IHS Test 2 - Intraoperative Monitoring Parts 1 and 2

A [blank_start]Standard of Care[blank_end] is the highest mandate for clinical behavior.

Select the standard of nursing practice that most applies to CRNAs.

Fill in the blanks for the AANA Standards for Nurse Anesthesia Practice: Standard V A. Monitor [blank_start]ventilation[blank_end] continuously. B. Monitor [blank_start]oxygenation[blank_end] continuously. C. Monitor [blank_start]cardiovascular[blank_end] status continuously. D. Monitor [blank_start]body temperature[blank_end] continuously. E. Monitor [blank_start]neuromuscular function[blank_end] and status. F. Monitor and assess the [blank_start]patient positioning[blank_end].

One of the key components to patient safety is to: [blank_start]Avoid turning your back on the patient[blank_end] and surgical procedure for long periods of time.

[blank_start]Monitors[blank_end] are placed first and removed last.

Name two ways (in alpha order) that CRNAs monitor the respiratory system: 1. [blank_start]Capnography[blank_end] 2. [blank_start]Pulse oximetry[blank_end]

What is the standard of care for monitoring of oxygenation?

The Beer-Lambert Law is a method for measuring what?

Drag and drop the spectrum of light to the appropriate type. Red: [blank_start]660[blank_end] nm Infrared: [blank_start]940[blank_end] nm

The Beer-Lambert Law and pulse oximetry measures the difference between absorbed light by [blank_start]oxyhemoglobin[blank_end] relative to [blank_start]deoxyhemoglobin[blank_end] in a pulsatile ([blank_start]arterial[blank_end]) bed.

[blank_start]Oxyhemoglobin Dissociation Curve[blank_end]: The percentage of hemoglobin saturation with oxygen at different partial pressures of oxygen in blood is described by this S-shaped curve.

Insert the appropriate corresponding numbers for the oxygen-hemoglobin dissociation curve. At an 02 reading of 97 percent, the Pa02 is likely [blank_start]100[blank_end]. At an 02 reading of [blank_start]90[blank_end] percent, the Pa02 is usually 60. At an 02 reading of 83 percent, the Pa02 is usually [blank_start]50[blank_end].

Your patient's pulse oximeter isn't reading well. What are some potential causes? Low flow conditions • [blank_start]Hypotension[blank_end]→vasoconstrictionoftheperiphery – Motion artifact – Nail polish – Ambient light interference – [blank_start]Dysfunctional hemoglobin[blank_end] • Fetal hemoglobin • Hemoglobin S – Carboxyhemoglobinemia • 240timestheaffinityforhgbvs.O2. – Methemoglobinemia – Methylene blue, indigo carmine

Name the three ways we verify intubation: 1. [blank_start]Auscultation[blank_end] 2. [blank_start]Chest excursion[blank_end] 3. Confirmation of [blank_start]CO2 in expired gases[blank_end].

What is an early indicator of esophageal intubation and airway disconnect?

[blank_start]Capnography[blank_end] continuously monitors all of the following: – Alveolar ventilation – Pulmonary perfusion – Respiratory patterns – Correct placement of endotracheal tube

Match the type of capnography with its description: [blank_start]Main-Stream Capnographs[blank_end] (non-diverting or flow-through): CO2 sensor located between endotracheal tube and breathing circuit [blank_start]Side-Stream Capnographs[blank_end]: (Diverting or aspiration): Sensor is located in the main unit and CO2 is aspirated via a sampling tube connected to a T-piece adapter located between endotracheal tube and breathing circuit.

Name two potentially fatal conditions that may first be indicated by capnographic changes: [blank_start]Pulmonary embolism[blank_end] [blank_start]Malignant hyperthermia[blank_end]

Use of [blank_start]capnography[blank_end] has markedly decreased incidence of unrecognized esophageal intubation and their associated brain injuries and deaths

Label the following image with the appropriate portions of the expiratory segment.

Label the appropriate angle segments of the expiration of capnography.

Which of the following options describes Phase I of the expiratory segment?

In capnography, what is part of the expiratory segment?

In capnography, the [blank_start]alpha[blank_end] angle is between Phases II and III. The [blank_start]alpha[blank_end] angle is an indirect indication of the V/Q status of the lung. The [blank_start]beta[blank_end] angle is between Phase III and descending limb of inspiratory segment. The [blank_start]beta[blank_end] angle is used to assess the extent of rebreathing.

