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Cardiopulmonary > Unit 3 Week 9 Monitoring and Life Support > Flashcards

Unit 3 Week 9 Monitoring and Life Support Flashcards

1
Q

what are considered noninvasive monitoring devices?

A

EKG, Vital monitors

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2
Q

when monitoring vitals what does the display usually include?

A

lead II EKG, HR, temp, BP, O2, RR

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3
Q

what are the indications of a declining status to look for in a patient? (common signs of emergency)

A

ST segment changes, multiple PVCs of change in foci, onset of ventricular tachycardia or ventricular fibrillation

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4
Q

what does pulse oximetry measure?

A

arterial oxygen saturation SpO2
expressed as a percentage of oxygen bound to hemoglobin

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5
Q

what is the threshold level of SpO2?

A

90%

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6
Q

what are the limitations of the pulse oximeter?

A

low perfusion or circulation, anemia, nail polish, fluorescent lighting, dark skin, jaundice, arrythmias

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7
Q

T/F: you should always rely on the pulse oximeter for an accurate pulse.

A

False
you should always take the pulse manually in the first couple of visits with a cardiac patient

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8
Q

what are the normal adult values of HR?

A

50-100 beats per min

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9
Q

what are the normal adult values of BP?

A

systolic 85 to 140 mmHg
diastolic 40 to 90 mmHg

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10
Q

what are the normal adult values of RR?

A

12 to 20 breaths per min

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11
Q

what are the normal adult values of oxygen saturation?

A

> 95% on fraction of inspired oxygen

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12
Q

what are the functions of an arterial line?

A

continuous BP management or hemodynamic monitoring, frequent ABGs taken, and drug administration

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13
Q

what are the common locations of arterial line placements?

A
  1. radial artery
  2. femoral artery
  3. brachial artery
  4. axillary artery
  5. ulnar artery
  6. dorsalis pedis artery
  7. posterior tibial artery
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14
Q

what precautions should you take when working with someone with an arterial line?

A

avoid dislodging - large blood loss
radial - limit or avoid WB on wrist
femoral - monitor closely and avoid dislodging

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15
Q

what are the functions of a central (venous) line?

A

measures central venous pressure (CVP) or right atrial pressure
allows IV access for medication administration

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16
Q

what is the difference between tunneled and non-tunneled central lines?

A

tunneled: long term - there is a short distance that the line is burrowed under the skin prior to entering the vein
non-tunneled: short term

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17
Q

where are central lines usually located?

A

inserted in the central vein like the subclavian or internal jugular; usually on the right side to give quick access close to the heart
femoral veins can also be used

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18
Q

where are PICC lines usually located?

A

cephalic, basilic, or brachial vein
for long term meds

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19
Q

what precautions should be taken when working with a patient with a CVP or PICC?

A

they need to remain sterile
usually well covered near skin insertion
secure ends before mobilizing
be aware of the location and avoid dislodging

20
Q

what is a swan ganz- pulmonary artery catheter?

A

surgically inserted catheter through a central vein threaded through the right atrium and ventricle into the pulmonary artery

21
Q

what are the functions of a swan ganz catheter?

A

measurement of blood pressure to locate/monitor heart failure through central venous pressure, right atrial pressure, pulmonary artery pressure, or pulmonary capillary wedge pressure

can also help with calculation of vascular resistance, SvO2 and temporary pacing

22
Q

what is pulmonary capillary wedge pressure? what is the significance of a swan ganz catheter is relation?

A

(indirect) left sided heart filling pressure
elevated PCWP indicates pulmonary HTN and resistance to flow into the left ventricle

swan ganz measures left atrial pressure, filling pressure of the left ventricle and an indirect assessment of left ventricular function

23
Q

what is a swan ganz catheter used for?

A

monitoring heart function (post sx)
diagnosing chronic heart failure
differentiating causes of pulmonary edema
and guiding dosing to manage fluid overload

24
Q

what complications can arise with the dislodgement of the swan ganz catheter?

A

serious arrythmias
pulmonary artery rupture
pulmonary valve damage
infection of the heart

25
Q

what invasive monitoring techniques can be used to monitor temperature?

A

swan ganz
urinary catheters
nasopharyngeal (if intubated)
rectal probe (only when comatose, intubated, confused)

26
Q

what is the function of intracranial pressure?

