Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
160 Cards in this Set
- Front
- Back
What is the best indicator of patient well-being? |
Vital signs |
|
Monitoring Parameters:
Vital Signs (8) |
1. heart rate 2. heart rhythm 3. respiratory rate and depth 4. mucous membrane color 5. CRT 6. pulse strength 7. blood pressure 8. body temperature |
|
Monitoring Parameters:
Reflexes are indicators of ______________ ________. |
Anesthetic depth |
|
Monitoring Parameters:
Involuntary reflexes: (6) |
1. palpebral 2. corneal 3. pedal 4. swallowing 5. laryngeal 6. papillary light reflex |
|
Monitoring Parameters:
Reflexes may be affected by: (3) |
1. drugs
2. disease
3. individual response variatioH |
|
How many Stages of Anesthesia are there? |
4 stages |
|
Which two stages of anesthesia do we try to jump over and why? |
Stages I & II
get past the excitement and movement |
|
What happens in Stage 1 of Anesthesia? (8) |
|
|
Stage 1 of Anesthesia ends with what? |
recumbency / loss of ability to stand |
|
Stage II of Anesthesia - what is it referred to as? |
The "excitement" stage |
|
Stage II of Anesthesia is characterized by: (7) |
*actions are not under conscious control |
|
Stage II of Anesthesia ends with what? |
muscle relaxation
decreased RR
decreased reflex activity |
|
Stage III of Anesthesia is the period of _______________ ___________________. |
surgical anesthesia |
|
Stage II of Anesthesia is divided into how many PLANES? |
Four planes |
|
Plane 1 of Stage III of Anesthesia: is it adequate for surgery? |
NO |
|
Plane 1 of Stage III of Anesthesia:
Characteristics of: |
1. no involuntary limb movement
2. eyeballs start to rotate ventrally
3. decreased pupillary light reflex
4. other reflexes still present but decreased response |
|
What can we do in Plane 1 of Stage III of Anesthesia ? |
intubate |
|
In what Plane / Stage do we intubate? |
Stage III, Plane 1 |
|
What is the suitable stage / plane for most surgical procedures (where we want to be and stay?) |
Stage III, Plane II
(Stage 3, Plane 2) |
|
Plane 2 of Stage III of Anesthesia:
characterized by: (8) |
1. regular and shallow breathing
2. decreased RR
3. mildly decreased HR
4. mildly decreased BP
5. relaxed muscle tone
6. no swallowing reflex
7. no pedal reflex
8. ventromedial eye rotation |
|
In Stage III, Plane 2, surgical stimulation may produce: |
1. mild increase in HR, BP, RR |
|
in Stage III, Plane 2, patient remains __________ and _____________. |
unconscious and immobile |
|
Stage III, Plane 3 is known as what kind of anesthesia? |
DEEP anesthesia (too deep) |
|
Is Stage III, Plane 3 acceptable for most anesthetic procedures? |
NO |
|
What is Stage III, Plane 3 characterized by? |
1. low HR and RR 2. decreased tidal volume 3. reduced pulse strength 4. increased CRT 5. poor - to - absent pupillary light reflex
***reflexes are totally absent - muscle tone is VERY RELAXED |
|
Stage III, Plane 4 = |
early anesthetic overdose |
|
Stage III, Plane 4 is characterized by: |
1. no jaw tone at all 2. abdominal breathing 3. fully dilated pupils 4. absence of all reflexes 5. marked depression of CV system 6. pale MM 7. increased CRT 8. flaccid muscle tone |
|
Stage IV Anesthesia = |
overdose |
|
Stage IV Anesthesia is characterized by: |
1. patient has stopped breathing
2. circulatory collapse
3. death |
|
What should you do in Stage IV Anesthesia? |
resuscitate immediately to save patient |
|
Stage III: What plane is known as "medium," optimal for most surgical procedures? |
Stage III, Plane II |
|
Stage III: What plane is known as "light" - not suitable for surgery |
Plane I |
|
Stage III: What plane is known as "deep" (excessive depth) |
Plane 3 |
|
4 Objectives of Surgical Anesthesia: |
1. patient does not move
2. patient is not aware
3. patient does not feel pain
4. patient has no memory of procedure |
|
Assessing vital signs:
3 Physical methods: |
1. touch
2. vision
3. hearing |
|
Assessing vital signs:
5 mechanical instruments: |
1. pulse ox
2. capnograph
3. ECG
4. BP monitor
5. Doppler blood flow monitor |
|
Monitoring Patient Safety:
Vital sign groupings: 3 major categories: |
1. circulation
2. oxygenation
3. ventilation |
|
Monitoring Patient Safety:
Vital Signs:
Circulation (5) |
1. HR & rhythm
2. pulse strength
3. CRT
4. MM color
5. BP |
|
Monitoring Patient Safety:
Vital Signs:
Oxygenation: (5) |
1. MM color
2. CRT
3. Hgb saturation
4. inspired O2
5. arterial blood O2 |
|
Monitoring Patient Safety:
Vital Signs:
Ventilation (5) |
1. RR rate & depth
2. breath sounds
3. end-expired CO2 levels
4. arterial CO2
5. blood pH |
|
Why do we give a breath? (2) |
1. expand lungs
2. make sure patient as a good breath of O2 |
|
Lower blood volume has what effect on heart rate? |
Increases HR
(Heart tries harder to push blood through to oxygenate body) |
|
If you can feel a pedal pulse the BP should be at least _________. |
60 (MAP) |
|
Indicators of Circulation: Heart Rate
Physical Assessment: (2) |
1. palpation of pulses
2. ausculatation with stethoscope (more difficult in recumbent, anesthetized animals) |
|
Indicators of Circulation: Heart Rate
Mechanical Assessment: (3) |
1. ECG
2. BP monitor (doppler or oscillometric)
3. intra-arterial line / transducer |
|
Indicators of Circulation: Heart Rate
Bradycardia: why might it happen (4) |
1. depressant effect of most anesthetics
2. drugs (alpha2-agonists & opioids)
3. excessive anesthetic depth
4. adverse effects of drugs |
|
Indicators of Circulation: Heart Rate
Tachycardia: why might it happen? (6) |
1. anticholinergics & cyclohexamines
2. inadequate anesthetic depth
3. pain
4. hypotension
5. blood loss / shock
6. hypoxemia & hypercapnea (too much CO2) |
|
Are sinus arrhythmia normal to see in cats? |
NO - not normal in cats! |
|
Indicators of Circulation: Heart Rhythm
Which lung should be up if the patient is in lateral recumbency? |
BEST LUNG ALWAYS UP |
|
Indicators of Circulation: Heart Rhythm
What can be used to detect 1st or 2nd degree heart block? |
ECG |
|
Indicators of Circulation: Heart Rhythm
What things cause arrhythmias?
(2 main categories) |
1. drugs
2. disease / medical state |
|
Name 4 classifications of drugs that could cause cardiac arrhythmia: |
1. barbituates
2. anticholinergics
3. cyclohexamines
4. alpha 2 agonists |
|
Name 5 diseases / medical states that could cause cardiac arrhythmia: |
1. hypoxia
2. hypercarbia (high level of CO2 in blood)
3. heart disease
4. trama
5. GVD |
|
Instruments used to monitor HR & Rhythm:
(2) |
1. esophageal stethoscope
2. ECG |
|
What does ECG measure? |
electrical activity of the heart |
|
Cardiac arrhythmias are usual within the first 10 minutes of initial use of what type of drug? |
barbituates |
|
Cardiac Conduction System:
Commonly encountered Cardiac Arrhythmias: |
Sinus arrhythmia |
|
Sinus arrhythmias coordinate HR with what? |
respirations |
|
Sinus arrhythmias are abnormal in what species? |
cats |
|
TRUE OR FALSE:
Sinus bradycardia is common during anesthesia when there is excessive anesthetic depth and/or drug reactions |
TRUE |
|
How can you potentially correct a sinus bradycardia? (2) |
1. anticholinergics
2. reversal agent |
|
Sinus tachycardia might happen as a result of what 3 things? |
1. inadequate anesthetic depth
2. drug reaction
3. surgical stimulation |
|
Cardiac Arrhythmias:
1st Degree A-V Heart Block has a prolonged ____________ interval |
P-R |
|
Cardiac Arrhythmias:
2nd Degree A-V Heart Block has occasional missing __________ complexes. |
QRS |
|
Cardiac Arrhythmias:
3rd Degree A-V Heart Block has randomly irregular ____________ intervals |
P-R |
|
Which degree A-V heart block is blood not being moved effectively? |
3rd degree |
|
In an A-V heart block, the __________ is not getting to the heart. |
message |
|
PEA stands for... |
Pulseless Electrical Activity |
|
PEA occurs when the heart is not contracting, but ________________ is normal. |
ECG |
|
PEA: definition |
Cessation of heart contractions and/or palpable pulse in the presence of normal or nearly normal ECG |
|
PEA (Pulseless Electrical Activity) is associated with ________ __________. |
Cardiac arrest
(mechanical activity of the heart) |
|
Anesthetist must do both _____________ monitoring and ____________ monitoring. |
physical
ECG |
|
Indicators of Circulation:
Why might there be a delay in CRT time? (8) |
1. patient is cold / low body temp
2. low BP
3. too deep
4. heart problem
(5. dehydration)
6. shock
7. blood loss
8. epinephrine release |
|
CRT indicates ________________________________. |
peripheral tissue blood perfusion |
|
Indicators of Circulation:
Blood pressure - is an indicator of _________ _______________. |
tissue perfusion |
