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Clinical Instruction (Kass) > Patient Monitors and analyzers > Flashcards

Patient Monitors and analyzers Flashcards

1
Q

What is one of the most important pieces of monitoring hardware available to RTs?

A

Pulse oximeter

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2
Q

What information does a pulse oximeter offer?

A

Hemoglobin saturation
Heart rate
Perfusion index
Pulse amplitude

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3
Q

What are the most common sites for placing a pulse oximeter?

A

Finger
Toe
Nose
Ear
Foot
forehead

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4
Q

What two principles do pulse oximeters operate off of?

A

Optical plethysmography
Spectrophotometry

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5
Q

What is the wavelength of the red portion of the light beam?

A

660 nm

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6
Q

What is the wavelength of the infrared portion of the light beam?

A

930 nm

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7
Q

In basic terms, how does a pulse oximeter work?

A

Shoots a beam of red and infrared light through the tissue where oxygen laden hemoglobin absorb the light. Unabsorbed light passes through and is picked up via a receptor where it is determined how loaded the hemoglobin are

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8
Q

How come bones, venous blood, and tissue do not affect the saturation reading?

A

Their absorption is constant over short periods of time and oximeters are able to account for them

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9
Q

What are the two main types of pulse oximeters?

A

Reusable
Disposable

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10
Q

What kind of alarms can be equipped onto pulse oximeters?

A

Audible and visual alarms

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10
Q

What are the 3 different sizes of pulse oximeters?

A

Adult
Pediatric
Neonatal

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11
Q

What fancy new features do modern pulse oximeters offer?

A

Perfusion index
Pulse amplitude
Trends
Error messages

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12
Q

What are the normal values for pulse oximetry in healthy individuals?

A

95-100

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13
Q

At what point is sat considered low?

A

90%

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14
Q

What factors can skew the results of a pulse oximeter?

A

Low blood perfusion
Motion
Dysfunctional hemoglobin
Venous pulsation
Dark nail polish
Dark skin pigmentation
Extreme anemia
Surrounding light

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15
Q

If placing a pulse oximeter on a finger, where should the hand be placed?

A

At the heart level

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16
Q

T/F: you must calibrate pulse oximeters between uses

A

False. Pulse oximeters cannot be calibrated

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17
Q

What are normal values for end tidal CO2?

A

35-45 mmHg

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18
Q

What is the purpose of end tidal CO2 monitoring?

A

Assess respiration
Assess placement of ET tubes
Assess adequacy of perfusion during CPR
Metabolic studies

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19
Q

What are the types of CO2 monitors?

A

Capnometer
Capnograph

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20
Q

Describe a capnometer

A

Continuously measures CO2 and displays discrete numbers

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21
Q

Describe a capnograph

A

Measures CO2 during each inspiratory and expiratory cycle and displays both a CO2 waveform and numeric data
graph=waveform

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22
Q

How do CO2 monitors work?

A

Use infrared absorption spectroscopy to measure the partial pressure of CO2 in exhaled gas

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23
Q

What are the types of CO2 monitors?

A

Mainstream
Side stream

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24
Q

Describe mainstream CO2 monitors

A

Direct measurement of total CO2 in exhaled gas

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25
Q

Describe sidestream CO2 monitors

A

Sampling of exhaled gas in intubated patients and spontaneously breathing patients

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26
Q

What can interfere with the accuracy of CO2 monitors?

A

Water vapor in tubing
Atmospheric pressure
Anesthetic vapors
Nitrous effect

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27
Q

What mechanisms can be utilized in side stream CO2 monitors to ensure their accuracy?

A

Water traps
Filters
Nafion tubing

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28
Q

What are the 2 points of calibration for CO2 monitors?

A

Zero and 5%

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29
Q

T/F: CO2 monitors do not need to be calibrated

A

False. CO2 monitors need to be calibrated at regular intervals

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30
Q

What is the concentration of FeNO that is measured by nitric oxide detectors?

