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
