cell, methemoglobin, carboxyhemoglobin)

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

methemoglobin has a 1:1 absorption ratio read at 85%, it falsely underestimates SpO2 if sats is

A

greater than 85%

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

methemoglobin has a 1:1 absorption ratio read at 85%, it falsely overestimates SpO2 if sats is

A

less than 85%

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

How do you treat methemoglobin?

A

Give methalyne blue - causes HGB to alter back to normal

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

What will the pulse Ox look like on a pt with carbon monoxide poisoning (carboxyhemoglobin)

A

will look the same as if pulse ox was reading O2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What can a co-oximetry do?

A

can differentiate between carboxyhemaglobin, methomoglobin, and oxyhemaglobin

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

Which dyes can effect the reading of an SpO2 when in circulation?

A

methalyne blue, indigeno carmen, inocyanine green.

when in circulation, it blocks light and drops pulse ox for a while but will return to normal (bladder surgery/cystoscopy)

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

A PaO2 of 40,50, 60 equals

A

Sats of 70, 80, 90

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

What color nail polish can effect O2 sats

A

blue, black, green

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

After placement of artificial airway device, how do you confirm placement?

A

auscultation, chest excursion, and confirmation of expired carbon dioxide.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Where is the best place to look for retractions?

A

right above sternum

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

Condensation in mask does not show adequacy of ventilation, it only show

A

that air is moving

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Does chest movement confirm ventilation?

A

NO, chest movement does not confirm ventilation. An obstructed pt will still have chest movement.

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

Failure to intubate is problematic, but failure to recognize misplacement is

A

catastrophic

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

What does a pericardial stethoscope provide?

A

continuous auditory confirmation of ventilation, quality of breath sounds, regularity of heart rate, and quality of heart tones

most often used in peds cases

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

When using a pericardial stethoscope, what does hearing muffled heart tones mean?

A

associated with decreased cardiac output

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

What is a contraindication to esophageal stethoscopes?

A

Instrumentation of the esophagus should be avoided if there is a history of esophageal varices or strictures, bariatric surgery

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

In a pericardial stethoscope, where is the bell placed on the patient?

A

Heavy bell-shaped piece of metal placed over the chest or suprasternal notch

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

What is a complication of esophageal stethoscopes?

A

If the stethoscope slides into the trachea vs. the esophagus a gas leak will occur around the endotracheal tube.

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

EtCo2 provides

A

information on adequacy of ventilation and confirms placement of endotracheal tube in the respiratory tract.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Is EtCo2 accurate in sedation patients, such as GI lab?

A

NO, it is accurate in intubated patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

The absence of an EtCo2 waveform could mean

A

esophageal intubation
circuit disconnect
cardiac arrest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is the measured difference between an EtCO2 measurement and an arterial CO2

A

EtCO2 lower by 2-5 torr is normal

> 10 something else going on (shunt??)

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

Advantages of a mainstream (inline) CO2 detector?

A

Faster response time
No water trap or pump mechanism

Disadvantage: increase apparatus dead space

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Disadvantages of a side stream (diverting) CO2 detector?

A

Response time slower
requires a water trap
Does NOT increase apparatus dead space

(Always has some suction to pull CO2 to analyzer)

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

In a CO2 waveform, what is A-B

A

Exhalation of atomic dead space (no CO2)

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

In a CO2 waveform, what is B-C

A

Exhalation of atomic dead space and alveolar gas (measurable CO2)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

In a CO2 waveform, what is C-D

A

Exhalation of alveolar gas (best correlates to V/Q status)

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

In a CO2 waveform, what is D-E

A

Inspiration of fresh gas that does not contain CO2 - return to baseline

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

Where is EtCO2 measured and what is normal range?

A

measured at point D

Normal is 35-40 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

If the alpha angle is increase, what does that mean?

A

airflow obstruction (COPD, bronchospasm, kinket ETT, asthma)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

If the beta angle is increased, what does that mean?

A

rebreathing (faulty unidirectional valve or exhausted CO2 absorbant)

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

Asthma, bronchospasm, COPD, foreign body in upper airway, kinked ETT will have what distinct shape on CO2 waveform?

A

sharkfin, as pt tries to breath out - creates slow upstroke

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

Hypoventilation, decreased RR, decreased TV, insufflation can cause what on the CO2 waveform?

A

increasing EtCO2

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

If you have malignant hyperthermia, what will you see in the EtCO2

A

Waveform gets taller and taller (very distant) CO2 will rise very quickly and in a short amount of time.

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

Decreasing EtCO2

A

Hyperventilation, increased RR, increased TV, metabolic acidosis, fall in body temp

51
Q

What will rebreathing CO2 look like?

