Management of Acute CV & Pulm Pt

Question 1

what are the effects of bedrest on the CV system?

Answer 1

• increased RHR
• decreased max HR
• decreased VO2 max
• orthostatic hypotension
• risk of DVT

Question 2

what are the effects of bedrest on the respiratory system?

Answer 2

• decreased vital capacity
• impaired ability to clear secretions
• ventilation-perfusion mismatch

Question 3

which device provides the lowest level of support?

Answer 3

IABP

Question 4

T/F: you can disconnect a pt from the ECG if they have an IABP.

Answer 4

FALSE - this will stop the device

Question 5

what is the only device that is rhythm dependent?

Answer 5

IABP

Question 6

what is an Impella device?

Answer 6

catheter-based miniaturized intravascular microaxial ventricular assist device;
pump blood from L ventricle to aorta

Question 7

what setting is the highest support for the Impella device?

Answer 7

P9

Question 8

which device is the highest level of supports?

Answer 8

ECMO

Question 9

T/F: a PT must call a perfusionist into the pt’s room to adjust or remove the ECMO before treatment.

Answer 9

T

Question 10

what complication can an LVAD cause?

Answer 10

pump thrombosis

Question 11

T/F: pts with LVADs may not have a pulse.

Answer 11

T

Question 12

how does a heart transplant effect the CV system, especially with activity?

Answer 12

• higher RHR
• slower response to exercise/activity
• denervated heart
• increased response time to changing positions or activity

Question 13

how long does it take for a heart to be full innervated by the SNS and PSNS after transplantation?

Answer 13

1 year to 18 months

Question 14

what lab value is increased in COPD?

Answer 14

CO2

Question 15

which organ always fails first?

Answer 15

kidney

Question 16

what do pressor meds do?

Answer 16

shift blood from the extremities to the heart

Question 17

adverse effect of pressors

Answer 17

can lead to necrosis/ischemia

Question 18

what is the criteria used to diagnose multiple organ dysfunction syndrome?

Answer 18

respiratory: PaO2/FiO2 ratio
hematology: platelet count
liver: serum bilirubin
renal: serum creatinine or urine output
brain: Glasgow coma scale
CV: hyPOtension & vasopressor requirement

Question 19

what is Post intensive care syndrome (PICS)?

Answer 19

• ICU acquired weakness and delirium
• affects mental, physical, and cognitive aspects

Question 20

what is the ICU Liberation Bundle?

Answer 20

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

Question 21

what are red flags for CV and pulmonary patients?

Answer 21

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

Question 22

what are acute complications of lung transplants?

Answer 22

pneumothorax
pleural effusions
hypoventilation
hypercarbia (increased CO2)
hypoxia
reperfusion injury (esp. w/i 1st 72 h)
phrenic nerve injury

Question 23

what are the consequences of denervated lungs (lung transplant)?

Answer 23

• decreased cough reflex
• increased risk of infections
• altered lymphatic drainage
• pulmonary edema
• mucus production
  decreased ciliary movement (1st year)

Question 25

what is a normal ejection fraction?

Answer 25

55-70%

Question 26

pre LVAD/Transplants tests/outcome measures

Answer 26

frailty testing:
- hand drip dynamometry
- 6 MWT
- gait speed

Question 27

how does IABP provide CV support?

Answer 27

• maximize coronary perfusion
• increases CO by reducing L ventricle
  afterload

Question 28

complications of IABP

Answer 28

aortic dissection
arterial perforation
limb ischemia
dislodgement of atherosclerotic emboli

Question 29

list the devices in order of least to most support

Answer 29

least: IABP (CO 0.3-0.5)
Impella (CO 2.5-6.2)
most: ECMO (CO 3-7)

Question 30

what system(s) does the veno-arterial ECMO support?

Answer 30

heart AND lungs

Question 31

what system(s) does the veno-venous ECMO support?

Answer 31

lungs

Question 32

a ____ (higher/lower) pump index on an LVAD indicates better L ventricular function

Answer 32

higher

Question 33

indications for a heart transplant

Answer 33

• 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%

Question 34

symptoms of a denervated heart

Answer 34

• pain impulses from ischemia lost
• NO chest pain or angina
• RHR > 90 bpm
• HR changes slower
• orthostatic HTN