5) CPPT In The ICU & Physiological Monitoring Flashcards Preview

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Flashcards in 5) CPPT In The ICU & Physiological Monitoring Deck (108):
1

What does interprofessional care (IPC) consist of?

HCP's communicating w/each other, pt's, & their families in an open, collaborative, & responsible manner

2

What things can be done in the ICU for CPPT?

*Postural drainage
*ACT
*Coughing/Cough Stimulation
*Breathing exercises
*Suctioning
*Pt mobilization

3

Indications for CPPT ICU pt's:

*Retained secretions
*Acute atelectasis
*Infiltrates
*Decr PaO2 or SpO2 from this retained secretions
*Prophylaxis for acute neuro diseases, smoke inhalation, or TBI

4

How is efficacy of CPPT determined?

*Decr pulmonary infection incidence
*Decr time on a vent
*PFT improvement
*Tracheostomy prevention

5

By what % can activity in the ICU incr metabolic rate by?

35%

6

What is needed for normal A/W clearance?

Mucociliary activity & an effective cough

7

What can cause secretion retention & why?

*Viscous secretions
*Cuffed tracheal tube
*Dehydration
*Hypoxemia
*Immobility
*Poor humidification

*All of these impede mucociliary clearance

8

What can neuro conditions & drug-induced paralysis that effects glottis & breathing muscles innervations cause?

Infective cough

9

Is PD & manual techniques as effective at removing a foreign object from the lungs as therapeutic bronchoscopy?

Yes

10

What can mobilization decrease the need for?

PD & P/V

11

Do manual techniques incr ICP?

No

12

How long should it take O2 levels to return to baseline?

15 minutes

13

What is the normal HR range?

60-90BPM

14

What is the normal range for MAP?

60-110mmHg

92 is the goal

15

What is the normal range for CVP?

2-6mmHg

16

What is the normal ICP?

15mmHg

17

What is the normal range for SpO2?

97-98%

18

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
*A/W protection

19

When is an ET tube used for an intubation?

For short-term management of the AW (<7-10days)

20

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

21

Can C-spine ROM & prone positioning be done for a pt w/a trach?

Yes

22

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

23

Complications associated w/intubation

*Ulceration
*Erosion/Scarring
*Fistula
*Laryngeal/Vocal Cord Damage
*A/W obstruction
*Active dislodgement or extubation
*Infection

24

What is a chest tube?

Tube placed in the pleural cavity or mediastinum to drain excess fluid or air

25

Where is a chest tube placed?

*In the 2nd intercostal space for a pneumothorax

*4th intercostal space for fluid

26

What should be avoided w/a chest tube?

Kinking

27

3 compartments of a chest tube container

1) Underwater sealed drainage
2) Collection chamber for fluid or air
3) Suction chamber

28

Can pt's connected to the underwater sealed drainage be mobilized & ambulated?

Yes

29

If a pt is connected to the suction chamber, can they be mobilized?

Talk to MD first

30

Can P/V be done w/a chest tube?

Yes

31

Can shoulder ROM & breathing exercises be done on a pt w/a chest tube?

Yes. It's absolutely necessary!

32

What is a pulse-ox used for?

To detect early hypoxemia, O2 flow rate, & O2 concentration

33

Is a pulse-ox absolute?

No, its a trend indicator

34

What is a hemodynamic monitor (HDM)?

Monitor that goes directly into the body to measure ABP, CVP, intercardiac pressures, & PAPs

35

Which tubes & monitors are usually sutured in place?

*Chest tubes
*HDM
*Hemo cath

36

What is the purpose of an arterial (A) line?

Used to:
*Draw blood
*Monitor ABP
*For vasopressin therapy

37

Where is an A-line usually inserted & why?

Into the radial artery for free ROM

38

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

39

Complications associated w/A-lines

*Ecchymosis
*Hematoma
*Soreness

40

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

41

Where is a central venous pressure (CVP) catheter placed & what is it used for?

To measure:
*End diastolic pressure
*R ventricular fxn
*Systemic fluid status

*Placed in the R atrium

42

If CVP is high, what does it mean?

R Ventricular Failure

43

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

44

Can you do shoulder ROM w/a Swan-Ganz catheter?

Yes

45

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

46

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

47

Risks associated w/PICC lines

*Mechanical phlebitis
*Infection
*Venous thrombosis
*Catheter embolus

48

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

49

What is a triple lumen catheter (TLC)?

3 separate catheters in 1 sheath for infusion of meds, nutrition, & blood & also allows for blood draws

50

What is a TLC inserted into?

Subclavian, Jugular, or Femoral veins up to the SVC; Placement is confirmed w/CXR

51

What are the risks associated w/TLC?

