Flipped Classroom - temperature monitoring Flashcards
As a general principle, the comfort of operating room personnel must be balanced with patient care. For adult patients, what is the recommended ambient room temperature range in the operating room?
A) 68°F to 75°F (20°C to 24°C)
B) 60°F to 65°F (15°C to 18°C)
C) 75°F to 80°F (24°C to 27°C)
D) 80°F to 85°F (27°C to 29°C)
Correct Answer:
A) 68°F to 75°F (20°C to 24°C)
Rationale:
Maintaining an appropriate operating room temperature is essential for both patient safety and the comfort of the surgical team. The recommended temperature range of 68°F to 75°F (20°C to 24°C) helps prevent patient hypothermia while ensuring a suitable working environment for personnel. Too low of a temperature increases the risk of perioperative hypothermia in patients, leading to complications such as increased infection rates, delayed wound healing, and coagulopathy. Conversely, excessively high temperatures can cause discomfort for the surgical team, impairing performance. (Butterworth et al., 2022)
Which of the following statements about hypothermia in the operating room is correct? ( Select 3 choose)
A) Hypothermia is defined as a core body temperature of less than 36°C.
B) General and regional anesthesia is a potential cause of intraoperative hypothermia.
C) Conductive heat loss is the primary mechanism of heat loss in the operating room.
D) Radiant heat loss is considered the greatest source of heat loss in preoperative and operative settings.
Correct Answers:
A) Hypothermia is defined as a core body temperature of less than 36°C.
B) Epidural anesthesia is a potential cause of intraoperative hypothermia.
D) Radiant heat loss is considered the greatest source of heat loss in preoperative and operative settings.
Rationale:
Hypothermia is a common issue in the operating room and is defined as a core body temperature below 36°C (Elisha et al., 2023). General and regional anesthesia contributes to hypothermia by causing vasodilation and impairing thermoregulation (Elisha et al., 2023). Radiant heat loss, the transfer of body heat to a cooler environment, is identified as the greatest contributor to heat loss in perioperative settings (Elisha et al., 2023). Option C is incorrect because conductive heat loss in is not the primary mechanism in the operating room; it is, radiant heat loss dominates.
Elisha, S., Heiner, J. S., & Nagelhout, J. J. (2023). Nurse Anesthesia (7th ed. p. 321). Elsevier.
Which of the following statements about malignant hyperthermia is correct?
A) Hyperthermia is always the first sign of malignant hyperthermia.
B) When hyperthermia occurs in malignant hyperthermia, core temperature can increase by 1°C every 5 minutes.
C) Malignant hyperthermia typically develops slowly over several hours.
D) Core temperature changes in malignant hyperthermia are minor and rarely significant.
Correct Answer:
B) When hyperthermia occurs in malignant hyperthermia, core temperature can increase by 1°C every 5 minutes.
Rationale:
Malignant hyperthermia is a life-threatening condition triggered by certain anesthetic agents, causing a rapid and extreme metabolic reaction. Hyperthermia is an early symptom, not the first sign (Butterworth et al., 2022. Early signs may include tachycardia, muscle rigidity, and increased CO2 production. When hyperthermia does manifest, core temperature can rise quickly, as much as 1°C every 5 minutes, emphasizing the urgency of immediate intervention (Butterworth et al., 2022). Malignant hyperthermia is a rapidly progressing condition, not a slow-developing making option C is incorrect. Core temperature changes are severe, not minor making option D incorrect.
Which of the following statements about preoperative warming is correct?
A) Prewarming the patient for 30 minutes with convective, forced-air warming blankets helps reduce the initial drop in core temperature.
B) Preoperative warming is ineffective in preventing perioperative hypothermia.
C) Prewarming works by increasing metabolic heat production.
D) The central-peripheral temperature gradient increases after prewarming.
A) Prewarming the patient for 30 minutes with convective, forced-air warming blankets helps reduce the initial drop in core temperature.
Rationale:
Preoperative forced-air warming is an effective strategy to reduce the phase one decline in core temperature by minimizing the central-peripheral temperature gradient before anesthesia is induced (Butterworth et al., 2022). This process helps prevent redistribution hypothermia, a common cause of perioperative hypothermia (Butterworth et al., 2022). Option B is incorrect because prewarming is an effective measure in preventing temperature drops. Option C is incorrect because prewarming does not significantly increase metabolic heat production; rather, it helps maintain existing heat distribution. Option D is incorrect because the central-peripheral temperature gradient actually decreases, not increases, after prewarming.
