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98 Cards in this Set

  • Front
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Infection Control & Prevention:
Aseptic Technique
Set of practices designed to prevent nosocomial infection by providing a clean, safe surgical environment.
Involves preparation of equipment and patient site, sterilization methods and the maintenance of aseptic techniques by all personnel involved.
Infection Control & Prevention:
Sterilization
Complete destruction of all living organisms
For it to be sterile, it must be free of all living organisms, including bacterial spores and viruses
Infection Control & Prevention:
Sterilization of Equipment
Single use
Pre-sterilized packages from the manufacturer
Multi-use forms (which can be sterilized by steam, chemicals or gas) *Sterility markers clearly visible*
Infection Control & Prevention:
Sterilization Methods:
Steam (Autoclave)
Most economical method
Fractionated, pre-vacuum sterilization is used most often in hospitals & considered the safest method
Cost effective, non-toxic, environmentally friendly, easy to manage procedure
4 Stages:
Type of sterilization determined
Heated with steam
Dried
Removed from chamber by appropriately gowned/gloved personnel
Infection Control & Prevention:
Sterilization Methods:
Flash
Used only in OR or sterile procedural area for items that will be used immediately
Items cannot be wrapped and stored for future use unless they under longer, conventional sterilization
Infection Control & Prevention:
Sterilization Methods:
Chemical
Glutaraldehyde solution - water soluble oil used as a disinfectectant or a chemical in form of a gas
Infection Control & Prevention:
Sterilization Methods:
Gas
Only for supplies that will not withstand sterilization by steam under pressure (electrical or rubber)
(ETO) Ethylene oxide ,metabolism of pathogens are blocked using this gas, 3-7 hours sterilization process, and then allowed to air out, very toxic
(FA) formaldehyde, alkalized proteins so pathogens cannot proliferate, highly toxic
Infection Control & Prevention:
Sterilization Methods:
Other methods
Hydrogen peroxide gas plasma sterilization
-alternative to gas sterilization
-suitable only for sterilizing heat- and moisture-sensitive items, delicate instruments & instruments with sharp edges
Infection Control & Prevention:
Sterilization Methods:
Environments
Humidity maintained 30-60%
Rooms kept cool at 68-73˚F
Room ventilated thru HE filters at a rate of 20-25 exchanges per hour
Infection Control & Prevention:
Sterile Technique: Sterile Field
Edges of sterile field deemed unsterile
If sterile field left unattended, its considered no longer sterile (no guarantee!)
Gowns; sterile from waist to chest and from elbow to fingerstips
Hands held at chest level when not busy
Nonsterile personnel should not lean or reach over field (12" away)
Nonsterile personnel should not pass between 2 sterile fields
Wiping contaminated object with disinfectant is not sufficient to restore it to sterile state
When in doubt, throw it out!
Infection Control & Prevention:
Cleaning in Cath Lab
Between cases, anything soiled laundered
Stretchers, straps cleaned between patients
Wear non-sterile rubber gloves when cleaning to prevent contamination
Cleaning defined by each institution for patients who are infected with transmissible organisms
Infection Control & Prevention:
Terminal Daily Cleaning
Final activity at the end of each day
in procedure rooms, scrub areas and utility areas
on lights, tracks, all furniture, cabinets, tables, surfaces
Bio-hazardous material removed to dirty utility
Transducers discarded after a day's use
Infection Control & Prevention:
Sterile Technique: Personnel
Nails short and free from chipping nail polish, no artificial nails
Jewelery is debatable for nursing staff
Personnel with colds, sore throats, open sores and other infections should not be permitted
Head coverings, facemasks, and booties (not worn outside lab) Removed upon leaving & replaced upon entering again
Infection Control & Prevention:
Sterile Technique: Scrubbing
Purpose to remove debris and microorganisms from nails, hands, and forearms.
