Term
| what are the 2 main categories of monitoring parameters? |
|
Definition
|
|
Term
| homeostatic mechanism's response to anesthesia |
|
Definition
|
|
Term
| which of the 2 main categories of monitoring parameters is the best indicator of patient wellbeing? |
|
Definition
|
|
Term
| involuntary response to stimulus |
|
Definition
|
|
Term
|
Definition
heart rate
heart rhythm
respiratory rate and depth
mucous membrane color
capillary refill time
pulse strength
blood pressure
body temperature |
|
|
Term
|
Definition
palpebral
corneal
pedal
swallowing
laryngeal
pupillary light reflex |
|
|
Term
| reflexes are indicators of what? |
|
Definition
|
|
Term
| monitoring parameters for reflexes offer what? |
|
Definition
| predictable responses to anesthesia at various depths |
|
|
Term
| reflexes can be affected by what 3 things? |
|
Definition
drugs
disease
individual response variation |
|
|
Term
| when to monitor anesthetized patients? what is ideal? |
|
Definition
as often as possible
continuously is ideal |
|
|
Term
| what are the stages and planes of anesthesia? |
|
Definition
four stages (I, II, III, IV)
stage III divided into four planes |
|
|
Term
| from stage I through stage IV of anesthesia, there is a progressive decrease in what 6 things? |
|
Definition
pain perception
motor coordination
consciousness
reflex responses
muscle tone
cardiopulmonary function |
|
|
Term
| the original stages and planes of anesthesia were based on patient response to what drug? |
|
Definition
|
|
Term
| the original stages and planes of anesthesia were based on patient response to diethyl ether and were established during WWI by who? |
|
Definition
|
|
Term
| 4 objectives of surgical anesthesia |
|
Definition
patient doesn't move
patient isn't aware
patient doesn't feel pain
patient has no memory of the procedure |
|
|
Term
| maintaining the optimum anesthetic depth requires what? |
|
Definition
| frequent assessment of the patient with proper adjustments to the rate of anesthetic administration throughout the procedure |
|
|
Term
| when in doubt about anesthetic depth, err on the side of caution and do what? |
|
Definition
| keep a patient at the least depth that will fulfill the objectives |
|
|
Term
| what are the 2 ways to assess vital signs? |
|
Definition
physical
mechanical instruments |
|
|
Term
| what are the 3 ways to physically assess vital signs? |
|
Definition
|
|
Term
| what are the 5 ways to mechanically assess vital signs? |
|
Definition
electrocardiogram
blood pressure monitor
capnograph
doppler blood flow monitor
pulse oximeter |
|
|
Term
| what are the 3 vital sign groupings? |
|
Definition
circulation
oxygenation
ventilation |
|
|
Term
| what are the 5 circulation vital signs? |
|
Definition
heart rate and rhythm
pulse strength
CRT
MM color
blood pressure |
|
|
Term
| what are the 5 oxygenation vital signs? |
|
Definition
MM color
CRT
hemoglobin saturation
inspired oxygen
arterial blood oxygen |
|
|
Term
| what are the 5 ventilation vital signs? |
|
Definition
respiratory rate and depth
breath sounds
end expired carbon dioxide levels
arterial carbon dioxide
blood pH |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| 3 ways to physically assess heart rate |
|
Definition
palpation of apical pulse through the thoracic wall
palpation of the peripheral pulse
auscultation with stethoscope (more difficult in recumbent, anesthetized animals) |
|
|
Term
| 3 ways to mechanically assess heart rate |
|
Definition
ECG machine
blood pressure monitor (doppler blood flow detector or oscillometric monitor)
intraarterial line and transducer |
|
|
Term
| depressant effect of most anesthetics |
|
Definition
|
|
Term
| what 2 classes of anesthetics cause bradycardi? |
|
Definition
|
|
Term
| 2 reasons for bradycardia |
|
Definition
excessive anesthetsia depth
adverse effects of drugs |
|
|
Term
| what 2 categories of anesthetics cause tachycardia? |
|
Definition
anticholinergics
cyclohexamines |
|
|
Term
|
Definition
inadequate anesthetic depth (too light)
pain
hypotension
blood loss and shock
hypoxemia and hypercapnia |
