Respiratory Monitors & Equipment 6.3 Flashcards by Kelly K

What type of pulmonary compliance is a function of both airway resistance and the elasticity of the chest wall?

resp. monitors & equip

dynamic compliance

section 1 flashcard

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What is the formula for dynamic compliance?

resp. monitors & equip

tidal volume / PIP - PEEP

section 1 flashcard

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What type of pulmonary compliance is a function of the elasticity of the chest wall only?

resp. monitors & equip

static compliance

section 1 flashcard

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What is the formula for static compliance?

resp. monitors & equip

tidal volume / plateau pressure - PEEP

section 1 flashcard

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Things that increase pulmonary resistance

resp. monitors & equip

Foreign body aspiration
Bronchospasm
ETT cuff herniation
Bronchial secretions
Kinked ETT
Airway compression

section 1 flashcard

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Things that decrease pulmonary compliance

resp. monitors & equip

Trendelenburg position
Endobronchial intubation
Pulmonary edema
Pleural effusion
Abdominal insufflation
Atelectasis
Tension pneumothorax
Inadequate muscle relaxation
Ascites

section 1 flashcard

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What does the first upward slope on the capnograph represent?
a. inspiration of fresh gas
b. exhalation of alveolar gas
c. exhalation of anatomic dead space
d. exhalation of anatomic dead space + alveolar gas

resp. monitors & equip

d. exhalation of anatomic dead space + alveolar gas

pre-lesson Q2

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Wher is the alpha angle measured capnograph?

resp. monitors & equip

First angle of the waveform

section 2 flashcard

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Where is the beta angle measured capnograph?

resp. monitors & equip

Second angle of the waveform

section 2 flashcard

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List 2 methods of CO2 analysis

resp. monitors & equip

mainstream (in-line)
sidestream (diverting)

section 2 flashcard

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Which method of CO2 analysis will take longer to reveal a circuit disconnect?

resp. monitors & equip

sidestream (diverting) because it has a longer response time. The sample must travel through long tubing before it reaches the monitor.

section 2 flashcard

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What does an increased alpha angle signify?

resp. monitors & equip

expiratory airflow obstruction such as COPD, bronchospasm, or a kinked ETT

section 2

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What characteristics of the capnograph represent airflow obstruction?

resp. monitors & equip

increased alpha angle leading to “shark fin” morphology

ex. COPD, bronchospasm, kinked ETT

section 3

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What characteristics of the capnograph represent cardiac oscillations?

resp. monitors & equip

decreasing peak EtCO2 near end of wave with small spikes

more common in children; caused by heart beating against lungs

section 3

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What characteristics of the capnograph represent a curare cleft?

resp. monitors & equip

small dip in the plateau

represents spont. breath during mechanical ventilation

section 3

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What characteristics of the capnograph represent an incompetent inspiratory valve?

resp. monitors & equip

increased beta angle with decreased slope of the inspiratory phase

part of the exhaled breath re-enters the insp. limb; may/may not reach 0

section 3

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What characteristics of the capnograph represent a leak in the sample line during PPV?

resp. monitors & equip

the beginning of the plateau is low because alveolar gas is diluted when atmospheric air is aspirated into the sample line
-not seen with spont. ventilation
-may also occur in obese or pregnant patients

section 3

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What characteristics of the capnograph represent biphasic expiratory platueas and what causes this?

resp. monitors & equip

two peaks in the plateau in single lung transplants
-first peak is from transplanted lung with a normal time constant
-second peak is from diseased lung d/t air trapping

section 3

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Factors that increase EtCO2

resp. monitors & equip

-incompetent unidirectional valve
-thyrotoxicosis
-increased apparatus dead space
-tourniquet removal
-MH
-opioid overdose
-laparoscopy

section 4 flashcard

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Factors that decrease EtCO2

resp. monitors & equip

-decreased CO
-esophageal intubation
-V/Q mismatch
-hypothermia
-airway obstruction
-hypotension

section 4 flashcard

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Select the statements that most accurately describe pulse oximetry. (Select 2)
a. oxygenated hemoglobin absorbs light at 940 nm
b. at the peak of the waveform, the ratio of arterial blood to venous blood is reduced
c. it is based on the Beer-Lambert law
d. it is based on the Doppler effect

resp. monitors & equip

a. oxygenated hemoglobin absorbs light at 940 nm
c. it is based on the Beer-Lambert law

pre-lesson Q5

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What wavelength of light is preferentially absorbed in venous blood?

resp. monitors & equip

red light 660 nm
deoxyhemoglobin

section 5 flashcard

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What wavelength of light is preferentially absorbed in arterial blood?

resp. monitors & equip

940 nm
oxyhemoglobin

section 5 flashcard

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How does the location of the pulse oximeter affect response time?

