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Cardio Unit 3 - Week 9 > Monitoring, Life Support And Respiratory Care > Flashcards

Monitoring, Life Support And Respiratory Care Flashcards

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1
Q

Noninvasive monitoring - Electrocardiogram (ECG/EKG)

A

10 electrodes to give 12 leads
Usual display has all vitals and lead II (temp, BP, O2 and RR)

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2
Q

Top of machine monitoring vitals

A

EKG lead 2 or V5
O2 saturation wave
Respiratory wave

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3
Q

On the right of the monitor for vitals

A

Heart rate
O2 saturation
Respiratory rate

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4
Q

EKG - What are emergencies to look out for?

A

ST segment changes
Multiple PVCs or change in foci
Onset of ventricular tachycardia or ventricular fibrilation
Progression/worsening of heart block

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5
Q

What would you do with a patient if the EKG showed A-fib and/or occasional PVC’s?

A

Note them in their chart

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6
Q

What does the pulse oximetry measure and how is it expressed?

A

Measurement of arterial oxygen saturation - SpO2
Expressed as a percentage of oxygen bound to hemoglobin

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7
Q

Principles of pulse oximetry

A

Threshold level = above 90%
Orders for titrations/adjustment during activity
Reasons for inaccuracies - can’t depend on this for HR

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8
Q

Limitations of the pulse oximeter

A

Low perfusion or circulation
Anemia
Nail polish
Fluorescent lighting
Dark skin
Jaundice
Arrhythmias

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9
Q

Heart rate normal range

A

50 - 100 beats per minute

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10
Q

Systolic BP normal range

A

85 to 140 mmHg

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11
Q

Diastolic BP normal range

A

40 to 90 mm Hg

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12
Q

Respiratory rate normal range

A

12 to 20 breaths per minute

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13
Q

Oxygen saturation normal range

A

> 95% of FiO2 (fraction of inspired oxygen)

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14
Q

Reasons for using arterial lines

A

For more unstable patient
Continuous BP management or frequent access to arterial system
Hemodynamic monitoring (fluid)
Frequent ABGs taken
Drug administration

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15
Q

Precautions for arterial lines

A

Avoid dislodging - large blood loss
Radial - limit or avoid WB on wrist
Femoral - monitor closely and avoid dislodging (mobility encouraged)

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16
Q

Potential arterial line placements in order from most to least common place to put it

A

Radial artery
Femoral artery
Brachial artery
Axillary artery
Ulnar artery
Dorsalis pedis artery
Posterior tibial artery

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17
Q

Noninvasive monitoring

A

Heart rate
Systolic and Diastolic BP
Respiratory rate
Oxygen saturation

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18
Q

Invasive monitoring

A

Arterial line
Central (venous- like
Swan Ganz - Pulmonary Artery Catheter
Temperature
Intracranial pressure

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19
Q

Central (venous) line

A

Measures central venous pressure (CVP) or R atrial pressure
Allows IV access for medication administration
Tunneled (long term) or non tunneled (short term)

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20
Q

What does it mean for a line to be tunneled?

A

Short distance that the line is burrowed under the skin prior to entering the actual vein
Decrease infection risk

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21
Q

What line is used for long term placement?

A

PICC line

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22
Q

Where is the PICC line placed?

A

Cephalic, basilic or brachial vein using sterile techniques
Still runs up to superior vena cava

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23
Q

Why is the R subclavian or internal jugular vein used for a central line?

A

Quick access to the heart

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24
Q

What is a port?