|
|
Term
| 2 instruments used to monitor heart rate and rhythm |
|
Definition
esophageal stethoscope
electrocardiography |
|
|
Term
| thin flexible catheter attached to audio monitor or conventional stethoscope |
|
Definition
|
|
Term
| what does an esophageal stethoscope do? |
|
Definition
| electronically amplifies heart sounds |
|
|
Term
| how is an esophageal stethoscope placed? |
|
Definition
| inserted into esophagus to level of the fifth rib and adjusted for maximum sound |
|
|
Term
| a graphic representation of the electrical activity of the heart |
|
Definition
|
|
Term
| what is electrocardiography used to detect? |
|
Definition
| arrhythmias (Common in anesthetized animals) |
|
|
Term
| what is electrocardiography used to differentiate? |
|
Definition
| normal from abnormal and dangerous from harmless rhythms |
|
|
Term
| what species is this ECG from?[image] |
|
Definition
|
|
Term
| what species is this ECG from?[image] |
|
Definition
|
|
Term
| what species is this ECG from?[image] |
|
Definition
|
|
Term
| 3 commonly encountered cardiac arrhythmias |
|
Definition
sinus arrhythmia (SA)
sinus bradycardia
sinus tachycardia |
|
|
Term
| what cardiac arrhythmia is this? [image] |
|
Definition
|
|
Term
| what occurs during a sinus arrhythmia? (3) |
|
Definition
heart rate coordinated with respirations
decreases during expiration
increases during inspiration |
|
|
Term
| in what species is sinus arrhythmia normal/abnormal? |
|
Definition
normal in dogs, horses, and cattle
abnormal in cats |
|
|
Term
| what is sinus bradycardia? |
|
Definition
| abnormally slow heart rate |
|
|
Term
| when is sinus bradycardia common during anesthesia? (2) |
|
Definition
excessive anesthetic depth
drug reactions |
|
|
Term
| how is sinus bradycardia corrected? (2) |
|
Definition
reversal agents
anticholinergics |
|
|
Term
| what is sinus tachycardia? |
|
Definition
| abnormally fast heart rate |
|
|
Term
| when does sinus tachycardia occur? (3) |
|
Definition
inadequate anesthetic depth
drug reactions
surgical stimulation |
|
|
Term
| how is sinus tachycardia treated? |
|
Definition
|
|
Term
| 6 medications that cause bradycardia |
|
Definition
buprenorphine
detomidine
fentanyl
hydromorphone
medetomidine
xylazine |
|
|
Term
| medication that causes tachycardia |
|
Definition
|
|
Term
| rate of color return to oral mucous membrane after application of gentle digital pressure |
|
Definition
| capillary refill time (CRT) |
|
|
Term
|
Definition
| peripheral tissue blood perfusion |
|
|
Term
| what is prolonged CRT and what does it indicate? |
|
Definition
>2 seconds
indicates poor perfusion |
|
|
Term
| 7 things that could cause prolonged CRT |
|
Definition
epinephrine release
low blood pressure
hypothermia
cardiac failure
excessive anesthetic depth
blood loss
shock |
|
|
Term
| what does prolonged CRT result in? |
|
Definition
| reduced temperature of affected parts |
|
|
Term
| 3 blood pressure measurements |
|
Definition
systolic pressure
diastolic pressure
mean arterial pressure (MAP) |
|
|
Term
| what is systolic pressure produced by? |
|
Definition
| contraction of the left ventricle |
|
|
Term
| all BP monitoring instruments can measure what pressure? |
|
Definition
|
|
Term
| pressure that remains in the arteries when the heart is in the resting phase between contractions |
|
Definition
|
|
Term
| not all BP monitoring instruments can measure what pressure? |
|
Definition
|
|
Term
| average pressure through the cardiac cycle |
|
Definition
| mean arterial pressure (MAP) |
|
|
Term
| which blood pressure measurement is a mathematical calculation? |
|
Definition
|
|
Term
| which BP measurement is the best indicator of blood perfusion to internal organs? |
|
Definition
|
|
Term
| what are the two categories of blood pressure monitors? |
|
Definition
|
|
Term
| which category of BP monitors is the most accurate? |
|
Definition
|
|
Term
| reading obtained via indwelling catheter inserted into an artery (facial or aural) and attached to pressure transducer and monitor |
|
Definition
|
|
Term
