Stoelting Study 15 Monitoring

Front 1

2. What are some monitors that have been mandated for use by the American Society of Anesthesiologists? How frequently is it mandated that intraoperative blood pressures be measured?

Back 1

2. The American Society of Anesthelioiogists has mandated that qualified anesthesia personnel shall be present in the room to admilister anesthesia and monitor the patient throughout the conduct of all general anesthetics, regional anesthetics, and monitored anesthesia care. The standard adopted by the American Society of Anesthesiologists i; that during all anesthetics the patient's oxygenation, ventilation, circu:ation, and temperature shall be continually evaluated. The full description of these standards also provides an explanation of each of these objectives and specific methods by which they can be achieved. In brief, the use of pulse oximetry, capnography, an oxygen analyzer, a disconnect alarm, and a visual display of the electrocardio~am are all addressed In addition, the blood pressure and heart nte are to be evaluated at least every 5 minutes during the course of anesthesia. (209)

Front 2

4. What is the appropriate-sized cuff for use with an automated oscillometric blood pressure measuring device?

Back 2

4. The appropriate cuff size for use with a noninvasive blood pressure measuring device is one whose width is between 30% and 40% the circumference of the patient's limb.

Front 3

7. What can be monitored through the use of a precordial or esophageal stethoscope?

Back 3

7. A precordial or esophageal stethoscope can be used to monitor cardiac and ventilatory sounds of the patient. This monitor should be immediately available to the anesthesiolo~st, although its routine use today is mainly among pediatric anesthesiologists.

Front 4

9. What is an advantage of an esophageal stethoscope over a precordial stethoscope?

Back 4

9. Esophageal stethoscopes may also have a temperature sensor as part of the instrummt, enabling simultaneous core temperature monitoring

Front 5

12. Which lead is selected on the electrocardiogram for continuous tracing on the monitor to best detect cardiac dysrhythmias? Why?

Back 5

12. Lead II provides for the test visualization of the P wave on the electrocardiogram, making it tle best lead for the detection of cardiac dysrhythroias on a cmtilluous tracing

Front 6

13. Which lead is selected on the tlectrccardiogram for continuous tracing on the monitor to best detect inferior wall myocardial ischemia? Which lead is selected for continuous tracing on the monitor to best detect anterior or lateral wall myocardial ischemia?

Back 6

13. Lead II m the electIOcardiogram provides for the best detection of inferior wall myocardial ischemia on a continuous tracing. The V5 precordial lead on the electrocardiogram provides for the best detection of anterior or lateral wall myocardial ischemia.

Front 7

14. How can the equivalent of a V5 lead be achieved with a three-electrode electrocardiogram?

Back 7

14. In a three-electrode electrocardiogram, the equivalent of the V5 lead can be achieved by placing the left arm electrode in the V5 position, then selecting the · a VL lead for continuous tracing on he monitor.

Front 8

15. How will the electrocardiogram appear in a patient with pulseless electrical activity?

Back 8

IS. A patient with pulseless electrical activity by definition still has electrical activity through the heart, although no blood pressure will be palpable. Therefore, there will be some electrical tracing on the electrocardiogram, although it mayor may not be a sinus rhythm.

Front 9

16. The use of a continuous pulse oximeter is valuable for the detection of what?

Back 9

16. The continuous use of a pulse oximeter is valuable for the detection of arterial hypoxemia. (21

Front 10

17. What is the Sp02? What is the Sao2? Which of these does a pulse oximeter measure?

Back 10

17. The Sp02 is the hemoglobin oxygen saturation in the peripheral arteries. The Sa02 is arterial hemoglobin saturation. The pulse oximeter measures the Spoz and is a reliabe measure of the Sa02

Front 11

18. How does a pulse oximeter work?

Back 11

18. A pulse omter works by emitting a light through a diode and sensing the light, usually on the opposite ,ide of a digit. The wavelength of light that is absorbed by oxyhemoglobin relative to reduced hemoglobin in the pulsatile (and therefore arterial) vessel allows the computer to calculate the saturation of oxygen in the peripheral artery.

Front 12

19. What is the Pao2 value likely greater than when the pulse oximeter is calculating a maintained Spoz greater than 9O%?

Back 12

19. The Pao2 IS likely greater than 60 when the pulse oximeter is calculating a maintained Spo2 greater than 90% based on the usual shape and position of the oxyhemoglobin dissociation curve.

Front 13

20. What are at least five factors that influence the accuracy of pulse oximetry?

Back 13

20. Factors that influence the ~curacy of pulse oximetry include low flow conditions. motion artifact, nail polish, ambient light interference. dysfunctional hemoglobins, methylene blue, and a shift in the oxyhemoglobin dissociation curve.

Front 14

31. What is a capnograph?

Back 14

31. A capnograph is a waveform display that illustrates the patient's inhaled and exhaled concentrations of carbon dioxide.

Front 15

33. What does the absence of carbon dioxide in a person's exhaled gases indicate during endotracheal intubation? What does the absence of carbon dioxide in a person's exhaled gases indicate after proper and confinned endotrocheal intubation?

