Clinical Monitoring 6/5 Flashcards
Test 1 (81 cards)
Monitoring standards for CRNAs are set by _______ (2)
AANA
ASA
What are the monitoring standards?
- Oxygenation
-clinical observation
-pulse ox
-ABGs (as indicated) - Ventilation
-auscultation
-chest excursion
-ETCO2
-pressure monitors/flow volume loops (as indicated) - Cardiovascular
-ECG
-auscultation (as needed)
-BP/HR q5min (at minimum) - Thermal regulation
-when clinically significant changes in body temp are anticipated or suspected - Neuromuscular
-as indicated –> when administered a NMB - Positioning/protective measures
-nerve damage can be caused dt positioning - Additional means depend depending on needs
-Ex) blood loss – giving blood; biz monitoring
Any omission of the above must be charted with a valid reason
Pulse ox mechanics is based on the ________ law, which is the “law of _______”. Describe it.
Beer-Lambert Law
Absorption
Visible light passing thru a chemical solution of fixed geometry experiences absorption proportional to the concentration of the solute
(More solute = more absorption you see, less solute = less absorption you see)
What happens to light when it goes thru matter?
it is transmitted, absorb, or reflected
What are the different types of Hb that are normally bound? (4)
Oxyhemoglobin (HbO2)
Reduced Hb
Methemoglobin (metHb)
Carboxyhemoglobin (COHb)
The most accurate type of oximetry & gold standard is ______. It operates off _____ wavelengths. When do we use this?
Co-oximetry
4
If there are 2 types of Hb showing the same dt only using 2 wavelengths w/ pulse oximetry
Normal pulse oximetry works off ____ wavelengths. What are the value of those?
2
660 & 940 nanometers
Pulse ox measure oxygenation from ____ blood. Why?
Arterial
Pulsatile expansion of the artery increases length of light path –> increases absorbency
From a pulse ox, light is transmitted through…. (give order)
Skin –> soft tissue –> venous blood –> arterial blood –> capillary blood
Equation: Pulse oximetry
Flucating component (pulsatile) / Nonflucating component for each wavelength
Ex) (AC 660/DC 660) / (AC 940/DC 940)
Whats the difference between SaO2 & SpO2?
SaO2 – ARTERIAL SATURATION
SpO2 – THIS IS THE PULSE OX READING
2-3% difference
What can cause artifact w/ pulse oximetry? (5)
- Ambient light
-solved by altering red/infrared –> machine set to do this - Low perfusion
-decreased BP; hypovolemia
-signal & artifact amplified - Venus blood pulsations
-slower to report changes - Additional light absorbers
-intravenous dyes & pulseox that uses 8 wavelengths - Additional forms of Hb
What are the monitoring standards that aren’t required with every case– Only as indicated? (4)
ABG’s
Pressure monitors/flow volume loops
Thermoregulation (still have to take temps)
Neuromuscular monitoring
We have to document vital signs every ____ minutes, this is the minimum
5
What happens when O2 is taken up into the lungs?
Blood is nearly 100% saturated
During passes through systemic capillaries, _______ amounts of O2 is released & there is a small _______ in PaO2 (tension)
large
small
What happens to the Oxyhemoglobin-dissociation curve if the blood is poorly saturated?
Curve goes to the L
Small amounts of O2 released (increased affinity) & LARGE drop in PaO2 (tension)
Why is it important to keep O2 sats above 90%?
Below that we see large drops in PaO2 (tension)
PaO2 =
PP of O2 in the ARTERY
At 90% saturation, the PaO2 is about _____. What is the revelance of this point?
60 mmHg
Above this point: slow rise of PaO2 tension/PP of O2 in artery
-Small change in PaO2 = small change in SpO2
-Hb is near fully saturated
-Slope more horizontal
Below this point: rapid decreased in PaO2 tension/PP of O2 in artery when saturation decreases
-Small changes in PaO2 = LARGE drops in SpO2
-Slope very steep/more vertical
What is the x & y axis of the Oxyhemoglobin-dissociation curve?
y (vertical): arterial saturation
x (horizontal): arterial O2 tension which is the PP of O2 in the arteries
A R shift in the Oxyhemoglobin-dissociation curve causes ______ O2 affinity. What does this mean? What causes this? (3)
Reduced
Releases O2 easier from Hb
Increased:
Temp
2-3 DPG
Hydrogen ions –> acidosis/decreased pH
________ (2) are sensitive to vasoconstriction. What can this cause?
Fingers & Toes
inaccurate readings w/o enough pulsatile flow
A L shift in the Oxyhemoglobin-dissociation curve causes ______ O2 affinity. What does this mean? What causes this? (3)
Increased
Hb doesnt want to release O2
Decreased:
Temp
2-3 DPG
Hydrogen ions –> alkalosis/increased pH
Increased carbon monoxide (CO)