A

Staircase step up, not returning back to baseline

52
Q

What can be some causes of rebreathing CO2

A 
Faulty expiratory valve
Inadequate inspiratory flow
Partial rebreathing
inadequate expiratory time
exhausted CO2 absorbant
53
Q

How does a curare cleft happen

A

happens when pt is mechanically ventilated and paralytic starte to wear off, diaphrams jumps

54
Q

What is mass spectrometry

A

tubing from up to 32 rooms where brought to 1 unit, particles separated by mass, got a reading at a later time

55
Q

What is monochromatic infrared spectroscopy?

A

Infrared wavelength passed through at 3.3um, monitor MUST be programed with agent selected

56
Q

What is polychromatic infrared spectroscopy?

A

Infrared light beam is passed through at 7-13um. The monitor can automatically identify the inhaled anesthetic agent.

Should the SRNA change from one inhalation agent to another, the monitor can measure the concentrations of both drugs simultaneously.

What we see today**

57
Q

What is Raman Scatter Spectrometry?

A

Uses high power argon laser to produce photons

58
Q

Respirometer/Ventimeter where used on old ventilator machines on the exhalation limb. What did they measure

A

tidal volume and minute ventilation

59
Q

When the PIP low pressure sounds alarms, what could that mean?

A

inspiratory pressure did not achieve predetermined level

Disconnect in circuit

Leak in breathing system

60
Q

When the PIP high pressure sounds alarms, what could that mean?

A

positive airway pressure exceeded a predetermined value. Usually set at 40cm H2O pressure.

may indicate low pulmonary compliance.

check for obstruction

61
Q

How often do you record BP and HR

A

at least every 5 minutes

62
Q

ECG reflects electrical activity

A

in the heart

63
Q

Is ECG a measure of heart function?

A

NO, You may have normal ECG complexes on the monitor with no effective cardiac output.

64
Q

For ST segment monitoring, standardized 1 mV signal change indicates a deflection of ______ on a paper monitor strip.

A

10 mm

65
Q

ECGs provide continuous analyzes of ST segments for early detection of

A

myocardial ischemia

66
Q

On ECG, the audible beep for each QRS complex should be set loud enough to detect _____ and ______ changes when visual attention is directed to other clinical tasks.

A

rate and rhythm changes

67
Q

Normal
PR interval
QRS duration
QT interval

A

PR interval - .12-.20
QRS interval - .06- .12
QT interval - < or equal to .40

68
Q

When performing a TE, where does the probe lay and what part of the heart is it looking at?

A

the transducer lies in the lower esophagus in close direct fluid contact with the posterior of the heart (the images are superb since there is no interference by lung tissue)

69
Q

From a clinical viewpoint CVP parallels right atrial pressure, which is a major determinant of

A

RV end diastolic volume

In healthy hearts, right and left ventricular performance is parallel, so left ventricular filling can also be assessed by CVP measurement.

70
Q

A BP cuff that is too small

A

overestimates SBP

71
Q

Cuff pressure to occlude the artery is _______ when cuff is too small

A

higher

72
Q

A BP cuff that is too large

A

underestimates SBP

73
Q

Cuff pressure to occlude the artery is _______ when cuff is too large

A

lower

74
Q

At aortic root,
SBP is
DBP is
PP is

A

SBP is lowest
DBP is highest
PP is narrowest

75
Q

At dorsalis pedis
SBP is
DBP is
PP is

A

SBP is highest
DBP is lowest
PP is widest

76
Q

Underdamped A line

A

overestimates SBP
underestimate DBP
map accurate

77
Q

Overdamped A line

A

underestimates SBP
Overestimates DBP
map accurate

causes: bubble or clot in tubing, pressure bag low

78
Q

In CVP, what does A wave represent

A

Right atrial contraction

79
Q

In CVP, what does C wave represent

A

Right ventricle contraction (tricuspid valve bulging into right atrium)

80
Q

In CVP, what does V wave represent

A

Passive filling of RA

81
Q

In CVP, what does X descent represent

A

Right atrial relaxation

82
Q

In CVP, what does Y descent represent

A

Right atrium empties through open TV

83
Q

Where should CVP be interpreted?

A

End expiration

84
Q

If transducer is above zero point, it will_________ CVP. If transducer below zero point, it will ________ CVP

A

underestimate

Overestimate

85
Q

Name some examples that decrease SVO2

A

Stress, pain, thyroid storm, shivering, fever, seizure, decreased PaO2/HGB/CO

86
Q

Name some examples that increase SVO2

A

hypothermia, cyanide toxicity (from Na nitroprusside), Sepsis, increased PaO2/HBG/CO, wedged PAC, L to R heart shunt

87
Q

When does temp need to be continuously monitored?