| which type of BP monitor is most commonly used in equine practices and research facilities? |
|
Definition
|
|
Term
| which type of BP monitor provides continuous reading throughout the cardiac cycle? |
|
Definition
|
|
Term
| 2 advantages of direct BP monitors |
|
Definition
real time monitoring of blood pressure trends, even in extremely hypotensive patients
minute by minute updates on patient's hemodynamic status (always the doctor to see if treatments are working) |
|
|
Term
| 3 disadvantages of direct BP monitors |
|
Definition
equipment required (costly)
arterial catheters are invasive, and arterial access can be technically difficult to obtain
complications: hematoma formation and significant hemorrhage |
|
|
Term
| what type of BP monitor is central venous pressure? |
|
Definition
|
|
Term
| what type of monitoring is this? [image] |
|
Definition
| central venous pressure (direct BP) |
|
|
Term
| blood pressure in a large central vein |
|
Definition
|
|
Term
| where is a catheter for central venous pressure placed? |
|
Definition
| catheter from the jugular vein into the anterior vena cava |
|
|
Term
| what does central venous pressure assess? |
|
Definition
| blood return to the heart and heart function, especially right sided heart failure |
|
|
Term
| what is the catheter used for central venous pressure connected to? |
|
Definition
|
|
Term
| a water manometer reading of what is considered elevated when measuring central venous pressure? |
|
Definition
|
|
Term
| how does central venous pressure monitor BP? |
|
Definition
| trends over time rather than single readings |
|
|
Term
| central venous pressure may detect what? |
|
Definition
| overhydration when administering IV fluids |
|
|
Term
| reading is obtained by using an external sensor and cuff |
|
Definition
|
|
Term
| what type of BP measurement is most commonly used in general veterinary practices? |
|
Definition
|
|
Term
| how invasive is indirect BP monitoring, and how is it placed? |
|
Definition
noninvasive
cuff is placed over appropriate superficial artery |
|
|
Term
| what are 2 indirect methods of BP monitoring? |
|
Definition
|
|
Term
| what type of BP measurement is a sphygmomanometer? |
|
Definition
|
|
Term
| 2 advantages of doppler BP monitoring |
|
Definition
relatively easy to use
affordable and readily available in most clinical settings |
|
|
Term
| disadvantage of doppler BP monitoring |
|
Definition
| does not provide a measurement of MAP or DAP |
|
|
Term
| 3 advantages of oscillometric BP monitoring |
|
Definition
automated requires less technical skills
monitors can be programmed to measure BP at timed intervals (every 5 minutes)
automated process causes less stress to patients |
|
|
Term
| disadvantages of oscillometric BP monitoring (5) |
|
Definition
tends to be less accurate in the following patients:
under 5kg
with cardiac arrhythmias, significant tachycardia or bradycardia, vasoconstriction or hypothermia
moving |
|
|
Term
| 4 medications that cause hypotension |
|
Definition
acepromazine
buprenorphine
xylazine
propofol |
|
|
Term
| 2 medications that cause hypertension |
|
Definition
|
|
Term
| why are indicators of oxygenation monitored? |
|
Definition
| to ensure adequate oxygenation of the patient's arterial blood |
|
|
Term
| assessment of oxygenation should be done whenever possible by ____, with ____ being employed when necessary for more critically ill patients |
|
Definition
pulse oximetry
blood gas analysis |
|
|
Term
| how is MM color assessed? |
|
Definition
|
|
Term
| is MM color the same between patients? |
|
Definition
| no, varies patient to patient |
|
|
Term
| when to measure MM to determine baseline |
|
Definition
|
|
Term
| MM color is a rough assessment of what 2 things? |
|
Definition
oxygenation
tissue perfusion |
|
|
Term
| 3 alternate sites of MM assessment |
|
Definition
tongue
conjunctiva of lower eyelid
mucous membrane lining of prepuce or vulva |
|
|
Term
| 3 meanings behind pale mucous membranes |
|
Definition
blood loss
anemia
poor capillary perfusion |
|
|
Term
| 3 meanings behind cyanotic mucous membranes (blue to purple) |
