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DPT 629: Cardio > Acute Care: Physiological Monitoring-Lines and Tubes > Flashcards

Acute Care: Physiological Monitoring-Lines and Tubes Flashcards

1
Q

what are the general goals of lines and tubes?

A

to to measurements and or provide access to internal body systems

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2
Q

what are the specific goals of lines and tubes?

A

rapidly deliver important meds

obtain real-time measurements of physiological fxn

collect bodily fluids

facilitate tissue healing

minimize secondary infections from lines and tubes

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3
Q

what is peripheral venous access?

A

an IV (flexible catheter inserted into a vein) used to deliver meds, fluids, or nutrition

also used to remove blood for sampling/testing

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4
Q

what are common problems associated with peripheral venous access?

A

inflammation/pain due to phlebitus/infection, dislodging IV, infiltration (leaking of fluid under the skin), clotting

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5
Q

t/f: we should avoid taking BP on the arm with a peripheral venous access IV

A

true

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6
Q

is taking BP on the arm with peripheral venous access IV in it contraindicated?

A

no, but we should avoid it if possible

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7
Q

can the line with peripheral venous access be disconnected?

A

sometimes, unless it is a continuous infusion like heparin, ask the nurse

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8
Q

what is a peripherally inserted central catheter (PICC)?

A

IV access for longer time (antibiotics, chemo, total parenteral nutrition (TNP) support)

catheter inserted peripherally and the tip is advanced to the superior vena cava

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9
Q

what are the typical peripheral vein insertion points for PICC lines?

A

basilic, cephalic, or brachial veins

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10
Q

should we take BP on the arm with the PICC line?

A

no

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11
Q

t/f: we should wait for an x-ray confirming the location of a PICC line b4 mobilizing a pt

A

true

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12
Q

what are the precautions with a PICC line?

A

don’t lift more than 10 lbs

no swimming, contact sports, shoveling, vacuuming, etc

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13
Q

what is hemodialysis?

A

a way to artificially perform the normal fxn of the kidneys where blood crosses a semi-permeable membrane (dialyzer), allowing metabolic waste products to diffuse into correction fluid (dialysate)

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14
Q

what is the dialyzer in HD?

A

the semi-permeable membrane

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15
Q

what is the dialysate?

A

the correction fluid in HD

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16
Q

what does HD do?

A

correct fluid or electrolyte abnormalities

remove toxic materials

maintain acid-base balance

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17
Q

what does HD do?

A

filters out byproducts from the blood that gets eliminated through urine and then the rest is filtered back into the blood

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18
Q

t/f: HD is accomplished through vascular access that allows high flows and repeated cannulation, while minimizing infection and clot formation

A

true

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19
Q

should you take BP on the arm with HD?

A

no

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20
Q

what are the access sites for HD?

A

central vein (ie the subclavian vein)

arterio-venous fistula

arterio-venous grafts

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21
Q

what is an arterio-venous fistula?

A

artificially created communication bw an artery in the arm and an adjoining vein

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22
Q

what is an arterio-venous graft?

A

uses an interposed synthetic graft that is less durable than an AV fistula

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23
Q

what is continuous renal replacement therapy (CRRT)?

A

nonstop veno-venous or arterior-venous hemodialysis

extracorporeal blood circulation through a small-volume, low resistance filter to provide continuous removal of solutes and fluid

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24
Q

where is the only place you will see CRRT?

A

in the ICU

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25
Q

t/f: CRRT is an absolute contraindication to PT

A

false, pts just tend to tolerate PT less so we need to coordinate with the team and closely monitor vitals and plan the session to allow sufficient line slack

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26
Q

what is peritoneal dialysis (PD)?

A

uses the peritoneum as the semi-permeable membrane and the diasylate is infused into the abdomen

the peritoneum is highly vascularized, allowing waste products and fluids to pass from the blood into the dialysis solution

diasylate remains in abdomen for several hours prior to drainage

27
Q

t/f: mobilization with HD is typically contraindicated

A

true

28
Q

why is mobilization with HD typically contraindicated?

A

bc of pt fatigue post dialysis

29
Q

what should we assess with HD prior to PT?

A

labs on fluids and electrolytes status

30
Q

t/f: we should monitor hemodynamics and activity tolerance closely with HD mobilization

A

true

31
Q

t/f: we should avoid placement of BP cuff over an AV fistula or graft site

A

true

32
Q

what is the purpose of wound drainage devices?

A

to collect fluid from internal cavities

33
Q

what is negative pressure wound therapy (wound VAC)?

