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Anesthesiology and Surgical Nursing > Quiz 4 study guide > Flashcards

Quiz 4 study guide Flashcards

1
Q

What is the insufficient elimination of carbon dioxide from the body relative to CO2 production

A

Hypoventilation

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2
Q

What is another definition for hypoventilation?

A

A reduction in alveolar minute ventilation

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3
Q

What can occur if the body is not able to get rid of CO2?

A

Respiratory acidosis

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4
Q

How is hypoventilation assessed?

A

Monitoring the PaCO2 with direct or indirect methods

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5
Q

What is the direct method for monitoring PaCO2?

A

Arterial or venous blood gas

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6
Q

What is the indirect method of monitoring PaCO2?

A

Capnograph

ETCO2

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7
Q

What is a PaCO2 reater than 45mmHg known as?

A

Hypercapnia

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7
Q

What is a PaCO2 reater than 45mmHg known as?

A

Hypercapnia

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8
Q

What are the causes of hypoventilation?

A

Any factor that causes a decrease in respiratory rate or tidal volume or an increase in mechanical dead space

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9
Q

How do you control the factors that cause hypoventilation?

A

Make sure the ET tube is the proper length

Limit the amount of components in the ET tube & respiratory line

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10
Q

What causes a dose dependent hypoventilation

A

Anesthetic agents

Administering large boluses of induction agents (apnea)

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11
Q

What happens as depth increases?

A

Excessive CNS depression
Decrease respiratory rate
Decrease in the normal response to an increased CO2

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12
Q

What are the factors that contribute to a decrease in tidal volume?

A

Abdominal distention
Obesity
Thoracic pain

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13
Q

How dose thoracic pain due to flail chest or fractured ribs lead to a decrease tidal volume?

A

Unable to generate a big enough breath to exhale the normal tidal volume to keep CO2 levels WNL

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14
Q

What are the factors that contribute to an increase in mechanical dead space?

A 
Malfunctioning or missing one-way valves
Improper packing of the CO2 absorbent
Cracked inner tube of a coaxial circuit
Too many adapters between the ET tube & breathing hoses
Not using a septum in the Y-piece
ET tube past the incisors
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15
Q

What factors can contribute to the re-breathing of CO2?

A

Exhausted CO2 absorbent
Malfunctioning scavenging system
Inadequate oxygen flow rates for non-rebreathing circuits

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16
Q

How do you prevent or treat hypoventilation?

A

Monitor CO2 (indirect or direct)
Asses the depth to make sure not excessive
Use a balanced anesthetic
Investigate the anesthesia machine

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17
Q

What should you do if the PaCO2 is approaching greater than or equal to 45mmHG?

A

Simply give the patient a breath 1-2 times a minute

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18
Q

What do you do if the PaCO2 is approaching 60mmHg

A

Intermittent positive pressure ventilation should be started at a controlled rate and tidal volume

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19
Q

How do you keep mechanical dead space to a minimum?

A

Using appropriate length ET tube
Not using more than one adapter between the ET tube and breathing circuit
Make sure the surgeon is not leaning on the patient

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20
Q

What is reduced oxygen in the blood

A

Hypoxemia

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21
Q

What does hypoxemia mean?

A

There is an insufficient amount of oxygen in the arterial blood

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22
Q

How do you monitor for Hypoxemia

A

By monitoring oxygenation

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23
Q

How do assess oxygenation?