A

Parts per billion

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31
Q

What are exhaled nitric oxide monitors used for?

A

Marker for diagnosis of asthma
Monitor response to anti-inflammatory meds
Monitor adherence to asthma therapy
Predict upcoming asthma exacerbations

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32
Q

How are nitric oxide detectors calibrated?

A

Nitric oxide detectors are calibrated via linear validation using at least 3-point calibration, 0, 200 and 500 parts per billion

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33
Q

What is nitric oxide measurement based on?

A

Chemiluminescence analysis

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34
Q

What is highly recommended for the FeNO detector calibration process?

A

Stable temp
Stable pressure
Stable humidity

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34
Q

T/F: medical air can be used to calibrate FeNO detectors

A

False. Medical air is not recommended for calibrating FeNO detectors

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35
Q

What is a transcutaneous monitor?

A

A method of noninvasive monitoring that allows for continuous monitoring via a sensor applied to the body
Allows for blood gasses diffusing through the skin to be detected and estimated

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36
Q

What can transcutaneous oxygen and CO2 monitors provide?

A

Real time readings, trends, histograms, themistors temps and alarms

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37
Q

T/F: two separate sensors are required for transcutaneous oxygen and carbon dioxide monitoring

A

False. There can be 2 monitors or both fields can be monitors by 1

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38
Q

What is transcutaneous monitoring?

A

Transcutaneous monitoring is the method of choice to continuously and non-invasively monitor oxygenation AND ventilation

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39
Q

What is the variable measured by transcutaneous monitors?

A

tcPO2 and tcPaCO2

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40
Q

T/F: tcPO2 and tcPaCO2 are always equal to PaO2 and PaCO2

A

False. They are not always equal but are general good indicators of the values

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41
Q

How do transcutaneous tcPO2 sensors work?

A

Electrode heats skin to 109-113 degrees fahrenheit
Arterial blood to dermal capillary increases
O2 diffuses through the sensors membrane to the cathode where it is measured

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42
Q

What are the two points of calibration for transcutaneous tcPO2 sensors?

A

A drop of solution with no free O2
Ambient air

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43
Q

Describe the accuracy of tcPO2 and tcPCO2 in neonates

A

tcPO2 is often similar
TcPCO2 is often higher than PaCO2

44
Q

What piece of machinery is use in tcPO2 detector?

A

Polarographic clark electrode
Silver anode
Semipermeable membrane
Heating element

45
Q

What piece of ,machinery is is used in a tcPO2?

A

Severinghaus electrode
pH electrode
Reference electrode
Teflon membrane
Heating element

46
Q

Describe how the tcPCO2 operates

A

Skin is heated to 108-113 degrees fahrenheit
Arterial blood supply is increased to dermal capillary
CO2 diffuses across the sensor membrane interacting with electrolyte solution
Hydrogen and bicarb ions are formed
CO2 is determined

47
Q

What mathematical equation is used to determine CO2 in a tcPCO2 sensor

A

Henderson-hasselbalch equation

48
Q

What kind of calibration is used for tcPCO2 sensors?

A

One and Two point calibrations

49
Q

Describe 1 point calibration for tcPCO2 sensors

A

Expose electrode surface to 5% CO2 gas for several minutes

50
Q

How often is one point calibration uses in tcPCO2 sensors?

A

Every 4 hours during continuous use
After any period of disuse

51
Q

What is the acceptable difference in calibrations when performing a 1 point calibration on tcPCO2 sensors?

A

2 mmHg

52
Q

Describe 2 point calibration for tcPCO2 sensors

A

Expose electrode surface to 5% and 10% CO2 gas for several minutes

53
Q

When should 2 point calibrations be performed on tcPCO2 sensors?

A

At least once during a 25 hour cycle of continuous use
After membrane and electrolyte change
Whenever in doubt of clinical reliability

54
Q

What can cause discrepancies in tcPCO2 and tcO2 monitors?