*Pneumothorax
*Embolization
*Vessel & tissue damage
*Hemorrhage
*Infection
*Catheter displacement

52

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

53

Where is an implantable port placed?

In the 3rd intercostal space up into the subclavian or internal jugular to the SCV or R atrium

54

What are the risks w/an implantable port?

*Pneumothorax
*Infection
*Venous thrombosis
*Catheter migration
*Catheter embolus
*Hemothorax
*Cardiac dysrhythmia

55

What is an electronic pacemaker?

Electrically stims the myocardium to control/maintain HR

56

Where is a temporary pacemaker inserted?

Under fluoroscopy into the subclavian or internal jugular to the R heart

57

What are the risks associated w/temporary pacemakers?

*Infection
*Arrhythmias
*Myocardial perforation
*Cardiac tamponde
*Pneumothorax
*PE
*Pacing wire displacement
*Bleeding at insertion site

58

PT implications for temporary pacemaker?

*Be careful w/UE ROM
*Coughing can cause displacement
*Clear your plans w/MD

59

What is a hemocath?

Allows access for urgent dialysis

60

Where is a hemocath placed?

Into the subclavian, internal jugular, or femoral vein

61

Risks associated w/hemo cath

*Pneumothorax
*Hemothorax
*Air embolism
*Bleeding at insertion site

62

What are the PT implications for for a hemo cath?

Clear your ROM, OOB, transfers, & amb plans w/MD

63

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

64

What will happen if a pt is ventilated for >10days?

They'll get a tracheostomy

65

What are the implications for mechanical ventilation?

*RR >30
*Inability to maintain arterial O2 says >90% w/O2
*PaO2 <50mmHg
*PaCO2 >50mmHg

66

What are the most commonly used vent modes?

AC, CMV, SIMV, & PSV

67

AC/CMV mode

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

68

SIMV mode

Partial support mode where the minimum # of fully assisted breaths per min is delivered--># is determined by the pt's strength, effort, & lung mechanics

*Weaning mode

69

When will the high pressure alarm on a vent go off?

If A/W is blocked, tension pneumothorax, or coughing

70

When will the low pressure alarm on a vent go off?

If there's an air leak or pt is disconnected from the vent

71

What is neurological monitoring used for?

To get info about brain fxn to minimize 2 complications-->Indicates worsening condition based on pressure incr

72

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

73

External Ventricular Drain (EVD)

Drains CSF

74

If a pt has an ICP, what should you not do?

Change the bed position w/out asking

75

Indications for ICP monitor:

*GSC <8
*Reye's Syndrome
*Cerebral hemorrhage
*Space-occupying brain lesions (CA)

76

True or False: Clinical signs are always predictive of a worsening brain injury?

False

77

What can a high ICP cause?

Decr cerebral perfusion w/no indication

78

Normal ICP range

0-15mmHg

79

How high can you push a pt's ICP to? What will happen if you push higher?

*20-25mmHg

*2 brain injury bc high pressure compresses tissue so it decr cerebral blood & tissue perfusion

80

How many peaks should an ICP wave have?

3

81

What do slight fluctuations in ICP waveform correlate w/?

Respiration & BP fluctuations

82

What does an alpha wave mean?

Sudden incr in ICP-->Correlates w/poor prognosis

83

What does a beta wave on an ICP mean?

Respiratory changes & decr brain compliance

84

Cerebral Perfusion Pressure (CPP)

Driving pressure of blood to the brain

85

If the CPP is >40mmHg, what does it mean?

Brain fxn can't be supported

86

Formula for CPP

CPP=MAP-ICP

87

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

88

How long can you put a pt in trendelenburg for & under what conditions?

15 minutes as long as ICP<25mmHg & CPP>50mmHg

89

Normal range for systolic pressure:

100-130mmHg

90

What is the normal range for end diastolic pressure?

60-90mmHg

91

What is the normal range for R CVP?

0-8mmHg

92

What is the normal range for systolic pulmonary artery pressure?

15-32mmHg

93

What is the normal range for end diastolic pulmonary artery pressure?

4-13mmHg

94

What is the normal range for mean pulmonary artery pressure?

9-19mmHg

95

What is the normal range for pulmonary artery wedged pressure?

4-12mmHg

96

ICP

Intracranial Pressure

97

HDM

Hemodynamic Monitoring

98

CVP

Central Venous Pressure

99

PAP

Pulmonary Artery Pressure

100

PICC

Peripherally Inserted Central Catheter

101

TLC

Triple Lumen Catheter

102

AC

*

103

CMV

*

104

SIMV

*

105

PSV

*

106

EVD

External Ventricular Drain

107

CPP

Central Perfusion Presure

108

PAWP

Pulmonary Artery Wedged Pressure