Surgical hand scrub is an antiseptic preparation, it is a broad spectrum, fast acting and persistent
Scrub 2-5 minutes
Drying hands before gloving is impt cause organisms are transferred in much larger numbers from wet hands than dry hands
Infection Control & Prevention:
Sterile Technique: Gloving
Closed method (inside the gown's cuffs)
Open method (outside the gown's cuffs)
Infection Control & Prevention:
Sterile Technique: Site Prep
Hair removal (clipper not shaver)
Skin prep:
Chlorhexidine, Isopropyl alcohol, Povidone-iodine
Sterile towels and Drapes
"police" the area to prevent any breaks
Infection Control & Prevention:
CDC Isolation Precautions: Transmission of infection
Contact
Indirect & Direct
Direct: transferred from one infected person to another
Indirect: transferred through an infected object or person
MRSA, patients with uncontained secretions or excretions
Wear gloves
Don gown upon entry, remove with hand hygiene at end
Limit transport
Use disposable noncritical equipment when possible
Frequently clean and disinfect rooms
Infection Control & Prevention:
CDC Isolation Precautions: Transmission of infection
Airborne
organisms containing infectious agents that are airborne droplets that can affect over time and distance
Need special air handling and venting systems
N95 masks for ex TB patients
Infection Control & Prevention:
CDC Isolation Precautions: Transmission of infection
Droplet
Technically a form of contact but respiratory droplets carrying infectious pathogens when the travel directly from the respiratory tract of the infected to the mucosal surfaces of the recipient.
Wear Mask around patients
Infection Control & Prevention:
CDC Isolation Precautions:
Standard Precautions
Based on the principle that all blood, body fluids, secretions, excretions except sweat, nonintact skin, and mucous membranes may contain transmissible infectious agents.
Infection prevention practices that apply to all patients, regardless of suspected or confirmed infection status, in any setting
Hand hygiene, gloves, gown, mask, eye protection & safe injection practices
Infection Control & Prevention:
CDC Isolation Precautions:
Transmission-based precautions
For patients who are known or suspected to be infected or colonized with infectious agents which require additional control measures to prevent transmission.
Includes gloves, masks, gown, eye protection etc
Include contact, droplet and airborne
Infection Control & Prevention:
Handling and Disposal of Biohazardous Materials
Handling materials should always put on protective clothing and gloves and avoid viral and other infectious disease transmissions
Equipment:
Waste bins
Tips disposal containers with lids
Biohazard waste bags
Disposable sharps containes
Latex gloves
Contrast Administration: Ionic
High osmolarity, with Benzene rings
Carboxyl group -COOH, negatively charged in solution
Higher osmolarity, increased side effects
Has anticoagulant properties
Ex. Isopaque, Hypaque
Contrast Administration: Non-ionic
Low osmolarity
Amide group -CONH, not charged in solution
Lower osmolarity, lower side effects & toxicity
Ex. Omnipaque, Visi, Isovue, Optiray
Contrast Administration: Contrast Reactions
Anaphlactic/Allergic Reactions
Uticaria (hives): steroids, benedryl
Bronchospasm: benedryl
Face/throat swelling: Albuterol inhaler or IV Epi

Minor: flushing, metallic taste, itching
Intermediate: uticaria, edema, vomiting, cough
Severe: SOB, low BP, loss of consciousness, cardiac arrest, dyspnea (diff breathing), dysphagia (diff swallowing)
Contrast Administration: Contrast Reactions
Adverse Reactions
Contrast-induced nephropathy - renal failure
Greater than 25% increase in creatine or 0.5mg/dL increase
Glomerular filtration rate (GFR): volume of fluid filtered from the kidney (creatine levels are estimates of GFR)
Normal range 100-130ml/min/1.73m
*Metformin (glucophage) for Type II Diabetic patients be held 48 hours post procedure (react with contrast)
*Non-ionic for patients with high creatine levels, contrast allergy, low HR
Emergency Care: Symptoms & Treatments
Cerebral Vascular Accident (CVA) Stroke
Rapid loss of brain function due to disturbance in blood supply to the brain
Symptoms: Symptoms depend on brain affected, sudden onset face weakness, arm drift, abnormal speech. FAST- face, arm, speech and time
Treatment: Angioplasty & Stenting, Thrombolysis, Thrombectomy, Rehabilitation
Emergency Care: Symptoms & Treatments
Embolism
Lodging of an embolus, which could be blod clot, a fat globule or a gas globule in the blood steam which can cause a blockage
Symptoms: MI, Stroke, Pain, dissorientation
Treatments: Thrombectomy, Thrombolysis, Plasty, Stenting
Emergency Care: Symptoms & Treatments
Thrombosis
Formation of a blood clot inside a blood vessel, obstructing the flow of blood through the circulatory system.
