Icu Flashcards
What are the benefits of enteral nutrition over parenteral?
Enteral nutrition preserves the structure and function of gut mucosa and prevents the movement of gut bacteria across the intestinal wall and into the bloodstream.
What are indications for parenteral nutrition?
Paralytic ileus, diffuse peritonitis, intestinal obstruction, pancreatitis, gi ischemia, intractable vomiting, and severe diarrhea
Cardiac index
Measurement of CO adjusted for BSA. It is a more precise measurement of the efficiency of the pumping action of the heart. (Stroke volume index is a measure of stroke volume adjusted for BSA)
CI=CO/BSA should be 2.2-4l/min/m2
CVP
2-8
PAWP
6-12
CO
SV x HR should be 4-8L/min
What does CVP represent?
Right ventricular pressure
What does PAWP represent?
LV end diastolic pressure
Preload
Increases CO but requires increased O2 delivery to myocardium.
Milrinone (primacor)
Vasodilator to reduce after load
Epi, ne (levophed), isoproterenol, dopamine (inotropin), dobutamine (dobutrex), dig, calcium, and milronone function to
Improve contractility
Negative inotropes
Alcohol, CCB, beta blockers, acidosis
If preload , heart rate, and after load remain constant, yet CO changes, what has changed?
Contractility
Referencing
Means positioning the transducer so that the zero reference point is at the level of the atria.
Zeroing
Confirms when pressure in the system is zero, the monitor reads zero. Open the reference stop cock to room air (off to the patient) observe the monitor for a zero reading. Zero the transducer during initial set up, immediately after insertion of the arterial line
Perform a dynamic response test
Square wave test q8-12 hours and when the system is opened to air. It involves activating the fast flush and checking that the equipment produces a distortion free signal.
Change pressure tubing, flush bag, and transducer
Q96h
To maintain line latency and limit thrombus formation
Assess the continuous flush system q1-4h to determine that the pressure bag is inflated to 300 mm Hg, flush bag contains fluid, and system is delivering 3-6 mL/hr. Assess neurovascualr status distal to the arterial insertion site hourly.
PAD and PAWP increase during
Heart failure or fluid volume overload.
Monitoring PA pressures (PAD and PAWP) permits
Precise therapeutic manipulation of preload allowing CO to be maintained without putting the patient at risk for pulmonary edema.
Contraindications to pulmonary artery catheterization
Coagulopathy
Endocardial pacemaker
Endocarditis
Mechanical tricuspid or pulmonic valve
Swan ganz lumens
Standard is 7.5 Fr, 43”, with 4-5 lumens
Distal port (catheter tip) is in PA: measures pressures and for mixed venous blood sampling
Right atrium port: measure CVP and injection of fluid for CO determination. Also for withdrawal of blood specimens.
Right ventricle port: infusion of fluids or drugs or blood sampling.
A thermistor is located near the distal tip to measure core temp and for the thee modulation method of measuring CO.
Before pa catheter insertion, assess what?
Electrolyte, acid-base, oxygenation, and coag status. Imbalances such as hypocalcemia, hypomagnesemia, hypoxemia, or acidosis can make the heart more irritable and increase the risk for ventricular dysthymias. Coagulopathy increases risk for hemorrhage
Prep for PA insertion
Arrange monitor, cables, infusion and pressurized flush solutions
