Flashcards in 5) CPPT In The ICU & Physiological Monitoring Deck (108):
What does interprofessional care (IPC) consist of?
HCP's communicating w/each other, pt's, & their families in an open, collaborative, & responsible manner
What things can be done in the ICU for CPPT?
Indications for CPPT ICU pt's:
*Decr PaO2 or SpO2 from this retained secretions
*Prophylaxis for acute neuro diseases, smoke inhalation, or TBI
How is efficacy of CPPT determined?
*Decr pulmonary infection incidence
*Decr time on a vent
By what % can activity in the ICU incr metabolic rate by?
What is needed for normal A/W clearance?
Mucociliary activity & an effective cough
What can cause secretion retention & why?
*Cuffed tracheal tube
*All of these impede mucociliary clearance
What can neuro conditions & drug-induced paralysis that effects glottis & breathing muscles innervations cause?
Is PD & manual techniques as effective at removing a foreign object from the lungs as therapeutic bronchoscopy?
What can mobilization decrease the need for?
PD & P/V
Do manual techniques incr ICP?
How long should it take O2 levels to return to baseline?
What is the normal HR range?
What is the normal range for MAP?
92 is the goal
What is the normal range for CVP?
What is the normal ICP?
What is the normal range for SpO2?
What are the purposes of tracheal tubes?
*Gives access to the upper A/W in pt's w/obstructions
*Allows for easier & safer suctioning
*Allow for mechanical ventilation
When is an ET tube used for an intubation?
For short-term management of the AW (<7-10days)
Where is a trach tube inserted & what do you need to make sure of?
*Inserted below the vocal cords, between the 3rd & 4th tracheal rings
*Need to make sure the low-pressure cuff's inflated during mechanical ventilation
Can C-spine ROM & prone positioning be done for a pt w/a trach?
What is a fenestrated trach & when is it used?
*Has opening in the posterior wall of the tube above the cuff
*Used to assess a pt's readiness for extinction
Complications associated w/intubation
*Laryngeal/Vocal Cord Damage
*Active dislodgement or extubation
What is a chest tube?
Tube placed in the pleural cavity or mediastinum to drain excess fluid or air
Where is a chest tube placed?
*In the 2nd intercostal space for a pneumothorax
*4th intercostal space for fluid
What should be avoided w/a chest tube?
3 compartments of a chest tube container
1) Underwater sealed drainage
2) Collection chamber for fluid or air
3) Suction chamber
Can pt's connected to the underwater sealed drainage be mobilized & ambulated?
If a pt is connected to the suction chamber, can they be mobilized?
Talk to MD first
Can P/V be done w/a chest tube?
Can shoulder ROM & breathing exercises be done on a pt w/a chest tube?
Yes. It's absolutely necessary!
What is a pulse-ox used for?
To detect early hypoxemia, O2 flow rate, & O2 concentration
Is a pulse-ox absolute?
No, its a trend indicator
What is a hemodynamic monitor (HDM)?
Monitor that goes directly into the body to measure ABP, CVP, intercardiac pressures, & PAPs
Which tubes & monitors are usually sutured in place?
What is the purpose of an arterial (A) line?
*For vasopressin therapy
Where is an A-line usually inserted & why?
Into the radial artery for free ROM
What do you need to be aware of in a pt w/an A-line?
Make sure that the transducer is at the same level of the R atrium
Complications associated w/A-lines
If a pt has a femoral A-line, what needs to be done & why?
Check w/MD before amb & sitting bc some don't allow hip flexion
Where is a central venous pressure (CVP) catheter placed & what is it used for?
*End diastolic pressure
*R ventricular fxn
*Systemic fluid status
*Placed in the R atrium
If CVP is high, what does it mean?
R Ventricular Failure
Where is a Swan-Ganz catheter placer & what is it's purpose?
*Measures hemo status to detect heart failure, sepsis, & pulmonary edema
*Inserted through the R atrium to the R ventricle to the pulmonary artery
Can you do shoulder ROM w/a Swan-Ganz catheter?
What is the purpose of a peripherally inserted central catheter (PICC) line?
*Gives long-term access for infusions of meds, nutrition, or blood products
*Eliminates complications that occur w/neck or chest insertions
Where & how is a PICC line placed?
Under a fluoroscopy into a vein in the antecubital fossa. The top of the catheter is then moved into the SVC & R atrium
Risks associated w/PICC lines
What are the PT implications for a pt w/a PICC line?
*Make sure the lines are slack before moving
*Don't take BP in the arm w/PICC line
*Clarify your plans & make sure they're ok
What is a triple lumen catheter (TLC)?
