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Chapter 19 study guide Flashcards

1
Q

what is the difference between invasive& noninvasive analyzing monitoring?

A

Invasive requires inerstion of sensor or collection device into body - more accuracy but greater risk
Noninvasive monitering is means of gathering data externally

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2
Q

what are the sites for arterial puncture and the preferred site?

A

Brachial artery
Radial Artery
Femoral Artery
Dorsalis Pedis
radial artery is preferred

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3
Q

indications for blood gas sampling

A

Evaluate ventilation, acid base balance, oxygenation status & oxygen carrying capacity of blood
Assess the patient’s response to therapy or diagnostic test
To monitor the severity & progression of a documented disease process

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4
Q

Complications of ABG puncture

A

Arteriospasm
Hemorrhage
Air or clotted blood emboli
Trauma to the vessel
Anaphylaxis from location anesthetic
Patient or sampler contamination
Vasovagal response
Hematoma
Pain

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5
Q

what are the supplies needed for percutaneous arterial blood sampling of an adult?

A

barrier protection (gloves/safety goggles)
Preheparinzied blood gas kit syringe (1-3mL)
Short bevel 20- to 22-gauge needle with a clear hub (23- to 25- gauge for children/infants)
Isopropyl alcohol (70%), povidone-iodine(Betadine)
Sterilize gauze squares, tape, bandages
puncture resistant container
ice slush, depending upon the analyzer
towels, sharp container, local anesthetic, & needle capping device

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6
Q

What do you check in a chat/medical record prior to an arterial puncture and invasive procedure involving blood sampling? (safety precautions for clinician&patient)

A

past medical history, medications, age, medications

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7
Q

Describe Modified Allen’s test meaning

A

Done before an arterial puncture to ensure collateral circulation of the hand

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8
Q

Describe safe handling of a used needle

A

never recap a used needle without a safety device
Never handle a used needle using both hands
Never point a used needle toward any part of the body
Never bend, break, or remove a used needle from syringes by hand
Always dispose of used syringes, needles, & other sharp items in appropriate puncture resistant sharps containers

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9
Q

Levels for Oxygen?

A

95%

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10
Q

Levels for pH (hydrogen levels in blood)

A

7.35-7.45 mmHg

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11
Q

Levels for partial pressure of carbon dioxide (PaCO2 associate to lung)

A

35 - 45 mmHg

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12
Q

Levels for Bicarbonate (HCO3 - associate to kidneys)

A

22 - 26 mEq/L

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13
Q

Acid-Base Status

A

pH , CO2, HCO3-

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14
Q

Levels for mild hypoxemia

A

60 - 79 mmHg

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15
Q

Levels for Moderate hypoxemia

A

40 - 59 mmHg

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16
Q

Levels for severe hypoxemia

A

<40mmHg

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17
Q

Oxygenation Status

A

PaO2

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18
Q

Low Oxygen Level is termed as?

A

hypoxemia

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19
Q

Can hyperventilation (unsteady breathing) cause changes in ABG results while doing the procedure?

A
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20
Q

What is the time to return to steady states for healthy lungs & lung disease?

A
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21
Q

Pre-analytic errors associated with arterial blood

A

occurs before sample analysis
obtaining samples anaerobically (with immediate expulsion of air bubbles) using proper anticoagulated syringes made of low diffusibility material, & prompt sample analysis using properly function equipment

22
Q

Pre-analytic error associated with air in sample

A

pH increases
PCO2 decreases
PO2 increase or decrease towards 150 mmHg (room air)
recognize : visible bubbles or froth
avoid : fully expel bubbles, cap sample quickly then mix sample

23
Q

Pre-analytic error associated with excess anticoagulant

A

pH decreases
PCO2 decreases towards 0 mmHg
PO2 increases or decreases towards 150 mmHg
recognize : visible heparin remains in syringe before sampling
avoid: use premade lyophilized(dry) heparin blood gas kits

24
Q

Pre-analytic error associated with venous admixture

A

pH decreases
PCO2 increases
PO2 decreases
recognize: failure of syringe to fill by pulsations (veins do not pulsate)
avoid: avoid brachial & femoral sites, do not aspirate & used a short bevel needle
do not “overshoot” crosscheck with SpO2%

