Physiologic Monitoring Flashcards
What is a normal reading for ECG?
60-90 b/min
What is the normal MAP? What is a contraindication?
60-110
Below or above the range. Consult MD
What is the norm for CVP?
2-6mmHg
What is the purpose of the tracheal tube?
Access upper airway for those with airway obstruction
Safe suctioning
Mech ventilation
Airway protection
What are some complications of the trach tube?
Ulcer Erosion Fistula Laryngeal damage Infection Dislodgement Airway obstruction
How long can you have an ET-T?
7-10 days
Can go up to 11 but after a tracheostomy is required
Where is the trach inserted?
3-4th tracheal rings
What should the cuff pressure be?
Below 25 cmH2O to minimize ischemic damage of tracheal mucosa.
What can be administered for a person with a trach in terms of exercise?
C/S ROM and prone positioning to pts tolerance
What is the difference between fenestrated and unfenestrated trach?
Fenestrated- hole in posterior wall of tube above cuff, used to assess pts readiness for extinction and permit speech ass gases pass thru. GET THEM OFF VENT ASAP. This is weening.
Do you tx if patient is weening?
NO, pt needs all the energy to learn to breathe on their own
What cavity is the chest tube placed in?
Pleural or mediastinal
What does the chest tube do?
Remove excess fluid or air
What are some indications of the chest tube?
Trauma, car accidents, open heart replacement, hemothorax, pneumothorax, bronchopleural fistula, empyema, mediastinal fluid
Where is it inserted for fluid drainage?
4th & 5th intercostal space at midaxillary line
Where is the chest tube inserted for pneumothorax?
2nd intercostal space at midclav line
Why is it inserted laterally?
Avoid discomfort when supine and sitting
Is pain related to size of tube?
No
Drainage has 3 compartments-
Under-water-seal drainage
Collection chamber
Suction chamber
Air bubbles indicate what?
Leakage which can lead to bronchopleural fistula (except in suction chamber)
What can kind of exercises would you do with a pt with a chest tube?
ROM to shoulders and breathing exercises. DONT KINK LINE
Pulse ox detects what?
Early hypoxemia
At what PaO2 will you see cyanosis?
90 mmHg
SpO2 of 90%= PaO2 ____mmHg
60
Around 50-60 mmHg what will occur?
Dysrhythmia
When will you get a false reading on the pulse ox?
Nail polish, anemia (false high reading occur bc RBCs decreased), vasoconstriction
What does the A-line monitor?
Arterial blood pressure
Most common site for A-line placement?
Radial artery
Transducer placed at…
Level of right atrium
If the transducer is placed too high..
Reading will be falsely low and vice versa if too low
What do you do with femoral A-lines?
Check with MD before ambulation, sitting or hip flexion
What are some complications of continuous arterial pressure monitoring?
Soreness, ecchymosis, hematoma
Where is the CVP placed?
Right atrium
CVP directly reflects _____ and indirectly reflects_____
Right atrial pressure
Right ventricular end-diastolic pressure
If the right ventricle is failing what happens to CVP?
It rises
What kind of info does CVP provide?
Cardiac fxn and vascular volume
Where is the swan ganz inserted?
Right atrium into right ventricle into pulmonary artery
When is the swan ganz indicated?
When you need precise measurement of CP pressure, flow, and circulating volumes
Any contraindications for swan ganz?
No
What do pulmonary artery catheters detect?
Pulmonary edema, heart failure, sepsis
What does the pulmonary art catheter measure?
Heart pressure flow
Pulmonary arterial wedge pressure is indicative of
Left atrial and left ventricular end diastolic pressures
Where is the ICP placed?
Side where the damage is
Can PTs treat when ICP is > than 20mmHg?
No
What does ICP maximize?
Perfusion
EVD
Drains CSF, can be ambulated
Bolt
Harder to ambulate
What’s indicated when the Glasgow scale is less than 8?
Less than or equal to 8= intubate
Do you keep the head of the bed elevated with normal pressures?
Yes
How do you calculate CPP?
MABP- ICP
What happens when CPP dips below 50mmHg?
Decreased tissue perfusion and prolonged at 40mmHg= inadequate to support brain fxn
When is it appropriate to tx?
After pt rests
What’s the protocol for CPT?
Trendelenberg, 15 min if ICP<25 & CPP > 50
What’s the purpose of the PICC line?
Administer nutrition, meds
Where is the PICC line placed?
Anteccubital fossa to the SVC and RA
What are the risks of PICC?
Mechanical phlebitis, infection, venous thrombosis, catheter embolus
Implications for PICC line would be
Do not take BP with PICC line inserted, allow slack, clarify orders with ROM
TLC placement?
SVC, IJV, EJV, femoral
What are the risks for TLC?
Pneumothorax, embolization, vessel and tissue damage, hemorrhage, infection, catheter displacement
Implications for PT with the TLC
Defer if pneumothorax, avoid hyperextension of neck during bed mob
PORT purpose
Vascular access for pts requiring repeated infusion of drugs
Port placed where?
SVC, RA, subclavian IJV, over 3rd or 4th ribs
What are some risks of the port?
Pneumothorax, infection, venous thrombosis, migration, embolus, hemothorax
