Advanced Patient Monitoring

Patient monitoring is essential as it gives insight into the patients status including ___, response to ___, and ___

presentation, therapy, degeneration

Method to monitor patients: ___ which includes looking, listening, and feeling, and ___ which utilizes various machines

physical, mechanical

Record keeping is important to patient monitoring as it ___ medical care with current information with trends, and allows ___ between personnel, regarding the patient’s progress during rounding

supports, communication

Rounding is used for the continuity of care like when a case is ___ or there is a ___ change

transfered, shift 

There are different level for patient monitoring a low level would be ___, a moderate level is minor ___, and high level is ___

boarding, illness, ICU

What are the parameters for a low level risk anesthesia patient either ___ or for ___ procedures

healthy, minor

The parameters for a moderate level risk anethesia patient, is either generally ___, or ___ procedures

healthy, uncomplicated

The parameters for high level risk anesthesia patients is either they are ___ or undergong a ___ procedure

compromised, complicated

The technician’s responsibility is monitoring ___. To have the ___ to continously pay attention, and not be bored. and acheive ___ of anesthesia for depth of safety

anesthesia, endurance, balance

Acheiving balance with anesthesia is at a good ___ but also ___ for the patient

depth, safety

Non invasive patient monitoring includes: 7 components

temperature, pulse, heart performance, respiration, urine output, hydration status, neurologic status

Invasive patient monitoring: 4

hematologic, respiratory function, CVP, heart performance

Temperature is a ___ between loss and production

balance

Heat is loss from the ___ and ___

skin, lungs

Heat is produced from ___ ___ and the ___

skeletal muscle, liver

Heat is transfered with 4 methods: ___, ___, ___, ___

radiation, convection, conduction, evaporation

Alterations to temperature can be due to the ___, ___ of the patient, and ___

environment, disease, interventions

Extreme varation of temperature can be due to ___ ___, a ___ disturbance, ___ ___ and ___ ___ ___

organ failure, pH, cardiac arrhythmia, disseminated intravascular coagulation

Methods to read temperature: ___ thermometer which is the gold standard. ___ thermometer which utilized infrared, and is more correlation, and can be impacted by otitis. ___ probe which is a mulitple function monitor. a ___ sensor

rectal, aural, thermister, skin

The gold standard for obtaining temperature is ___ as it is close to true core

rectal

Pulse can be taken via ___ ___, and can allow rapid problem recognition

digital palpation

Too much digital pressue can ___ the pulse 

occlude

Locations to feel digital pulse: ___ which is most common, ___, ___, ___ during anesthesia, ___ which is less common, and ___ in LA

femoral, metacarpal, carotid, lingual, aural, facial

A hypokinetic pulse is due to decreased ___ ___

cardiac output

Decreased cardiac output can cause a hypokinetic pulse. Decreased CO can be caused by ___ disease, ___, ___ disease, ___, an obstruction in the ___ ___ and ___

myocardial, hypovolemia, pericardial, tachycardia, left ventricle, shock

Hyper kinetic pulse can be due to a ___ ___ like AI or PDA, a ___, ___ causing compensation, and ___

cardiac defect, fever, anemia, thyrotoxicosis

Cardiac defects that could cause hyperkinetic pulse: ___ ___, ___ ___ ___

aortic insufficiency, patent ductus arteriosis

When checking pulse check the ___ and the ___ of it

quality, characteristics

Check the cardiac ___ by checking both the pulse and heart beat simutaneously

correlation

Also when checking ___ ___ pulses for a thrombus or embolus

bilateral femoral

What animal is more likely to have a femoral thrombus/ embolus

cat

The heart performance can be assesed via ___, checking the ___, and ___

palpation, MM, auscultation

The mucus membranes can be checked for ___ and ___

color, CRT

When ausculting the heart the ___, ___, and ___ can be checked. Specifically ___ are very important

rate, rhythmn, sounds, murmurs

A grade 1 murmur is

a very soft murmur that can only be detected after very careful ausculation. It is the lowest intensity able to be heard

A grade 2 murmur is 

a soft murmur, that is readily evident, but is restricted to a local area

A grade 3 murmur is

A moderately intense murmur not associated with a palpable precordial thrill, immeadiately with ausculation

A grade 4 murmur is

A loud murmur, and a palpable precordial thrill is not present or is intermittent

A grade 5 murmur is 

a loud cardiar murmur associated with a palpable precordial thrill, but isn’t audible when the stethoscope is lifted 

A grade 6 murmur is

a loud cardiac murmur associated with a palpable precordial thrill even when the stethoscope is lifted

