Critical Care

Question 1

Purpose of Arterial Line

Answer 1

continuous monitoring of arterial blood pressure and allows blood draw access for arterial blood gas measurements- provides systolic, diastolic, and mean arterial pressure info

Question 2

where is an arterial line inserted?

Answer 2

Usually radial artery but can also be through femoral artery or carotid

Question 3

PT implications for an arterial line

Answer 3

When arterial line is in the groin then mobility may be limited

Question 4

What is MAP?

Answer 4

Mean arterial pressure- the average pressure tending to push blood through the circulatory system and it reflects the tissue perfusion pressure
-normal: 70-110 mmHg
< 60 mmHg indicates inadequate tissue perfusion

Question 5

Purpose of a central line

Answer 5

To allow IV access for medication administration and other procedures. Also for monitoring central venous pressure or right arterial pressures to assess cardiac function

Question 6

What is a central line placed?

Answer 6

through subclavian or jugular vein, sometimes femoral vein

Question 7

what is a PICC line?

Answer 7

It is used instead of a central line for patients that require prolonged placement
-is inserted through a peripheral vein (cephalic or brachial vein) and is advanced until the tip rests in the distal SVC

Question 8

What is the Swan-Ganz Catheter?

Answer 8

A pulmonary artery catheter that can only be placed by a physician

Question 9

What are the risks associated with insertion of the central venous access line?

Answer 9

-pneumothorax
-bleeding
-arrhythmias
-arterial entry

Question 10

What are the delayed risks associated with central venous access line?

Answer 10

-infection
-catheter fracture
-catheter dislodgment
-catheter occlusion
-air in catheter

Question 11

What does pulmonary capillary wedge pressure measure?

Answer 11

LAP is the outflow or venous pressure for the pulmonary circulation and the L ventricular end- diastolic pressure reflects the peripheral vascular resistance and is the primary indicator of L ventricular performance
-measurement of LAP reflects the value of LVEDP
-The pulmonary artery end diastolic pressure is essentially equal to the LVEDP (normally less than 12mmHg)

**still confused about this lol

Question 12

Reasons to measure pulmonary capillary wedge pressure

Answer 12

-assess severity of L ventricular function
-assess mitral and aortic valve dysfunction
-assess and treat pulmonary edema
-assess pulmonary HTN
-assess and treat hypovolemic state

Question 13

Normal ICP

Answer 13

0-10 mmHg
-0-5 mmHg for children under 5

**pts with a brain injury who have a high ICP will correlate with low cerebral perfusion pressure

Question 14

T/F Patients with elevated ICP may be mechanically hyperventilated with a manual resuscitator bag to keep arterial partial pressure of CO2 at low levels because hypercapnia dilates cerebral vessels and hypocapnia restricts them

Answer 14

True

Question 15

What is the indication for an intraaortic balloon pump and what is it used for?

Answer 15

Indicated for pathologies that cause the patient to be hemodynamically unstable
-assists in blood circulation through the body and reduced myocardial oxygen consumption but forcing blood into the aortic arch to flow in a retrograde direction into the coronary arteries when the balloon is inflated

Question 16

Where is an intraaortic balloon pump (IABP) inserted?

Answer 16

inserted in one of the femoral arteries and advanced until the tip is in the thoracic aorta, just distal to the L subclavian artery
-it is inflated during diastole (when the aortic valve closes)

Question 17

Precautions of working with a patient with an IABP?

Answer 17

-no hip flexion in the leg with the catheter
-bed rest until catheter is removed

Question 18

What is a Extracorporeal membrane oxygenation (ECMO)

Answer 18

Life support machine- replaces the function of the heart and lungs

Question 19

Who uses an ECMO machine?

Answer 19

-those with lungs that cannot provide enough oxygen to the body
-lungs cannot get rid of carbon dioxide, even with help of a ventilator
-heart cant pump enough blood to the body
-those who are waiting for an organ transplant

Question 20

How does an ECMO machine work?

Answer 20

it pumps blood from the patient’s body to an artificial lung that adds oxygen to it and removes carbon dioxide. Then sends blood back to the patient via a pump with the same force as the heart-thus it replaces the function of the person’s own lungs and heart

Question 21

Whats a Berlin Heart?

Answer 21

a heart pump that maintains blood flow in babies and small children with serious heart failure
-an effective therapy to bridge children to heart transplant

Question 22

How does a Berlin heart work?

Answer 22

a pump the pulls blood from the left ventricle and then sends that blood to the aorta- takes away extra work from the native heart

Question 23

T/F The Berlin Heart has been worldwide and is the only device of its kind available for babies and children with severe heart failure

Answer 23

True

Question 24

Definition: A disturbance of consciousness with inattention accompanied by a change in cognition or perceptual disturbance that develops over a short period of time (hours to days) and fluctuates over time

Answer 24

Delirium- up to 80% of mechanically ventilated ICU patients develop delirium

Question 25

What are the three motoric subtypes of delirium?

Answer 25

1. Hyperactive ( ICU psychosis)
2. Hypoactive (quiet delirium)
3. Mixed (fluctuation between hypo and hyper)

Question 26

Definition: Is made up of health problems that remain after critical illness. They are present when the patient is in the ICU and may persist after the patient returns home. These problems can involve the patient’s body, thoughts, feelings, or mind and may affect the family.

Answer 26

Post-Intensive Care Syndrome (PICS)

Question 27

Warning signs for PICS

Answer 27

-muscle weakness or balance problems
-problems with thinking and memory
-severe anxiety
-depression
-nightmares

Question 28

Symptoms of PTSD

Answer 28

otherwise unexplained and recurrent panic attacks, depression, fear, sadness, pain, or mental/ physical flashbacks in which unreal memories are re-experienced
-similar to those experienced by casualties of war, natural disasters and serious accidents

Question 29

What is an ICU diary and why is it used?

Answer 29

The ICU diary is a diary that is written for ICU patients during their time of sedation and ventilation. It is written by relatives, nurses and others. The patient can read his or her diary afterwards and is more able to understand what has happened

Question 30

Rehab interventions in the critically ill

Answer 30

1. cognitive stimulation
2. in-bed cycling
3. early mobility

Question 31

Reasons of cognitive stimulation

Answer 31

-address arousal and awareness
-correct patients when they make incorrect statements regarding awareness
-provide modification of visual or auditory stimuli (earplugs, eye mask, music therapy)

Question 32

A big key to PT treatment in the ICU

Answer 32

Check the placement of all femoral catheters before and after treatment: all femoral lines, venous lines, and ECMO cannulas

Question 33

When to stop early mobility in the ICU

Answer 33

-symptomatic decrease in MAP
-HR <50 or >130 bpm for 5 mins
-systolic BP >180 mmHg for 5 mins
-pulse ox <88% for 5 mins
-patient distress
-new arrhythmia
-concern of myocardial ischemia
-concern for airway device integrity
-fall to knees
-endotracheal tub removed