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2) Cardiopulm > 5) CPPT In The ICU & Physiological Monitoring > Flashcards

5) CPPT In The ICU & Physiological Monitoring Flashcards

(108 cards)

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1
Q

What does interprofessional care (IPC) consist of?

A

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

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2
Q

What things can be done in the ICU for CPPT?

A
  • Postural drainage
  • ACT
  • Coughing/Cough Stimulation
  • Breathing exercises
  • Suctioning
  • Pt mobilization
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3
Q

Indications for CPPT ICU pt’s:

A
  • Retained secretions
  • Acute atelectasis
  • Infiltrates
  • Decr PaO2 or SpO2 from this retained secretions
  • Prophylaxis for acute neuro diseases, smoke inhalation, or TBI
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4
Q

How is efficacy of CPPT determined?

A
  • Decr pulmonary infection incidence
  • Decr time on a vent
  • PFT improvement
  • Tracheostomy prevention
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5
Q

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

A

35%

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6
Q

What is needed for normal A/W clearance?

A

Mucociliary activity & an effective cough

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7
Q

What can cause secretion retention & why?

A
  • Viscous secretions
  • Cuffed tracheal tube
  • Dehydration
  • Hypoxemia
  • Immobility
  • Poor humidification

*All of these impede mucociliary clearance

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8
Q

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

A

Infective cough

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9
Q

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

A

Yes

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10
Q

What can mobilization decrease the need for?

A

PD & P/V

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11
Q

Do manual techniques incr ICP?

A

No

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12
Q

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

A

15 minutes

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13
Q

What is the normal HR range?

A

60-90BPM

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14
Q

What is the normal range for MAP?

A

60-110mmHg

92 is the goal

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15
Q

What is the normal range for CVP?

A

2-6mmHg

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16
Q

What is the normal ICP?

A

15mmHg

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17
Q

What is the normal range for SpO2?

A

97-98%

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18
Q

What are the purposes of tracheal tubes?

A
  • Gives access to the upper A/W in pt’s w/obstructions
  • Allows for easier & safer suctioning
  • Allow for mechanical ventilation
  • A/W protection
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19
Q

When is an ET tube used for an intubation?

A

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

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20
Q

Where is a trach tube inserted & what do you need to make sure of?

A
  • Inserted below the vocal cords, between the 3rd & 4th tracheal rings
  • Need to make sure the low-pressure cuff’s inflated during mechanical ventilation
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21
Q

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

A

Yes

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22
Q

What is a fenestrated trach & when is it used?

A
  • Has opening in the posterior wall of the tube above the cuff
  • Used to assess a pt’s readiness for extinction
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23
Q

Complications associated w/intubation

A
  • Ulceration
  • Erosion/Scarring
  • Fistula
  • Laryngeal/Vocal Cord Damage
  • A/W obstruction
  • Active dislodgement or extubation
  • Infection
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24
Q

What is a chest tube?

A

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

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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

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