A

Skin oxygenation consumption
Heating of the underlying skin
Impaired peripheral circulation
Shock
Very low core temp

54
Q

What should calibration readings be within when performing a 2 point calibration on a tcPCO2 sensors

A

Should be within 4 mmHg

55
Q

What might affect the accuracy of transcutaneous oxygen and carbon dioxide monitors?

A

Ambient air temp
Humidity
Barometric pressure
Membrane thickness
Rate of oxygen and CO2 diffusion across electrode
Polarization voltage of the electrodes

56
Q

Compare readings between arterial and transcutaneous readings

A

tcPO2 is like PO2
tcPCO2 is higher than PCO2

57
Q

What are the hazards of transcutaneous monitors?

A

Burns

58
Q

What can affect the response time of transcutaneous monitoring?

A

Material and size of cathode
pH of the electrolyte used in the sensor
Membrane potential

59
Q

What physiologic factors can cause differences between transcutaneous sensors and ABGs?

A

Skin permeability
Unusual capillary configurations
Temp differences
Impaired peripheral circulation

60
Q

What are the hazards of transcutaneous monitors?

A
61
Q

What can apnea monitors track?

A

Apnea (duh)
Heart rate
Oxygen saturation

62
Q

What patients are apnea monitors most frequently used on?

A

Premature babies
Patients at risk for apnea (DUH)

63
Q

Describe the detection methods for apnea monitors

A

Impedance pneumography
Thermistors
Infrared CO2 sensors
Mattress pressure pads
Pneumatic abdominal sensors

64
Q

How does impedance pneumography work?

A

Detects changes in electrical impedance

65
Q

How do thermistors, proximal airway pressure sensors and carbon dioxide sensors work?

A

Directly monitor airflow

66
Q

How do pneumatic abdominal sensors work?

A

Changes in pressure with expansion or contraction

67
Q

How are apnea monitors calibrated?

A

Not frequently or extensively calibrated
Calibrated via functional self test

67
Q

What are the standard features of apnea monitors?

A

Timers
Visual and audible alarms
Heart rate monitors
SpO2 monitors

68
Q

What can cause issues with apnea monitors?

A

Artifacts from heart activity
Patient movement
Home appliances

69
Q

Indirect calorimetry can be used for what?

A

Understand metabolic diseases
Type II diabetes
Heart disease
Lung disease

70
Q

What can indirect calorimetry be used for that is not disease related

A

Athletes to determine caloric needs
Nutritionists to determine caloric needs

71
Q

What does indirect calorimetry measure

A

Inspired gas flows
Expired gas flows
Volumes and concentrations of oxygen and CO2

72
Q

What patients can indirect calorimetry be used on?

A

Ventilated patients
Spontaneous breathing patients

73
Q

T/F: indirect calorimetry requires a closed circuit method

A

False. Can be done in a closed or open circuit method

74
Q

Describe the theory behind indirect calorimetry

A

All energy is derived from the oxidation of carbs, fats and proteins and the ratio of CO2 produced to O2 consumed (respiratory quotient) is characteristic of the fuel being burned

75
Q

Describe open circuit indirect calorimetry

A

Concentrations and volumes of inspired and expired O2 and CO2 are measured to determine O2 consumption and CO2 production

76
Q

What is required to ensure the accuracy of indirect calorimetry?

A

Stable FiO2
Leak free system

77
Q

What does calibration of indirect calorimetry involve?

A

Calibration of gas analyzers, pressure transducers and flow sensors

77
Q

When is calibration of indirect calorimetry performed?

A

Usually automatic
Once daily

78
Q

How does closed circuit indirect calorimetry differ from open circuit?

A

Method for measuring o2 consumption
Uses volumetric spirometer, mix chamber, carbon dioxide analyzer and carbon dioxide absorber

79
Q

What are the applications for an esophageal pressure catheter?