|
Definition
respiratory arrest
oxygen depravation
pulmonary disease |
|
|
Term
| 3 things that affect MM color |
|
Definition
body temperature
vascular resistance
gum disease |
|
|
Term
| adequate oxygen is necessary for ____ processes |
|
Definition
|
|
Term
| 2 components of total oxygen content |
|
Definition
free, unbound oxygen molecules
bound oxygen |
|
|
Term
| where are free, unbound oxygen molecules found, and how much? |
|
Definition
dissolved in plasma
minor content |
|
|
Term
| where is bound oxygen found? |
|
Definition
| chemically bound to hemoglobin in erythrocytes |
|
|
Term
| how many oxygen binding sites are there per hemoglobin molecule? |
|
Definition
|
|
Term
| most oxygen is carried by ____ |
|
Definition
|
|
Term
| what does 100% saturation mean? |
|
Definition
| all available hemoglobin binding sites are filled with oxygen |
|
|
Term
| because about ____% of the oxygen carried in blood is bound to hemoglobin, the ____ is an important determinant of oxygen available to tissues |
|
Definition
|
|
Term
| 3 values used to measure blood oxygen |
|
Definition
calculated oxygen content
partial pressure (PaO2)
percent oxygen saturation (percent SaO2) |
|
|
Term
| measures both bound and dissolved oxygen |
|
Definition
| calculated oxygen content |
|
|
Term
| calculated oxygen content is an accurate measurement expressed as |
|
Definition
|
|
Term
| (CaO2) = (Hb x 1.39 x SaO2/100) + (PaO2 x 0.003) |
|
Definition
| calculated oxygen content |
|
|
Term
|
Definition
| 80-120 mm Hg arterial blood |
|
|
Term
| measures unbound oxygen dissolved in plasma |
|
Definition
|
|
Term
| percent of total oxygen measured by PaO2 |
|
Definition
|
|
Term
| PaO2 is expressed as ____ and varies in arterial, capillary, or venous blood |
|
Definition
|
|
Term
| where is PaO2 highest and lowest? |
|
Definition
highest in arterial blood
lowest in venous blood |
|
|
Term
| percentage of total number of available hemoglobin binding sites occupied by oxygen molecules |
|
Definition
| percent oxygen saturation (SaO2) |
|
|
Term
|
Definition
|
|
Term
| where is SaO2 highest and lowest? |
|
Definition
highest in arterial blood
lowest in venous blood |
|
|
Term
|
Definition
|
|
Term
| average normal hemoglobin is ____ g/d |
|
Definition
|
|
Term
| when PaO2 is ____, the percent SaO2 begins to drop more rapidly |
|
Definition
|
|
Term
| what type of relationship do partial pressure and oxygen saturation have? |
|
Definition
| nonlinear direct relationship |
|
|
Term
| what does it mean for PaO2 and SaO2 to have a nonlinear direct relationship? |
|
Definition
| as one decreases so does the other, but not at the same rate |
|
|
Term
| in the PaO2/SaO2 relationship, which one follows which? |
|
Definition
| as partial pressure decreases, the oxygen saturation also decreases, but not as rapidly |
|
|
Term
| the PaO2/SaO2 relationship indicates ____ in animals with normal hemoglobin levels |
|
Definition
|
|
Term
| in a patient with low hemoglobin, what happens with PaO2 and SaO2? (3) |
|
Definition
neither parameter gives an accurate indication of oxygen availability
both parameters may be normal
insufficient hemoglobin is available to carry all the oxygen necessary |
|
|
Term
|
Definition
|
|
Term
| how to measure PaO2 and SaO2 |
|
Definition
blood gas analyzers measure partial pressure
pulse oximeters measure oxygen saturation |
|
|
Term
| when are both PaO2 and SaO2 elevated |
|
Definition
| in anesthetized patients breathing pure oxygen |
|
|
Term
| what can low PaO2 and SaO2 during anesthesia indicate? |
|
Definition
| hypoxemia and the need for oxygen supplementation or assisted ventilation |
|
|
Term
| 6 reasons for low pulse oximeter readings |
|
Definition
incorrect instrument use
anesthetic agent causes vasoconstriction
inadequate tissue perfusion
inadequate oxygen delivery to patient
inadequate ventilation
inadequate circulation |
|
|
Term
| patients with a subnormal PaO2 or SaO2 reading may require one of what 3 things? |
|
Definition
supplemental oxygen delivery
ventilation through bagging
use of a ventilator |
