CPPT In ICU Flashcards
Green (ECG) normal values
60-90 bpm
Red: BP and (MAP- mean arterial pressure) normal values
120/80 mmHg and MAP is between 60-110, normal is 92
CVP (Central venous pressure) normal values
2-8 cmH2O or 2-6 mmHg
Blue- Intracranial pressure normal values
0-15 mmHg, can treat up to 20 mmHg, if 19, talk to nurse
Purple- SpO2- normal values
97-98
Endotracheal tube can be inserted by what two ways?
Oral and nasal
3 classifications of tracheostomy tubes
Cuffed and cuffless
Fenestrated and nonfenestrated
Metal and plastic
ET-T is used for short or long term management?
Short
Where are trachs inserted?
Below vocal cords
Btw third and fourth tracheal rings at sternal notch
What should the cuff pressure on the trach be?
Below 25 cmH2O
Trach patients should have what kind of motion done?
C/S ROM and prone positioning
Where are chest tubes inserted for fluid?
Btw fourth and fifth intercostal space at the midaxillary line for fluid (low)
Where are the chest tubes inserted for a pneumothorax?
IN the second intercostal space at the midclavicular line (high)
Where should the drainage container be placed for patients with a chest tube?
Upright and below the level of the chest connecting the tubes to an under water seal drainage system and applying suction
3 compartments of drainage containers
Under water seal drainage
A collection chamber for air or fluid
A suction chamber
In the 3 compartments of the drainage containers, where is it okay to see bubbles?
The suction chamber
True or false: patients connected to an under water seal drainage can be mobilized and ambulated?
True
Can percussion and vibration be performed with chest tubes?
Yes
ROM of what body part is necessary with breathing exercises for people with chest tubes?
Shoulder ROM
Orange hair syndrome
Patient need 2-4x amount of normal pain meds to feel relief
An spO2 of 90% corresponds to a PaO2 of ….
60 mmHg
Below 90% of SpO2 is a problem, and this can occur…
Dysrhythmias
At what SpO2 and PaO2 do most dysrhythmias occur?
SpO2- 85% and PaO2 of 50 mmHg
HDM-A Line: Peripheral Arterial Catheters: What artery is this usually put into?
Radial artery
HDM-A Line: Peripheral Arterial Catheters: What two things are the catheter connected to?
A flush device and transducer
HDM-A Line: Peripheral Arterial Catheters: Where should the transducer be placed?
At the level of the right atrium
HDM-A Line: Peripheral Arterial Catheters: What will the pressure readings be if the transducer is below the right atrium?
Falsely high
HDM-A Line: Peripheral Arterial Catheters: What will the pressure readings be if the transducer is above the right atrium?
Falsely low
HDM-A Line: Peripheral Arterial Catheters: What is one thing you should not change without notifying the nurse?
The height of the bed
This kind of line has a loop along thumb and the wrist is bandaged
A line
Central Venous Pressure (CVP) catheters: are placed where?
Directly into the heart (right atrium)
Central Venous Pressure (CVP) catheters: This is an important tool to assess…
Right atrial pressure
Right ventricular function
Systemic fluid status
Central Venous Pressure (CVP) catheters: Directly reflects ______
Indirectly reflects _______
Directly: right atrial pressure
Indirectly: right ventricular end diastolic pressure
Central Venous Pressure (CVP) catheters: If the right ventricle is failing, what will rise?
CVP
Central Venous Pressure (CVP) catheters: The waveform fluctuates with inspiration
_______ with spontaneous inspiration
_______ with positive pressure respiration
Decreases
Increases
Swan Ganz: How is it inserted
Through the right atrium, right ventricle, and then passed into the pulmonary artery
Swan Ganz: What three things can be calculated?
Preload
Contractile state
Afterload
Pulmonary Artery Catheters: During balloon inflation, the pulmonary artery wedge pressure is calculated and the wave is _____
Dampened
Pulmonary Artery Catheters: Pulmonary artery wedge pressure is indicative of…
Left atrial and left ventricular end diastolic pressures
Pulmonary Artery Catheters: The balloon should NOT be inflated for more than ___ seconds
15
What side of the brain are ICP devices placed on?
Injured side of the brain
Two different types of neurological monitoring devices:
EVD (external ventricular drain) and Bolt
What two things does the (external ventricular drain) drain?
Spinal fluid and CSF
For someone on Bolt or EVD, how should the bed be set up?
Head of bed MUST be elevated
What kind of wave demonstrates sudden increases in ICP with peaks of 50-100 mmHg
Alpha wave
What kind of wave is a saw tooth pattern, correlates with respiratory changes and occurs decreasing brain compliance
Beta wave
Cerebral perfusion pressure is the drive pressure of….