Fill in the blanks for the five characteristics of capnogram that should be evaluated: -Frequency -Rhythm -[blank_start]Height[blank_end] -Baseline -[blank_start]Shape[blank_end]

Your patient has low or no ETCO2 -- what are two of the major causes? [blank_start]Decreased CO2 production/delivery[blank_end]. Causes: Hypothermia [blank_start]Decreased pulmonary perfusion[blank_end]. Causes: Hypovolemia Hypotension Pulmonary embolism Decreased cardiac output (arrest)

Select some causes of low ETCO2.

Match the causes of low ETCO2 to the examples (in alpha order) Altered Alveolar Ventilation [blank_start]Apnea (accidental extubation)[blank_end] [blank_start]Hyperventilation[blank_end] [blank_start]Increase in dead space ventilation[blank_end] [blank_start]Partial/total airways obstruction[blank_end] Technical Errors/Machine Faults [blank_start]Esophageal intubation[blank_end][blank_start]Sampling line leak[blank_end] [blank_start]Ventilator malfunction[blank_end]

Name the two chief causes of elevated CO2. [blank_start]Increased CO2 production/delivery[blank_end]. [blank_start]Increased pulmonary perfusion[blank_end]

Drag and drop the cause of the elevated ETCO2 with its cause: Increased CO2 production/delivery. [blank_start]Fever[blank_end] [blank_start]Hyperthyroid storm[blank_end] [blank_start]Laparoscopic surgeries[blank_end] [blank_start]Malignant hyperthermia[blank_end] [blank_start]Right-to-Left Shunts[blank_end] [blank_start]Sepsis[blank_end] [blank_start]Shivering[blank_end] [blank_start]Sodium bicarbonate[blank_end] [blank_start]Tourniquet[blank_end] Increased pulmonary perfusion [blank_start]Increased blood pressure[blank_end] [blank_start]Increased cardiac output[blank_end]

Select some examples of elevated CO2 causes.

You notice your patient is experiencing small breaths at various points in the ETCO2 waveform. What is NOT a potential cause of this?

Cardiac oscillations are most prominent in what patient population?

[blank_start]Cardiac oscillations[blank_end] are small gas movements produced by pulsations of the aorta and heart.

This image is an example of what on a capnograph?

Other considerations/things that may mimic [blank_start]cardiac oscillations[blank_end] – negative intrathoracic pressure – low respiratory rate – low I:E ratio – Waning muscle relaxation

Phase II and III are prolonged or slanted when a patient experiences a [blank_start]prolonged expiratory upstroke[blank_end].

You are administering anesthesia when you suddenly notice your patient's baseline is elevated. You immediately:

You see the capnograph below during your case. You know this is a sign of:

An [blank_start]expiratory valve[blank_end] defect allows exhaled CO2-rich gases to be rebreathed with each inspiration.

ETC02 is indicative of [blank_start]alveolar[blank_end] CO2.

You have two CO2 readings: 38 and 43. Which one is the arterial concentration or PACO2?

The [blank_start]facial[blank_end] nerve is the better site to monitor for onset of block because the larynx also mimics the response of the diaphragm.

The [blank_start]ulnar[blank_end] nerve is the best nerve to monitor for recovery.

Match the pattern of stimulation to its stimulus. [blank_start]Single stimulus:[blank_end] The simplest mode of stimulation; consists of a single supramaximal electrical stimulus that is delivered from every 1 to 10 seconds (1‐0.1 Hz) [blank_start]Train of Four:[blank_end] Four successive 200 μs stimuli at 2Hz delivered every 0.5 seconds for 2 seconds [blank_start]Double Burst Stimulation:[blank_end] delivers two bursts (at 50Hz) of three electrical stimulations separated by 750 sec followed later by two such impulses [blank_start]Tetanus:[blank_end] Repetitive, high-frequency stimulation at frequencies of 50 Hz or greater for five seconds

Which form of peripheral nerve monitoring is based on the concept that acetylcholine is depleted by successive stimulation?

In Train of Four stimulation, no twitches equals what kind of blockage?

Clinical relaxation usually require what percentage of neuromuscular blockage?

What PNM improves accuracy over the T4/T1 ratio by delivering a stronger stimulation and eliminating the second and third twitches?

Which PNM option may provide an indication of the time until return of the first response in the TOF and subsequent readiness for reversal of neuromuscular blockage?

Which of the following muscle groups are most sensitive to neuromuscular blocking agents?