Monitoring, Life Support, Resp. Care Flashcards
(35 cards)
Noninvasive monitoring techniques
EKG, vitals machine, Pulse ox, BP, manual pulse, body temp
Emergency s/s on EKG
ST segment changes
Multiple PVC’s
VTach/VFib
Worsening of heart block
(A Fib and occasional PVC should be noted)
Pulse Ox
Measurement of arterial O2 saturation (SpO2)
% of O2 bound to Hb’
Threshold > 90%
Limitations of pulse Ox
Low perfusion/circulation or anemia
-(not enough RBCs or regular pulse under sensor)
Nail polish
Fluorescent lighting
Dark skin
Jaundice
Arrhythmias
“Normal” adult ranges for CVP values @ rest (acute setting - safe to mobilize)
HR: 50-100bpm
SBP: 85-140mmHg
DBP: 40-90mmHg
RR: 12-20 bpm
O2 sat: >95% on fraction of expired O2
Invasive Monitoring Techniques
Arterial lines
Central venous lines
Swan Ganz Pulmonary Artery Catheter
Temp and IntraCranial Pressure
Arterial Lines
Displays continuous measurements of BP and MAP
Indications for Arterial Lines
Continuous BP management
Hemodynamic monitoring
Frequent ABGs
Drug administration
Arterial Line Precautions
Transducer needs to be at level of R. Atrium
-too high -> BP reads too low
-too low -> BP reads too high
Avoid Dislodging
Radial - limit/avoid WB wrist
Femoral - monitor closely, avoid dislodging
Arterial line placements
- Radial a.
- Femoral a.
- Brachial a.
- Axillary a.
- Ulnar a.
- Dorsalis pedis
- Post tib.
Central Venous Line (function and location)
Function:
Measures CVP or R. Atrial pressure
Allows IV access for meds
Location: subclavian or internal jugular vein on R side (close to heart)
PICC Line
Location:
Placed in cephalic, basilic, or brachial vein and runs up to SVC
Function:
For long term meds
Swan Ganz-Pulmonary Artery Catheter (location and function)
Location:
-thru central vein (femoral, jugular, brachial) -> RA/RV -> pulmonary artery
Function: measurement of BP to locate/monitor HF
-Central venous pressure (CVP)
-Right atrial pressure
-Pulmonary artery pressure
-Pulmonary capillary wedge pressure
-helps calculate SvO2 and temporary pacemaker in emergencies
Right Atrial Pressure
Measures R side filling pressuring for measuring venous return + resistance to flow
Pulmonary Capillary Wedge Pressure
-L Atrial pressure (related to EDV of LV)
-Estimates/measures LV filling pressure and calculates vascular resistance
-determines status of pulmonary circulation
-indirectly assesses LV function
Elevated PCWP
Indicates:
-pulmonary HTN (impairs O2/CO2 exchange -> congestion)
-resistance to flow in LV
-LV dysfunction or impaired filling
Intracranial Pressure
-Used for neurological trauma
-Increased levels cause decreased perfusion of brain
-increased levels controlled by low CO2 levels
Nasal cannula
Support:
Lowest level
Function:
Deliver O2 @ flow rates b/w 1-6L/min
-humidify when > 4L/min
FiO2
Fraction of inspired air that is O2
Rule of 4’s (room air at sea level = 20% O2, 4% increase in FiO2 w/ every 1 L/min flow)
Face Mask
Delivers O2 w/ mask over mouth or nose @ 5-10L/min
~35-56% FiO2
Humidify > 4L/min
Low support
Trach Mask
Worn over tracheostomy site
Similar flow rates and FiO2 as face mask
Low support
ALWAYS Humidified
Why is trach mask always humidified
Trach mask bypasses upper airways where humidification occurs
Venturi mask
selects FiO2 delivered (that dictates L/min)
More supportive
Adapters control O2 being delivered (FiO2) which dictates flow rates
Orifice size of adapter creates different pressure amounts and pulls O2 in @ different rates
Non-rebreather mask
Provides up to 100% O2 thru 1 way valve that separates mask from bag preventing air from mixing
Bag fills from wall w/ O2 > 15L/min
Breathe in - air from bag to mask
Breathe out - air goes from mask to environment
