Otterbein/Grant CRNA Basic/Advanced Monitoring Review

The correct progression is RA, RV, PA, PCWP. This is because the progression follows the flow of blood through the heart and lungs. RA stands for right atrium, which receives deoxygenated blood from the body. RV stands for right ventricle, which pumps the deoxygenated blood to the pulmonary artery (PA). PA stands for pulmonary artery, which carries the deoxygenated blood to the lungs to be oxygenated. PCWP stands for pulmonary capillary wedge pressure, which measures the pressure in the left atrium and left ventricle.

Femoral arterial line placement site is associated with retroperitoneal hemorrhage because it involves accessing the femoral artery, which is located in the groin area. Retroperitoneal hemorrhage refers to bleeding that occurs behind the peritoneum, which is the membrane that lines the abdominal cavity. The femoral artery runs through the retroperitoneal space, and if there is a complication during the arterial line placement, such as accidental puncture or damage to the artery, it can lead to retroperitoneal hemorrhage.

Elevated with the elderly or w/bair hugger use

I know she said only esophageal, rectal, bladder, but the chart and google says tympanic is considered core.

Temp

IJ site contraindications = anticoagulant therapy, ipsilateral CEA

The correct answer is II because lead II provides the best view of the electrical activity of the heart. Lead II is formed by placing the positive electrode on the right leg and the negative electrode on the left arm. This placement allows for the visualization of the electrical signals moving from the right atrium to the left ventricle, giving a clear representation of the heart's rhythm and detecting any abnormalities.

According to the Scope and Standards for Nurse Anesthesia Practice, it is necessary to continuously monitor the cardiovascular status of patients undergoing anesthesia. This includes monitoring via electrocardiogram (EKG) and listening to heart sounds. Additionally, blood pressure (BP) and heart rate (HR) should be recorded at least every 5 minutes. This regular monitoring helps ensure the patient's cardiovascular stability and allows for timely intervention if any abnormalities are detected.

Any case over 20 minutes must have a temperature recorded.

Hypothermia is a medical condition characterized by a dangerously low body temperature. A body temperature of less than 36°C is considered hypothermic. This condition can occur when the body loses heat faster than it can produce it, leading to symptoms such as shivering, confusion, and loss of consciousness. It is important to seek medical attention and take steps to warm the body when experiencing hypothermia, as it can be life-threatening if left untreated.

When inserting a PA catheter, it is advisable to avoid using the left internal jugular if possible. This is because the thoracic duct is located on the left side of the body and can be at risk of damage during the procedure. The thoracic duct is responsible for draining lymphatic fluid from the lower body and left upper body into the venous system. Damage to the thoracic duct can lead to leakage of lymphatic fluid, which can cause complications such as chylothorax. Therefore, to minimize the risk of damaging the thoracic duct, the left internal jugular should be avoided if possible.

The explanation for the given correct answer is that the upstroke on an a-line reflects cardiac contractility and SVR (systemic vascular resistance). A rapid upstroke indicates increased contractility or low SVR, while a slow upstroke indicates low contractility or high SVR. Therefore, it is true that the upstroke on an a-line reflects cardiac contractility and SVR.

Inadequate output, also known as oliguria, is defined as a urine output less than 0.5 mL/kg/hour. This means that if a person is producing urine at a rate lower than 0.5 mL per kilogram of body weight per hour, it is considered inadequate. This can be a sign of kidney dysfunction or dehydration, and it is important to monitor and address this issue to prevent further complications.

Inject no more than 1.5 mL of air into the balloon.

The PA catheter tip should be positioned in Zone III. This is because Zone III represents the pulmonary artery, which is the correct location for the PA catheter tip placement. Zones I, II, and IV do not accurately represent the correct position for the catheter tip.

Measuring cardiac output at the end of expiration is recommended because it corresponds to the end of diastole, when the heart is at its most relaxed state. This allows for a more accurate measurement of the amount of blood pumped out of the heart per minute. Additionally, measuring at the end of expiration ensures that the measurement is not affected by the changes in intrathoracic pressure that occur during inspiration.

Despite this, the MAP remains accurate

Dicrotic notch disappears, systolic peak increases, diastolic trough decreases, transmission delay

Normal = color return in 5 seconds
Abnormal = >10 seconds

Where the aortic valve closes.

Positive pressure ventilation is a method of providing artificial respiration by forcing air into the lungs. During this process, the air pressure inside the lungs is increased, causing the lungs to expand and fill with air. This elevation of the CVP (central venous pressure) occurs because the increased pressure in the chest pushes against the veins that return blood to the heart. As a result, blood flow to the heart is impeded, leading to an elevation in CVP.

The most common complication of CVP placement is infection. When a central venous catheter is inserted, there is a risk of introducing bacteria into the bloodstream, leading to an infection. This can result in serious complications such as sepsis or bloodstream infections. It is important to maintain strict aseptic technique during the insertion and care of CVP lines to minimize the risk of infection.

Normal is 60-80

Right median basilic = 40 cm

The ulnar nerve is located in the arm, while the facial nerve is located in the face. During a surgical procedure, nerve stimulation is often used to assess the functionality of the nerves. Since the ulnar nerve is located closer to the site of stimulation (arm) compared to the facial nerve (face), it is expected to return its functionality sooner. Therefore, it is true that the ulnar nerve will return before the facial nerve during nerve stimulation at the end of a case.

The most prominent and easily-identifiable abnormality on a PA catheter waveform is the tall V waves seen with mitral regurgitation. Mitral regurgitation is a condition where the mitral valve in the heart does not close properly, causing blood to flow backward into the left atrium. This abnormal flow of blood creates a characteristic waveform on the PA catheter, with tall V waves indicating the regurgitation. This abnormality can be easily identified and distinguished from other conditions based on the waveform pattern.

Median nerve damage is associated with brachial arterial line placement.

The left is preferred d/t decreased risk of carotid obstruction/cerebral embolism

Pulse oximetry measures the oxygen saturation level in the blood. Anemia, which is a decrease in the number of red blood cells or the amount of hemoglobin, can affect the accuracy of pulse oximetry results. Since anemia reduces the oxygen-carrying capacity of the blood, it can lead to lower oxygen saturation levels. Therefore, anemia will alter pulse oximetry results. The other options, including methemoglobin, carboxyhemoglobin, fetal hemoglobin, and hemoglobin S, can all affect pulse oximetry results as they interfere with the normal oxygen-carrying capacity of hemoglobin.