Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Lindsays Flashcardlet > RE 3- 17 > Flashcards

RE 3- 17 Flashcards

0
Q

What is “sweeping”?

A

systematic visualization of anesthesia field from machine to patient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
1
Q

Which standard is the AANA Scope and Standards for Nurse Anesthesia Practice

A

Standard V

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What type of events occur most often?

A

respiratory

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the main areas of AANA Standard V? (4)

A 
ventilation
oxygenation
cardiovascular
temperature
neuromuscular
positioning
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is AANA ‘s standard for continuous ventilation monitoring?(3)

A

1) Verify ETT by auscultation, chest excursion, and EtCO2
2) continuously monitor EtCO2 during controlled/assisted breathing or artificial airway
3) use spirometry and ventilatory pressure monitors as indicated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is AANA’s standard for continuous oxygenation monitoring? (3)

A

clinical observation
pulse oximetry
ABG if indicated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is AANA standard for continuous CV monitoring?

A

EKG and heart tones

Record BP and HR at least Q5m

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is AANA standard for neuromuscular monitoring?

A

when NMB used

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is AANA standard for monitoring temperature?

A

all peds receiving GA

when indicated in all other patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is AANA standard for assessing patient positioning?

A

assess and institute protective measures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Airway observations include:

A 
chest movement
airway obstruction: retractions, seesaw motion
condensation
feel of subtle air movement
sense of smell for disconnected circuit
airway sounds: stridor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Above all, what airway parameter should be observed?

A

minute ventilation

* Resp rate alone isn’t accurate to determine ventilatory status**

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

T or F Skin color alone is a reliable measure of adequate ventilation and oxygenation

A

F

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is a late sign of anemia and hypoxia?

A

cyanosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What do ABGs assess?

A

ventilation and metabolic status

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Is an ABG a direct or indirect measure of ventilation and metabolic state?

A

direct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

The measure of CO2 in the blood is based on what?

A

H+

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Bicarbonate buffer system reaction =

A

CO2 + H20 <> H2CO3 <> H+ + HCO3-

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What do colorimetric EtCO2 devices detect?

What can cause false positives? (3)

A

carbonic acid via pH change

False positives= CO2 forced into stomach, carbonated beverages, or antacids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How many breaths are needed for accurate reading on disposible EtCO2?

A

6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the most common means of monitoring CO2 levels in anesthesia?

A

continuous electronic measurements of expired CO2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How does EtCO2 relate to arterial CO2?

A

ETCO2 is ~ 2 to 5 torr lower than arterial CO2 in patients without cardiac or pulmonary abnormalities.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Define capnogram.

A

continuous display of CO2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How does continuous CO2 monitoring work?

A

Infrared analysis-Each gas absorbs infrared radiation at a different wavelength.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Older monitors have difficulty distinguishing between CO2 and _.

A

nitrous oxide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Nondiverting CO2 sampling is know as_.

A

mainstream

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Diverting CO2 sampling is known as _.

A

sidestream

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Nondiverting CO2 sampling advantages.

A

minimal sample-time delay
few disposable items
no scavenging

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Nondiverting CO2 sampling disadvantages _.

A

Can’t measure gases other than CO2 and nitrous
increase circuit deadspace
interference by condensation and secretions
traction on tube- circuit disconnect
can’t sample nonintubated patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Diverting CO2 sampling disadvantages.

A

need to scavenge

contamination by condensation/secretions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Diverting CO2 sampling advantages.

A

minimal increase in deadspace
versatility in gas analysis (sample can be sent to agent monitors)
adapted to awake patients spont ventilating

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

T or F Sampling EtCO2 in Spont Vent patient’s hyopharynx is not reliable or accurate.

A

F

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

T or F EtCO2 has shown to be a more sensitive indicator of hypoventilation than clinical observation or pulse ox during sedation.

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Discuss phase 1 of capnogram.

A

A-B
baseline
end of inspiration to the beginning of expiration
gas from anatomic deadspace with no CO2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Dicuss phase 2 of capnogram.

A

B-C
expiratory upstroke
mix of deadspace and alveolar gas
rapid passing of initial expired gas through upper airways

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Discuss phase 3 of capnogram.

