Lecture 2 Flashcards
What is ICU?
intensive care unit
Reason for ICU admission?
Invasive hemodynamic monitoring,
Mechanical ventilation
Patient require more intensive nurse care
Chest tube can drain air?
yes, pneumothorax
Chest tube insertion above or below rib?
above because below rib VAN
Purpose of water seal chamber?
prevent drainage back into the chest cavity
3 chambers of of chest tube collection
collection chamber (how much is he losing)
water seal chamber (need to remain upright)
suction chamber
Swing - chest tube?
normal 5 cm increase when coughing
if stops moving up and down urgent call the clinical team
tubing may be occluded
swing reduced when suction on
Meaning of bubbling of the underwater seal?
air leak in pleural space
bubbles on coughing = small air leak
Increase liquid in the collection chamber small and big could be due to what?
small - movement
large- hemorrhage
when is the tube removed?
when drainage less than 100 mL/24h
purpose of emptying collection chamber before exercise ?
increase chest expansion
T or F
patient can lie on chest tube
device should be kept above the chest tube insertion site
disconnection of the wall suction is allowed for mobilization
Shoulder ROM exercises aren’t encouraged?
T (avoid traction and kinking of tube)
F lower (avoid drainage of fluid back to patient)
T
F Should be encouraged
what could happen if occlusion chest tube?
air not going out →risk of tension pneumothorax
if the tubes goes out what do you do?
close with your hand (wear gloves) and call for assistance
Peripheral intravenous line
goal?
concern for PT?
administration of fluid
avoid bending at the involved joint (ex: elbow)
Arterial line
Goal
PT concern
ABG, hemodynamic monitoring
no hip flexion over 90 degrees (femoral)
disconnection → hemorrhage
keep the patient wrist at the right curve for good readings
if discontinued → wait for 3-6 hours before mobilizing the patient
MAP normal?
70-110 mm hg
Central venous line
Goal
PT concern
administration of drugs + hemodynamic monitoring
Be cautious of kinking and movement ROM of jt near insertion
what is central venous pressure?
Right heart function (R atrium pressure)
Increase in CVP meaning T and F
increased vascular volume
increased ventricular function
global heart failure
decreased pulmonary vascular resistance
systemic vasodilatation
positive end expiratory pressure
increased vascular volume
decreased R ventricular function
global heart failure
increased pulmonary vascular resistance
systemic vasoconstriction
positive end expiratory pressure
Decrease in CVP T or F
hypovolemia
posture, legs lowered to the floor
with inspiration
PICC line
goal
PT concern
-alternative to central venous line with less complication and can be left for months + can be done by patient
-should not lift more than 10lb with arm and avoid strenuous repetitive activity with arm
-exercise on the side of PICC not contraindicated
-don’t do a lot of movements and don’t go full ROM (caution bending elbow beyond 45 degrees
port a cath
goal
PT concern
-Implanted surgically, pectoral portal + catheter
-patient can resume regular activities (exercise, swimming,…)
-avoid manual technique over device and contact sport
Swan Ganz
Goal
Pt concern
measure PULMONARY ARTERY PRESSURE (directly on the heart)
ambulation not typically done, HOWever, study show no complication
- sit to stand beside bed possible
if it’s femoral you can’t mobilize and pt will be bed rest for 4-6h when its removed
Pulmonary artery wedge (occlusion) pressure
Goal
PT concern
pulmonary artery catheter with BALLON INFLATED
Provide information on filling pressures of L side of heart (end diastolic L ventricular pressure: pressure of capillaries pushing blood into the pulmonary tissue)
5-12 mm hg normal
12-18 optimal filling pressur e
18-30 interstitial edema
30 and more pulmonary alveolar edema
Nasograstric (NG) tube
goal
PT concern
provides nurtrition and removes gastric content
can disconnect for mobilisation
pt position never flat or head down, head of the bed elevated to 45 degrees
What is PEG and PEJ
feeding tube directly to the stomach or intestin
no chest expansion limitation and the patient can eat with it
urinary catheter ?
make sure its mobilize with him
ECG purpose
monitor HR and find arrythmias
Intra-aortic balloon pump
goal
PT concern
increase cardiac output
don’t mobilize and wait 24h before mobilize
Epidural goal and PT concern
Decrease pain
be careful to hypotension
intracranial pressure monitoring
goal + PT concern
measure intracranial pressure
level of the captor shouldn’t be moved (aligned with head of pt)
so if mobilize ask nurse to clamp system
hemodialysis catheter
goal
PT concern
removed waist from the blood when kidney doesn’t work
can walk and stand
no manual technique on catheter
CVVH
goal
PT concern
removed waist from blood when pt can’t tolerate hemodialysis
depends where the catheter is putted
if Upper body - can move in room
if Lower body - move in bed
PAo2 and SpO2 for none hypoxemia and for severe
Pao2 and Spo2 none: 80-110 and 95-100
Pao2 and Spo2 severe: less than 40 (mmHg) and less than 75-80 (%)
Nasal Cannula
Fio2: 24-44%
amount of Fio2 depends on pt flow rate and breathing pattern - not an exact measure
flow: 1L/min
approximative FiO2: 24%
every increase of 1L/min = 4% increase of approximative Fio2
simple mask
Fio2: 40-60%
minimum flow rate: 5 - 6 L/m
not an exact measurement again same reason nasal canula
oxymizer
higher fio2 than nasal canula for the same flow
24-44%
reduce o2 losses during exhalation
non breathing mask
Fio2: 70-11%
flow 15L/min
best choice for emergency
venturini mask
Precise measures
24 - 50%
Depends on color of piece attached
high flow venturini mask
with humidity
28-98%
optiflow FIo2
flow
Fio2: 30-100%
40-60 ml
Pulse oxymeter what does it measure
Its a lecture of how much % of light is absorbed oxygenated vs deoxygenated hemoglobin
Spo2= blood saturation
Factors that could influence Spo2 reading? 5
pulsatil measure so everything that affect perfusion of the hand could modify Spo2 measures
Where do we take Spo2 1st choice, 2nd choice and 3rd
3 to 4 finger
ear lobe
forehead
criteria of Po2 to have O2 at home?
Pao2 ≤ 55 mm Hg
Criteria for nocturnal oxygen alone Spo2?
SpO2 < 90% for > 30% of recording time
Benefit of of supplemental O2 short term
decrease dyspnea patient with COPD and ILD
increase exercise tolerance
Benefit of of supplemental O2 long term
When whe give O2 is not for the lungs its for the heart
Because if desaturation below its going to make the heart work harder meaning risk of core pulmonale at long term
