Clinical Monitoring Pt. 1 - Exam 1 Flashcards by Erin Baker

Q

What are the AANA monitoring standards for Oxygenation?

A

-Clinical observation
-Pulse Ox
-ABGS (as indicated)

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Q

What are the AANA monitoring standards for Ventilation?

A

-Auscultatoin
-Chest excursion
-ETCO2
-Pressure monitors as indicated (Flow volume loops)

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Q

What are the AANA cardiovascular monitoring standards?

A

-Electrocardiogram
-Asucultation as needed
-BP and HR q 5 min

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Q

What are the AANA cardiovascular monitoring standards for thermoregulation?

A

Applies when clinically significant changes in body temp are anticipated / suspected

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Q

If you omit one of the AANA monitoring standards, what must you do?

A

Chart the reason

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Q

What are the AANA monitoring standards for neuromuscular monitoring?

A

When paralytic given

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Q

What are the AANA monitoring standards for positioning / protective measure?

A

Monitor! Except aspects performed exclusively by other providers

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Q

What is the Beer-Lambert law?

A

A beam of visible light passing through a chemical solution of fixed geometry experiences absorption proportional to the concentration of the solute

aka

The more solute, the more absorption of light

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Q

What are the 4 types of hemoglobin we commonly see in adult blood?

A

-Oxyhemoglobin
-Methemoglobin
-Reduced Hb
-Carboxyhemoglobin

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Q

Traditional pulse oxes looked at 2 wavelengths: __ and ___ nm
However, there is something more modern called a co-oximeter that looks at ___ wavelengths

VERY new pulse oxes look at __ wavelengths

A

660, 940

4 wavelengths

8 wavelengths

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Q

With a pulse ox, light is transmitted through these 5 things:

A

-Skin
-Soft tissue
-Venous blood
-Arterial blood
-Capillary blood

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Q

How does pulsatile expansion of the artery impact the length of the light path?

Does this decrease or increase light absorbency?

A

-Increases length
-Increases absorbency

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Q

A normal difference between SaO2 and SpO2 readings should be…

A

2-3%

If more than that, your machine needs to be recallibrated

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Q

Signal artifact can be caused by ambient light. How do we solve this?

A

Alternate red and infrared

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Q

What 5 things can cause pulse ox signal artifact?

A

-Ambient Light
-Low perfusion
-Additional light absorbers (IV dye)
-Venous blood pulsations
-Additional forms of Hb

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Q

If blood is poorly saturated, ___ amounts of O2 (small or large?) are released and there are ___ (small or large) drops in tension

A

Small
Large

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Q

Throwback! What things cause a left shift in the Oxyhemoglobin dissociation curve?

A

-Low temp
-Low 2-3 DPG
-Low Hydrogen ions
-Alkalosis
-Carbon monoxide

Also:
-Low CO2

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Q

With a pulse ox, is the detection of desaturation and resaturation slower centrally or peripherally?

A

Peripherally

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Q

What SpO2 monitor placement is reliable with epidural blocks?

A

the toes

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Q

Why are the tongue/cheek/forehead quicker at reflecting desaturation?

A

They are less affected by vasoconstriction

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Q

Pulse oxes are good because of the following reason:

They are accurate (+/- 2%) when measured against ABGS when the sat is >___%

A

70%

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Q

Limitations of pulse ox (pic)

A

sorry im just not typing this out

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Q

This type of hemoglobin absorbs as much light in the 660 nm range as oxyhemoglobin dose

A

Carboxyhemoglobin

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Q

For every 1% increase in COHb it will increase SpO2 by ___%

A

1

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Many smokers have greater than ___% COHb

6

Who developed the understanding of the circulatory system in the 1600s? Who invented the sphygmomanometer in 1881?

-Dr. William Harvey -Samuel Von Basch

In 1905, moderen blood pressure measurement with systolic and diastolic pressures was discovered. These are known as __ sounds

Korotkoff

Who did the 1st recorded BP on a horse

Reverend Hales

Kortokoff sounds are a series of audible frequencies produced by ___ blood flow beyond the partially occluding cuff

turbulent

What is the Phase 1 Kortokoff sound? What does it sound like?

SBP! The most turbulent / audible

What does the Phase II-III Kortokoff sound like?

This is when the sound character changes

What does the Phase II-III Kortokoff sound like? What does it represent?

Muffled/absent DBP

MAP Equation

(2DBP + SBP) / 3

4 Limitations to BP auscultation?

-Decreased peripheral flow -Changes in vessel compliance -Shivering -Incorrect cuff size

Maximum cuff pressure for adults Infants?

300 mmHg 150 mmHg

Standards of NIBP

-Maxmimum cuff pressure (300 adults, 150 infants) -Some means to prevent extended inflation -Cuff bladder (40% of arm circumference; 80% of the length of the upper arm)

Automatic NIBP techniques are based on oscillometry. The maximal amplitude is the ___

MAP

Automatic NIBP techniques are based on oscillometry. The SBP is usually ___-___% higher than the MAP

25-50%

Automatic invasive techniques are roughly accurate when the MAP is _____ or higher

75

What is the average difference of the NIBP with actual BP on art line?

+/- 5 mmHg

Advantages of NIBP

What types of trauma can the NIBP cuff cause?

-Coagulopathies -Peripheral neuropathies -Arterial/venous insufficiency -Compartment syndrome

Indications for invasive BP monitoring

-Need for real time BP -Pharmacological manipulation -Repeated blood samples -Determination of volume responsiveness -Timing of IABP counterpulsation

What do we use the Allen's test for?

To check if ulnar artery blood flow is sufficent before art line placement in the event of a radial artery occlusion for ischemia prevention

Allen's test is ___% accurate for color change at 5 seconds

80

With the Allen's test. color of palm should return in less than ___ seconds

10

What is the Seldinger's Technique?

What is the transfixion technique?

Arterial line functions (pic)

What is number 1?

What is number 2?

What is number 3?

What is number 4?

What is number 5?

What is number 6?

Why do arterial pressures on an art line measured at different sites have different morphologies?

Impedence changes along the vascular tree

How does the pressure wave on an art line change as it moves TO the periphery?

Waveforms on the arterial line are a summation of ___ waves

sine

If your line is ____ (over or under) damped, systolic pressures will be elevated

Underdamped

How does an overdamped waveform present?

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

What are some pathologies that can impact the arterial line waveform?

SLIDE 181