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Anesthesiology and Surgical Nursing > Quiz 4 study guide > Flashcards

Quiz 4 study guide Flashcards

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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
Q

What is the direct method for monitoring oxygenation?

A

Arterial blood gas

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25
Q

What is the indirect method of monitoring oxygenation?

A

Pulse Oximeter (SPO2)

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26
Q

What is the predicted PaO2 when compared to inspired oxygen?

A

4-5 times the inspired oxygen concentration

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27
Q

If a patient is on 100% oxygen what would the PaOC be?

A

Between 400-500mmHg

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28
Q

What does a PaO2 less than 80mmHg indicate?

A

Moderate hypoxemia

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29
Q

What does a PaO2 less than 60mmHg indicate?

A

Severe hypoxemia

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30
Q

When is a patient considered to be hypoxemic?

A

When the PaO2 falls below 80mmHg

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31
Q

What are the causes of hypoxemia?

A

Ventilation to Perfusion Inequality

V/Q mismatch

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32
Q

What is V/Q mismatch

A

Ventilation and blood flow are mismatched at the level of the alveoli

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33
Q

When V/Q mismatch is happening what is occurring anatomically?

A

Portion of the lung field is ventilated well but does not get the blood flow or perfusion it needs
Vice/versa

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34
Q

What does V/Q mismatch result in?

A

The inefficient gas exchange between the lungs and pulmonary blood

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35
Q

What is the most common cause of reduced oxygenation in an anesthetized patient?

A

V/Q mistmatch

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36
Q

When does maximum gas exchange occur?

A

When the ratio between ventilation (V) and perfusion (Q) are equal to 1

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37
Q

A V/Q ration of <1 means that perfusion is occurring but ventilation is not, what does this contribute to?

A

Venous admixture

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38
Q

What is venous admixture?

A

The blood does not become fully oxygenated as it passes through the lungs
Arterial blood is diluted with de-oxygenated blood

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39
Q

What might cause a V/Q ration less than 1?

A

Atelectasis

Bronchial intubation

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40
Q

What does it mean when a V/Q ratio is greater than 1?

A

Ventilation is present but perfusion is not

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41
Q

What causes a V/Q ratio of greater than 1?

A 
Dead space ventilation
Pulmonary thromboembolism
Severe hypovolemia or hypotension
Patient in dorsal recumbency
Patine in the head-down position for a long time
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42
Q

What is Dead space ventilation termed?

A

Wasted ventilation

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43
Q

What are other causes of hypoxemia

A

Diffusion impairment
Anatomical Shunts
Severe Hypoventilation
Low inspired oxygen

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44
Q

What is diffusion impairment?

A

Any condition that prevents the normal uptake of oxygen from the alveoli to the pulmonary capillary blood

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45
Q

Define Anatomical shunts

A

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

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46
Q

What is more of a concern during the post operative period when the patient is breathing room air

A

Severe hypo-ventilation

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47
Q

How do you prevent hypoxemia?

A 
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
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48
Q

What is extremely difficult to treat if it happens after the patient is already on 100% O2 during anesthesia?

A

Hypoxemia

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49
Q

What are the treatment options for hypoexmia?

A

Increase peak airway pressure to 40 cm H2O
Hold positive pressure for 3-5 seconds
Provide positive end expiratory pressure (PEEP)

50
Q

How does providing positive end expiratory pressure (PEEP) help with hypoxemia

A

Causes positive pressure to remain in the lungs at the end of expiration which increases alveolar volumes and recruits collapsed alveoli

51
Q

What is defined as below normal arterial blood pressure?

A

Hypotension

52
Q

How do you indirectly monitor hypotension?

A

Oscillometric or doppler

53
Q

How do you directly monitor hypotension?

A

Arterial catheterization

54
Q

What defines hyptension in small animals?

A

less than 80 mmHg

55
Q

What causes hypotension?

A 
Anesthetic drugs
Inhalants 
Hypovolemia
Dehydration
Inadequate volume admin
Reduced vascular tone
Excessive inspiratory pressure on the caudal vena cava
Hypothermia
Excessive anesthetic depth
56
Q

How do you prevent Hypotension?