|
Factors involved in blood pressure: (5) |
|
|
Systolic pressure is produced by _____________ of the __________ _____________. |
contraction
left ventricle |
|
Diastolic pressure is the pressure that remains in the arteries when the heart is in the _____________ __________ between _____________. |
resting phase
contractions |
|
Can all BP monitoring instruments measure systolic pressure? |
YES |
|
Can all BP monitoring instruments measure Diastolic pressure? |
NO |
|
Hypertension can damage delicate tissue in the: (3) |
1. kidneys
2. lungs
3. retina |
|
What is the best indicator of blood perfusion to the internal organs? |
MAP (mean arterial pressure) |
|
Indicators of Circulation:
Pulse Strength is used as a rough indicator of _________ _______________. |
blood pressure |
|
Pulse strength is typically ___________ in anesthetized animals. |
lowered |
|
Pulse strength is a ____________ interpretation. |
subjective |
|
Direct BP readings are obtained via an ________________ ______________ inserted into an ____________. |
indwelling catheter
artery |
|
Direct BP readings are most commonly used with what species? |
horses |
|
What type of BP reading provides continuous reading throughout the cardiac cycle and is the most accurate? |
Direct |
|
Indirect BP readings are obtained by using an ________________ _____________ and ________. |
external sensor
cuff |
|
Name 3 types of indirect BP reading equipment: |
1. Doppler ultra sound
2. Osciollometric
3. Sphygmomanometer |
|
What type of BP reading is common at referral hospitals for prolonged surgeries? |
Central venous pressure |
|
Central venous pressure assesses ______________________________________ and __________ __________. |
blood return to the heart
heart function |
|
Central venous pressure usually uses a catheter from the ____________ vein into the ___________ ________ _________. |
jugular
anterior vena cava |
|
Indicators of Oxygenation:
MM Color: should be _________
3 places you can measure:
|
pink
1. gums
2. conjunctiva
3. anus |
|
MM color provides a rough assessment of ___________________ and ___________ ______________. |
oxygenation
tissue perfusion |
|
The goal is to have oxygenation of at least ______%. |
95% |
|
Pale MM indicate: (2) |
1. anemia
2. poor capillary perfusion |
|
Cyanotic membranes indicate: (3) |
1. respiratory arrest
2. O2 deprivation
3. pulmonary disease |
|
MM color is affected by: (3) |
1. body temperature
2. vascular resistance
3. gum disease |
|
Physiology of O2 Transport:
Most O2 is carried by ____________. |
hemoglobin |
|
100% O2 saturation means: |
all available Hgb - binding sites are filled with O2 |
|
Indicators of Oxygenation:
Measuring Blood O2:
Partial Pressure (PaO2) measures ________________ O2 dissolved in ____________. |
unbound
plasma |
|
PaO2 is highest in ___________ blood.
Lowest in __________ blood. |
highest in arterial
lowest in venous |
|
As PaO2 decreases, SaO2 _______________. |
also decreases
(but not at the same rate / not as rapidly) |
|
Indicators of Oxygenation Saturation:
TRUE OR FALSE:
When a patient is breathing pure O2 from anesthetic machine the % saturation will increase. |
FALSE
The amount of DISSOLVED O2 will increase, not necessarily the % saturation. |
|
Indicators of Oxygenation:
Blood gas analyzers measure __________ ____________. |
partial pressure |
|
Pulse Oximeters measure ___________ _____________. |
Oxygen saturation |
|
What measures partial pressure of O2? |
Blood gas analyzer |
|
What measures O2 saturation? |
Pulse oximeter |
|
Pulse oximeter measures what 2 things? |
1. O2 saturation
2. heart rate |
|
O2 Saturation:
>________% is normal in patient breathing pure O2.
<_________% saturation for >_________ seconds is a medical emergency |
95%
85% / 30 seconds |
|
Pulse Oximeter can also be used in exam room to look at ______________ _____________. (Example, on cats) |
vascular efficacy
|
|
Two types of probes used in pulse oximetry: |
1. transmission probe
2. reflective probe |
|
What type of pulse ox probe is better to use in horses? |
reflective |
|
Name 2 places you can put a pulse ox probe (on a small animal) |
1. tongue
2. in between toes |
|
If you lose your Pulse Ox reading or get a LOW reading, what are the 1st three things to do? |
1. reposition probe
2. check ventilation (is bag / drape moving?)