A

Differentiation of chest wall, lung, and respiratory system mechanics
Monitoring parenchymal lung stress
Limiting peak end inspiratory transpulmonary pressures
Monitoring vent synchrony
PEEP titration

80
Q

Where is the esophageal pressure monitor placed?

A

The lower 3rd of the esophagus

81
Q

Describe the components of an esophageal pressure catheter

A

Balloon tipped catheter attached to a pressure transducer

81
Q

What is the esophageal pressure catheter used for?

A

Used to estimate pleural pressure

82
Q

What are contraindications for esophageal pressure catheters?

A

Esophageal varices, tumors, ulcerations, diverticulitis

83
Q

Describe the principles of operation of an esophageal pressure catheter

A

Air filled balloon ( 0.5-1.5 mL) placed in lower 3rd of esophagous
Proximal end is connected to pressure transducer
Pressure transducer incorporated in mechanical ventilators

84
Q

What area of insertion is preferred for esophageal pressure monitors?

A

Nasal

85
Q

What is done after an esophageal pressure monitor is inserted?

A

Positioning is checked via xray

86
Q

Describe galvonic oxygen analyzers

A

Use galvanic or polargraphic cells
Self energizing
Sensor consists of an anode and a cathode
Contains a semipermeable membrane and electrolight

87
Q

When should esophageal pressure monitors be replaced?

A

Every 29 days

88
Q

What are the two points of calibration for oxygen analyzers?

A

21% and 100%

89
Q

Describe polarographic oxygen analyzers

A

External electric source
Electrochemical sensor measures changes in partial pressure of O2
Contains anode and cathode
Contains electrolyte

90
Q

What are the two types of helium analyzers?

A

Handheld
Incorporated into diagnostic systems (ie PFTs(

91
Q

What does the electronic circuit of a helium analyzer measure

A

Measures the difference between the thermal conductivity of the gas mixture and that of a reference gas and then calculates the helium content

92
Q

How is helium content analyzed?

A

Measurement is based off the high thermal conductivity of helium

93
Q

What are the two main components of a helium analyzer?

A

Sensor block
Electronic circuit

94
Q

Describe the calibration requirements of a helium analyzer

A

Supplied fully calibrated
Needs calibration check every 30 days
Requires very little maintenance
Sensitive to vibration

95
Q

What is exhaled nitric oxide used for?

A

as a marker for the diagnosis of asthma
to monitor the response to anti-inflammatory meds
to monitor adherence to asthma medications
predict upcoming asthma exacerbations

96
Q

How many points of of calibration do exhaled nitric oxide monitor use?

A

3

97
Q

to measure the oxygen from a large volume jet neb to determine the correct FiO2, the therapist needs:

A

oxygen analyzer

98
Q

What situation can change the results of pulse oximetry?

A

low perfusion to a digit
motion
anemia
interference from surrounding light

99
Q

Babies who need a monitor to ensure they are breathing need a:

A

apnea monitor

100
Q

What is indirect calorimetry?

A

a technique that measure inspired and expired gas glows, volumes, and concentrations of O2 and CO2

101
Q

What kind of electrode does a transcutaneous CO2 monitor use?

A

severinhaus electrode

102
Q

A baby that needs ventilation of PCO2 monitored would need a

A

transcutaneous carbon dioxide monitor

103
Q

to determine the inspired and expired gas flow, volumes and concentrations of carbon dioxide and oxygen, what kind of test/monitor should be used?

A

indirect calorimetry test

104
Q

What does and esophageal pressure catheter monitor?

A

estimates pleural pressure

105
Q

What oxygen analyzer is self energizing, contains an anode and a cathode and contains a semipermeable membrane and electrolyte?

A

galvanic oxygen analyzer

106
Q

Describe a polarographic analyzer

A

a polarographic analyzer has an electrochemical sensor to measure the partial pressure of oxygen

Clinical Instruction (Kass) (13 decks)

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