Clincal monitoring Flashcards by Tanner W

What 6 things must be incorporated into care by the crna based on the AANA monitoring standards

-Oxygenation
-Ventilation
-Cardivascular(EKG, BP and HR Q 5 mins)
-Thermoregulation
- Neuromuscular
-Positioning

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What law is associated with the pulse oxyemeter light absorption principle

Beer Lambert Law

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The beer lambert law states that light passing through a chemical solution experiences absorption proportional to the concentration of the

Solute

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If pulse oximetry is inaccurate, what is the gold standard to perform next

Co-oximetry

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Difference between SaO2 and SpO2

SaO2- Arterial blood saturation

SpO2- Saturation detected by pulse oximeter

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What is the typical difference between a SaO2 and SpO2

2-3%

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What things can cause artifact of the pulse oximeter reading?

Ambient light
Low perfusion
Venous blood pulsations
Additional light absorbers(venous dye)
Additional forms of Hb

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If blood is fully saturated with oxygen and a large amount of O2 is released how does this effect O2 tension?

Relatively small drop

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If blood is poorly saturated with Oxygen and a small amount of O2 is released how does this effect the O2 tension?

Large drop

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Is detection of desaturation and resaturation faster peripherally or slower

Slower

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What finger should the pulse ox not be placed on?

Index finger

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Up until what ABG saturation is the pulse oximetry accurate by + or - 2% when measured against the AGB sat

ABG sat greater than > 70%

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What part of the body may be more reliable for a pulse ox reading after epidural blocks?

Toes

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What part of the body are sensitive to vasconstriction?

Fingers

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What three things are less affected by vasoconstriction, reflecting desaturation quicker

Tounge
Cheek
Forehead

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Can a pulse oximeter indicated decreased cardiac output?

YES
(weak waveform)
(inconsistent readings)

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How much light dose carboxyhemoglobin absorb compared to oxyhemoglobin

as much light in the 660 nm range

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Does carboxyhemoglobin elevate SpO2 or decrease

ELEVATES falsely

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For every what percent COHb (carboxyhemoglobin) does SpO2 percent increase by 1%

Each 1% COHb increases SpO2 byt 1%

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Smokers will have a carboxyhemoglobin level > than

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First recorded blood pressure was by ____ _____ in what year

Reverend Hales
1733

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First sphygmomanometer invented by who

Samuel von Basch

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What year was Korotkoff sounds developed or discovered

1905

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What phase of the Korotkoff sounds is most turbulent/audible

Phase 1

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What phase of Korotkoff sounds are muffled/absent and represent DBP

Phase IV-V

How to calculate MEAN BP

2xDBP+SBP/3

What are some things that can limit accurate auscultation of bp

decreased flow vessel compliance shivering wrong cuff size

What is the standard maximum cuff pressure on a manual bp

300mmhg adults 150mmhg neonates

What must a standard bp cuff for asculation have means of doing

Prevent extended inflation

The cuff bladder sohuld be ___ of arm circumference and ___ length of upper arm

40%, 80%

Automatic non invasive bp cuff is based on ______

Oscillometry

SBP is usually ____ to ____ percent of MAP amplitude when BP is being calculated via an autmatic cuff

25-50%

When arterial map is ____ mmhg or greater an automatic bp cuff is roughly accurate to a direct arterial BP

The average difference in pressure mmhg of an automatic bp cuff compared to an arterial line

+/- 5 mmhg

An automatic cuff can _____ MAP during hypertension

Underestimate

An automatic cuff can ____ MAP during hypotension

Overestimate

CRNA must look at what when evaluating the need for internvention

TRENDS

Does a pulse ox alarm if automatic BP cuff inflates?

What is the significance of pressure pulse contour

The shape of this waveform, including its slope, area, and velocity, provides information about the dynamic characteristics of the arterial system and the heart's performance.

Most common invasive arterial monitoring site

Radial

What test was used to assess colateral blood flow before placing radial line

Allens test

Color of the palm after ulnar artery release during the allens test should return in less than ___ seconds

10 seconds

Good collateral flow is ____ percent accurate for color change at 5 seconds

80%

Most common technique for arterial line insertion

Seldingers technique

Whats the second technique used for arterial line insertion?

Transfixion technique

How many mL per hour via automatic flush prevents thrombus formation with an arterial line

1-3 mL

Where is a arterial line zeroed at?

Aortic root/midaxillary line

What does the diacrotic knotch represent

Aortic valve closure

As pressure waves move to the periphery

Arterial upstroke steeper Systolic peak higher DPB lower MAP changes very little

How are waveforms made in an arterial line?

Summation of sine waves

What two waves are added together in an art line to show the final arterial line waveform

Fundamental waves + Harmonic waves

This analysis is represented by how an aterial wavefor is calculated

Fourier Analysis

What test is used to detect over dampening or underdampening

Square wave test

There should be no more than _____ oscilltations following a fast flush during the square wave test

The amplitude of each oscillation should be no greater than _____ of the previous oscillation

1/3rd

Underdamped means

Systolic pressure elevated

Overdamped means

-Systolic pressure decreased - Absent dicrotic notch - Narrowed pulse pressure -Loss of detail

What things in the elderly are common causes of the arterial line being underdamped

Lack of distensibility Athersclerosis Dissection vasopressors

Why do we analyze arterial pressure waveforms

To identify presence of preload reserve

What is the normal SPV in mechanically ventilated patients

7-10mmhg

What is a normal increase in Systolic pressure and what is a normal decrease in SBP in spv

up 2-4mmhg down 5-6

What does an increased SPV mean?

The pt will be volume responsive

What is a normal PPV

<13%

What is a normal SVV (stroke volume variation)

10-13%

Accurate results for SVV must have a pt whom

Ventilated with stable rr and Vt 8-10cc/kg Closed chest Noraml intra abdom pressure Regular cardiac rhythm

How to calculate SVV

SV max - SV min / SV mean

Two types of expire gas sampling

Non diverting Diverting

Non diverting is

-Gas is not removed from the circuit (mainstream)

Diverting sampling is

Gas IS removed from the circuit for analysis elsewhere (side stream)

The further away from the elbow the less ____ is the expired gas

accurate

What can challenge mainstream

Water vapor Secretions Blood More interfaces for disconnections

What can challenge Side stream

Kinging of sampling tubing water vapor failure of sampling pump leaks in line

Mass Spectrometry can calculate up to ____ gases

Clincal monitoring Flashcards

(75 cards)