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

5) CPPT In The ICU & Physiological Monitoring Flashcards

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
Q

Where is a chest tube placed?

A
  • In the 2nd intercostal space for a pneumothorax

* 4th intercostal space for fluid

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26
Q

What should be avoided w/a chest tube?

A

Kinking

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27
Q

3 compartments of a chest tube container

A

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

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28
Q

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

A

Yes

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29
Q

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

A

Talk to MD first

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30
Q

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

A

Yes

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31
Q

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

A

Yes. It’s absolutely necessary!

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32
Q

What is a pulse-ox used for?

A

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

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33
Q

Is a pulse-ox absolute?

A

No, its a trend indicator

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34
Q

What is a hemodynamic monitor (HDM)?

A

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

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35
Q

Which tubes & monitors are usually sutured in place?

A
  • Chest tubes
  • HDM
  • Hemo cath
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36
Q

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

A

Used to:

  * Draw blood
  * Monitor ABP
  * For vasopressin therapy
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37
Q

Where is an A-line usually inserted & why?

A

Into the radial artery for free ROM

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38
Q

What do you need to be aware of in a pt w/an A-line?

A

Make sure that the transducer is at the same level of the R atrium

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39
Q

Complications associated w/A-lines

A
  • Ecchymosis
  • Hematoma
  • Soreness
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40
Q

If a pt has a femoral A-line, what needs to be done & why?

A

Check w/MD before amb & sitting bc some don’t allow hip flexion

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41
Q

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

A

To measure:

  • End diastolic pressure
  • R ventricular fxn
  • Systemic fluid status

*Placed in the R atrium

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42
Q

If CVP is high, what does it mean?

A

R Ventricular Failure

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43
Q

Where is a Swan-Ganz catheter placer & what is it’s purpose?

A
  • Measures hemo status to detect heart failure, sepsis, & pulmonary edema
  • Inserted through the R atrium to the R ventricle to the pulmonary artery
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44
Q

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

A

Yes

45
Q

What is the purpose of a peripherally inserted central catheter (PICC) line?

A
  • Gives long-term access for infusions of meds, nutrition, or blood products
  • Eliminates complications that occur w/neck or chest insertions
46
Q

Where & how is a PICC line placed?

A

Under a fluoroscopy into a vein in the antecubital fossa. The top of the catheter is then moved into the SVC & R atrium

47
Q

Risks associated w/PICC lines

A
  • Mechanical phlebitis
  • Infection
  • Venous thrombosis
  • Catheter embolus
48
Q

What are the PT implications for a pt w/a PICC line?

A
  • 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
Q

What is a triple lumen catheter (TLC)?

A

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

50
Q

What is a TLC inserted into?

A

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

51
Q

What are the risks associated w/TLC?

A
  • Pneumothorax
  • Embolization
  • Vessel & tissue damage
  • Hemorrhage
  • Infection
  • Catheter displacement
52
Q

What are the PT implications for a pt w/a TLC?

A
  • 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
Q

Where is an implantable port placed?

A

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

54
Q

What are the risks w/an implantable port?

A
  • Pneumothorax
  • Infection
  • Venous thrombosis
  • Catheter migration
  • Catheter embolus
  • Hemothorax
  • Cardiac dysrhythmia
55
Q

What is an electronic pacemaker?

A

Electrically stims the myocardium to control/maintain HR

56
Q

Where is a temporary pacemaker inserted?

A

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

57
Q

What are the risks associated w/temporary pacemakers?

A
  • Infection
  • Arrhythmias
  • Myocardial perforation
  • Cardiac tamponde
  • Pneumothorax
  • PE
  • Pacing wire displacement
  • Bleeding at insertion site
58
Q

PT implications for temporary pacemaker?

A
  • Be careful w/UE ROM
  • Coughing can cause displacement
  • Clear your plans w/MD
59
Q

What is a hemocath?

A

Allows access for urgent dialysis

60
Q

Where is a hemocath placed?

A

Into the subclavian, internal jugular, or femoral vein

61
Q

Risks associated w/hemo cath

A
  • Pneumothorax
  • Hemothorax
  • Air embolism
  • Bleeding at insertion site
62
Q

What are the PT implications for for a hemo cath?

A

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

63
Q

What is mechanic ventilation?

A

Delivers constant cycled volume of air at a contestant pressure to pt’s in respiratory failure to improve pulmonary gas exchange

64
Q

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

A

They’ll get a tracheostomy

65
Q

What are the implications for mechanical ventilation?

A
  • RR >30
  • Inability to maintain arterial O2 says >90% w/O2
  • PaO2 <50mmHg
  • PaCO2 >50mmHg
66
Q

What are the most commonly used vent modes?

A

AC, CMV, SIMV, & PSV

67
Q

AC/CMV mode

A

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
Q

SIMV mode

A

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
Q

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

A

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

70
Q

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

A

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

71
Q

What is neurological monitoring used for?

A

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

72
Q

Intracranial Pressure (ICP) monitor

A

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
Q

External Ventricular Drain (EVD)

A

Drains CSF

74
Q

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

A

Change the bed position w/out asking

75
Q

Indications for ICP monitor:

A
  • GSC <8
  • Reye’s Syndrome
  • Cerebral hemorrhage
  • Space-occupying brain lesions (CA)
76
Q

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

A

False

77
Q

What can a high ICP cause?

A

Decr cerebral perfusion w/no indication

78
Q

Normal ICP range

A

0-15mmHg

79
Q

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

A
  • 20-25mmHg

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

80
Q

How many peaks should an ICP wave have?

A

3

81
Q

What do slight fluctuations in ICP waveform correlate w/?

A

Respiration & BP fluctuations

82
Q

What does an alpha wave mean?

A

Sudden incr in ICP–>Correlates w/poor prognosis

83
Q

What does a beta wave on an ICP mean?

A

Respiratory changes & decr brain compliance

84
Q

Cerebral Perfusion Pressure (CPP)

A

Driving pressure of blood to the brain

85
Q

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

A

Brain fxn can’t be supported

86
Q

Formula for CPP

A

CPP=MAP-ICP

87
Q

Implications for CPP monitoring

A
  • 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
Q

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

A

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

89
Q

Normal range for systolic pressure:

A

100-130mmHg

90
Q

What is the normal range for end diastolic pressure?

A

60-90mmHg

91
Q

What is the normal range for R CVP?

A

0-8mmHg

92
Q

What is the normal range for systolic pulmonary artery pressure?

A

15-32mmHg

93
Q

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

A

4-13mmHg

94
Q

What is the normal range for mean pulmonary artery pressure?

A

9-19mmHg

95
Q

What is the normal range for pulmonary artery wedged pressure?

A

4-12mmHg

96
Q

ICP

A

Intracranial Pressure

97
Q

HDM

A

Hemodynamic Monitoring

98
Q

CVP

A

Central Venous Pressure

99
Q

PAP

A

Pulmonary Artery Pressure

100
Q

PICC

A

Peripherally Inserted Central Catheter

101
Q

TLC

A

Triple Lumen Catheter

102
Q

AC

A

*

103
Q

CMV

A

*

104
Q

SIMV

A

*

105
Q

PSV

A

*

106
Q

EVD

A

External Ventricular Drain

107
Q

CPP

A

Central Perfusion Presure

108
Q

PAWP

A

Pulmonary Artery Wedged Pressure

2) Cardiopulm (16 decks)

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