resp. monitors & equip

As a general rule, the closer the monitorin gsite is to the central circulation, the faster it will repsond to arterial desaturation

section 5 flashcard

The pulse oximeter reads 80%. You estimate the PaO2 is approximately: ## Footnote resp. monitors & equip

50 mmHg ## Footnote pre-lesson Q6

Which factors shift the oxyhemoglobin dissociation curve to the left? ## Footnote resp. monitors & equip

carboxyhemoglobin fetal hemoglobin methemoglobin increased pH hypothermia decreased 2,3 DPG hypocapnia ## Footnote section 6 flashcard

Which factors shift the oxyhemoglobin dissociation curve to the right? ## Footnote resp. monitors & equip

MH chronic anemia increased 2,3 DPG decreased pH pyrexia thyroid storm hypoxia hypercapnia ## Footnote section 6 flashcard

Identify the PaO2 values for each SpO2 value. 1. SpO2 70% 2. SpO2 80% 3. SpO2 90% ## Footnote resp. monitors & equip

1. 70% = 40 mmHg 2. 80% = 50 mmHg 3. 90% = 60 mmHg ## Footnote section 6 flashcard

The pulse oximeter is a useful monitor of: a. ventilation b. bronchial intubation c. anemia d. vascular compression ## Footnote resp. monitors & equip

d. vascular compression ## Footnote pre-lesson Q7

Factors that the pulse oximeter can monitor for: ## Footnote resp. monitors & equip

insight about fluid responsiveness measure oxyhemoglobin saturation measure heart rate assess peripheral perfusion ## Footnote section 7 flashcard

Which condition is least likely to affect the reliability of the pulse oximeter? a. jaundice b. LVAD c. carboxyhemoglobin d. blue nail polish ## Footnote resp. monitors & equip

a. jaundice ## Footnote pre-lesson Q8

What is an acceptable margin of error for the pulse oximeter? ## Footnote resp. monitors & equip

When the SpO2 is 70-100%, the margin of error is +/- 2-3% When SpO2 is 50-70%, the margin of error is 3% ## Footnote section 8 flashcard

Describe the optical characteristics of methemoglobin. ## Footnote resp. monitors & equip

absorbs both near-infrared light (940 nm) and red light (660 nm) equally which can lead to erroneous readings on the pulse oximeter. ## Footnote section 8 flashcard

What factors affect the reliability of the pulse oximeter? ## Footnote resp. monitors & equip

Raynaud's disease Indigo carmine Cardiopulmonary bypass Vasoconstriction Indocyanine green Shivering Methylene Blue ## Footnote section 8 flashcard

What is the most common method of measuring exhaled gases inside the breathing circuit? a. mass spectrometry b. Raman scattering c. piezoelectric crystals d. infrared absorption ## Footnote resp. monitors & equip

d. infrared absorption ## Footnote pre-lesson Q9

How does the mass spectrometry analzye an exhaled gas sample? ## Footnote resp. monitors & equip

Bombards a gas sample with eletrons creating ion fragments ## Footnote section 9 flashcard

How does the Raman Scatter Spectrometry analyze an exhaled gas sample? ## Footnote resp. monitors & equip

Uses a high power argon laser to produce photons, which in turn collide with the gas molecules ## Footnote section 9 flashcard

How do Piezoelectric Crystals analyze an exhaled gas sample? ## Footnote resp. monitors & equip

Detects inspired, expired, and breath to breath changes of a particular gas by incorporating a lipid layer on the crystal ## Footnote section 9 flashcard

How does Infrared Absorption analyze an exhaled gas sample? ## Footnote resp. monitors & equip

Different gases absorb different wavelengths of infrared light, each having a signature "fingerprint". Diatomic moleculres don't absorb IR light. ## Footnote section 9 flashcard

During a laparoscopic gastric sleeve procedure, the peak inspiratory pressure acutely increases from 38 to 52 cm H2O. The plateau pressure remains unchanged. What are the most likely etiologies of these findings? a. bronchospasm b. tension pneumothorax c. kinked ETT d. pulmonary edema ## Footnote resp. monitors & equip

a. bronchospasm c. kinked ETT | increased airway resistance results in inc. PIP and unchanged plat. pres ## Footnote post lesson quiz

What is the most likely cause of an acute reduction in the end-tidal carbon dioxide concentration? a. opioid overdose b. convulsions c. rebreathing d. hemorrhage ## Footnote resp. monitors & equip

d. hemorrhage | others would increase EtCO2 ## Footnote post lesson quiz

During anesthetic induction, the SpO2 fails to display on the monitor. The circulating nurse notes that the patient is wearing green nail polish. What is the most appropriate intervention at this time? a. remove the fingernail polish b. rotate the probe 90 degrees on the finger c. monitor serial ABGs during the procedure d. switch to a cerebral oximeter ## Footnote resp. monitors & equip

b. rotate the probe 90 degrees on the finger ## Footnote post lesson quiz

Which conditions can cause a falsely increased pulse oximeter value? a. tricuspid regurgitation b. fluorescein c. red nail polish d. carboxyhemoglobin ## Footnote resp. monitors & equip

d. carboxyhemoglobin ## Footnote post lesson quiz

Which conditions are associated with a decreased PaCO2 to EtCO2 gradient? a. venous air embolism b. dysfunctional inspiratory unidirectional valve c. CO2 absorption during laparoscopic surgery d. seizures ## Footnote resp. monitors & equip

b. dysfunctional inspiratory unidirectional valve | rebreathing=increased both CO2 measures but smaller gradient ## Footnote post lesson quiz

Placing the pulse oximeter on which finger is most likely to cause a corneal abrasion during anesthetic emergence? a. middle b. index c. ring d. pinky ## Footnote resp. monitors & equip

b. index ## Footnote post lesson quiz

Which monitor is unable to measure the oxygen concentration in the breathing circuit? a. paramagnetic analysis b. infrared absorption spectrophotometry c. clark electrode d. raman scatter spectrometry ## Footnote resp. monitors & equip

b. infrared absorption spectrophotometry | O2 does not absorb infrared light ## Footnote post lesson quiz

What is the most reliable monitor for the detection of bronchial intubation? a. capnograph b. chest auscultation c. oxygen analyzer d. pulse oximeter ## Footnote resp. monitors & equip

b. chest auscultation ## Footnote post lesson quiz

In which patients is the pulse oximeter most likely to provide an inaccurate measurement? (Select 2) a. 7 year-old rescued from a basement fire b. 10 year-old with jaundice c. 15 year-old who received fluorescein d. 3 year-old toxic from EMLA cream overdose ## Footnote resp. monitors & equip

a. carbon monoxide poisoning d. methemoglobinemia ## Footnote review exam

Which pulse oximeter location is associated with the slowest response time? a. finger b. nose c. tongue d. ear ## Footnote resp. monitors & equip

a. finger ## Footnote review exam

Determinants of dynamic compliance include all of the following except: a. plateau pressure b. PEEP c. tidal volume d. peak inspiratory pressure ## Footnote resp. monitors & equip

a. plateau pressure ## Footnote review exam

Which of the following is the least reliable monitor for endobronchial intubation? a. fiberoptic bronchoscope b. lung auscultation c. pulse oximeter d. pressure-volume loop ## Footnote resp. monitors & equip

c. pulse oximeter ## Footnote review exam

Choose the statement that reflects the most complete understanding of pulse oximetry. a. it is based on the Coanda effect b. 660 nm light is preferentially absorbed by reduced hemoglobin c. it emits two wavelengths of ultraviolet light d. at the trough of the waveform, the sample contains more arterial blood ## Footnote resp. monitors & equip

b. 660 nm light is preferentially absorbed by reduced hemoglobin ## Footnote review exam

The mixed venous oxygen saturation monitor reads 70%. Estimate the PvO2. ## Footnote resp. monitors & equip

40 mmHg | 40,50,60 = 70,80,90 ## Footnote review exam

All of the following contribute to an increased PaCO2-EtCO2 gradient except: a. laparoscopy b. sample line leak c. right-to-left shunt d. pulmonary embolism ## Footnote resp. monitors & equip

a. laparoscopy ## Footnote review exam

Match each condition with its most likely effect on pulmonary pressure monitoring. 1. pulmonary embolism 2. mucus plug 3. endobronchial intubation a. decreased static compliance b. decreased dynamic compliance c. no change in dynamic or static compliance ## Footnote resp. monitors & equip

1c 2b 3a | dynamic=PIP, static=PP ## Footnote review exam

Infrared analysis is able to measure: (Select 3) a. carbon dioxide b. oxygen c. xenon d. helium e. nitrous oxide f. volatile anesthetics ## Footnote resp. monitors & equip

a. carbon dioxide e. nitrous oxide f. volatile anesthetics | cannot measure gases with only one type of atom ## Footnote review exam

Which of the following is a contraindication to pulse oximetry? a. Raynaud's disease b. Takayasu arteritis c. cardiopulmonary resuscitation d. there are no contraindications to pulse oximetry ## Footnote resp. monitors & equip

d. there are no contraindications to pulse oximetry ## Footnote review exam

When compared to a mainstream carbon dioxide sensor, which of the following is an advantage of a sidestream carbon dioxide sensor? a. elimination of the water trap b. absence of a pumping mechanism c. less apparatus dead space d. faster response time ## Footnote resp. monitors & equip

c. less apparatus dead space ## Footnote review exam