A

used for neurological trauma (head injury, brain surgery, hemorrhage, tumor meningitis)

increase ICP causes decrease perfusion of the brain

27
Q

what can help control ICP?

A

low CO2 levels
drain or shunt may be placed

28
Q

what effect does mobilization have on ICP?

A

mobilization can quickly change ICP

29
Q

what is the approximate FiO2 of room air?

A

20.5%

30
Q

what is the rule of four in reference to FiO2 and its relation to O2 flow rate?

A

for each L of oxygen added to the air the percentage of inspired oxygen (FiO2) goes up by 4%
1 L/min = 24%
2 L/min = 28%

31
Q

what is the most common device for O2 delivery?

A

nasal cannula

32
Q

what level of support does a nasal cannula provide? what are the usual flow rates?

A

lowest level of support
flow rates between 1 and 6 L/min
humidified when rate is > 4 L/min

33
Q

what are the usual flow rates for a face mask or trach mask? FiO2 level? when is humidification added?

A

5-10 L/min
~35-56% FiO2
humidification added at 4L/min; trach mask is always humidified

34
Q

why is the trach mask always humidified?

A

air normally gets humidified in the upper airways; a trach bypasses the upper airway so it misses the humification process

35
Q

how does a venturi mask differ from a face mask?

A

much more specific /precise FiO2 delivery
an order is made for FiO2 which dictates the L/min setting on the O2 supply
has an adapter that have different orifice sizes that create different amounts of pressure and deliver oxygen at different rates

36
Q

what is the difference between a non-rebreather mask and a face mask?

A

can provide up to 100% oxygen
a bag fills with oxygen from the with O2 > 15L/min
the pt breathe in the air from the bag but they breathe out into the room
there is a one way valve that prevents the air from mixing

37
Q

what is the difference between a high flow nasal cannula and normal nasal cannula?

A

can provide from 25-60 L/min
can only use wall source of oxygen
pushes O2 into areas of the lungs that the pt could not use effectively removing or decreasing the amount of dead space in the upper airways

38
Q

what are the two types of non-invasive mechanical ventilation? what are the differences?

A

CPAP: constant positive pressure during both inhalation and exhalation (sleep apnea)
BiPAP: 2 levels of pressure, one for inhalation and one for exhalation (used to wean off ventilator)

both keep airways open decreasing energy needed to breathe by allowing more time for oxygen exchange

39
Q

what are the two types of invasive mechanical ventilation?

A

endotracheal tube: short term (nasal or oral)
tracheostomy tube: longer term issues

40
Q

what are the indications for invasive mechanical ventilation?

A

failure to oxygenate (inadequate exchange of gas at the alveolar level)
failure to ventilate
combination of both
airway protection

41
Q

what is including in the settings on a ventilator? explain each.

A

tidal volume: amount of air delivered per breathe (uses height rather than weight)
PEEP positive expiratory end pressure: pressure used to keep airways from collapsing (splints open airway)
respiratory rate: breathes per minute machine delivers
FiO2: percent of O2 in delivered air
mode: amount of assist

42
Q

what is the normal RR that ventilators are usually set to?

A

10-14 bpm

43
Q

what is the normal FiO2 that ventilators are usually set to?

A

starts at 100% titrated down to 21% which is normal atmospheric

44
Q

what is the goal when setting FiO2 on a ventilator?

A

goal PaO2 > 60 mmHg and O2 sat > 90%

45
Q

what are the four modes of mechanical ventilation? explain each.

A

control mode: ventilator has complete control; volume and RR are set with no pt initiation
assist control-volume control (AC-VC): set RR, set volume; pt can initiate more breaths but the machine still gives the set volume
synchronized intermittent mandatory ventilation (SIMV-VC; hybrid): set # of breaths with a set volume; when pt takes more breaths than the set RR the tidal volume is not controlled
spontaneous or pressure support: set pressure, PEEP and FiO2; pt dictates tidal volume and RR

46
Q

Co2 and O2 require different vent adjustments, what are these adjustments?

A

For Co2: adjust RR or TV
For O2: adjust FiO2 or PEEP

47
Q

what is monitored in order to help adjust ventilation settings?

A

Pulse Ox and EtCO2

Cardiopulmonary (23 decks)

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