A

Directly or indirectly

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24
What is the direct method for monitoring oxygenation?
Arterial blood gas
25
What is the indirect method of monitoring oxygenation?
Pulse Oximeter (SPO2)
26
What is the predicted PaO2 when compared to inspired oxygen?
4-5 times the inspired oxygen concentration
27
If a patient is on 100% oxygen what would the PaOC be?
Between 400-500mmHg
28
What does a PaO2 less than 80mmHg indicate?
Moderate hypoxemia
29
What does a PaO2 less than 60mmHg indicate?
Severe hypoxemia
30
When is a patient considered to be hypoxemic?
When the PaO2 falls below 80mmHg
31
What are the causes of hypoxemia?
Ventilation to Perfusion Inequality | V/Q mismatch
32
What is V/Q mismatch
Ventilation and blood flow are mismatched at the level of the alveoli
33
When V/Q mismatch is happening what is occurring anatomically?
Portion of the lung field is ventilated well but does not get the blood flow or perfusion it needs Vice/versa
34
What does V/Q mismatch result in?
The inefficient gas exchange between the lungs and pulmonary blood
35
What is the most common cause of reduced oxygenation in an anesthetized patient?
V/Q mistmatch
36
When does maximum gas exchange occur?
When the ratio between ventilation (V) and perfusion (Q) are equal to 1
37
A V/Q ration of <1 means that perfusion is occurring but ventilation is not, what does this contribute to?
Venous admixture
38
What is venous admixture?
The blood does not become fully oxygenated as it passes through the lungs Arterial blood is diluted with de-oxygenated blood
39
What might cause a V/Q ration less than 1?
Atelectasis | Bronchial intubation
40
What does it mean when a V/Q ratio is greater than 1?
Ventilation is present but perfusion is not
41
What causes a V/Q ratio of greater than 1?
``` Dead space ventilation Pulmonary thromboembolism Severe hypovolemia or hypotension Patient in dorsal recumbency Patine in the head-down position for a long time ```
42
What is Dead space ventilation termed?
Wasted ventilation
43
What are other causes of hypoxemia
Diffusion impairment Anatomical Shunts Severe Hypoventilation Low inspired oxygen
44
What is diffusion impairment?
Any condition that prevents the normal uptake of oxygen from the alveoli to the pulmonary capillary blood
45
Define Anatomical shunts
Congenital heart abnormalities that cause blood to be shunted from the right side of the heart to the left side without passing through the lungs to become oxygenated
46
What is more of a concern during the post operative period when the patient is breathing room air
Severe hypo-ventilation
47
How do you prevent hypoxemia?
``` Pre-oxygenate patients Intubate patients Minimize anesthesia & surgical time Check oxygen source Calculate the appropriate oxygen flow rate for the type of anesthesia breathing circuit ```
48
What is extremely difficult to treat if it happens after the patient is already on 100% O2 during anesthesia?
Hypoxemia
49
What are the treatment options for hypoexmia?
Increase peak airway pressure to 40 cm H2O Hold positive pressure for 3-5 seconds Provide positive end expiratory pressure (PEEP)
50
How does providing positive end expiratory pressure (PEEP) help with hypoxemia
Causes positive pressure to remain in the lungs at the end of expiration which increases alveolar volumes and recruits collapsed alveoli
51
What is defined as below normal arterial blood pressure?
Hypotension
52
How do you indirectly monitor hypotension?
Oscillometric or doppler
53
How do you directly monitor hypotension?
Arterial catheterization
54
What defines hyptension in small animals?
less than 80 mmHg
55
What causes hypotension?
``` Anesthetic drugs Inhalants Hypovolemia Dehydration Inadequate volume admin Reduced vascular tone Excessive inspiratory pressure on the caudal vena cava Hypothermia Excessive anesthetic depth ```
56
How do you prevent Hypotension?
Use a balanced anesthesia approach Keep the inhalant concentration to a minimum Provide IV fluids
57
How do you treat Hypotension?
Turn down vaporizer Give a 5-20ml/kg bolus of fluids Consider colloids or hypertonic saline Consider inotropes (Dopamine, dobutamine)
58
What is defines as the reduction in the effective intravascular blood volume?
Hypovolemia
59
What is absolute hypovolemia?
The actual loss of intravascular volume
60
When do you see absolute hypovolemia?
Intravascular fluid losses exceed intravascular fluid gains
61
What is relative hypovolemia?
An increase in intravascular space due to vasodilation
62
How do you monitor for hypovolemia
Physical parameters & monitoring tools are used to help assess adequate circulating blood volume and tissue perfusion
63
What are the physical parameters that may indicate hypovolemia?
``` Pale mucous membranes Prolonged CRT Thready pulse quality Cold extremities Tachycardia Hypotension ```
64
What monitoring tools are available to help assess hypovolemia?
PCV/TP Lactate Urine output Central venous pressure
65
A lactate value of more than 2mmol/L can indicate what?
Poor tissue perfusion
66
An urine output of less than 0.5mL/kg/hr could indicate what?
Poor perfusion/ hypovolemia
67
What does a low (<0cmH2O) or decreasing CVP suggest?
Hypovolemia
68
What are the common causes of absolute hypovolemia?
Acute hemorrhage Water & electrolyte loss Plasma losses
69
What does third space loss involve?
Re-distribution of fluid within the body | Intravascular space to interstitial space
70
What are the causes of relative hypovolemia?
Adverse drug reactions Sepsis Anaphylaxis Anesthesia drugs (Ace & inhalants)
71
How do you prevent hypovolemia? what are the 5 Ps?
Previous planning prevents poor performance
72
How do you treat hypovolemia?
Replacement of crystalloid fluids Colloid therapy Hypertonic Saline Blood products