A

C-D
plateau, alveolar emptying
very nearly flat
longest duration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What part of the capnogram is EtCO2?

A

D

end of of the plateau just prior to inspiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Discuss phase 4 of capnogram.

A

D-E
rapid decrease in CO2
inspiration
should return to nearly 0

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

When are EtCO2 measurements inaccurate?

A

significant ventilation/perfusion mismatches

39
Q

When v/q ratio is large= ____ in deadspace causes a ____ concentration of EtCO2.

A

increase, low

40
Q

How do small tidal volumes affect EtCO2?

A

Reflects inadequate alveolar ventilation can underestimate arterial CO2

41
Q

Describe rebreathing CO2 waveform and causes.

A

fails to return to baseline

inadequate FGF or depleted soda lime

42
Q

What does a sloping of the plateau phase mean on CO2 wave? Causes?

A

progressive prolongation of expiration

COPD, kinking ETT or tubing, obstruction or VQ mismatch

43
Q

Describe cardiac oscillation on CO2 wave.

A

regular, sawtooth waves within expiratory phase
heart contractions force gas in and out
common in pediatrics dt size of heart to thorax

44
Q

Describe a curare cleft and causes?

A

irregular asynchronous waveform
spontaneous effort r/t insufficient anesthesia or paralytics
Causes increase or decrease ETCO2 levels

45
Q

T or F Transcutaneous CO2 monitoring provides immediate, breath by breath verification of ETT placement.

A

F

46
Q

How does transcutaneous CO2 monitoring work?

A

measures the change in H+ beat to beat

47
Q

When is transcutaneous CO2 monitoring beneficial?

A

ventilation/perfusion mismatching
severe obesity
OLV
when EtCO2 not practical (awake pt spont vent)

48
Q

What is most helpful in assessing acid-base balance and respiratory function?

A

ABG

49
Q

Clinical observation of oxygenation includes:

A 
skin color and temperature
nailbed perfusion signs
assessment of depth and rate of respirations
auscultation
assessment of upper airway patency
50
Q

How does pulse oximeter work?

A

transcutaneous measurement using a spectrophotometer to determine SpO2.
Oxygenated Hgb absorbs infrared light at diff wavelength then deoxygenated Hgb.
Measures amt of Unabsorbed red light via photosensitive diode.
Measures change in transmitted light during pulsatile flow (drop in light intensity w/each beat)

51
Q

Is most O2 in the body carried bound or unbound?

A

bound

52
Q

Oxygen carrying capacity is mainly dependent on _.

A

amount of Hb

53
Q

What is the oxygen carrying capacity of Hb?

A

1.34 ml/g of Hb

54
Q

What is the dissolved oxygen constant?

A

0.003 ml O2 / 100 ml blood at PaO2 100 mmHg

55
Q

What does CaO2 stand for?

A

total arterial oxygen content

56
Q

What is the equation for CaO2?

A

(0.003 x PaO2) + (1.34 x Hb x SaO2)

57
Q

What determines the amount of O2 that binds to Hgb?

A

PaO2 of plasma

58
Q

What two things is actual O2 delivery depend on?

A

oxygen content and CO

59
Q

What does oxygen saturation measure?

A

portion of Hb bound to O2, not the dissolved O2 in blood

60
Q

What does the oxyhemoglobin dissociation curve represent?

A

relationship between oxygen tension and percent oxygen saturation

61
Q

What is on the x and y axis of oxyhemoglobin dissociation curve?

A

x- PaO2

y- SpO2

62
Q

What is special about a PaO2 50 mmHg on oxyhemoglobin dissociation curve?

A

The amount of SpO2 rapidly increases per increase in PaO2 and then slows thereafter

63
Q

On the oxyhemoglobin dissociation curve, what does a PaO2 of 60 mmHg correlate to?
PaO2 of 40 mmHg =____%SpO2

A

60=SpO2 90%

40= SpO2 75%

64
Q

Discuss a right shift in oxyhemoglobin dissociation curve. Causes?

A 
more ready release of O2 to tissues
Elevated CO2
elevated temperature
elevated 2,3-DPG
Decreased ph, acidosis, elevated H+
65
Q

Discuss a left shift in oxyhemoglobin dissociation curve. Causes?