A

Use a balanced anesthesia approach
Keep the inhalant concentration to a minimum
Provide IV fluids

57
Q

How do you treat Hypotension?

A

Turn down vaporizer
Give a 5-20ml/kg bolus of fluids
Consider colloids or hypertonic saline
Consider inotropes (Dopamine, dobutamine)

58
Q

What is defines as the reduction in the effective intravascular blood volume?

A

Hypovolemia

59
Q

What is absolute hypovolemia?

A

The actual loss of intravascular volume

60
Q

When do you see absolute hypovolemia?

A

Intravascular fluid losses exceed intravascular fluid gains

61
Q

What is relative hypovolemia?

A

An increase in intravascular space due to vasodilation

62
Q

How do you monitor for hypovolemia

A

Physical parameters & monitoring tools are used to help assess adequate circulating blood volume and tissue perfusion

63
Q

What are the physical parameters that may indicate hypovolemia?

A 
Pale mucous membranes
Prolonged CRT
Thready pulse quality 
Cold extremities
Tachycardia
Hypotension
64
Q

What monitoring tools are available to help assess hypovolemia?

A

PCV/TP
Lactate
Urine output
Central venous pressure

65
Q

A lactate value of more than 2mmol/L can indicate what?

A

Poor tissue perfusion

66
Q

An urine output of less than 0.5mL/kg/hr could indicate what?

A

Poor perfusion/ hypovolemia

67
Q

What does a low (<0cmH2O) or decreasing CVP suggest?

A

Hypovolemia

68
Q

What are the common causes of absolute hypovolemia?

A

Acute hemorrhage
Water & electrolyte loss
Plasma losses

69
Q

What does third space loss involve?

A

Re-distribution of fluid within the body

Intravascular space to interstitial space

70
Q

What are the causes of relative hypovolemia?

A

Adverse drug reactions
Sepsis
Anaphylaxis
Anesthesia drugs (Ace & inhalants)

71
Q

How do you prevent hypovolemia? what are the 5 Ps?

A

Previous planning prevents poor performance

72
Q

How do you treat hypovolemia?

A

Replacement of crystalloid fluids
Colloid therapy
Hypertonic Saline
Blood products

73
Q

What is the percentage of total blood volume loss a healthy anesthetized animal can tolerate?

A

10-20%

74
Q

What are the shock doses of fluids for dogs in severe cases of hypovolemia?

A

80-90ml/kg

75
Q

What are the shock doses of fluids in cats with severe hypovolemia?

A

40-60ml/kg

76
Q

How do colloids like hetastarch, pentastarch and Voluven help treat hypovolemia?

A

Restore intravascular volume
Help maintain oncotic pressure
Keep fluid in the intravascular space longer than crystalloid fluids

77
Q

What is the bolus rate of colloids in dogs and cats?

A

Dogs = 5-10 mL/kg

Cats + 2-5 mL / kg

78
Q

What is used for rapid low volume resuscitation in the treatment of hypovolemic shock and causes rapid intravascular volume expansion

A

Hypertonic saline

79
Q

How long does hypertonic saline last and what is the rate in cats and dogs?

A

30 minutes
Dogs = 4-6mL/kg
Cats = 2-3mL/kg

80
Q

In what patients is hypertonic saline contraindicated?

A

Severely dehydrated
Cardiac disease
hypernatremic

81
Q

When is whole blood indicated to treat hypovolemic shock

A

When greater than 25% of circulating blood volume is lost

When both oxygen-carrying capacity & intravascular volume is needed to be restored

82
Q

What contains red blood cells, plasma, coagulation factors & platelets?

A

Fresh whole blood less than 6-8 hours old

83
Q

What contains red blood cells, plasma, and decreased levels of coagulation factors, and no active platelets?

A

Fresh whole blood 8-24 hours old

84
Q

When is Packed RBC indicated?

A

When the PCV is less than 20% but TP is adequate

Only restores oxygen-carrying capacity

85
Q

When is plasma indicated to treat hypovolemia?

A

When the PCV is adequate but the TP is less than 3.5 g/dL

86
Q

What is defines as a below normal body temperature?

A

Hypothermia

87
Q

What is a mild hyothermia?

