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MedSurg Test 1 > Chapt 66 > Flashcards

Chapt 66 Flashcards

1
Q

What are RRT’s

A

Critical care nurse, RT, MD or APN. RRT do not guarantee a doctor.

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2
Q

What is the difference between calling RRT and a code blue?

A

The presence of a doctor

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3
Q

What are PCUs?

A

Transition between ICU and general care. Stable enough to leave ICU but not enough for general because they are still connected to all the monitors

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4
Q

What are common problems with ICU patients?

A 
Venous thromboembolism d/t immobility
Skin problems d/t immobility
HAI= Trachs and Foleys
Sepsis= Inflammatory response
Multiple Organ dysfunctions Syndrome= Inflammatory response linked to sepsis
Nutrition deficiencies d/t hpermetabolic and catabloic states.= Healing burns calories, we need nutrients; PEG TUBE G TUBE TPN
Anxiety
Impaired Communication
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5
Q

What medications is typically used ICU Sedation?

A

Propofal, Diprivan (sedative wjth a short half life) and Fentanyl, Sublimaz (analgesic.

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6
Q

What is the purpose of a sedation vacation?

A

When doing a neuro assessment we need to pull the patient out of sedation. that is why Propofal, Dirprivan is used because of the short half life.

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7
Q

What common problem do 80% of ICU patients have?

A

Sensory-Perceptual Problems r/t delirium

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8
Q

How do you treat delirium in the ICU?

A

Address physiological factors first (oxygen)
Use clocks and calendars to orient the patient
Encourage caregiver presence
Haloperidol,Haldol (last intervention)

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9
Q

How do you treat sleep problems in the ICU?

A 
Structure the environment for sleep and wake cycles. 
Cluster activities
Scheduled rest periods
Limit noise
Provide comfort measures (back rub)
Use benzodiazepines cautiously
           Tamazepam,Restoril
            Zolpidem, Ambien
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10
Q

Should caregivers be in the room when a pts codes?

A

Yes, because they can see that we are doing everything we can for our patient.

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11
Q

CVP

A

Central Venous Pressure. We use a Swan Ganz Cathater

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12
Q

Systemic and Pulmonary atrial pressures

A

Blood pressure cuff on either the brachial, radial, or femoral arteries.

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13
Q

PAWP

A

Pulmonary artery wedge pressure. Determines preload on the left side of the heart.

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14
Q

SaO2
SvO2
SpO2

A

Arterial O2
Mixed venous oxygen saturadation.
Oxygen Saturation

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15
Q

CHF

A

Too much fluid in the heart

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16
Q

What are the two goals of Hemodynamic Monitoring?

A

Maintain adequate tissue perfusion
Early detection of changes
Titration of therapy in unstable patients
Determine what organ is a causing a problem

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17
Q

When do we use hemodynamic monitoring?

A 
Shock
Spesis
Any loss of cardia function
burns
surgeries
hemorrhage
dehydration
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18
Q

Cardiac Output

A

Icreases with high volume

decreases with low volume

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19
Q

Stroke volume

A

Volume of blood ejected with each heartbeat. Determined by preload, afterload, and contractility.

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20
Q

Ejection Fraction

A

Measurement of the percentage of blook leaving you heart each time it contracts.
Normal=60-75%
Determined on a echocardiogram

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21
Q

Left sided CHF issues

A

Left side means systemic.

Pumping issues/systolic

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22
Q

Right sided CHF issues

A

Diastolic functioning effected

Filling issue

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23
Q

Contractility
Increase effects
decreased effects

A

Strength of Contraction
Increased: Positive inotropes, B1 receptors (epi,Norepi,dopamine)
Decreased: Heart Failure, alcohol, negative inotropes
(Calcium channel blockers, beta blockers)

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24
Q

What are the different receptors and effects?

A

B1- Contraction=Postiive Inotropes
B2- Lungs Open
A1- Vasoconstriction
Dopaminergic- Vasodilate organ vasculature/ constrict peripheral arteries.

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25
Q

Preload

A

Volume in the ventricle at the end of diastole

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26
Q

Diastole

A

the phase of the heartbeat when the heart muscle relaxes and allows the chambers to fill with blood

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27
Q

Frank Sterlings Law

A

PAWP will show us left ventricular preload

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28
Q

CVP (Central Venous Pressure) shows >

A

Right Ventricular Preload

29
Q

What does vasoconstriction do to afterload?

A

Decreases

30
Q

Afterload

A

Resistance the ventricle has to over come to send blood to the body (SVR) or to the lungs (PVR).

31
Q

What happens to CO when afterload is increased?

A

CO is decreased

32
Q

What medication would you give a pt to decrease PVR?

