Unit 7 : monitoring the patient

kelompok 3 :
1. Allya Billa Izzah 066121154
2. Nanda Salsabila 066121139
3. Maya Nurhidayatika Utomo 066121152
4. Wildan Fauzi 066121134
5. Ruzika Nurazizah 066121137
 Monitoring the patient

DEFINITION OF PATIENT MONITORING

• monitoring can be rigorously defined as repeated or continuous observations or
meas urements of the patient, his or her physiological function, and the
function of life sup- port equipment, for the purpose of guiding management
decisions, including when to.

THE MAJOR FUNCTIONS OF PATIENT MONITORING

• Patient monitors measure, record, distribute and display combinations of
biometric values such as heart rate, SPO2, blood pressure, temperature and
more. High capability, multi function monitors are typically used in hospitals
and clinics to ensure a high level of quality patient care
 The four basic Monitoring

01 04
ECG Blood pressure

02 05
SpO2 : arterial O2 Saturation Capnography
 Intraoperative monitoring : introduction

The most primitive method of monitoringthe patient 25 years ago

was continous palpation of the radial pulsations throughout the
operation.
 GOAL OF INTRAOERATIVE MONITORING (IOM)

ü immediate postoperative neurologic deficit- New ( or worsened)

neurologic deficit is recognized immediately postoperatively,
typically within a few hours of recovering from surgical
anesthesia

ü Permanent or persisting neurologic deficit - New ( or worsened)

neurologic deficit persists beyond the immediate postoperative
period and is present at the time of hospital discharge or last
clinical follow - up
A. Answer the following questions :
1. What are the measurements of monitoring in the critical care unit in
the hospital ?
Answer : Monitoring usually includes measurement of vital signs
(temperature, blood pressure, pulse, and respiration rate), quantification
of all fluid intake and output, and often daily weight. Blood pressure may
be recorded by an automated sphygmomanometer, or an arterial
catheter can be used for continuous blood pressure monitoring. A
transcutaneous sensor for pulse oximetry is used as well.
2. What are invasive and non-invasive surgery ?
Answer : Invasive surgery includes a biopsy (taking a sample of tissue
for examination), and a vaginal or rectal examination. In contrast,
noninvasive surgery is a procedure that is performed without the skin
having to be opened or sliced, and is performed from outside the body
3. Describe the ICP Monitoring ?
Answer : Intracranial pressure monitoring is standard for patients with severe
closed head injury and is occasionally used for some other brain disorders, such
as in selected cases of hydrocephalus and idiopathic intracranial hypertension
(pseudotumor cerebri) or in postoperative or postembolic management of
arteriovenous malformations. These devices are used to monitor ICP (normally 5
to 15 mm Hg) and to optimize cerebral perfusion pressure (mean arterial pressure
minus intracranial pressure). Typically, the cerebral perfusion pressure should be
kept > 60 mm Hg.Several types of intracranial pressure monitors are available.
The most useful method places a catheter through the skull into a cerebral
ventricle (ventriculostomy catheter). This device is preferred because the catheter
can also drain cerebrospinal fluid (CSF) and hence decrease intracranial pressure.
However, the ventriculostomy is also the most invasive method, has the highest
infection rate, and is the most difficult to place.
Occasionally, the ventriculostomy becomes occluded due to severe brain
edema.Other types of intracranial devices include an intraparenchymal monitor
and an epidural bolt inserted between the skull and the dura through which a
pressure sensor is passed. Of these, the intraparenchymal monitor is more
commonly used. All intracranial pressure devices should usually be changed or
removed after 5 to 7 days because infection is a risk.

4. What does it mean by PAC Monitoring ?

Answer : Use of a pulmonary artery catheter (PAC, or Swan-Ganz catheter) is
becoming less common in ICU patients. This balloon-tipped, flow-directed catheter
is inserted via central veins through the right side of the heart into the pulmonary
artery. The catheter typically contains several ports that can monitor pressure or
inject fluids. Some PACs also include a sensor to measure central (mixed) venous
oxygen saturation. Data from PACs are used mainly to determine cardiac output
and preload. Preload is most commonly estimated by the pulmonary artery
occlusion pressure.
However, preload may be more accurately determined by right ventricular end-
diastolic volume, which is measured using fast-response thermistors gated to heart
rate.Despite longstanding use, PACs have not been shown to reduce morbidity
and mortality. Rather, PAC use has been associated with excess mortality.
This finding may be explained by complications of PAC use and misinterpretation
of the data obtained. Nevertheless, some physicians believe PACs, when
combined with other objective and clinical data, aid in the management of certain
critically ill patients. As with many physiologic measurements, a changing trend is
typically more significant than a single abnormal value. Possible indications for
PACs are listed in the table Potential Indications for Pulmonary Artery
Catheterization
 THE CONTINOUS TENSE

The past continous The present continous

tense tense

FORM: FORM
was/were + present participle (+ ing) am/is/are + present participle ( + ing)

