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Terms in this set (60)
What is the standard which all CRNAs are held accountable?
AANA standards for Nurse Anesthesia Practice (Standard V)
What is the difference between "Continuous" and "Continual"?
Continuous is withOUT interruptions
Continual allows for set interruptions
According to the AANA standards for monitoring, what is monitored "Continuously" in regards to oxygenation?
Chest Excursion/Skin Color
What three indicators are used to verify tracheal intubation?
2. Chest Excursion
3. Expired CO2
What measurement is "Continuously" monitored in regards to ventilation?
How many waveforms of ETCO2 is considered confirmation of airway placement?
According to AANA standards of monitoring: Section V, what parameters are measured continuously for cardiovascular?
How frequently are BP and HR documented?
At least every 5 minutes
Do we use thermoregulation techniques with all general anesthetics?
How are neuromuscular blocking agents monitored?
How is patient positioning monitored?
What does SpO2 measure?
Oxygen bound to HgB, measured non-invasively
What does SaO2 measure?
Oxygen bound to HgB measured by blood sample
What does PaO2 measure?
Partial pressure of oxygen dissolved in blood
What must the patient have in order for SpO2 to be measured accurately?
In pulse oximetry, oxygenated hemoglobin preferentially absorbs which type of light?
If a patient is experiencing Carbon Monoxide poisoning, what will you see on your SpO2 measurement?
CO mimics O2 leading to a normal looking measurement, or false high
You can only see changes on an ABG
SpO2 should approximately correlate with what arterial blood measurement?
What graphically represents the association between SpO2 and PaO2?
Oxy-Hemoglobin Dissociation Curve
At what PaO2 value do large changes start being reflected in the SpO2 value?
PaO2= 60 mmHg
What is the Gold Standard gas agent analyzer?
Infrared Absorption Spectrophotometry (IRAS)
What gases is the IRAS unable to detect?
Should CO2 levels be higher in the blood or the alveoli?
PACO2 < PaCO2
What is the difference between a Capnographer and a Capnometer?
Capnographers use waveforms
Capnometers are just a digital display
How much higher is PaCO2 than ETCO2? Why?
PaCO2 is 2-5 mmHg higher than ETCO2 because of alveolar dead space and dilution with other gases
What does Phase 1 of the ETCO2 capnograph correspond to?
Anatomic Dead Space
What should the Phase 1 ETCO2 baseline numerical value be?
What could be wrong if the baseline ETCO2 is elevated?
CO2 absorber is exhausted
Machine valve incompetency
What does Phase 2 of the ETCO2 capnograph correspond to in the respiratory cycle? What does the waveform do?
What could the patient be experiencing if Phase 2 is prolonged?
What does Phase 3 of the ETCO2 capnograph correspond to the in the respiratory cycle? What is the approximate shape?
Expiratory Plateau (Maximal CO2)
Flat to mild upstroke
What does Phase 4 of the ETCO2 capnograph correspond to in the respiratory cycle?
Inspiration (Pure Fresh Gas)
What could be the problem if there is a prolonged Phase 4?
Restrictive Lung Disease
What effect will a decrease in Cardiac Output have on your capnograph?
Decreases the height of Phase 2
A pulmonary embolism ______ the amount of alveolar dead space, leading to a _______ in the height of the capnograph.
Describe the appearance of the capnograph when a patient is purely hyperventilating.
Gradual decrease in the height of the capnograph while the baseline remains at ZERO
When the CO2 absorber is exhausted or exhausting, what happens to your waveform?
Gradual increase in the height of the capnograph, while the baseline (Phase 0) does not return to ZERO
There is a small dip toward the end of Phase 2 on the capnograph. What is happening?
The patient is attempting to breath spontaneously
This is called the Kiari Effect
The height of the capnograph is gradually getting higher while the baseline is returning to zero between each breath. What is happening?
The patient is hypoventilating
What lead is most commonly monitored in anesthesia?
What sizing and positioning with an NIBP cuff would result in a falsely HIGH reading?
Cuff is too small
Cuff is below heart
What sizing and positioning with an NIBP cuff would result in falsely LOW readings?
Cuff is too large
Cuff is above heart
What is lead II monitoring the best for detecting?
Inferior Wall Ischemia
What is the calculation for MAP?
MAP= 1/3 (SBP + (DBP x2))
What are indications for placement of an arterial line?
Anticipated large blood loss
Titration of Vasoactive agents
What is the gold standard for BP monitoring?
Where is the phlebostatic access point to level your transducer for an Arterial line?
4th ICS, Mid-Axillary line
When the Arterial line is Overdampened, what implication does this have on your reading?
SBP is underestimated
When using a peripheral nerve stimulator to assess NM blockade, where do you place the red probe and black probe?
Red- Proximal (Close to Heart)
What is used in conjunction with other monitors to prevent intra-operative awareness?
Bispectral Index Monitoring
What is the BIS measuring? What number is ideal for a GA case?
BIS is a raw EEG measurement
Ideally the patient should be between 40-60
Can BIS monitoring detect pain or patient movement?
What population has temperature continuously monitored?
What is the average temperature loss per unit time in the OR?
0.5-1 degree C an hour
What temperature is considered normothermia?
What is hypothermia?
< 36 C
< 34 C
> 38 C
What is the largest perpetrator of heat loss in the anesthetize patient?
Radiation (Infrared) 60%
What is the numeric indicator of oliguria?
< 0.5 ml/kg/hr
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