A
  • O2
  • Calcium Channel Blockers
  • Aminophylline,
  • Isoproteronol
33
Q

What medications would we give to decrease SVR

A

We want to vasodilate

  • Morphine
  • Nitrates
34
Q

What increases PVR

A

Pulmonary HTN (Right heart Failure)
Hypoxia
PE

35
Q

What increases SVR

A 
HTN
hardened arteries
CAD
low volume
catecholamines
36
Q

How do you set up Hemodynamic monitoring?

A
  1. Arterial cathater is placed
  2. Get pressure bag (NS)
  3. Place a pressure cuff over the bag
  4. Spike the bag and prime tubing
  5. Inflate the bag to 300mmHg/Insures 3-6 mL are going into the heart lines at one time.
  6. Transducers reads the presssure and sends it to the montior
  7. 3 way stop cock needs to be zero out
  8. Fast Flush device allow a bolus of fluid to to the patient. This prevents clots
37
Q

When reading hemodynamic montioring, what angle does the pt needs to be at

A

45 degrees

38
Q

When do you obtain hemodynamic results?

A

At the end of expiration

39
Q

What is the phlebostatic Axis?

A

4th intercoastal, mid axillary line. The tranducer is at this level to prevent flase high and or lows

40
Q

How often is pressure tubing, flush bag, and transducer changed in hemodynamic monitoring?

A

Every 3 days to decrease risk for infection.

41
Q

When do you fast flush?

A

Every shift to insure accurate wave forms.

42
Q

What is the dicrotic Notch?

A

Represents the atrial valve closing.

43
Q

Before an aterial line is placed, what test should you peform?

A

Allan Test

44
Q

What is the normal MAP

A

70-105

45
Q

What is the formula for MAP

A

(Diastolic x 2 ) + Systolic/ 3

46
Q

Normal range for pH

A

7.35-7.45

47
Q

Normal PaCO2

A

35-45

48
Q

Normal range for Bicarb

A

22-26

49
Q

Aterial Oxygen Saturation (bound to hemoglobin) (SaO2)

A

95-100%

50
Q

Partial Pressure of Aterial Oxygent (PaO2)

-Total amount of O2 in the blood (bound = unbound)

A

80-100

51
Q

What position is the patient in when CVP monitoring is placed?

A

Trendelberg position

52
Q

What is the purpose of CVP monitoring?

A

To measure the filling pressure of the right side of the heart

53
Q

What happens to SvO2 (how much o2 is returing to the heart) in alkalosis?

A

Increase affinity for O2 so blood dosent let it go. Pt organs begin to shut down from starvation

54
Q

Why is tension pnuemothorax a complication of CVP monitoring?

A

Because we punctured the lung during placement.

55
Q

What pressure does CVP (Central Venous Pressure )represent?

A

Right Aterial Filling Pressure/ Preload of Right side of the heart
2-8mmHg

56
Q

What is another name for the Pulmonary Aterial Cathater?

A

Swan Ganz/Venous Circulation

57
Q

What is beneficial about the Swan Ganz catheter?

A

Mult ports.

  • CVP/RAP Monitoring 2-8mmHg
  • Blood sampling
  • SvO2 (60-80%
  • Temp
  • CO thermo monitoring (Stroke Volume)
  • Pulmonary Wedge pressure (6-12 mmHg)
58
Q

What does the pumonary wedge pressure tell us?

A

The preload of the L side of the heart

6-12 mmHg

59
Q

When are ciculatory Assist Devices used?

A

Used temporarily or permanently to decrease ventricular work and improve end-organ perfusion.

60
Q

What are two examples of Circulatory Assist Devices?

A
  1. Intraaortic Balloon Pump= IABP (most common)

2. Ventricular Assist Device=VAD

61
Q

What percentage of blood does the myocardium need?

A

80%

62
Q

Describe IABP

A

The baloon is placed in the descendig thoracic aorta above the renal arteries. The balloon fills with helium at the start of diastole and deflates before systole. Inflates opposite to ventricular contraction. The balloon inflates at every heart beat.

63
Q

How can you check the therapuetic effect of IABP?

A

Perfusion

64
Q

What are the two main befits from IABP

A
  1. Feeds the mycardium during diastole

2. Decrease afterload

65
Q

What is the nursing care for IABP

A

Heparin- to prevent clotting
HOB>30 degrees b/c of leg cannulation (femoral a)
Hourly Urine Output (Renal a.)
Limit movement to prevent balloon displacement
Hourly assessments of CV, Neurovascular,and hemodynamic status

66
Q

Is IABP temporary or permanent?

A

Temoporary

67
Q

What is a Vascular Assist Device (VAD)

A

Takes blood from the Left atrium to the device, and then to the aorta. Bypassing the Left ventricle. Can be used on the left and the right side of the heart.

68
Q

What is the nursing care for VAD?

A

Odd heart sounds
May no have a pulse
CPR is not safe for them but ahs to be done.
Need to be disconnected for difibrillaton

69
Q

When a pt has a VAD how do you obtain their BP?

A

MAP

Doppler device

MedSurg Test 1 (6 decks)

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