3. check circulation |
|
Ventilation vs. Respiration
What is ventilation? |
The movement of GAS in and out of the alveoli. |
|
What is respiration? |
The tissue using the O2 and exchanging the CO2. |
|
Respiratory Rate = _____________ |
# of breaths per minute (bpm) |
|
2 ways to physical monitor RR:
2 ways to mechanically monitor RR: |
1. watch bag fill
2. watch chest wall movements
----------------------------
1. apnea monitor
2. capnograph |
|
Tachypnea during anesthetic procedure may result from: (4) |
1. hypercapnea (too much CO2in blood)
2. pulmonary disease
3. mild surgical stimulus
4. progression from moderate to LIGHT anesthesia |
|
Tidal Volume = ________________________________. |
the amount of air inhaled during a breath |
|
Patients under anesthesia tend to
a) hyperventilate
b) hypoventilate |
HYPO ventilate (Shallow Breathing)
(risk of becoming acidotic due to CO2 accumulation) |
|
Hypoventilation can lead to _________________.
(the collapse of the ____________.) |
atelectasis
lungs |
|
In HYPERventilation you would see ______________ tidal volume. |
elevated |
|
A patient might start hyperventilating if they are _______________. |
painful |
|
The risk of HYPERventilation is________________. |
losing too much CO2 and becoming alkalotic. |
|
Respiratory character refers to the____________________________________ |
effort required to breathe |
|
abdominal breathing is referred to as (acronym) |
COPD |
|
Examples of respiratory character (2) |
1. dyspnea
2. apneustic pattern |
|
Respiratory character can be measured by: (2 ways) |
1. visually - watching chest (time between inspiration / expiration
2. listening - harsh noises, whistles, squeaks |
|
What piece of equipment warns that the patient hasn't taken a breath in a preset time period? |
Apnea monitor |
|
A capnograph measures _____________________. |
End tidal CO2 |
|
End tidal CO2: normal shape on monitor should be a: |
"flattened mountain" |
|
Capnogram:
Inspiration = CO2 is _________mmHg
Expiration = CO2 is __________mmHg |
0
35-45 |
|
Abnormal CO2 levels are most commonly due to changes in ________________. |
ventilation |
|
With hyperventilation you will see a gradual _________________ in ETCO2 value. |
decrease |
|
With hypoventilation you will see a gradual ________________ in ETCO2 value. |
increase |
|
The #1 thing that affects pH is _______________. |
ventilation |
|
What else might affect pH? |
Fluids |
|
Capnogram abnormalities unrelated to ventilation or equipment problems: (4) |
1. cardiac arrest
2. hypotension
3. hypothermia
4. hyperthermia |
|
CO2 levels and Acid-Base Status:
Anesthetized patients may become mildly ______________. |
acidotic |
|
CO2 levels and Acid-Base Status:
How can you determine if a patient's acidosis is respiratory or metabolic? |
compare blood pH to PaCO2 |
|
PaO2 should be ____________x the inspired O2 concentration (room air rate) |
5 times |
|
Room air is 21% O2, so PaO2 should be ________. |
100mmHg |
|
Pure O2 is 100% O2, so PaO2 should be ________. |
500mmHg |
|
Hypoxemia in the absence of disease is commonly seen in what anesthetized species? |
horses |
|
Indicators of Body Temp:
Reasons why an animal would get cold under Anesthesia: (4) |
1. shaving & cleaning surgery site
2. temp of fluids
3. opening abdomen to air
4. can't shiver under anesthesia
5. vasodilation caused by pre & anesthetics |
|
How to minimize / manage Heat Loss during anesthesia? (6) |
1. warm IV fluids
2. avoid cold prep / Sx / Tx rooms
3. barrier between patient and table top
4. circulating warm water blanket
5. forced warm air blanket
6. heating lamps |
|
Heating animals: avoid using _____________ _______. |
heating pads (will burn them) |
|
Hyperthermia is not normal, but when it happens is most often seen during or just before ______________. |
recovery |
|
Management of hyperthermia: (5) |
1. cool fluids IV, IP, or rectally
2. fans
3. ice or alcohol application
4. reversal agents
5. increase flow rate of O2 in non-rebreathing systems |
|
Malignant Hyperthermia is most commonly seen in what species?
What causes it? |
pigs
genetic defect |
|
Clinical signs of malignant hyperthermia (4) |
1. patient becomes hot and stiff
2. ears turn red
4. increased CO2 production
5. tachyarrhythmias |
|
How to treat malignant hyperthermia: (3) |
1. stop Ax immediately and give 100% O2
2. use cooling methods
3. treat with dantrolene |
|
Reflexes:
What is used to determine when to pull the trach tube? |
swallowing reflex |
|
What is the palpebral reflex? |
blink reflex |
|
Slow palpebral reflex in horses indicates ______________________________. |
adequate surgical anesthetic depth |
|
Checking a corneal reflex is done by _______________________________ and is most useful in ______________ animals. |
dropping a drop of sterile saline or artificial tears into eye
large |
|
Corneal reflex is used primarily to determine if a large animal patient is _______ ___________. |
too deep |