Therapy Plans/Trouble shooting

Question 1

What are important factors to consider when examining the ETT on a Pt?

Answer 1

1. Side to side movement (when was the last time it was moved)
2. Depth?
   - too deep in the right than the left lung will collapse (atelectasis)

Question 2

What are important factors to consider when examining the cuff pressure on a Pt?

Answer 2

1. Too high = risk of occluding (closing) tracheal cap bed.
2. Too low = Aspiration

Question 3

What is the ideal depth of ETT?

Answer 3

2-3 cm above carina, if the pts head moves it can still be secured.

Question 4

What are important factors to consider when examining the twill ties/method of securing ETT?

Answer 4

1. Is the ETT too tight; it can cut the pt
2. Are they holding well?

Question 5

What are important factors to consider when examining the suctioning?

Answer 5

1. when was the last time Sx was performed?
2. Color of sputum?
3. How many passes
4. Pay attention to time and freq. of passes

Question 6

How can you treat hypertension?

Answer 6

Give oxygen to correct the hypoxemia

Question 7

What increases PVR?

Answer 7

Acidosis

Question 8

Shock = inadequate perfusion of the tissues, what represents these changes?

Answer 8

Usually represented very low systemic blood pressure

Question 9

What goals/parameters do we adjust for failing cardiopulmonary system?

Answer 9

1. Maximize ventricular performance by altering preload, afterload, and contractility.
2. Pipe, pump, fluid model

Question 10

Pipe, pump, fluid model describe what changes to observe/manipulate for the cardiopulmonary system?

Answer 10

Pipe = vessel tone

pump = heart contractility

fluid = volume

Question 11

Cardiopulmonary management how do you:
1. Increase Volume
2. Decrease volume

Answer 11

1. I.V infusion of liquid; end result is increasing preload (which decreases PVR/SVR and HR)
2. Diuretics: decrease preload by reduction of intravascular volume. = decrease in preload

Question 12

Cardiopulmonary management:
1. When would you use vasodilator therapy
2. What are the goals of vasodilator therapy?

Answer 12

1. Use when SVR/PVR is high.
2. Decrease SVR/PVR, Decrease afterload and preload

Question 13

Cardiopulmonary management:
1. When would you use vasopressor therapy
2. What are the goals of vasopressor therapy?

Answer 13

1. when SVR/PVR is low
2. Increase afterload, SVR/PVR, and Preload

Question 14

What do you need to determine when assessing left ventricular function?

Answer 14

Optimal preload (wedge pressure for LV)