A

Central line implanted under the skin

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25
CVP or PICC Precautions
Need to remain sterile Usually well covered near skin insertion Secure ends well before mobilizing Be aware of location and avoid dislodging Use precautions when femoral PICC used
26
Swan Ganz-Pulmonary artery catheter
Surgically inserted catheter —> through a central vein —> threaded through R atrium and ventricle into pulmonary artery
27
What can the Swan Ganz- Pulmonary Artery catheter measure?
Central venous pressure (CVP) R atrial pressure Pulmonary artery pressure Pulmonary capillary wedge pressure
28
What is a Swan Ganz - Pulmonary artery catheter?
Measurement of blood pressure to locate/monitor heart failure
29
What can pulmonary capillary wedge pressure calculate/measure?
Measure and estimate L side filling pressure and calculate vascular resistance
30
What else can the Swan Ganz - Pulmonary artery catheter help with?
Calculation of vascular resistance SvO2 and temporary pacing
31
What does pulmonary artery pressure help determine?
Problems like pulmonary HTN or resistance to flow through the lungs
32
Why is the Swan Ganz Catheter so important?
Measurement of left sided heart failure
33
Pulmonary capillary wedge pressure and left sided heart function
(Indirect) LEFT side heart filling pressure Because it’s a closed system, it can determine status of pulmonary circulation, detect pulmonary HTN, and estimate filling pressure of the L atrium?
34
What happens if there’s pressure in the pulmonary vessels?
It pushes the fluid into the interstitial tissue and causes problems w CO2 and O2 exchange
35
What does issues with CO2 and O2 exchange cause?
Congestion in the lungs
36
What else can the Swan Ganz catheter help with due to its location?
Guide fluid management in critically ill and dosing of diuretics
37
Elevated PCWP
Pulmonary HTN Indicates resistance to flow into the L ventricle
38
Uses of Swan Ganz Catheter
Monitoring heart function (post op) Diagnosing chronic heart failure Differentiating causes of pulmonary edema Guiding diuretic dosing to manage fluid overload
39
Complications of dislodgment of Swan Ganz
Serious arrhythmias Pulmonary artery rupture Pulmonary valve damage because it goes through it Infection - heart
40
Invasive ways to monitor temperature
Swan Ganz Urinary catheter Nasopharyngeal Rectal probe
41
When are the only times you’d use a rectal probe?
Comatose Intubated Confused
42
What is intracranial pressure monitoring used for?
Neurological trauma - head injury, brain surgery, hemorrhage, tumor meningitis
43
What does increased ICP cause?
Decreased perfusion of brain
44
What can low CO2 levels help control?
Increased ICP
45
What can be placed to help control ICP?
Drain (Temporary) Shunt (Permanent)
46
Most supportive respiratory support
Mechanical Ventilation via tracheostomy
47
Respiratory support in order from least to greatest support
Nasal cannula, face make, trach color Non-rebreather mask, Venturi mask CPAP
48
Nasal cannula
Most common device for O2 delivery Lowest level of support
49
Flow rates for nasal cannula
Between 1 and 6 L/min
50
When will a nasal cannula supply humidity?
When rate is > 4L/min
51
What is FiO2?
Fraction of inspired air that is oxygen
52
Face mask/trach mask flow rate
5-10 L/min
53
FiO2 for face mask/trach mask
About 35-56%
54
Humidification for face mask/trach mask
Face mask: common at about 4 L/min Trach mask: ALWAYS humidified
55
Why must a trach mask always be humidified?
Humidification of air happens in the upper airways and the trach is a bypass of all the upper airways
56
Venturi Mask
Much more specific/precise FiO2 delivery; order for FiO2 Dictates the L/min setting on the O2 supply Provides more support Used to ensure a specific saturation is achieved
57
Non-Rebreather Mask
Can provide up to 100% oxygen Bag fills from wall w/ O2 > 15 L/min Breathe in air from bag Breathe out - air goes into room One way valve (green) prevents air from mixing Due to high flow rate: need to start w full tank and bring a spare
58
High flow nasal cannula
Important to decrease dead space in upper airways, increase O2 reserve in system and help pt maintain O2 levels Provides flow rate for 25-60 L/min
59
CPAP
Constant positive pressure during both inhalation and exhalation Common use in sleep apnea
60
BiPAP
2 levels of pressure, one for inhalation and one for exhalation Used to wean off ventilator or prior to invasive ventilation
61
Why would you use invasive mechanical ventilation?
Failure to oxygenate Failure to ventilate Combo of both Airway protection and
62
Why would you have failure to oxygenate?
Inadequate exchange of gas at the alveolar level Pulmonary disease impacting the alveoli
63
Why would there be failure to ventilate?
Pt w decreased mental status or where compliance of the lung has decreased so much that it’s very difficult and patients can’t ventilate on their own because they’re expending too much energy
64
Why would you need airway protection?
Trauma —> When they’re trying to protect pts airway b/c they see things going bad During surgical procedures because of sedation
65
What types of invasive mechanical ventilation are there?
Endotracheal tube (Short term) Tracheostomy tube (Long term)
66
Ventilator Settings
Total volume PEEP —> Positive Expiratory End Pressure Respiratory Rate FiO2 Mode
67
What is the mode on ventilator settings?
The amount of assist
68
What is the tidal volume on a ventilator?
Amount of air delivered per breath Ensures certain volume is delivered
69
What is PEEP (Positive Expiratory End Pressure) on ventilator settings?
Pressure used to keep airway from collapsing (splints open airways) —> better O2 exchange
70
What is Respiratory Rate on a ventilator?
Breaths per minute machine delivers
71
What is the FiO2 on a ventilator setting?
Percent of O2 in delivered air Try to keep below 50% if it’s going to be used long term
72
What are the 4 levels of assist from most to least support?
Control Mode Assist Control - Volume Control (AC-VC) Synchronized Intermittent Mandatory Ventilation (SIMV-VC) Spontaneous or Pressure Support
73
Control Mode aka Ventilation Control
Ventilator has complete control —> machine does all the work to control volume and rate of breaths Preset tidal volume and respiratory rate that blocks all spontaneous breaths —> no pt initiation
74
Assist Control-Volume Control (AC-VC)
Set number of breaths (RR) Every breath has set volume Pt can initiate more breaths - machine still gives the set volume Some patient involvement with initiating when breaths will occur over the base rate Ventilator will ALWAYS give set volume
75
Synchronized Intermittent Mandatory Ventilation (SIMV-VC)
Set number of breaths w/ set volume given When pt takes more breaths than set RR Tidal volume is NOT controlled —> when pt initiates extra breaths
76
Spontaneous or Pressure Support
Set pressure, PEEP and FiO2 to help make it easier Pt dictates tidal volume and RR Use own force to generate how much air will go in Pt initiates breath, vent delivers preset pressure to help overcome airway resistance Set amount of FiO2 is supplied but pt is responsible for how much volume of air they’ll inhale

Cardio Unit 3 - Week 9 (7 decks)

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