A

98-99.9 F

88
Q

What is a moderate hypothermia?

A

96-98 degrees F

89
Q

What is a severe hypothermia?

A

92-96 degrees F

90
Q

What is a critical hypothermia?

A

less than 92 degrees F

91
Q

How often should temperature be monitored?

A

every 15-20 minutes

92
Q

What are the causes of hypothermia?

A 
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
Q

How is heat lost during anesthesia?

A

Convection
Conduction
Radiation or evaporation

94
Q

What are ways to prevent hypthermia?

A 
Maintain a warm operating room
Utilize warm air blankets
Conductive fabric warmers
Circulating warm water blankets
Fluid warmers
Wrap extremities
95
Q

What are the No-No’s to preventing/treating hypthermia?

A

microwaved warming devices

Electrical heating pads

96
Q

What is defined as a below normal blood glucose level?

A

Hypoglycemia

97
Q

What should blood glucose levels be maintained between?

A

70-120mg/dL

98
Q

What patients should glucose always be monitored in?

A 
Pediatric patients
Diabetics
Hepatic disease
Portal systemic shunts
Insulinomas
Septicemias
Endotoxemias
99
Q

What are the consequences of hypoglycemia?

A 
Coma
Hypotension
Long anesthetic recovery
Depression
Weakness
Seizures
100
Q

How do you prevent/Treat hypglycemia?

A

Add dextrose to fluids if warranted

101
Q

What are the common concentrations of dextrose added to fluids?

A

2.5% and 5%

102
Q

How do you prepare a dextrose solution?

A

Add 100mL of 50% dextrose to 900ml of fluid to make a 5% dextrose

103
Q

What is defined as an above normal body temperature

A

Hyperthermia

104
Q

What are the causes of hyperthermia?

A 
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
Q

What is hyperthermia sometimes manifested as?

A

Malignant hyperthermia syndrome

106
Q

What is malignant hyperthermia syndrome?

A

A life-threatening hypermetabolic condition triggered by stress & certain anesthetic agents

107
Q

What is a Pheochromocytoma?

A

Neuroendocrine tumor of the medulla of the adrenal glands

Causes sympathetic nervous system hyperactivity

108
Q

When is treatment of hyperthermia indicated?

A

when the temperature reaches 105.8 degrees F

109
Q

What are not recommended as treatments of hyperthermia because it can cause peripheral vasoconstriction
Shivering that leads to further increase core body temperature

A

Ice packs and full submersion in cool water

110
Q

What is defined as excessive elimination of CO2 from the body relative to CO2 production or an increase in alveolar minute volume?

A

Hyperventilation

111
Q

What does hyperventilation lead to?

A

Hypcapnia

112
Q

When is hyperventilation indicated?

A

When the PaCO2 is less than 35mmHg

113
Q

What can hyperventilation cause?

A

Severe cerebral vasoconstriction which may result in brain ischemia

114
Q

What causes hyperventilation?

A 
Inadequate anesthetic depth or response to pain
Overzealous ventilation 
Hypoxemia
Hyperthermia
Low inspired O2 concentrations
Increased CO2 production
115
Q

What is the prevention/treatment of hyperventilation?

A 
Assess anesthetic depth
Monitor for pain
Decrease tidal volume
Decrease RR
Avoid hyperthermia
Use appropriate O2 flow
116
Q

What is defined as an above normal arterial blood pressure?

A

Hypertension

117
Q

What is hypertension is defined as?

A

MAP > 120mmHg
SAP > 160mmHg
DAP > 95mmHg

118
Q

What happens if hypertension is left untreated?

A

Increased myocardial workload & oxygen demand

119
Q

What is considered hypertension under GA?

A

greater than 100mmHg

120
Q

What can hypertension cause damage to?

A 
Eyes
Kidneys
Heart
Brain
Peripheral vessels
121
Q

What are the causes of hypertension?

A

Pain
Inadequate depth
Hypercapnia
Anesthetic drugs

122
Q

What underlying disease can cause hypertension?

A 
Renal disease
Hyperadrenocorticism
Hyperthyroidism
DM
HF
Pheochromocytoma

Anesthesiology and Surgical Nursing (23 decks)

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