Monitoring, Life Support And Respiratory Care Flashcards
Noninvasive monitoring - Electrocardiogram (ECG/EKG)
10 electrodes to give 12 leads
Usual display has all vitals and lead II (temp, BP, O2 and RR)
Top of machine monitoring vitals
EKG lead 2 or V5
O2 saturation wave
Respiratory wave
On the right of the monitor for vitals
Heart rate
O2 saturation
Respiratory rate
EKG - What are emergencies to look out for?
ST segment changes
Multiple PVCs or change in foci
Onset of ventricular tachycardia or ventricular fibrilation
Progression/worsening of heart block
What would you do with a patient if the EKG showed A-fib and/or occasional PVC’s?
Note them in their chart
What does the pulse oximetry measure and how is it expressed?
Measurement of arterial oxygen saturation - SpO2
Expressed as a percentage of oxygen bound to hemoglobin
Principles of pulse oximetry
Threshold level = above 90%
Orders for titrations/adjustment during activity
Reasons for inaccuracies - can’t depend on this for HR
Limitations of the pulse oximeter
Low perfusion or circulation
Anemia
Nail polish
Fluorescent lighting
Dark skin
Jaundice
Arrhythmias
Heart rate normal range
50 - 100 beats per minute
Systolic BP normal range
85 to 140 mmHg
Diastolic BP normal range
40 to 90 mm Hg
Respiratory rate normal range
12 to 20 breaths per minute
Oxygen saturation normal range
> 95% of FiO2 (fraction of inspired oxygen)
Reasons for using arterial lines
For more unstable patient
Continuous BP management or frequent access to arterial system
Hemodynamic monitoring (fluid)
Frequent ABGs taken
Drug administration
Precautions for arterial lines
Avoid dislodging - large blood loss
Radial - limit or avoid WB on wrist
Femoral - monitor closely and avoid dislodging (mobility encouraged)
Potential arterial line placements in order from most to least common place to put it
Radial artery
Femoral artery
Brachial artery
Axillary artery
Ulnar artery
Dorsalis pedis artery
Posterior tibial artery
Noninvasive monitoring
Heart rate
Systolic and Diastolic BP
Respiratory rate
Oxygen saturation
Invasive monitoring
Arterial line
Central (venous- like
Swan Ganz - Pulmonary Artery Catheter
Temperature
Intracranial pressure
Central (venous) line
Measures central venous pressure (CVP) or R atrial pressure
Allows IV access for medication administration
Tunneled (long term) or non tunneled (short term)
What does it mean for a line to be tunneled?
Short distance that the line is burrowed under the skin prior to entering the actual vein
Decrease infection risk
What line is used for long term placement?
PICC line
Where is the PICC line placed?
Cephalic, basilic or brachial vein using sterile techniques
Still runs up to superior vena cava
Why is the R subclavian or internal jugular vein used for a central line?
Quick access to the heart
What is a port?
Central line implanted under the skin
CVP or PICC Precautions
Need to remain sterile
Usually well covered near skin insertion
Secure ends well before mobilizing
Be aware of location and avoid dislodging
Use precautions when femoral PICC used
Swan Ganz-Pulmonary artery catheter
Surgically inserted catheter —> through a central vein —> threaded through R atrium and ventricle into pulmonary artery
What can the Swan Ganz- Pulmonary Artery catheter measure?
Central venous pressure (CVP)
R atrial pressure
Pulmonary artery pressure
Pulmonary capillary wedge pressure
What is a Swan Ganz - Pulmonary artery catheter?
Measurement of blood pressure to locate/monitor heart failure
What can pulmonary capillary wedge pressure calculate/measure?
Measure and estimate L side filling pressure and calculate vascular resistance
What else can the Swan Ganz - Pulmonary artery catheter help with?
Calculation of vascular resistance
SvO2 and temporary pacing
What does pulmonary artery pressure help determine?
Problems like pulmonary HTN or resistance to flow through the lungs
Why is the Swan Ganz Catheter so important?
Measurement of left sided heart failure
Pulmonary capillary wedge pressure and left sided heart function
(Indirect) LEFT side heart filling pressure
Because it’s a closed system, it can determine status of pulmonary circulation, detect pulmonary HTN, and estimate filling pressure of the L atrium?
What happens if there’s pressure in the pulmonary vessels?
It pushes the fluid into the interstitial tissue and causes problems w CO2 and O2 exchange
What does issues with CO2 and O2 exchange cause?
Congestion in the lungs
What else can the Swan Ganz catheter help with due to its location?
Guide fluid management in critically ill and dosing of diuretics
Elevated PCWP
Pulmonary HTN
Indicates resistance to flow into the L ventricle
Uses of Swan Ganz Catheter
Monitoring heart function (post op)
Diagnosing chronic heart failure
Differentiating causes of pulmonary edema
Guiding diuretic dosing to manage fluid overload
Complications of dislodgment of Swan Ganz
Serious arrhythmias
Pulmonary artery rupture
Pulmonary valve damage because it goes through it
Infection - heart
Invasive ways to monitor temperature
Swan Ganz
Urinary catheter
Nasopharyngeal
Rectal probe
When are the only times you’d use a rectal probe?