Symptoms: myocardial infarction (muscle death)
Treatments: anticoagulants, PTCA
Emergency Care: Symptoms & Treatments
Respiratory Arrest
The cessation of normal respiration due to failure of the lungs to contract effectively
Symptoms: from cardiac arrest, loss of consciousness, brain injury
Treatment: Artificial ventilation
Emergency Care: Symptoms & Treatments
Myocardial Infarction
Occlusion of a coronary artery following a rupture of a vulnerable atherosclerotic plaque, which is an unstable collection of cholesterol and fatty acids and WBC in the wall of the artery.
Symptoms: Chest Pain, SOB, nausea, vomiting, palpitations, sweating, and anxiety
Treatment: PCI, thrombolysis, medication therapy or bypass
Emergency Care: Symptoms & Treatments
Congestive Heart Failure
Occures when the heart is unable to provide sufficient pumping action to maintain blood flow to meet the needs of the body.
Symptoms: SOB, leg swelling, exercise intolerance, confirmed with Echo & physical exam
Treatment: smoking cessation, light exercise, dietary changes & medication to device implant and heart transplant
Emergency Care: Symptoms & Treatments
Cardiac Arrhythmias
Condition in which there is an abnormal electrical activity in the heart. Too fast too, slow, regular or irregular heart beats.
Symptoms: Palpitations, low BP, lightheadedness, syncope
Treatment: physical maneuvers, medications, electricity conversion, or electro or cryo cautery
Emergency Care: Symptoms & Treatments
Vasovagal Response
a feeling of uneasiness or out of sorts mediated by the vagus nerve (10th of 12 paired cranial nerves)
Leads to syncope or fainting, then called vasovagal syncope
Symptoms: recurrent episodes when predisposed person is exposed to a specific trigger, lightheadedness, nausea, feeling really hot/cold, ringing in ears, uncomfortable in heart, fuzzy thoughts, confusion, weakness, then loss of consciousness (if it is lost)
Treatment: Avoidance of triggers, restoring blood flow to brain during impending episode, Medications such as Beta Blockers, vasoconstrictors , or even pacemaker implant,
Emergency Care: Symptoms & Treatments
Anaphylaxis
A serious allergic reaction that is rapid in onset and may cause death.
Symptoms: itchy rash, throat swelling, and low BP
Treatments: Epinephrine, antihistamines, corticosteriods
Emergency Care: Symptoms & Treatments
Hypotensive Episodes
Considered to be systolic BP < 90 mm Hg (Mercury) or diastolic < 60 mm Hg
Symptoms: Lightheadedness, dizziness, fainting, seizures
Treatments: Caffeine, adding electrolytes, Blood Sugar control, Nutrition. . . for Severe drops, atropine, dobutamine
Emergency Care: Symptoms & Treatments
Hypertensive Episodes
High BP with impairment of 1 or more organ systems.
Symptoms: Suffer from LV dysfunction, CP, arrythmias, Headache, Dyspnea, Vertigo, Anxiety
Treatment: Sodium Nitroprusside (vasodilator) infusions to lower the mean arterial pressure by 20% in 1-2 days
Systolic 140-159mm Hg/ Diastolic 90-99mm Hg
Emergent >180/>120mmHg
Emergency Care: Symptoms & Treatments
Cardiogenic Shock
Insufficient perfusion of tissue to meet the required demands for oxygen & nutrients. Largely irreversible.