|
|
Term
| indicators of ventilation are monitored to ensure that the patient's ventilation is adequately ____ |
|
Definition
|
|
Term
| ventilation is assessed by observation of what 2 movements? |
|
Definition
thoracic wall
breathing bag |
|
|
Term
| ventilation may be assessed by auscultation of breath sounds via one of what 3 devices? |
|
Definition
external stethoscope
esophageal stethoscope
audible respiratory monitor |
|
|
Term
| when assessing ventilation, what is recommended? |
|
Definition
| capnography is recommended with blood gas analysis as necessary |
|
|
Term
| 5 values used to assess ventilation |
|
Definition
respiratory rate
tidal volume
respiratory character
ETCO2
blood pH |
|
|
Term
| movement of gas in and out of the alveoli |
|
Definition
|
|
Term
| process by which oxygen is supplied to and used by the tissues and carbon dioxide is eliminated from the tissues |
|
Definition
|
|
Term
| number of breaths per minute |
|
Definition
|
|
Term
| how is RR monitored visually? |
|
Definition
| by watching the chest wall movements or movements of the reservoir bag |
|
|
Term
| how is RR monitored mechanically? |
|
Definition
| with apnea monitor or capnograph |
|
|
Term
| what happens to RR during anesthesia? |
|
Definition
|
|
Term
|
Definition
hypercapnea
pulmonary disease
mild surgical stimulus |
|
|
Term
| tachypnea may indicate what |
|
Definition
| progression from moderate to light anesthesia during recovery |
|
|
Term
| tachypnea must be differentiated from what? |
|
Definition
|
|
Term
| the amount of air inhaled during a breath |
|
Definition
|
|
Term
| how is tidal volume measured mechanically? |
|
Definition
|
|
Term
| where is a respirometer located? |
|
Definition
| between the expiratory hose of a circle breathing circuit and the anesthetic machine |
|
|
Term
| subnormal tidal volume or shallow breathing |
|
Definition
|
|
Term
| hypoventilation can lead to what? |
|
Definition
|
|
Term
| how is hypoventilation reversed? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| hyperventilation can result from what 2 things? |
|
Definition
hypercapnia
surgical stimulation |
|
|
Term
| the effort required to breathe |
|
Definition
|
|
Term
| how is respiratory character monitored visually? |
|
Definition
| by watching the chest wall movements |
|
|
Term
| respiratory character measures what relationship? |
|
Definition
| time relationship between inspiration and expiration |
|
|
Term
| how is respiratory character monitored physically? |
|
Definition
by auscultating the chest
listen for harsh noises, whistles, or squeaks |
|
|
Term
| labored or difficult breathing |
|
Definition
|
|
Term
| dyspnea may be caused by what 5 things? |
|
Definition
blocked airway
respiratory disease
pressure buildup in the breathing circuit
hypoxemia |
|
|
Term
| prolonged pause between inspiration and expiration |
|
Definition
| apneustic respiratory pattern |
|
|
Term
| an apnea monitor measures what? |
|
Definition
|
|
Term
| an apnea monitor warns the anesthetist when? |
|
Definition
| if a patient hasn't taken a breath in a preset time period |
|
|
Term
| an apnea monitor detects what? |
|
Definition
| temperature differences between inspired air (cool) and expired air (warm) |
|
|
Term
| where is an apnea monitor sensor placed? |
|
Definition
| between endotracheal tube connector and breathing circuit |
|
|
Term
| what does a capnograph measure? |
|
Definition
| end tidal carbon dioxide (ETCO2) |
|
|
Term
| what does an ETCO2 monitor measure? |
|
Definition
| the carbon dioxide in air that is inhaled and exhaled |
|
|
Term
| ETCO2 value closely mirrors what? |
|
Definition
|
|
Term
| ETCO2 sensor placed directly between the endotracheal tube and breathing circuit |
|
Definition
|
|
Term
| ETCO2 sensor located in a computerized monitor |
|
Definition
|
|
Term
| what type of capnograph: air is pulled in through a tube attached to the fitting between the endotracheal tube and breathing circuit |
|
Definition
|
|
Term
| a ____ is noninvasive and continuous monitoring, which provides waveform information as well as a numerical display |
