Quiz 5 Flashcards
What does pulse oximetry measure?
hemoglobin saturation of oxygen
What law is associated with pulse oximetry?
Beer Lambert
What are some conditions that could alter your pulse oximetry reading?
altered hemoglobins- methemoglobin, carboxyhemoglobin, fetal hemoglobin, hemoglobin S
Which organization has standards for monitoring?
ASA
Which organization deals with scope and standards of care?
AANA
What is ASA Standard 1?
qualified anesthesia personnel should be present in room throughout conduct of all GA, RA, and MAC
What is AANA Standard 5?
CRNA should be in constant attendance of pt until responsibility of care has been accepted by another qualified provider- continuous clinical observation and vigilance
What is ASA Standard II?
during all anesthetics, pt oxygenation, ventilation, circulation, and temp should be continually evaluated
What is AANA Standard V?
monitor pt physiological condition as appropriate for type of anesthesia and specific pt needs
What does CVP measure and what does it assume?
measures fluid pressure entering R side of heart and assesses fluid volume; assumes parallel function of R and L side of heart
What is the a wave of the CVP waveform?
R atrial contraction
What is the c wave of the CVP waveform?
ventricular contraction; tricuspid closes and bulges into RA
What is the V wave of CVP waveform?
atrial filling
What is the x descent of the CVP waveform?
atrial relaxation/ventricular systole
What is the y descent of the CVP waveform?
tricuspid opens, blood fills ventricle
What does the a wave line up with on the EKG?
just after P wave
What does the c wave line up with on the EKG?
just after QRS complex
What does the x descent line up with on the EKG?
ST segment
What does the y descent line up with on the EKG?
just after T wave begins
What does the V wave line up with on the EKG?
after T wave
What is the equation for CO?
SV x HR
What is the equation for CI?
CO/BSA
What is the equation for SVR?
(MAP-CVP) X 80/CO
What is the equation for PVR?
(PAP- PCWP) X 80/CO
What decreases SvO2?
increased O2 consumption (stress, pain, thyroid storm, shivering, fever, seizures) and decreased O2 delivery (decreased PaO2, Hgb, CO)
What increases SvO2?
decreased O2 consumption (hypothermia, cyanide toxicity, alkalosis), and increased O2 delivery (increased PaO2, increased Hgb, increased CO), sepsis, unintentional PA wedge
What is the calculation for SvO2?
SaO2 - VO2/(Q x 1.34 x Hgb x 10)
Q is CO
What is the normal SvO2?
65-75%
What does SvO2 indicate?
O2 extraction from SVC, IVC, and coronary sinus
What are conditions where PAOP underestimates LVEDV?
aortic insufficiency, R BBB
What are the distances from the R IJ to the RA, RV, PA, PCW?
RA 20-30 cm, RV 30-40 cm, PA 40-50 cm, PCW 45-55 cm
What is normal RA/CVP?
1-10
What is normal RV pressure?
15-30/0-8
What is normal PA pressure?
15-30/5-15
What is normal MPAP?
10-20
What is normal PAOP/PcWP?
5-15
What is normal LAP?
4-12
What is normal LVEDP?
4-12
What does a low CVP mean?
hypovolemia
What does a high CVP mean?
hypervolemia, reduced ventricular compliance, increased intrathoracic pressure
What is the peak of the Aline waveform?
systolic BP
What is the trough of the Aline waveform?
DBP
What does the upstroke indicate on the Aline waveform?
contractility
What does the area under the curve on the Aline tracing indicate?
stroke volume
What is the dicrotic notch on the Aline waveform?
aortic valve closure
What does the height of the dicrotic notch indicate?
SVR
What conditions overestimate your BP?
cuff that is too small, BP cuff location below heart
What conditions underestimate your BP?
cuff that is too large, BP cuff above heart
For every 10 cm change, the BP changes by?
7.4 mmHg
For every inch change, the BP changes by?
2 mm Hg
How do you calculate MAP?
[SBP+2(DBP)]/3
What are the goals of operative positioning?
optimum surgical exposure, assess for monitoring, prevent complications and injuries, maintain body integrity and physiological functions
What is the best surgical position for ventilation?
sitting
What is the conducting zone and what structures are in it?
anatomical dead space- does not participate in gas exchange (trachea, mainstem bronchi, lobar and small bronchi, bronchioles, terminal bronchioles
What is the respiratory zone and what structures are in it?
gas exchange- respiratory bronchioles, alveolar ducts, alveolar sacs
What is the relationship between Pa, Pv, and PA in the West Zones?
Zone 1- PA>Pa>Pv; Zone 2- Pa>PA>Pv; Zone 3 Pa>Pv>Pa
What lung zone has the most blood flow?
Zone 3- dependent part
What indicates a brachial plexus injury?
muscle of arm and hand not working properly, loss of feeling
What indicates an ulnar nerve injury?
numbness and tingling of 4th and 5th fingers
What indicates a radial nerve injury?
drooping of wrist and fingers
What indicates a suprascapular nerve injury?
pain in the shoulder, weakness or loss of shoulder function
What indicates a sciatic nerve injury?
weakness of knee flexion, foot movements, difficulty bending foot inward or down
What indicates a common peroneal nerve injury?
inability to point toes toward body (dorsiflexion)
What indicates a posterior tibial nerve injury?
flattening of foot, inward ankle roll, turning out of toes and foot
What indicates a saphenous nerve injury?
loss of sensation over medial aspect of lower leg
What indicates a obturator nerve injury?
difficulty with ambulation and development of unstable leg
What indicates a pudendal nerve injury?
phantom pain in lower regions of the pelvis
What indicates a femoral nerve injury?
inability to walk, decreased sensation in leg and foot
What’s a rare but serious complication that can arise from the sitting position?
venous air embolism (VAE)
What are some s/s of a venous air embolism?
decreased BP and EtCO2, SpO2, rise in CVP, onset of dyspnea, air on TEE
What do you do if you suspect a VAE?
100% FiO2, flood surgical field with saline, place surgical site below heart, aspirate air from central line, rapid fluid bolus, turn off volatile anesthetic, give epi, start CPR if necessary, left lateral decubitus
What are the 4 mechanisms of nerve injury?
stretch/traction, transection, compression, and kinking
