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Anesthesia Principles I > Test I part I > Flashcards

Test I part I Flashcards

1
Q

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?

A

Q 5min

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2
Q

AANA standard #9 states:

A

monitor, evaluate, and document the patients physiologic condition as appropriate for the procedure and anesthetic technique

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3
Q

AANA std #9 states that when a physiological monitoring device is used, what must be done regarding the alarms?

A

variable pitch and threshold alarms are turned on and audible

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4
Q

_________________ is how close the value is to the true value

A

accuracy

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5
Q

____________ how repeatable are the measurements

A

precision

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6
Q

__________________ is a simple and reliable means of monitoring heart and breath sounds

A

stethoscopy

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7
Q

what are the two ways stethoscopy can be accomplished?

A
  1. precordial stethoscope
  2. esophageal stethoscope
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8
Q

precordial stethoscope is most commonly used with which surgical population?

A

peds (but can be used on adults as well)

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9
Q

_______________ is a metal bell attached to tubing and a custom earpiece

A

precordial stethoscope

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10
Q

T/F: a precordial stethoscope can be used during all forms of anesthesia: MAC, regional, and general

A

true

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11
Q

______________ is a form of stethoscopy that monitors heart sounds, breath sounds, and temperature

A

esophageal stethoscope

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12
Q

esophageal stethoscope can only be used during which anesthesia technique?

A

general

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13
Q

what population would you avoid the use of an esophageal stethoscope?

A

esophageal or gastric bypass surgery
pt with esophageal varices

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14
Q

T/F: there is a high risk of pharyngeal or esophageal trauma, and/or insertion into lung with an esophageal stethoscope

A

false; low risk

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15
Q

when might you see a pulse deficit (i.e. pulse rate less than heart rate)

A

with ectopy, Afib, PVCs, PEA

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16
Q

______________ is a detectable peripheral arterial pulsation

A

pulse rate

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17
Q

what is the most common and required diagnostic tool in the OR?

A

ECG

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18
Q

approximately __________ of patients for non-cardiac surgery have risk factors for CAD

A

1/3

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19
Q

what is the incidence of perioperative ischemia in patients with CAD scheduled for cardiac or non-cardiac surgery?

A

20-80%

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20
Q

ST trending with a continuous ECG in the OR may reduce __________________

A

morbidity

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21
Q

indications for ECG

A
  1. measurement of heart rate
  2. diagnosis of arrhythmias, electrolyte imbalances, and conduction defects
  3. diagnosis of ischemia
  4. pathologic Q waves
22
Q

continuous ECG monitoring is a standard of care and required for any patient receiving and anesthetic. This includes which components of the ECG?

A
  1. heart rate
  2. heart rhythm
  3. for some pts: ST segments & T waves
23
Q

a lead composed of 2 electrodes of opposite polarity is called a _______________

A

bipolar lead

24
Q

a lead composed of a single positive electrode and a reference point is a ________________

A

unipolar

25
Q

which ECG leads are your bipolar leads?

A

std limb leads (I, II, III)

26
Q

which leads are your unipolar leads?

A

precordial leads (V1-V6)

27
Q

what leads are your modified unipolar leads?

A

goldbergers augmented leads (aVR, aVF, aVL)

28
Q

what view of the heart is not “visible” with a 3 lead ECG?

A

anterior

29
Q

T/F: improper placement of ECG leads in a 3 lead system in pt with CAD will not be an issue

A

false; may lead to abnormal ECG pattern (ST deviation, inverted T waves, Q waves)

30
Q

the _____________ lead placement ECG has been deemed a standard of care for at risk patients

A

5

31
Q

what are the 2 most common ECG monitoring leads used in a 5-lead placement

A

II and V5

32
Q

which lead in a 5-lead is preferred for arrhythmia monitoring , due to its ability to monitor P-waves

A

II

33
Q

which lead in a 5-lead system has been found to detect ischemia earliest and most frequently

A

V3

34
Q

which leads in a 5-lead placement are preferred for ischemia monitoring

A

V3-V5

35
Q

for standard limb leads (I, II, III) what is the basic morphology of the waveforms?

A

positive deflection

36
Q

what is the basic morphology of the ECG waveform in aVR lead?

A

negative deflection

37
Q

basic morphology of ECG waveform in aVL lead?

A

P & T are negative
QRS biphasic

38
Q

what is the basic morphology of the ECG waveform in aVF?

A

positive deflection

39
Q

what is the basic morphology of the ECG waveform in the precordial leads (V1-6)

A

P & T positive
QRS starts negative and ends positive.

40
Q

what are the most common cause of ECG artifact in the OR

A

ECU (most common)
Intraoperative nerve monitoring (IONM) stimulation
shavers

41
Q

which part of the ECG is the most sensitive to myocardial ischemia

A

ST segment

42
Q

ST elevation with/without tall T waves is ______________ ischemia; which is d/t ______________

A

transmural ; Acute coronary artery occlusion or spasm

43
Q

which type of myocardial ischemia is more likely to have a Q wave

A

transmural

44
Q

ST depression is indicative of ___________________ ischemia ; most often d/t ______________, and/or ____________

A

subendocardial; stable angina; significant but stable CAD

45
Q

what will the ECG monitor look like with hypokalemia

A

ST depression, flattened T wave

46
Q

decreased __________ prolongs repolarization as seen in long QT syndrome and torsades de points

A

potassium

47
Q

with mildly elevated hyperkalemia, what ECG changes will you see

A

narrow, peaked T waves, short QT interval

48
Q

with moderately elevated hyperkalemia, what ECG changes will you see

A

QRS widening, flat P wave, PR prolongation, 2nd and 3rd degree heart block

49
Q

with extremely elevated hyperkalemia, what EKG changes will you see

A

ventricular flutter, asystole

50
Q

ECG changes with hypercalcemia

A

short QT, decreased T wave amplitude or inversion

Anesthesia Principles I (5 decks)

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