A

application of localized negative pressure by controlled suction to the wound surface

noninvasive therapy to promote healing in difficult wounds that fail to respond to established Rx modalities

34
Q

t/f: wound VAC provides a closed, moist wound healing environment

A

true

35
Q

what are the benefits of wound VAC/negative pressure wound therapy?

A

assists granulation

helps remove interstitial fluid

helps remove infectious materials

36
Q

what is a major precaution with wound VAC/negative pressure wound therapy?

A

don’t break the seal!

37
Q

what is a foley catheter (indwelling catheter)

A

a urinary drainage tube

thin, sterile inserted into the bladder to drain urine with a balloon at the end filled with sterile water to hold it in place

38
Q

t/f: foley catheter may be placed for urinary retention

A

true

39
Q

what lines and tubes need to be kept below the level of the waist?

A

chest tubes and foley catheters

40
Q

what are the considerations for PT with urinary drainage tubes?

A

need to maintain the foley catheter below the level of the bladder

drain any urine in the tubing b4 mobilizing for prevention of backflow

make recommendations to the team when the catheter bag needs to be emptied or a pt is mobile enough to use the commode

41
Q

what is the purpose of feeding tubes?

A

to deliver nutrition when GI is obstructed, aspiration, or calorie supplementation is needed

42
Q

what is a Dobhoff tube?

A

short term nutritional needs while intubated or if the pt is at risk for aspiration

43
Q

what is a gastrostomy (G) tube/percutaneous endoscopic gastrostomy (PEG) tube?

A

a small, flexible, hollow tube w/a balloon or flared tip surgically inserted and secured into the stomach for nutrition

44
Q

what are the considerations for NG tubes?

A

determine if the tube is to suction or gravity drainage and whether the tube can be disconnected for out of bed mobility

determine if the tube can be disconnected prior to and/or during therapy session

45
Q

t/f: NG tube and feeding tubes are the same thing

A

false

46
Q

what are the CV consequences of bed rest and immobility?

A

decreased exercise tolerance/VO2max

decreased CO

decreased resting HR

decreased resting and max SV

increased venous compliance

decreased orthostatic tolerance

venous pooling

47
Q

t/f: anytime there is blood pooling, there is an increased risk for clotting

A

true

48
Q

what are the hematologic consequences of bed rest and immobility?

A

decreased blood volume

decreased RBCs

increased DVT risk

49
Q

what are the MSK consequences of bed rest and immobility?

A

muscles atrophy (can happen very quickly)

decreased mitochondria density and aerobic enzymes

bone demineralization, osteopenia, osteoporosis

50
Q

what are the psychiatric consequences of bed rest and immobility?

A

increased anxiety

increased agitation

increased delirium

increased depression

51
Q

what are the pulmonary consequences of bed rest and immobility?

A

decreased lung volumes and capacities

decreased respiratory muscles strength

increased risk for pneumonia/PE

52
Q

what are the metabolic/endocrine/electrolyteconsequences of bed rest and immobility?

A

increased insulin resistance

increased urinary excretion of sodium, potassium, calcium, and phosphorus

hypercalcemia/renal stone formation

53
Q

what are the nutritional consequences of bed rest and immobility?

A

cachexia/malnutrition

obesity

54
Q

why is there a loss of respiratory strength and endurance with bed rest and immobility?

A

bc the pts are not taking deep breaths

55
Q

t/f: pts can lose their sense of upright with bed rest and immobility

A

true

56
Q

why is the digestive system influenced by bed rest and immobility?

A

bc the body cant mechanically break down food or absorb nutrients well in supine

57
Q

what is sitting upright good for?

A

prevention of aspiration, breathing, and orientation

58
Q

in pts who are highly mobile b4 admission, what % are disabled at d/c?

A

13%

59
Q

in pts who are moderately mobile b4 admission, what % are disabled at d/c?

A

35%

60
Q

in pts who are of low mobility b4 admission, what % are disabled at d/c?

A

71%

61
Q

what % of pts over 90 y/o lose their ability to do their daily activities following hospitalization?

A

65%

62
Q

what can we do for a pt if they CAN walk?

A

walk the pt to the bathroom instead of using the bedside commode

encourage family/friends to walk with the pt

take a walk down the hallway b4/after each meal;

walk to and from the door

brush teeth in the bathroom

63
Q

what can we do if a pt CAN’T walk?

A

help the pt uses the bedside commode instead of the bed pan

increased total amount of time spent outside of bed

help the pt sit in a chair for all meals

64
Q

why is bed rest so bad?

A

bc it can cause thromboembolic disease, jt contractures, atelectasis, skeletal muscle atrophy/weakness, and pressure ulcers

DPT 629: Cardio (11 decks)

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