A 
greater attachment of O2 to Hb, decrease to tissue
decreased CO2
decreased temperature
decreased 2,3-DPG
elevated ph, alkalosis, decreased H+
66
Q

Discuss pulse oximetry accuracy.

A

within 2% if SpO2 80-100%

within 5% SpO2< 80%

67
Q

Methemoglobin absorbs light equal to _.

A

oxyhemoglobin

68
Q

Discuss the effect of methemoglobin on SpO2?

A

falsely underestimates when SpO2 >85% and falsely overestimates when SpO2 <85%

69
Q

What effect does carboxyhemoglobin have on SpO2?

A

overestimate SpO2

70
Q

List factors that can affect pulse ox reading?

A 
methemoglobin
carboxyhemoglobin
sickle cell
rare anemias
methylene blue
indigo carmine
71
Q

List other uses for pulse oximetry.

A 
determining SBP
locating vessels
determine presence of PVD
changes in sympathetic tone
degree of regional block
72
Q

Earlobe pulse oximetry is a sensitive measure of ____.

A

systemic circulation and SV bc it is not affected by changes in sympathetic tone
** ear lobe is effected by change in pulse pressure**

73
Q

What percentage of postoperative patients experience some degree of hypothermia?

A

70%

74
Q

List hypothermia risks with anesthesia.

A 
wound infection
delayed healing
increased O2 consumption with shivering
increase risk CV and MI events
increased sickling
prolonged PACU time = increased cost
75
Q

Define normothermia.
Hypothermia=
Hyperthermia=

A

37 deg C
<36 deg C
> 38 deg C

76
Q

What regulated body temperature?

A

hypothalamus

77
Q

Causes of hypothermia.

Body’s response=

A 
low ambient OR temperature
radiation
evaporation
convection
conduction
Body's Response = vasoconstriction & shivering
78
Q

List risk factors contributing to hypothermia.

A 
high ASA
lengthy or involved surgery
combined epidural/general anesthsia
long surgery
elderly
lean body mass
79
Q

Protective factors against hypothermia? (3)

A

Increased body weight
Higher preop temp
Warmer rooms

80
Q

Causes of hyperthermia.

Body’s response =

A 
malignant hyperthermia
fever
infection
hypermetabolic state
amphetamines, cocaine, ecstasy
atropine- inhibit sweating
Body response = vasodilation &sweating
81
Q

When does the greatest heat loss occur perioperatively?

A

first hour

82
Q

Define radiant heat loss.

A

transfer of body heat into a cooler environment

83
Q

What accounts for the majority of heat loss perioperatively?

Second most cause?

A

1st=radiant heat loss

2nd= evaporative

84
Q

Define evaporative heat loss.

A

liquids on the skin dissapating into the air.

cleasing and perspiration

85
Q

Define convection heat loss.

A

through moving cool air

86
Q

Define conductive heat loss.

A

through direct contact with a cooler object

87
Q

Define redistribution heat loss.

A

Lower temperature blood from vasodilated periphery to central compartment

88
Q

What types of anesthesia inhibit thermoregulation & cause significant vasodilation?

A

general and regional

89
Q

What is the ASA’s position on temperature monitoring?

A

when significant changes in temperature are intended, anticipated, or suspected

90
Q

What is the AANA’s position on temperature monitoring?

A

all pediatric patients receiving general anestesia and when indicated in all other patients

91
Q

Types of core temp monitoring ? Which are most accurate?

Core temp is most reflective of _____

A

Types: tympanic membrane, distal esophagus, nasopharynx, pulmonary artery
Most accurate: IV (pulm artery) or Bladder Thermistor
Core Temp is most reflective of thermal state

92
Q

Out of OR increased anesthetic risks caused by: (3)

A
  1. Decreased anesthesia staff available
  2. Less adjunct equipment
  3. Unfamiliarity with support staff & settings
93
Q

What is the most common mechanism of injury for anesthesia adminisered outside the operating room?

A

inadequate oxygenation or ventilation

94
Q

Pressure-volume loops provide insight into lung _________ and show volume on the ______ axis

A

Compliance, vertical

95
Q

Flow-volume loops provide information on pulmonary ______. And volume is on the _____ axis

A

Resistance, horizontal

Lindsays Flashcardlet (27 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions