Test I part I Flashcards
according to the AANA standard #9 on monitoring and alarms, how often is blood pressure, heart rate, and respiration required to be documented for all anesthestics?
Q 5min
AANA standard #9 states:
monitor, evaluate, and document the patients physiologic condition as appropriate for the procedure and anesthetic technique
AANA std #9 states that when a physiological monitoring device is used, what must be done regarding the alarms?
variable pitch and threshold alarms are turned on and audible
_________________ is how close the value is to the true value
accuracy
____________ how repeatable are the measurements
precision
__________________ is a simple and reliable means of monitoring heart and breath sounds
stethoscopy
what are the two ways stethoscopy can be accomplished?
- precordial stethoscope
- esophageal stethoscope
precordial stethoscope is most commonly used with which surgical population?
peds (but can be used on adults as well)
_______________ is a metal bell attached to tubing and a custom earpiece
precordial stethoscope
T/F: a precordial stethoscope can be used during all forms of anesthesia: MAC, regional, and general
true
______________ is a form of stethoscopy that monitors heart sounds, breath sounds, and temperature
esophageal stethoscope
esophageal stethoscope can only be used during which anesthesia technique?
general
what population would you avoid the use of an esophageal stethoscope?
esophageal or gastric bypass surgery
pt with esophageal varices
T/F: there is a high risk of pharyngeal or esophageal trauma, and/or insertion into lung with an esophageal stethoscope
false; low risk
when might you see a pulse deficit (i.e. pulse rate less than heart rate)
with ectopy, Afib, PVCs, PEA
______________ is a detectable peripheral arterial pulsation
pulse rate
what is the most common and required diagnostic tool in the OR?
ECG
approximately __________ of patients for non-cardiac surgery have risk factors for CAD
1/3
what is the incidence of perioperative ischemia in patients with CAD scheduled for cardiac or non-cardiac surgery?
20-80%
ST trending with a continuous ECG in the OR may reduce __________________
morbidity
indications for ECG
- measurement of heart rate
- diagnosis of arrhythmias, electrolyte imbalances, and conduction defects
- diagnosis of ischemia
- pathologic Q waves
continuous ECG monitoring is a standard of care and required for any patient receiving and anesthetic. This includes which components of the ECG?
- heart rate
- heart rhythm
- for some pts: ST segments & T waves
a lead composed of 2 electrodes of opposite polarity is called a _______________
bipolar lead
a lead composed of a single positive electrode and a reference point is a ________________
unipolar
which ECG leads are your bipolar leads?
std limb leads (I, II, III)
which leads are your unipolar leads?
precordial leads (V1-V6)
what leads are your modified unipolar leads?
goldbergers augmented leads (aVR, aVF, aVL)
what view of the heart is not “visible” with a 3 lead ECG?
anterior
T/F: improper placement of ECG leads in a 3 lead system in pt with CAD will not be an issue
false; may lead to abnormal ECG pattern (ST deviation, inverted T waves, Q waves)
the _____________ lead placement ECG has been deemed a standard of care for at risk patients
5
what are the 2 most common ECG monitoring leads used in a 5-lead placement
II and V5
which lead in a 5-lead is preferred for arrhythmia monitoring , due to its ability to monitor P-waves
II
which lead in a 5-lead system has been found to detect ischemia earliest and most frequently
V3
which leads in a 5-lead placement are preferred for ischemia monitoring
V3-V5
for standard limb leads (I, II, III) what is the basic morphology of the waveforms?
positive deflection
what is the basic morphology of the ECG waveform in aVR lead?
negative deflection
basic morphology of ECG waveform in aVL lead?
P & T are negative
QRS biphasic
what is the basic morphology of the ECG waveform in aVF?
positive deflection
what is the basic morphology of the ECG waveform in the precordial leads (V1-6)
P & T positive
QRS starts negative and ends positive.
what are the most common cause of ECG artifact in the OR
ECU (most common)
Intraoperative nerve monitoring (IONM) stimulation
shavers
which part of the ECG is the most sensitive to myocardial ischemia
ST segment
ST elevation with/without tall T waves is ______________ ischemia; which is d/t ______________
transmural ; Acute coronary artery occlusion or spasm
which type of myocardial ischemia is more likely to have a Q wave
transmural
ST depression is indicative of ___________________ ischemia ; most often d/t ______________, and/or ____________
subendocardial; stable angina; significant but stable CAD
what will the ECG monitor look like with hypokalemia
ST depression, flattened T wave
decreased __________ prolongs repolarization as seen in long QT syndrome and torsades de points
potassium
with mildly elevated hyperkalemia, what ECG changes will you see
narrow, peaked T waves, short QT interval
with moderately elevated hyperkalemia, what ECG changes will you see
QRS widening, flat P wave, PR prolongation, 2nd and 3rd degree heart block
with extremely elevated hyperkalemia, what EKG changes will you see
ventricular flutter, asystole
ECG changes with hypercalcemia
short QT, decreased T wave amplitude or inversion
