What Is Patient Monitoring?

Continuous measurement of patient parameters such as heart rate and rhythm, respiratory rate, blood
pressure, blood-oxygen saturation, and many other parameters have become a common feature of the care of
critically ill patients. When accurate and immediate decision-making is crucial for effective patient care,
electronic monitors frequently are used to collect and display physiological data. Increasingly, such data are
collected using non-invasive sensors from less seriously ill patients in a hospital’s medical-surgical units, labor
and delivery suites, nursing homes, or patients’ own homes to detect unexpected life-threatening conditions
or to record routine but required data efficiently.

We usually think of a patient monitor as something that watches for—and warns against—serious or life-
threatening events in patients, critically ill or otherwise. Patient monitoring can be rigorously defined as
“repeated or continuous observations or measurements of the patient, his or her physiological function, and
the function of life support equipment, for the purpose of guiding management decisions, including when to
make therapeutic interventions, and assessment of those interventions” (Hudson, 1985, p. 630). A patient
monitor may not only alert caregivers to potentially life-threatening events; many also provide physiologic
input data used to control directly connected life support devices.

In the past, most clinical data were in the form of heart and respiratory rates, blood pressures, and flows, but
today they include integrating data from bedside instruments which measure blood gases, chemistry, and
hematology as well as integrating data from many sources outside the intensive-care unit (ICU). Although we
deal primarily with patients who are in ICUs, the general principles and techniques are also applicable to other
hospitalized patients.

For example, patient monitoring may be performed for diagnostic purposes in the emergency room or for
therapeutic purposes in the operating room.

Patient Monitoring in Intensive-Care Units

There are at least five categories of patients who need physiological monitoring:

1. Patients with unstable physiological regulatory systems; for example, a patient whose respiratory system is
suppressed by a drug overdose or anesthesia

2. Patients with a suspected life-threatening condition; for example, a patient who has findings indicating an
acute myocardial infarction (heart attack)

3. Patients at high risk of developing a life-threatening condition; for example, patients immediately after
open-heart surgery or a premature infant whose heart and lungs are not fully developed

4. Patients in a critical physiological state; for example, patients with multiple trauma or septic shock.

5. Mother and baby during the labor and delivery

nurse at a patient’s ICU bedside. Above the nurse’s head is the bedside monitor which measures and displays key
physiological data, above her left hand is an IV pump connected to a Medical Information Bus (MIB), to her right are two
screens of a patient ventilator and to the far right is a bedside computer terminal used for data entry and data review.

Care of the critically ill patient requires prompt and accurate decisions so that life protecting and life-saving
therapy can be appropriately applied. Because of these requirements, ICUs have become widely established in
hospitals. Such units use computers almost universally for the following purposes:

● To acquire physiological data frequently or continuously, such as blood pressure readings

●To communicate information from data-producing systems to remote locations (e.g., laboratory and radiology
departments)

● To store, organize, and report data

● To integrate and correlate data from multiple sources

● To provide clinical alerts and advisories based on multiple sources of data

● To function as a decision-making tool that health professionals may use in planning

the care of critically ill patients

● To measure the severity of illness for patient classification purposes

● To analyze the outcomes of ICU care in terms of clinical effectiveness and cost

Effectiveness
Block diagram of a modern Bedside Monitor. Physiological signals from the patient are acquired by transducers. These
transducers convert the appropriate physiological signal into an electrical signal that is then amplified and conditioned
(usually an analog filter of some sort) and then present the signal to an Analog to Digitial converter (ADC) . The ADC sends
the data to a microprocessor based signal processor which extracts features such as heart rate and blood pressure.

After processing, the physiological signals are displayed on a display device and usually sent to a centralized ICU display
system and frequently to a electronic patient record.

Central Monitoring System

Continuous monitoring is a valuable tool that helps provide additional information to the
medical and nursing staff about the physiologic condition of the patient.

Depending on their configuration, central monitors include modules to measure various

parameters, including ECG, respiratory rate, NIBP and IBP, body temperature, SpO2, cardiac
output, intracranial pressure, and airway gas concentrations. They include computing
capabilities and additional displays to observe trend information. They do not replace bedside
monitors.

Central Station is a powerful computer with one or two color displays, with a sound alarm
system, laser and thermal printers.

Central Station provides:

 Comprehensive review

 Remote control access

 Reception, analysis and documentation of real-time information

 Continuous monitoring of basic parameters of patient’s condition

 Patients databases maintenance

 Data exchange within a local hospital or the global information network

UNIT IV

Endoscope

The basic technology behind the modern endoscope was developed in the early 1950s by English
physicist Harold Hopkins.

Endoscope is an instrument used to examine the interior of a hollow organ or cavity of the body.
The device uses fiber optics and powerful lens systems to provide lighting and visualization of
the interior of a joint. The portion of the endoscope inserted into the body may be rigid or
flexible, depending upon the medical procedure.

Endoscopes may be rigid or flexible. The two types differ in appearance, but function in similar
ways.

Flexible endoscopes are useful for looking at the digestive and respiratory tracts because they
bend in places. They use fibre optics to shine light into the body.

Rigid endoscopes are much shorter than flexible endoscopes. They are used to look at the
surface of internal organs, and may be inserted through a small cut in the skin. Rigid endoscopes
are commonly used to examine the joints.

Components

An endoscope consists of

 a rigid or flexible tub

 a light delivery system to illuminate the organ or object under inspection. The light source is
normally outside the body and the light is typically directed via an optical fiber system.

 a lens system transmitting the image from the objective lens to the viewer, typically a relay
lens system in the case of rigid endoscopes or a bundle of fiberoptics in the case of a fiberscope.

 an eyepiece.

 A camera transmits image to a screen for image capture.

 an additional channel to allow entry of medical instrument like foreceps, scissors,etc.

Light from a bright lamp outside the patient's body shines into one of the endoscope tubes.
Gastroscope: Stomach

The light bounces along the walls of the fiber-optic endocope tube into the patient's body
cavity.

The diseased or injured part of the patient's body is illuminated by the light shining in.

Light reflected off the body part travels back up a second fiber-optic tube, bouncing off the glass
walls as it goes.

The light shines up into the physician's eyepiece so, looking down, the physician can see what's
happening inside the patient's body

Types of endoscopes

Arthroscope: Joints

Bronchoscope: Esophagus and lung

Colonoscope: Colon and bowel

Cytoscope: Bladder

Duodenoscope: Small intestine

Esophagogastroduodenoscope: Esophagus, stomach and small intestine

Fetoscope: Womb

Hysteroscope: Womb

Laparoscope: Abdomen

Laryngoscope: Larynx

Rhinoscopy

- examination of the inside of the nose.

Sigmoidoscope: Large intestine

Thoraco scope: Thorax

Applications

Endoscopy allows doctors to check for irritation, ulcers, inflammation and abnormal tissue
growth in the internal organs. It can be used to close off a blood vessel or remove small
growths.