Comatose
Intubated
Confused
What is intracranial pressure monitoring used for?
Neurological trauma - head injury, brain surgery, hemorrhage, tumor meningitis
What does increased ICP cause?
Decreased perfusion of brain
What can low CO2 levels help control?
Increased ICP
What can be placed to help control ICP?
Drain (Temporary)
Shunt (Permanent)
Most supportive respiratory support
Mechanical Ventilation via tracheostomy
Respiratory support in order from least to greatest support
Nasal cannula, face make, trach color
Non-rebreather mask, Venturi mask
CPAP
Nasal cannula
Most common device for O2 delivery
Lowest level of support
Flow rates for nasal cannula
Between 1 and 6 L/min
When will a nasal cannula supply humidity?
When rate is > 4L/min
What is FiO2?
Fraction of inspired air that is oxygen
Face mask/trach mask flow rate
5-10 L/min
FiO2 for face mask/trach mask
About 35-56%
Humidification for face mask/trach mask
Face mask: common at about 4 L/min
Trach mask: ALWAYS humidified
Why must a trach mask always be humidified?
Humidification of air happens in the upper airways and the trach is a bypass of all the upper airways
Venturi Mask
Much more specific/precise FiO2 delivery; order for FiO2
Dictates the L/min setting on the O2 supply
Provides more support
Used to ensure a specific saturation is achieved
Non-Rebreather Mask
Can provide up to 100% oxygen
Bag fills from wall w/ O2 > 15 L/min
Breathe in air from bag
Breathe out - air goes into room
One way valve (green) prevents air from mixing
Due to high flow rate: need to start w full tank and bring a spare
High flow nasal cannula
Important to decrease dead space in upper airways, increase O2 reserve in system and help pt maintain O2 levels
Provides flow rate for 25-60 L/min
CPAP
Constant positive pressure during both inhalation and exhalation
Common use in sleep apnea
BiPAP
2 levels of pressure, one for inhalation and one for exhalation
Used to wean off ventilator or prior to invasive ventilation
Why would you use invasive mechanical ventilation?
Failure to oxygenate
Failure to ventilate
Combo of both
Airway protection and
Why would you have failure to oxygenate?
Inadequate exchange of gas at the alveolar level
Pulmonary disease impacting the alveoli
Why would there be failure to ventilate?
Pt w decreased mental status or where compliance of the lung has decreased so much that it’s very difficult and patients can’t ventilate on their own because they’re expending too much energy
Why would you need airway protection?
Trauma —> When they’re trying to protect pts airway b/c they see things going bad
During surgical procedures because of sedation
What types of invasive mechanical ventilation are there?
Endotracheal tube (Short term)
Tracheostomy tube (Long term)
Ventilator Settings
Total volume
PEEP —> Positive Expiratory End Pressure
Respiratory Rate
FiO2
Mode
What is the mode on ventilator settings?
The amount of assist
What is the tidal volume on a ventilator?
Amount of air delivered per breath
Ensures certain volume is delivered
What is PEEP (Positive Expiratory End Pressure) on ventilator settings?
Pressure used to keep airway from collapsing (splints open airways) —> better O2 exchange
What is Respiratory Rate on a ventilator?
Breaths per minute machine delivers
What is the FiO2 on a ventilator setting?
Percent of O2 in delivered air
Try to keep below 50% if it’s going to be used long term
What are the 4 levels of assist from most to least support?
Control Mode
Assist Control - Volume Control (AC-VC)
Synchronized Intermittent Mandatory Ventilation (SIMV-VC)
Spontaneous or Pressure Support
Control Mode aka Ventilation Control
Ventilator has complete control —> machine does all the work to control volume and rate of breaths
Preset tidal volume and respiratory rate that blocks all spontaneous breaths —> no pt initiation
Assist Control-Volume Control (AC-VC)
Set number of breaths (RR)
Every breath has set volume
Pt can initiate more breaths - machine still gives the set volume
Some patient involvement with initiating when breaths will occur over the base rate
Ventilator will ALWAYS give set volume
Synchronized Intermittent Mandatory Ventilation (SIMV-VC)
Set number of breaths w/ set volume given
When pt takes more breaths than set RR
Tidal volume is NOT controlled —> when pt initiates extra breaths
Spontaneous or Pressure Support
Set pressure, PEEP and FiO2 to help make it easier
Pt dictates tidal volume and RR
Use own force to generate how much air will go in
Pt initiates breath, vent delivers preset pressure to help overcome airway resistance
Set amount of FiO2 is supplied but pt is responsible for how much volume of air they’ll inhale