Back 15

33. The absence of carbon dioxide in a patient's exhaled gases just after attempted endotracheal intubation with properly functioning equipment provides evidence that the patient's lmgs are not being ventilaed. That is, the endotracheal tube may not be in the trachea. The absence of carbon dioxide in a patient's exhaled gases after intubation of the trachea has been confirmed may indicate that there is either a malfunction of equipment, a malfunction in the interface between the patient and the equipment (as in disconnection from the anesthesia circuit), movement or dislodgment of the endotracheal tube from its previously proper position, or a physiologic patient problem such as a cardiac arrest.

Front 16

35. What are some possible causes of an increase in the concentration of carbon dioxide in a person's exhaled gases?

Back 16

35. Possible causes of an increase in the exhaled concentration of carbon dioxide include hypoventilation, hyperthermia, sepsis, rebreathing, the administration of bicarbonate, and fue insufflation of carbon dioxide during laparoscopy

Front 17

I 43. Where is the respirometer commonly placed in the anesthetic breathing system? What infonnation does it provide?

Back 17

43. The respiromete:, which is commonly placed on the exhalation limb of the anesthetic breathing system, measures the patient's tidal volume. With this infonnation the patient's minute ventilation can be calculated

Front 18

44. A low airway pressure alarm is useful for the detection of what?

Back 18

44. A low airwa~ pressure alann on the mechanical ventilat<Jr is triggered if the patient's maximum peak inspiratory presswe does not reach the predetennined level. This alarm is useful for the detection of a large pressure leak or disconnection of the patient from the anesthetic breathing system. C:

Front 19

45. A high airway pressure alarm is useful for the detection of what

Back 19

45. A bigh airway pressure alarm on the mechanical ventilator is triggered if the patient's maximum peak inspiratory pressure exceeds the predetennined level. This alarm is useful for the detection of changes in the patient's airway resistance or an obstruction in the anesthetic breathing system.

Front 20

46. What is the maximum airway pressure that can be delivered to a patient who is SPQltaneously ventilating into the gas reservoir bag? Why?

Back 20

46. The maximum airway pressure that can be delivered to a patient who is spontaneously ventilating into the gas reservoir bag is 50 em H20. Pressures exceeding this will lead to expansion of the bag into a sphere with minimal changes in pressure. ·

Front 21

50. How does a patient's body temperature usually change under anesthesia?

Back 21

50. Patients will typically have a passive decrease in body temperature by 1°C to oc during anesthesia.

Front 22

51. What are some sites for measurement of a patient's body temperature? When is a nasopharyngeal temperature not accurate?

Back 22

51. Sites for body temperature monitoring inclule the esophagus, nasopharynx, rectum, bladder, and tympanic membrane. A nasopharyngeal temperature probe is only accurate when a cuffed endotra::heal tube is present in the trachea preventing respiratory gases from artificially cooling the temperatur! probe.

Front 23

52. What is the purpose of measuring the inspired concentration of oxygen of a patient under general anesthesia?

Back 23

52. The purpose of measuring the inspired concentration of oxygen of a patient under general anesthesia is to ensure the patient is not breathing a hypoxic mixture

Front 24

64 Why is the central venous pressure able to be used to estimate a patient's intravascular fluid volume status?

Back 24

64. The central venous pressure parallels right atrial pressure in a patient with nonnal cardiovascular physiology. In these patients the central venous pressure can be used to estimate the patient's intravascular fluid volume status.

Front 25

78. What is an evoked potential?

Back 25

78. An evoked potentia; is a measured low amplitude signal from the central nervous system that occurs in response to sensory or motor nerve stimulation.

Front 26

76. What is the hispectral index monitor?

Back 26

76. The bispectral index monitor performs a bispectral analysis of the electroencephalogram and provides the clinician with a processed evaluation of its analysis through its displa) of a number between 0 to 100. The analysis is done through superficial scalp electrodes typically on the forehead of the patient. The number provideri by the bispectral index monitor rellects the state of wakefulness of the central nervous system. (:

Front 27

79. What are some intraoperative uses of evoked potentials? What is the most common procedure for which evoked potentials are used intraoperatively?

Back 27

79. Evoked poteniais can be used intraopentively 0 assess the integrity of the neural pathway; during anesthesia. Evoked {Xltentials are typically used as a monioring tool in patients undergoing Harrington rod procedures for the treatment of scolio;is. During these procedllres intactness of the sensory nerve pathways from the periphery to the somatosensory cortex via the spinal cord can be confirmed

Front 28

81. What factors may influence the results of evoked potentials, thereby limiting their usefulness in the intraoperative period?

Back 28

81. Factors that may limit the intraoperative usefulness of evoked potentials because of their inffuence on the results include age and gender of the patiwt, arterial blood gas tensions, and body temperature. In addition, the cost and complexity of performing evoked potentials intraoperatively contribute to its limitations.

Front 29

83. What is a line isolation monitor?

Back 29

83. A line isolation monitor tests to confirm that power output lines are isolated from the ground. Power output lines that are not isolated from ground may provide for a completed circuit through contact with a patient and ground. The line isolation monitor will alarm when the short circuit has the potential to allow current flow of 2 rnA to leak to ground.