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Cardiopulmonary > CCU & ICU > Flashcards

CCU & ICU Flashcards

1
Q

Goals and Considerations of PT practice in the CCU/ICU

A
  1. High Risk Patients (Medically unstable)

Goals:
* Decrease complication and overall morbitidty
* Restore patient to maximal functional capacity

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2
Q

Prior to starting treatment, what should you do?

A

Check all sites of lines

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3
Q

What is an Aterial Pressure Line?

A
  • Thin catheter placed into the artery in the forearm
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4
Q

What are the 3 purposes for an arterial line?

A
  1. Direct BP measurement (Continuous SBP, DBP, and mean BP - MAP)
  2. Sampling blood
  3. Medication delivery
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5
Q

What do you need to consider when working with a patient with an APL?

A
  • Prior to intervention, note the transducers position and waveform and catheter site location
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6
Q

Arterial Pressure Norms

A
  • Systolic: 100-140 mm Hg
  • Diastolic: 60-90 mm Hg
  • MAP 70-105 mm Hg
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7
Q

What would an normal APL wave be?

A
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8
Q

What would an overdampened wave look like? What does this mean?

A
  • Transducer is above the heart
    OR
  • Heart is not able to keep up. Pt. will likely have symptoms. If you elevate them and you see this you need to return them to a supine position. May be experiencing hypotension.
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9
Q

What does an underdampened wave mean? What does it look like?

A
  • Transduce is below the heart
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9
Q

What does an underdampened wave mean? What does it look like?

A
  • Transduce is below the heart
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10
Q

What readings would you get if the transducer is above or below the heart level?

A
  • if transducer is below right atrium the pressure readings will be increased
  • ~1 inch below = 2 mmHg rise
  • if transducer is above right atrium pressure readings will be decreased
  • ~1 inch above = 2 mmHg reduction
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11
Q

Arterial Line Complications

A
  • Bleeding
  • Infection
  • Lack of blood flow to the tissue distal to the incision (due to catheter); Need to look at the color, temp and pulse to ensure good blood flow
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12
Q

What is a central venous pressure?

A
  • Cathether that is inserted (via subclavian, jugular, or femoral) that sits just outside thr right atrium that reads the pressure in the large vein
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13
Q

Normal Range for CVP? What would abnormal possibly indicate?

A
  • 2-8 cm H2O
  • Greater than 12 could indicate: HF or Pulmonary artery stenosis
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14
Q

What is the CVP used for?

A
  • High volume administration (large veins)
  • Frequent blood draws
  • Medications
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15
Q

PT considerations CVP

A
  • ROM can be performed but ensure NOT to occlude the catheter (may happen with arm exercises)
  • Ensure the transducer stays at the heart level and that if it needs to be disconnected to ask nursing to do so.
  • If entry site is on an arm, NO BP on that arm
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16
Q

What is a Peripherally inserted catheter? What is it used for?

A
  • Catheter inserted in the central or peripheral vein that sits just outside the right atrium
  • Used to provide medications (Ex: antibiotics)
17
Q

PT Considerations - PICC

A
  • Less invasive, lower risks and can be placed for longer period of time
  • ROM may be performed, DO NOT OCCLUDE CATHETER
  • NO BP on that arm
18
Q

What is a pulmonary artery catheter? What does it do?

A
  • Catheter that goes through subclavian, jugular or femoral into the pulmonary artery
  • Gives information about the R atrial and R ventrciular pressure and pulmonary artery pressure
  • Information on preload
  • Allows for medications, fluids and venous O2 sat
19
Q

PT Considerations - PAC

A
  • No ambulation
  • Pt may sit at edge of bed or pivot transfer (with nurse present)
  • Caution w/ ROM not to occlude catheter
  • Towel roll under axilla or neck may aid in preventing line occlusion in side-lying
  • Pulmonary HTN: mean pressure greater than 25 mmHg; norm is 10-20 mmHg
  • Pulmonary Wedge Pressure (balloon with catheter in pulmonary artery; be careful with tugging)
20
Q

What is an Intra-aortic balloon pump? What does it do?

A

Balloon that contracts in diastole to help in increasing the blood to send blood to the coronaries to better feed heart that is recoverying. Typically ported in the femoral artery.