What part of our brain is impaired during anesthesia that allows heat loss due to altered perception of temperature in the anesthetized dermatomes?
A. Pons
B. Hypothalamus
C. Frontal lobe
D. Occipital lobe
Correct answer:
B) Hypothalamus
Rationale:
The thermoregulatory impairment caused by conduction anesthesia results in continued heat loss due to the altered perception of temperature by the hypothalamus in the anesthetized dermatomes.
Which of the following temperature monitoring techniques are not recommended for patients that are getting open heart surgery?
A) Pulmonary artery and esophageal probe
B) Tympanic temperature monitoring
C) Oral temperature monitoring
D) Temporal temperature monitoring
Correct answer:
A) Pulmonary artery and esophageal probe
Rationale:
Esophageal and pulmonary artery temperature monitoring is less accurate and less reflective to core temperature during open heart surgery (Elisha et al., 2023). Tympanic membranes are considered an ideal site of core temperature because it reflects brain temperature (Elisha et al., 2023). Oral and temporal temperature monitoring is considered noninvasive and does not reflect core body temperature (Elisha et al., 2023).
__________defines the thermal state of an object?What defines the thermal state of an object?
The thermal state
(Elisha et al., 2023. p. 227)
How does the body regulate temperature?
The body regulates temperature through thermoregulatory mechanisms, including Radiation, Convection, Conduction, and Evaporation.
How do humans exchange heat ?
Humans exchange heat from high concentration to lower concentration.
__________ is most significant mechanism of which humans loose heat
Radiation
What is considered normal core body temperature?
37 degrees Celsius
(Elisha et al., 2023. p. 321)
What is hypothermia?
core body temperature of less than 36 degrees Celsius.Cause by:
* general and regional anesthesia by inhibiting
thermoregulation and vasodilation
* Radiant heat loss or transfer of body heat to cooler
environment in ambient operating room temperature.
Considered to be greatest amount of heat lost for patients
undergoing surgery
What is hyperthermia?
core body temperature raises above 38 degrees Celsius. Could be normal for some ppl. could be caused by recreational drug or atropine
What can cause hyperthermia during surgery?
Hyperthermia can be caused by general and regional anesthesia, which inhibit thermoregulation and vasodilation (ether, halothane, methoxyflurane,
enflurane, isoflurane, desflurane, and sevoflurane) or succinylcholine
What causes heat lost for patients undergoing surgery?
Radiant heat loss or transfer of body heat to a cooler environment in ambient operating room temperature.
What effect can atropine have on body temperature?
Atropine can inhibit the sweating response and impair regulatory temperature response, raising core body temperature.
What happens during malignant hyperthermia?
- There is an uncontrolled increase in the release of intracellular calcium in skeletal muscle –> sustained muscle contraction.
- Increased ATP results in uncontrolled hypermetabolic state
that requires increase oxygen consumption, increase CO2 production, LA, and hyperthermia
What is an early sign of malignant hyperthermia?
Hyperthermia is an early sign, with core temperature potentially rising 1 degree C every 5 minutes.
What are the rare incidence rates of malignant hyperthermia?
The incidence is 1 in 15,000 in pediatrics and 1 in 40,000 in adult patients.
What is the treatment for malignant hyperthermia?
- Discontinue anesthetic
- call for help
- mix dantrolene
- bicarbonate
- cooling blanket with temperature monitoring hooked up to core temperature probe (i.e esophageal or bladder probe)
- cooling lavage with temperature monitoring hooked up to core temperature probe,
- cold IV solution
- ice packs over major arteries
- treat hyperkalemia
- treat arrhythmia
_______ monitoring of patients during surgery is critical for patient safety and standard of care.
(Elisha et al., 2023. p. 1325)
What is the purpose of temperature monitoring?
Prevents hypothermia and hyperthermia.
What are the effects of hypothermia?
Increased surgical site infection risk, postoperative shivering with tachycardia and hypertension, impaired coagulation, cardiac arrhythmias, and decreased drug metabolism.
(Butterworth et al., 2022. p. 1238)
What are the effects of hyperthermia?
Can lead to tachycardia, vasodilation, and neurological injury.
(Butterworth et al., 2022. p. 126)