3 separate catheters in 1 sheath for infusion of meds, nutrition, & blood & also allows for blood draws
What is a TLC inserted into?
Subclavian, Jugular, or Femoral veins up to the SVC; Placement is confirmed w/CXR
What are the risks associated w/TLC?
*Vessel & tissue damage
What are the PT implications for a pt w/a TLC?
*Avoid cervical hyperextension
*Don't to PT until CXR confirms TLC placement & r/o pneumothorax
*Make sure catheter is slack before moving
*Check your plans w/MD
Where is an implantable port placed?
In the 3rd intercostal space up into the subclavian or internal jugular to the SCV or R atrium
What are the risks w/an implantable port?
What is an electronic pacemaker?
Electrically stims the myocardium to control/maintain HR
Where is a temporary pacemaker inserted?
Under fluoroscopy into the subclavian or internal jugular to the R heart
What are the risks associated w/temporary pacemakers?
*Pacing wire displacement
*Bleeding at insertion site
PT implications for temporary pacemaker?
*Be careful w/UE ROM
*Coughing can cause displacement
*Clear your plans w/MD
What is a hemocath?
Allows access for urgent dialysis
Where is a hemocath placed?
Into the subclavian, internal jugular, or femoral vein
Risks associated w/hemo cath
*Bleeding at insertion site
What are the PT implications for for a hemo cath?
Clear your ROM, OOB, transfers, & amb plans w/MD
What is mechanic ventilation?
Delivers constant cycled volume of air at a contestant pressure to pt's in respiratory failure to improve pulmonary gas exchange
What will happen if a pt is ventilated for >10days?
They'll get a tracheostomy
What are the implications for mechanical ventilation?
*Inability to maintain arterial O2 says >90% w/O2
What are the most commonly used vent modes?
AC, CMV, SIMV, & PSV
Total ventilators support
*All breaths are mandatory & delivered by the vent at a preset volume, pressure, breath rate. & inspiratory time
*Not a good sign if pt is on this
Partial support mode where the minimum # of fully assisted breaths per min is delivered--># is determined by the pt's strength, effort, & lung mechanics
When will the high pressure alarm on a vent go off?
If A/W is blocked, tension pneumothorax, or coughing
When will the low pressure alarm on a vent go off?
If there's an air leak or pt is disconnected from the vent
What is neurological monitoring used for?
To get info about brain fxn to minimize 2 complications-->Indicates worsening condition based on pressure incr
Intracranial Pressure (ICP) monitor
Placed on the injured side of the brain to measure pressure exerted by the brain, blood, & CSF against the skull; Helps to maximize cerebral perfusion
External Ventricular Drain (EVD)
If a pt has an ICP, what should you not do?
Change the bed position w/out asking
Indications for ICP monitor:
*Space-occupying brain lesions (CA)
True or False: Clinical signs are always predictive of a worsening brain injury?
What can a high ICP cause?
Decr cerebral perfusion w/no indication
Normal ICP range
How high can you push a pt's ICP to? What will happen if you push higher?
*2 brain injury bc high pressure compresses tissue so it decr cerebral blood & tissue perfusion
How many peaks should an ICP wave have?
What do slight fluctuations in ICP waveform correlate w/?
Respiration & BP fluctuations
What does an alpha wave mean?
Sudden incr in ICP-->Correlates w/poor prognosis
What does a beta wave on an ICP mean?
Respiratory changes & decr brain compliance
Cerebral Perfusion Pressure (CPP)
Driving pressure of blood to the brain
If the CPP is >40mmHg, what does it mean?
Brain fxn can't be supported
Formula for CPP
Implications for CPP monitoring
*PT should always be aware of the ICP & CPP
*Changing waveforms need to be reported
*If pt needs to rest, come back later
*Can do trendelenburg for 15min as long as ICP<25mmHg & CPP>50mmHg
*Always check w/MD first
How long can you put a pt in trendelenburg for & under what conditions?
15 minutes as long as ICP<25mmHg & CPP>50mmHg
Normal range for systolic pressure:
What is the normal range for end diastolic pressure?
What is the normal range for R CVP?
What is the normal range for systolic pulmonary artery pressure?
What is the normal range for end diastolic pulmonary artery pressure?
What is the normal range for mean pulmonary artery pressure?
What is the normal range for pulmonary artery wedged pressure?
Central Venous Pressure
Pulmonary Artery Pressure
Peripherally Inserted Central Catheter
Triple Lumen Catheter
External Ventricular Drain
Central Perfusion Presure