A

on all pediatric cases receiving general anesthesia

88
Q

During general anesthesia the body cannot compensate for hypothermia because anesthetics inhibit

A

central thermoregulation by interfering with hypothalamic function.

89
Q

What is the best thing to do in order to prevent heat loss?

A

STAY ahead, keep them warm from the start

90
Q

To check a TOF you place it where there is a ______ and ______ near the nerve

A

nerve and muscle

91
Q

When checking a TOF on the ulnar nerve, what is stimulated?

A

adductor pollicis muscle

92
Q

When checking a TOF on the facial nerve, what is stimulated?

A

obiqularis oculi muscle

93
Q

On a nerve stimulator, the red is ______ and the black is _____. The ______ should be placed closer to the heart.

A

red is positive
Black is negative

red should be closer to heart

94
Q

The nerve stimulater sends an impulse down the ___________, and __________ is released to produce a stimulus

A

neuromuscular junction

acetylcholine

95
Q

Succs is a __________ neuromuscular blocking agent. How does it work?

A

Depolarizing.

goes to receptor and “sticks” it open so it can’t depolarize again. Will see fascinations.

96
Q

Vec/rec are __________ neuromuscular blocking agent. How does it work?

A

Non-depolarizing neuromuscular blocking agents.

Hit receptors and block them– you get paralysis

97
Q

A single twitch provides

A

1 twitch at 0.2 msec duration

.1-1 hert

98
Q

TOF provides

A

4 twitches 0.2 msec duration at 500 msec apart

2 hertz

99
Q

Describe Tetany

A

As long as button is held down, it will deliver continuous stimulation (do it for a period of 5 seconds)

50-100htz

100
Q

When doing tetany and they can hold the contraction for more than 5 seconds, what does that mean?

A

there is not enough paralytic

if fades out - paralytic still around

101
Q

Double Burst stimulation is

A

2 Burts further apart

.2 msec in duration and 750 ms apart
50htz
possibly more accurate

102
Q

What is post tetanic facilitation?

A

Checking a TOF after tetany

103
Q

When paralyzing a patient, the more receptors blocker, the

A

more paralyzed the pt

104
Q

When you get to 70-75% if receptors being blocked,

A

twitches will still be the same (strong)

105
Q

When you hit 75% and beyond of receptors being blocked, the twitches

A

get weaker

106
Q

Fading means difference between twitch 1 and twitch 4. This ONLY happens with what paralytics?

A

Non-depolarizing (Roc/Vec)

107
Q

When 90% of receptors blocked, how many twitches will you get

A

1

108
Q

I can get 4 twitches on my TOF (or have 75% of receptors blocked) and the patient may

A

STILL BE PARALYZED

can have respiratory problems in pacu. Give reversal

109
Q

If I check a TOF on a pt the I gave Succs (depolarizing) to, how will the twitches look?

A

They will be the same 1-4 (NO FADING)

110
Q

Oliguria is defined as

A

UOP < 0.5 ml/hr

111
Q

EEGs can provide early evidence of

A

cerebral ischemia

112
Q

When monitoring the depth of anesthesia, EEG activity will

A

decrease in amplitude and frequency while under general anesthesia

113
Q

What is an evoked potential

A

is an electrical manifestation of the brain’s response to an external stimulus

electrophysiologists read these

114
Q

When evoked potentials are used during a surgical procedure, it increases

A

potential of neurologic injury

115
Q

How to measure Somatosensory evoked potentials (SSEP)

A

looking at sensory side of spinal cord – Afferent, start signal at feet and monitor it at the head

(afferent is toward brain)

116
Q

How to measure Motor evoked potential (MEP)

A

monitor Efferent, stimulate from head, monitor at periphery

E for exit

117
Q

What will general anesthesia do to evoked potential?

A

depress signals

118
Q

What will propofol do to evokes potentials?

A

nothing

119
Q 
On a BIS
0 means
20 means
40 means
60 means
80 mean
100 means
A 
0 mean flat line
20 means burst suppression
40 means deep hypnotic sleep
60 mean general anesthesia
80 means light sedation
100 means fully awake
120
Q

What is the range we try to keep BIS numbers?

A

40-60

121
Q

What is cerebral oximetry monitoring?

A

Provided real time changes in regional oxygenation

122
Q

Cerebral oximetry measures non pulsatile flow, so what blood is it measuring in the brain?

A

venous blood

123
Q

What percent change in baseline would suggest a reduction in cerebral oxygenation?

A

a change of 25% from baseline

APA 1 (7 decks)

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