Perioprrative monitoring

Question 1

Hb-O2 dissociation curve

Answer 1

Y-axis = SpO2
X-axis = PaO2
Right shift: increased temp, H+, 2,3-BPG, CO2
Left shift: decreased temp, H+, 2,3-BPG, CO2

Question 2

Info from pulse oximetry waveform

Answer 2

Pulsation waves: matches HR
Dicrotic notch: aortic valve closure
Envelope height varies with respiration

Question 3

Indications for pulse ox

Answer 3

Sedation
Weaning off oxygen/ventilator
Monitoring during procedure
Sleep-study

Question 4

Noninvasive BP monitoring

Answer 4

Know process of measuring
Artifacts: movement, obesity, hypotension, wrong cuff, arrhythmia
Complications: tissue injury, necrosis, phlebitis, neuropathy

Question 5

Temp monitoring

Answer 5

Thermistors: quantify temp

Question 6

Complications of hyperthermia

Answer 6

More rapid and less predictable drug clearance
Cellular/metabolic derangement so
CNS more vulnerable to injury

Question 7

Complications of hypothermia

Answer 7

Increased length of stay, wound infections, coag problems, dysrhythmias
Increased cardiac events, blood loss, shivering

Question 8

Placement for temp monitoring

Answer 8

Core temp (esophageal,PA) more meaningful than she’ll temp (rectum/axilla)

Question 9

Malignant hyperthermia

Answer 9

Temp increase 0.5 C in 15 min should raise concern

EARLY dantrolene is only effective therapy

Question 10

Causes for increased resistance and dampening of ABP

Answer 10

Longer, thinner tube
Increased viscosity
Kinks/bends in tubing

Question 11

Hazards of arterial line

Answer 11

Embolism: flush y
Thrombus: increased risk with increased duration
Nerve, vascular and limb injury

Question 12

Indications for ABP

Answer 12

Surgery with tight BP control
Need MAP to determine cerebral perfusion pressure
HTN
Sepsis, hypovolemia 
Frequent blood sampling
Ineffective BP monitoring elsewhere

Question 13

CVP monitoring

Answer 13

Uses: central drug/fluid/blood product administration, renal replacement therapy or temporary pacemaker placement

Question 14

Hazards of central line

Answer 14

PTX, arterial puncture
Brachial plexus injury, infection
Thoracic duct injury
Dysrhythmias

Question 15

Artifacts with CVP

Answer 15

Positioning
Abdominal compression -> impede preload
Insufflation of CO2 in abdomen -> raise CVP
Rapid infusion -> raise CVP
AV fistula -> raise CVP

Question 16

Indications for CVP

Answer 16

Monitor central pressures (RA, CVP)
Monitor RV overload
Treat RV infarction
Chemo/pressors 
Fluids/transfusions

Question 17

Pulse oximetry basis

Answer 17

2 wavelengths absorbed differently by Hb and Hb-O2

- pulsating arteriolar flow subtracted fro, nonpulsatile flow -> gives saturation