Management of Acute CV & Pulm Pt Flashcards
what are the effects of bedrest on the CV system?
- increased RHR
- decreased max HR
- decreased VO2 max
- orthostatic hypotension
- risk of DVT
what are the effects of bedrest on the respiratory system?
- decreased vital capacity
- impaired ability to clear secretions
- ventilation-perfusion mismatch
which device provides the lowest level of support?
IABP
T/F: you can disconnect a pt from the ECG if they have an IABP.
FALSE - this will stop the device
what is the only device that is rhythm dependent?
IABP
what is an Impella device?
catheter-based miniaturized intravascular microaxial ventricular assist device;
pump blood from L ventricle to aorta
what setting is the highest support for the Impella device?
P9
which device is the highest level of supports?
ECMO
T/F: a PT must call a perfusionist into the pt’s room to adjust or remove the ECMO before treatment.
T
what complication can an LVAD cause?
pump thrombosis
T/F: pts with LVADs may not have a pulse.
T
how does a heart transplant effect the CV system, especially with activity?
- higher RHR
- slower response to exercise/activity
- denervated heart
- increased response time to changing positions or activity
how long does it take for a heart to be full innervated by the SNS and PSNS after transplantation?
1 year to 18 months
what lab value is increased in COPD?
CO2
which organ always fails first?
kidney
what do pressor meds do?
shift blood from the extremities to the heart
adverse effect of pressors
can lead to necrosis/ischemia
what is the criteria used to diagnose multiple organ dysfunction syndrome?
respiratory: PaO2/FiO2 ratio
hematology: platelet count
liver: serum bilirubin
renal: serum creatinine or urine output
brain: Glasgow coma scale
CV: hyPOtension & vasopressor requirement
what is Post intensive care syndrome (PICS)?
- ICU acquired weakness and delirium
- affects mental, physical, and cognitive aspects
what is the ICU Liberation Bundle?
A: Assess, prevent, & manage pain
B: Both spontaneous awakening and spontaneous breathing trials
C: Choice of analgesia & sedation
D: Delirium
E: Early mobilization & exercise
F: Family engagement
what are red flags for CV and pulmonary patients?
acute change in:
- mental status
- BP, HR, RR, breathing patterns,
ECG
- lab value(s) change requires
imaging or stat lab orders
- changes in clinical presentation
during therapy
- chest pain, SOB, excessive
fatigue
- fainting/syncope
- signs and symptoms of DVT or
PE
what are acute complications of lung transplants?
pneumothorax
pleural effusions
hypoventilation
hypercarbia (increased CO2)
hypoxia
reperfusion injury (esp. w/i 1st 72 h)
phrenic nerve injury
what are the consequences of denervated lungs (lung transplant)?
- decreased cough reflex
- increased risk of infections
- altered lymphatic drainage
- pulmonary edema
- mucus production
decreased ciliary movement (1st year)
what is a normal ejection fraction?
55-70%
pre LVAD/Transplants tests/outcome measures
frailty testing:
- hand drip dynamometry
- 6 MWT
- gait speed
how does IABP provide CV support?
- maximize coronary perfusion
- increases CO by reducing L ventricle
afterload
complications of IABP
aortic dissection
arterial perforation
limb ischemia
dislodgement of atherosclerotic emboli
list the devices in order of least to most support
least: IABP (CO 0.3-0.5)
Impella (CO 2.5-6.2)
most: ECMO (CO 3-7)
what system(s) does the veno-arterial ECMO support?
heart AND lungs
what system(s) does the veno-venous ECMO support?
lungs
a ____ (higher/lower) pump index on an LVAD indicates better L ventricular function
higher
indications for a heart transplant
- recurrent readmission for CHF on inotropic support
- severe hypertrophic or restrictive cardiomyopathy (NYHA class IV)
- NYHA class III or IV symptoms despite optimal medical therapy
- prognosis for 1 year survival < 51%
symptoms of a denervated heart
- pain impulses from ischemia lost
- NO chest pain or angina
- RHR > 90 bpm
- HR changes slower
- orthostatic HTN