|
Definition
|
|
Term
| waveform of carbon dioxide levels passing through the capnograph |
|
Definition
|
|
Term
| what is the normal shape of a capnogram? |
|
Definition
|
|
Term
| label the parts of the capnogram:[image] |
|
Definition
A: start of expiration
B: dead space gas replaced by alveolar gas
C-D: pure alveolar gas
D: start of respiration
E: dilution of alveolar gas by inspired fresh gas |
|
|
Term
| the capnograph measures the ____ of the CO2 in the air moving between the endotracheal tube and the breathing circuit |
|
Definition
|
|
Term
| as long as the patient is not rebreathing expired gases, and the CO2 absorbent is not exhausted, what is the CO2 during inhalation? |
|
Definition
|
|
Term
| the capnogram represents what value? |
|
Definition
|
|
Term
| what is CO2 at expiration? |
|
Definition
|
|
Term
| when does CO2 abruptly return to baseline (0 mm Hg)? |
|
Definition
| at the beginning of inspiration |
|
|
Term
| when is CO2 value most reflective of arterial CO2 levels? |
|
Definition
|
|
Term
| 5 capnogram abnormalities related to ventilation or equipment problems |
|
Definition
hyperventilation
hypoventilation
flat line (no waveform)
elevated baseline
rounding of edges of waveform |
|
|
Term
| what capnogram abnormality is caused by gradual decrease in ETCO2 value? |
|
Definition
|
|
Term
| what capnogram abnormality is caused by gradual increase in ETCO2 value? |
|
Definition
|
|
Term
| cause of flat line (no waveform) during capnogram |
|
Definition
|
|
Term
| what capnogram abnormality is caused by lack of carbon dioxide reaching sensor or machine malfunction? |
|
Definition
|
|
Term
| what capnogram abnormality is caused by patient rebreathing carbon dioxide or the sensor being contaminated? |
|
Definition
|
|
Term
| what capnogram abnormality is caused by a leaking cuff or partially kinked endotracheal tube? |
|
Definition
| rounding of edges of waveform |
|
|
Term
| 5 capnogram abnormalities unrelated to ventilation or equipment problems |
|
Definition
cardiac arrest
hypotension or sudden decrease in cardiac output
hypothermia
hyperthermia
subtle waveform changes |
|
|
Term
| what is this capnogram abnormality caused by: rapid loss of waveform that returns if CPCR is successful? |
|
Definition
|
|
Term
| what is this capnogram abnormality caused by: rapid decrease in height of rectangle? |
|
Definition
| hypotension or sudden decrease in cardiac output |
|
|
Term
| what is this capnogram abnormality caused by: gradual decrease in ETCO2 value (short rectangle) |
|
Definition
|
|
Term
| what is this capnogram abnormality caused by: gradual increase in ETCO2 value (tall rectangle) |
|
Definition
|
|
Term
| what is this capnogram abnormality caused by: subtle waveform changes (5) |
|
Definition
high or low gas flow
type of breathing circuit used
amount of dead space
excess moisture in sampling line
blockage or leak in the system |
|
|
Term
| Dissolved oxygen and carbon dioxide gas in arterial blood |
|
Definition
|
|
Term
| Dissolved oxygen and carbon dioxide gas in venous blood |
|
Definition
|
|
Term
| Blood pH is an indicator of what 3 things? |
|
Definition
oxygenation
Ventilation
Acid base status |
|
|
Term
| Blood pH is influenced by what? |
|
Definition
| respiratory function (rate, depth, character) |
|
|
Term
| Blood gas analysis is most commonly performed in what practices? |
|
Definition
|
|
Term
| Why is blood gas sample collection difficult? |
|
Definition
| a use sample must be from an artery or possibly the lingual vein |
|
|
Term
| How is handling a blood gas sample intense? |
|
Definition
| It must be stored on ice and analyzed within 2 hours |
|
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Term
| Where may blood gas samples be taken to be analyzed? |
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Definition
| Since analyzers are not commonly found in veterinary practices, the sample may have to be taken to a local reference laboratory or a human hospital laboratory |
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