73
What is the percentage of total blood volume loss a healthy anesthetized animal can tolerate?
10-20%
74
What are the shock doses of fluids for dogs in severe cases of hypovolemia?
80-90ml/kg
75
What are the shock doses of fluids in cats with severe hypovolemia?
40-60ml/kg
76
How do colloids like hetastarch, pentastarch and Voluven help treat hypovolemia?
Restore intravascular volume Help maintain oncotic pressure Keep fluid in the intravascular space longer than crystalloid fluids
77
What is the bolus rate of colloids in dogs and cats?
Dogs = 5-10 mL/kg | Cats + 2-5 mL / kg
78
What is used for rapid low volume resuscitation in the treatment of hypovolemic shock and causes rapid intravascular volume expansion
Hypertonic saline
79
How long does hypertonic saline last and what is the rate in cats and dogs?
30 minutes Dogs = 4-6mL/kg Cats = 2-3mL/kg
80
In what patients is hypertonic saline contraindicated?
Severely dehydrated Cardiac disease hypernatremic
81
When is whole blood indicated to treat hypovolemic shock
When greater than 25% of circulating blood volume is lost | When both oxygen-carrying capacity & intravascular volume is needed to be restored
82
What contains red blood cells, plasma, coagulation factors & platelets?
Fresh whole blood less than 6-8 hours old
83
What contains red blood cells, plasma, and decreased levels of coagulation factors, and no active platelets?
Fresh whole blood 8-24 hours old
84
When is Packed RBC indicated?
When the PCV is less than 20% but TP is adequate | Only restores oxygen-carrying capacity
85
When is plasma indicated to treat hypovolemia?
When the PCV is adequate but the TP is less than 3.5 g/dL
86
What is defines as a below normal body temperature?
Hypothermia
87
What is a mild hyothermia?
98-99.9 F
88
What is a moderate hypothermia?
96-98 degrees F
89
What is a severe hypothermia?
92-96 degrees F
90
What is a critical hypothermia?
less than 92 degrees F
91
How often should temperature be monitored?
every 15-20 minutes
92
What are the causes of hypothermia?
``` Heat loss during ansethesia Anesthetic agents Using a non-rebreathing Large surgical incisions Prolonged anesthesia times Cool surgical scrub Placing an animal on a cold operating table ```
93
How is heat lost during anesthesia?
Convection Conduction Radiation or evaporation
94
What are ways to prevent hypthermia?
``` Maintain a warm operating room Utilize warm air blankets Conductive fabric warmers Circulating warm water blankets Fluid warmers Wrap extremities ```
95
What are the No-No's to preventing/treating hypthermia?
microwaved warming devices | Electrical heating pads
96
What is defined as a below normal blood glucose level?
Hypoglycemia
97
What should blood glucose levels be maintained between?
70-120mg/dL
98
What patients should glucose always be monitored in?
``` Pediatric patients Diabetics Hepatic disease Portal systemic shunts Insulinomas Septicemias Endotoxemias ```
99
What are the consequences of hypoglycemia?
``` Coma Hypotension Long anesthetic recovery Depression Weakness Seizures ```
100
How do you prevent/Treat hypglycemia?
Add dextrose to fluids if warranted
101
What are the common concentrations of dextrose added to fluids?
2.5% and 5%
102
How do you prepare a dextrose solution?
Add 100mL of 50% dextrose to 900ml of fluid to make a 5% dextrose
103
What is defined as an above normal body temperature
Hyperthermia
104
What are the causes of hyperthermia?
``` Excessive application of heat Fever Contamination of IV fluids High ambient temps Loss of temperature regulation in the CNS Thyrotoxicosis Dissociatives Pure mu opiods (cats) ```
105
What is hyperthermia sometimes manifested as?
Malignant hyperthermia syndrome
106
What is malignant hyperthermia syndrome?
A life-threatening hypermetabolic condition triggered by stress & certain anesthetic agents
107
What is a Pheochromocytoma?
Neuroendocrine tumor of the medulla of the adrenal glands | Causes sympathetic nervous system hyperactivity
108
When is treatment of hyperthermia indicated?
when the temperature reaches 105.8 degrees F
109
What are not recommended as treatments of hyperthermia because it can cause peripheral vasoconstriction Shivering that leads to further increase core body temperature
Ice packs and full submersion in cool water
110
What is defined as excessive elimination of CO2 from the body relative to CO2 production or an increase in alveolar minute volume?
Hyperventilation
111
What does hyperventilation lead to?
Hypcapnia
112
When is hyperventilation indicated?
When the PaCO2 is less than 35mmHg
113
What can hyperventilation cause?
Severe cerebral vasoconstriction which may result in brain ischemia
114
What causes hyperventilation?
``` Inadequate anesthetic depth or response to pain Overzealous ventilation Hypoxemia Hyperthermia Low inspired O2 concentrations Increased CO2 production ```
115
What is the prevention/treatment of hyperventilation?
``` Assess anesthetic depth Monitor for pain Decrease tidal volume Decrease RR Avoid hyperthermia Use appropriate O2 flow ```
116
What is defined as an above normal arterial blood pressure?
Hypertension
117
What is hypertension is defined as?
MAP > 120mmHg SAP > 160mmHg DAP > 95mmHg
118
What happens if hypertension is left untreated?
Increased myocardial workload & oxygen demand
119
What is considered hypertension under GA?
greater than 100mmHg
120
What can hypertension cause damage to?
``` Eyes Kidneys Heart Brain Peripheral vessels ```
121
What are the causes of hypertension?
Pain Inadequate depth Hypercapnia Anesthetic drugs
122
What underlying disease can cause hypertension?
``` Renal disease Hyperadrenocorticism Hyperthyroidism DM HF Pheochromocytoma ```

Anesthesiology and Surgical Nursing (23 decks)

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