Blood to the brain
How can CPP be calculated?
MAP-ICP=CPP
What value do we want CPP to be?
> 60 mmHg
Can put a patient in trendelenberg if ICP is _____ and CPP is ____
<25 mmHg
>50 mmHg
MAP= formula
((2 x DBP) + SBP) / 3
CVP mean number is…
0-8 mmHg
Pulmonary artery values:
Systolic:
End diastolic:
Mean
15-32 mmHg
4-13 mmHg
9-19 mmHg
Normal mean range for pulmonary artery wedge pressure is…
4-12 mmHg
Peripherally Inserted Central Catheter (PICC Line): Infusion of what?
Meds, nutrition, fluids, or blood products
Peripherally Inserted Central Catheter (PICC Line): What is the placement?
Under fluoroscopic guidance, catheter is inserted percutaneously into a vein in antecubital fossa.
The tip of the Cather is moved into the superior vena cava and right atrium and goes right into the heart
Peripherally Inserted Central Catheter (PICC Line): What is important about blood pressure?
Cannot take blood pressure in extremity with PICC line
Peripherally Inserted Central Catheter (PICC Line): Can you ambulate with patient?
Yes
TLC (Tri Lumen Catheter): Infusion of…
Meds, nutrition and blood products
Allows blood withdrawal
TLC (Tri Lumen Catheter): Placement?
Inserted percutaneously into the superior vena cava through the subclavian, external jugular, or internal jugular vein or into the femoral vein of the LE
TLC (Tri Lumen Catheter): What needs to be ruled out before giving therapy?
A pneumothorax
TLC (Tri Lumen Catheter): When do you need to calcify orders for transfer training OOB with MD?
When they have a femoral catheter placement
Implantable Port: Infusion of…
What population usually gets these?
Drugs, TPN, blood products and other fluids; typically in patients with cancer
Implantable port: placement?
Percutaneous placement into super vena cava or right atrium via subclavian or internal jug vein
Portal place over 3rd and 4th ribs
Temp pacemaker: Placement
Pacing wire is inserted transvenously through subclavian or IJ vein into right atrium, right ventricle or both
Temp pacemaker: Wire is ____ and device is ____
Internal
External
Temp pacemaker: What is a contraindication for people with a temp pacemaker?
Shoulder flexion/abduction ROM- typically for 1 month min
Hemo Catheter: Permits access for _____
Urgent dialysis/acute renal failure
Hemo Catheter: If you are on a hemo catheter, you are usually on this kind of machine as well
Dialysis
Hemo Catheter: Placement
Catheter is inserted percutaneously into subclavian, IJ, or femoral vein; sutured into place
Mechanical ventilation: If you RR is this value, you may be intubated
RR >30
Mechanical ventilation: May be intubated if PaCO2 >50 mmHg with pH<7.25
True
What is the 50/50 rule?
MV is indicated if a patient’s PaO2 falls below 50 mmHg and the PaCO2 rises above 50 mmHg
Mechanical ventilation: Most commonly used modes of MV are…
Assist-control
Continuous mandatory ventilation
CMV (continuous mandatory ventilation) means that the vent is doing ______ of the work
100%
SIMV: means that the patient is doing _____ of the work
Less than 100%
PEER (positive end expiratory pressure) means that…
The patient is breathing on their own
The higher the PEEP, the more support pt needs (want PEEP to come down)
When the breath is patient triggered, it is referred to…
IMV
When the breath is delivered by the vent, it is termed
SIMV
Do you do PT if a patient is on a vent and is beating weaned on SBT?
NOOOOOO
High pressure alarm is probably because…
A/W is blocked, sputum, coughing (needs to be suctioned)
Low pressure alarm means:
Disconnected from vent, likely pt pops off vent
4 indications of CPPT in the ICU
Retained secretions
Acute atelectasis or infiltrate
Decrease in PaO2 or SpO2 as a result of secretion retention
Prophylactic use
4 things that the efficacy of CPPT is determined by:
Decrease in pulmonary infection incidence
Improvement in the PFT
Decrease duration of mechanical ventilation
Prevention of tracheostomies
Activities in the ICU including CPPT can increase metabolic rate by ____%
35%
What FEV1% is needed for patient to have an effective cough?
60%
Do manual techniques increase the ICP?
No, it is not a contraindication
It appears that the increase in VO2 and VCO2 that occurs with manual techniques returns to baseline in how many minutes?
15 minutes
When doing manual techniques, out of these measures what increases and what decreases? HR, BP, RR, O2
HR, BP, and RR increase
O2 decrease
All return to baseline in 15 min or better after PT