Systolic murmurs that occur between S₁ - S₂  ___ and ___

midsystolic, holosystolic

Midsystolic murmurs occurs from ___ ___

outflow stenosis

Holosystolic murmurs can result from ___ ___ or ___ ___

AV insufficiency, septal defects

diastolic murmurs occur during S₂ - S₁ can be caused by ___ ___ and ___ ___

outflow insufficiency, AV stenosis

A continuous murmur is due to ___

PDA

ECG utilize and measure ___ ___

electrical activity

A P wave is ___ ___ on an ECG

atrial depolarization

A QRS wave on an ECG is ___ ___

ventricular depolarization

The T wave on the ECG is ___ ___

ventricular repolarization

Although a ECG may be functioning it may not correlate to heartrate due to ___ ___ ___ or PEA

pulseless electrical activity

Conduction means how depolarization waves move through the ___

heart

abnormal conduction of the heart results in heart ___

arrhythmia

The P wave in a canine will be less than ___ and less than ___ in cats

0.04 s, 0.04 s

The PR interval in a dog will last ___- ___

0.06-0.13 s

The PR interval for a cat is ___-___

0.05-0.09s

The QRS waves for dogs less than 20 kgs will last less than ___ 

0.05 s

The QRS waves for dogs more than 20 kgs will be less than ___

0.06 s

Giant breed dogs will have a QRS wave that lasts less than ___

0.065 s

Cat’s QRS wave last less than ___

0.04 s

The QT interval in dogs will last ___-___

0.15-0.25s

The QT interval in cats will last ___-___

0.12-0.18 s

A P wave amplitude in dogs is less than ___

0.4 mV

A P wave amplitude in cats is less than ___

0.2 mV

A R wave amplitude for a dog less than 20 kgs  is less than ___ and a dog greater than 20 kgs will be less than ___

2.5 mV, 3.0 mV

A R wave amplitude for a cat will be less than ___

0.9 mV

A P wave being abnormally long indicates that the ___ ___ ___

left atrial enlargement

The amplitude of a P wave being abnormally larger indicates ___ ___ ___

right atrial enlargement

A left ventricle enlargement can be indicated by ___ wave ___ increasing, or ___ wave ___ increasing, but at times it may be normal

R, amplitude, QRS, duration

A R ventricle enlargement may be indicated by the ___ wave being ___ than usual

S, deeper

The sinus rhythmn is the rhythmn coming from the ___ node

sinoatrial

Sinus arrhythmia means that the impulses that come from the SA node are not in a ___ rhythmn

consistent

With sinus arrhythmia, when inhaling the ___ will increase and the ___ impulses will decreasing. Then when exhaling the ___ will decrease

heartrate, parasympathetic, heartrate

A wandering pacemaker results in changing ___ wave ___

P, amplitude

Is it normal when cats have sinus arrhythmia?

no

Cats can normally get ___ ___

sinus tachycardia

Sinus bradycardia in dogs is less than ___, and in cats is ___

60 bpm, 150 bpm

Causes of sinus bradycardia includes: ___ disease, ___ disease, ___, ___, and increased ___ tone

heart, endocrine, hypothermia, drugs, vagal

Atrial standstill means the atria are not ___

contracting 

Atrial standstill causes reduced or no ___ waves

P

Causes for atrial standstill: ___, ___ obstruction, ___

hyperkalemia, urinary, hypoadrenocorticism

Sinus arrest is when the ___ isn’t working

SA

Sinus arrest is when there is a pause that last longer than 2 ___ intervals

R-R

Sinus arrest occurs in dogs with increased ___ tone and dogs who are brachycephalic, have ___ ___ or on ___

vagal, sick sinus, drugs

 ___ often occurs when sinus arrest is present

syncope

a first degree AV block is when the ___ ___ is increases occasionally

PR interval

Causes of 1st degree heart block increased ___ tone, early ___, ___ and ___

vagal, hyperkalemia, age, drugs

A 2nd degree AV block specifically Mobitz 1 will have ___ ___which progressively increases, and occasionally a P wave will not be followed by a ___ complex. The QRS complex is usually ___

PR interval, QRS, normal

Causes of a Mobitz type 1 AV block: increased ___ tone, ___ like digitalis but it may be ___ in some cases

vagal, drugs, normal

Mobitz type 2 AV blocks will have a ___ PR intervals then a ___ complex is dropped, and they can also be ___, and multiple ___ waves can be seen before a QRS complex appears

constant, QRS, wide, P

Causes of a Mobitz type 2 AV block: the failure of the SA impulse to pass through the ___ of ___  or disease the area

bundle of His 

3rd AV block have a ___ rate which is fast and regular but a ___ rate that is regular but slower.

atrial, ventricle

A dog with a 3rd degree AV block may have a bpm of ___-___and a cat may have a bpm of ___-___

40-50, 90-110

Causes of 3rd degree AV block is when SA impulses ___ to go through the ___ ___, or there is disease in that area

fail, His bundle

Sinus tachycardia in puppies are ___ bpm, in small dogs is ___ bpm, in larger dogs is ___ bpm, and in cats is ___ bpm

220, 180, 140, 240

Causes of sinus tachycardia is ___, ___, ___, ___ ___, ___, and is some cases ___ which will decrease in a bit

pain, fever, anemia, reduced CO, hyperthyroidism, excitement

Atrial fibrillation have no distinct ___ wave, and will have ___ but ___ ECG

P, rapid, irregular

Causes of atrial fibrillation: ___ ___ impulses, the ___ of atrium, ___ valve insufficiency, ___, ___ ___ disease, or ___ breed dogs

multiple atrial, dilation, AV, cardiomyopathy, congenital heart, giant 

VPC is ___ ___ ___

ventricular premature contration

VPC is when the ventricle receives an ___ from an irregular location

impulse

With VPC the QRS looks ___ and ___, and the ventricle may receive impulses from ___ places

wide, bizarre, multiple