21
Q

PT considerations - Intra-aortic balloon pump

A
  • Generally no PROM or AROM of LE on involved side (typically bedrest)

General Rules:
* Keep hip flexion less than 70 degrees for transfers
* Keep involved leg straight
* Out of bed activities contraindicated until catheter is removed
* Avoid kinking when rolling

22
Q

The only way for someone to get more oxygen is by…

A

changing the partial pressure!

23
Q

What are chest tubes used for?

A

Drains blood, fluid and air to allow for full expansion of the lungs
Placed into the pleural space by suturing a tube in between the ribs.

24
Q

Pt Considerations - Chest Tube

A
  • Pt mobility is encouraged
  • Activity limited to room unless approval to disconnect pt from suction
  • Keep chest tube (chamber) lower than insertion point
  • Avoid kinking the tubes (or standing on them!)
  • Shoulder ROM and deep breathing exercises are recommended to increase arm function and mobilize chest wall
25
Q

What do you do if a chest tube comes out?

A
  • Stop what you are doing
  • Place hand over the hole
  • Call for nurse
  • Sit patient upright
  • Assess for breath sounds
26
Q

Tracheostomy Types and PT Considerations

A

Two Types:
* Cuffed (acute); Cannot Talk
* Cuffless

  • Be aware of the amount of oxygen pt is receiving
  • Monitor oxygen levels during intervention
  • Notify staff if pt needs to be suctioned (gurgling sound)
27
Q

What is a CPAP?

A
  • Pt does the work; starts/stops breath
  • Continuous level of positive airway pressure
  • CPAP means a constant PEEP
28
Q

What is a PEEP? What does it do?

A
  • Amount of positive pressure during exhalation
  • Positive pressure attempts to open closed alveoli at end of expiration
29
Q

What does a pacemaker do? What does it look like on an EKG? Indications?

A

Pace the heart
See pacer spike on EKG

Indications:
* Sick sinus syndrome (age related)
* 3rd Degree HB

30
Q

Where are pacemakers located?

A

Below the clavicle

31
Q

Types of Pacemakers

A
  • Single Chamber: Signal to and from either R Atrium OR R Ventricle
  • Dual Chamber: One lead in atrium AND ventricule. Can monitor and deliver impulses.
  • Fixed: Same Rate
  • Demand: Detects when moving and adjusts as needed
  • Atrial-triggered
  • Ventricular-triggered
32
Q

Pacemaker Codes

A

5 Letter Code
1st: Where current is sent (A, V, D)
2nd: Where something is sensed (A, V, D)
3rd: Sense Response (I, T, D)
4th: Rate Responsive (R, 0)
5th: Anti-tachycardia components (A, V, D, 0); Caridoversion or Defibrillation; Pacing

A: Atrium
V: Ventricular
D: Both A and V
R: Rate Modulation
0: None

33
Q

What is rate responsive?

A

Ability to detect and when when someone goes from rest to moving

34
Q

What is pacing?

A

Series of electrical signals for the next 5-8 cycles.

35
Q

When working with someone who has a Pacemaker, you should monitor what?

A
  • Monitor ECG: rest and during exercise when available
  • Symptoms at rest and exercise – post Ex
    – Dyspnea scale
    – RPE
  • SBP & DBP at rest and exercise – post Ex
36
Q

If someone has a fixed pacemaker what is required?

A
  • Low level activity for a longer period of time with warm up to get catecholimines to be able to create a metabolic demand change.
  • Assess RPE, BP and Sx
37
Q

If someone has a demand pacemaker, what is important to consider?

A
  • Activity and Ventilatory require longer warm up periods
  • Need to know the upper limit of the pacemaker
38
Q

Calculate Reserve BP, No Rate Modulation

Training SBP range = 60-70%
Training SBP =
Max = 180
Rest = 120

A

Training SBP range = 60-70%
(SBP max – SBP rest) (intensity) + SBP rest
Training SBP =
Max = 180
Rest = 120

A: Range 156-162 SBP mmHg

39
Q

What is an AICD or ICD?

A
  • Automatic Impantable Cardiac Defibrillator
  • Manage uncontrolled ventricular arrhythmias
    – Low energy (cardioversion)
    – High energy (defibrillation)
  • Senses heart rhythm and cardioverts or defibrillates if necessary

Cardiopulmonary (21 decks)

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