Examples: Examples:
• The baby was crying in the oxygen. • The surgeon is removing the Michel
• The It’s the closest
paramedics were giving the Clips
man planet
artificial the Sun now.
respiration when hist breathing • She is bandaging the burnt blister with
and the smallest
stopped. sterile
of them all gauze dressing.
 THE PRESENT CONTINOUS TENSE

Let’s focus on the present continuous tense

The Present Continuous Tense is used to :
Show actions, which happen at the time of speaking. It is sometimes used with
words
such as: now, still, at present, at the moment.
Examples:
I am studying now. At the moment, she is using the artery forceps to stop the
bleeding.
The patient is still complaining of repeated pain.
Show an activity that will happen in the immediate future.
Examples:
The ambulance is leaving soon.
Dr. Azmi is getting married to Staff Nurse Rosnah in November.
Now, let's study the forms of the present continuous tense in the
POSITIVE, NEGATIVE and INTEROGATIVE
 EXERCISE 1

Change these verbs into The Present Participle.

1. Begin = begining
2. Remove = removing
3. Admit = admitting
4. Hope = hoping
5. Lecture = lecturing
6. Lose = losing
7. Put = putting
8. Lie = lying
9. Cough = coughing
10. Sue = suing
 EXERCISE 2

Fill in the blanks with the verbs given in brackets. Use The Present Continuous
Tense
1. Roselind's relatives always asking (ask) unnecessary questions.
2. Dr. Aimi is examining (examine) the patient now.
3. Professor Masbah Omar is delivering (deliver) a speech at the seminar tomorrow.
Please be quiet when he is speaking (speak).
4. Wahiza is working (work) on the night shift tonight.
5. I am telling (tell) you the truth but she is liying (lie).
6. Linda is feeding (feed) her son.
7. Please be quiet. You are talking (talk) too loudly and you are distrubing (disturb) the
others.
8. They are Operating (operate) on him at the moment.
 EXERCISE 2

9. Professor Idrus : "you are coming (come) with us? We are planing (plan) to leave
tomorrow.“
Dr. Shahrul : "I'm sorry, I can't join you as I am working (work) on a difficult project at
the moment.“
10. Nurse: "Do not disturb this patient. He is resting (rest)".
 EXERCISE 3

Complete the blanks with the correct form of The Present Continous Tense

It is a bussy day at the Psychiatric ward The doctor (1) Are examining (examine)
the patients while the nurses (2) Are assisting (assist) the doctors in the grand
ward round. Two patients (3) Are quarreling (quarrel) over a book while another
patient (4) is screaming (scream) his heart out.The clinical assistant (5) is trying
(try) his best to pacify the screaming Patient. An hold man (6) is running (run)
around the ward, (7) distrubing (distrub) and (8) teasing (tease) other
patients.some of the patients (9) is beginning (begin) to run after him now. Two
student nurses (10) are standing (stand) helplessly not knowing what to do with
these mentally ill patients.
 EXERCISE 4

Complete the sentences below with a verb in the box. Write the verb in The Present
Continuous Mix Affect Exchange
Tense and use each verb only ONCE. Tidy up Explain Supervise
Run out Identify Administer
Undergo

1. Professor Rizwan is mixing the two solutions in the Pathology Laboratory now.
2. At the moment, the nurses is explaining to Encik Ismaznizam the importance of personal
hygiene.
3. If headaches is affecting your quality of your life, then you should consult your physician.
4. The surgeons is exchanging views and ideas among themselves before confirming the
diagnosis.
 EXERCISE 4

5. At the moment, the student nurses is identifying the subcutaneous injection on the
patients.
6. Rozmel is tidying up the messy ward.
7. We are running out of blood.
8. Hamid is undergoing an operation tomorrow.
9. The students is administering the parts of a nasogastric tube.
10. Puan Malathi is supervising the student nurses in the Oncology Ward
 EXERCISE 5

Complete each of the sentences below with a verb in the box. Write the verb
in The Present Continuous
Leave Carry out Die
Tense and use each verb only ONCE.
Give Inspect Take
Conduct Bleed sleep
Suture Transfer Put

1. Mrs. Ong is taking out still birth control pills

2. Professor Maggs is conducting a lecture on Research Methodology in
Nursing.
3. I am suturing the surgical site carefully.
4. The nurses is giving preoperative shaving procedure at the moment.
5. Professor Sharaf and his wife are leaving for Philadelphia in two weeks'
time.
 EXERCISE 5

6. The patient is bleeding profusely.

7. The children is sleeping soundly in the nursery.
8. Hafizah's boyfriend is dying of leukemia.
9. Professor Zulfiqar of the Science University of Malaysia is carrying out a
research on oral cancer.
10. Staff Nurse Zalizant is putting the cuff of the sphygmomanometer around
the patient's upper arm.
11. He is inspecting the patient's dressing to check for anysigns of excessive
haemorrage.
12. They are transfering the patient to the recovery room soon.
 Thank u
and
see u next time! ^^