25
Pre-analytic error associated with metabolic effects
pH decreases PCO2 increases PO2 decreases recognize : time lag since sample was collected avoid: analyze within 15 minutes & place sample in slush (iced to prevent metabolizing)
26
what is the recommended time for analysis of arterial blood?
within 10-15 minutes no later than 30 minutes
27
what is the amount of blood required for arterial sampling?
Volume of 0.5 - 1ml of blood actual depends on anticoagulant used requirements of specific analyzer used whether or not other test will be performed on obtained sample
28
what should be charted/recorded once an arterial puncture has been completed?
Date, time & site of sampling Results of the modified Allen test Patient's body temp, position, activity level, & respiratory rate Type & level of O2 supplementation & all applicable ventilatory support settings
29
what is the advantage of point of care testing?
bedside non invasive
30
define the purpose of transcutaneous monitoring & gases monitored ; is it invasive or noninvasive?
Noninvasive The need to monitor continuously the adequacy of arterial oxygenation or ventilation The need to quantify the real time responses to disgnostic & therapeutic interventions, as evidenced by PtcO2 or PtcCO2 values
31
define capillary blood gases (CBG)
Reflect & provide clinically useful estimates of arterial pH & PCO2 levels
32
Indications for CBGs
ABG analysis is indicated, but arterial access is unavailable Noninvasive monitor readings are abnormal assessment of initiation, administration, or change in therapy is indicated A change in patient status is detected by history or physical assessment Monitoring the severity & progression of a documented disease process is desirable
33
Common sites for transcutaneous monitoring
Infants/Children - abdomen, chest, & lower back
34
Indications for transcutaneous monitoring
The need to monitor continuously the adequacy of arterial oxygenation or ventilation Need to quanify the real time responses to diagnostic & therapeutic interventions, as evidenced by PtcO2 or PtcCo2 values
35
Define pulse oximetry & its use in monitoring (invasive or noninvasive)
Noninvasive monitoring technique performed at bedside SpO2 normal > 95% on room air Noninvasive portable monitoring device providing estimates of SaO2
36
What is carboxyhemoglobin (HbCO)
when carbon monoxide binds to hemoglobin preventing it from carrying oxygen
37
Problems when monitoring with pulse oximetry, can the reading be accurate?
Device limitations causing false-negative results for hypoxemia or false positive results for normoxemia or hypoxemia may lead to inappropriate treatment of patients Factors affecting SpO2, accuracy include motion artifact, abnormal hemoglobins, intravascular dyes, low perfusion states, skin pigmentation, & nail polish Unreliable during carbon monoxide poisoning
38
What other oximetry analysis should we recommend if carbon monoxide is suspected?
Hemoximety (cooximetry)
39
Precautions/complications of capillary blood gas
Contamination & infection of the patient Burns Hematoma Bruising Scarring Bleeding
40
What is capnometry? Mainstream sampling (common) Sidestream sampling
The measurement of CO2 in respiratory gases. A device that measures CO2. Mainstream - places an analysis chamber in patient's breathing circuit Sidestream - pumps small volume of gas from circuit into nearby analyzer
41
Understand etCO2 range
35-mmHg or 5% co2
42
Understand waveform
Waveforms
43
Understand gradient
measures the difference between oxygen concentration in the alveoli and arterial system
44
Why is the Radial Artery preferred/common?
Near the surface/easy to stabilize Collateral circulation usually exists No large veins are near Relatively pain free
45
Describe Modified Allen Test procedure
Hand is clenched into a tight fist Hand is opened (not fully); palm & fingers are blanched Removal of pressure on the ulnar artery should cause flushing of the entire hand (5-10 sec) which indicate adequate collateral circulation (positive)
46
What is PaCo2
partial pressure of carbon dioxide in arterial blood
47
What is pH & PaCO2
ph measure the acidity or alkalinity of the blood PaCO2 measures the partial pressure of carbon dioxide in arterial blood
48
What is SaO2
arterial oxygen saturation
49
Clinical signs & needs for Blood Gas Sampling
Sudden, unexplained dyspnea Cyanosis Abnormal breath sounds severe, unexplained tachypnea Changes in ventilator settings Cardiopulmonary resuscitation Acute hypotension Acute deterioration in neurologic function Sudden appearance or progression of cardiac arrythmias
50
Contraindictaions for Transcutaneous Monitoring
There are no absolute contraindications. In patients with poor skin integrity or adhesive allergy, alternative devices should be considered
51
Hazards of Transcutaneous Monitoring
False negative or false positive results may lead to inappropriate treatment Tissue injury (erythema, blisters, burns, skin tears) may occur at the measuring site

RCP (10 decks)

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