Symptoms: Altered Mental State, Hypotension, Decreased cardiac output, weak & rapid pulse, cool, clammy, distended jugular veins, fatigue
Treatment: IABP;reduces workload for the heart, improves perfusion of the coronary arteries or LVAD; augments the pump-function of the heart
Emergency Care: Symptoms & Treatments
Cardiac Tamponade
Fluid accumulating in the pericardium (sac which surrounds the heart), which puts pressure on the heart muscle
Symptoms: Hypotension (decreased SV), jugular-venous distension, muffled heart sounds
Treatment: Pericardiocentesis by ultrasound, or in an emergency, Pericardial window
Emergency Care: Symptoms & Treatments
Aortic dissection
When the inner wall of the aorta tears and causes blood to flow between the layers of the wall
Symptoms: Chest or abdominal pain, 'tearing', stabbing pain
Treatment: Surgical dissection of the affected area, Insertion of Stent Graft (covered graft), Medications: Beta Blockers, Vasodilators (sodium nitroprusside), Calcium channel blockers (verapamil, dilitiazem)
Cardiac Life Support:
Basic Life Support (BLS)
CABs:
Circulation: Proper perfusion (chest compressions)
Airway: Head tilt, chin lift
Breathing: Inflation & deflation of lungs (breaths)
30 compressions, 2 rescue breaths
100 compressions per minute, 5cm or 2.5 inches depth
2 rescue breaths in 5 seconds lasting for 1 second
Cardiac Life Support:
Advanced Cardiac Life Support (ACLS)
Set of clinical interventions for the urgent treatment of cardiac arrest, stroke, and other medical emergencies.
Requires ability to manage airway, initiate IV access, read and interpret ECGs and understand emergency pharmacology (physicians, pharms, dentists, NPs, Pas, RTs, RNs and paramedics.
Commonly used drugs: epinephrine & amiodarone
Medications: Types & Administration Routes
Narcotics
Opioids: Morphine (IV, IM or oral), Meperidine (Demerol) (IV, IM or oral), Fentanyl (100x more potent than morphine) (IV, transmucosal, transdermal, spinal and epidural formulations
(Reversal is Naloxone)
Medications: Types & Administration Routes
Antiarrhythmics
Suppress abnormal rhythms of the heart (A Fib, A Flutter, V Tach and V Fib)
Adenosine, Lidocaine (IV)
Medications: Types & Administration Routes
Anticoagulants
Prevents coagulation, clotting of blood
Heparin, (IV) Aspirin (oral), Anti-thrombin III, Fibrin
Coumarins (Vitamin K: oral) - Warfarin, coumadin
Medications: Types & Administration Routes
Antibiotics
Inhibits growth of or destroys microorganisms
Cephalosporin, Dioxycycline, Erythromycin, Amoxicillin, Tetracycline, Penicillin (Oral, Infusion)
Medications: Types & Administration Routes
Thrombolytics
Used to dissolve clots in patients with DVT, PE or AMI
(Given when not able to cath right away - lytics)
Streptokinase (Streptase) (infused IV), Anistreplase (Eminase) (IV bolus), Urokinase (Abbokinase), rTPA (Alteplase or Activase) (IV bolus), Reteplase (Retavase) (IV bolus)
Medications: Types & Administration Routes
Vasodilators
Relaxes the smooth muscle cells within the vessel walls
Adenosine (IV, IC), Prostacyclin, Nitric oxide, Nitroglycerin (IC, IV, sublingual-tablet, translingually-spray, transdermally, intranasal), Sodium Nitroprusside (IC 200-400 mcg)
Medications: Types & Administration Routes
Vasoconstrictors
"pressors", pupil dilation, narrows the blood vessels which results in an increase in systemic blood pressure. . . includes antihistamines, decongestants and stimulants, amphetamines, caffeine, vasopressin, epinephrine, dopamine
Medications: Types & Administration Routes
Emergency Medications
Epinephrine - to treat MI, bronchodilator and vasoconstrictor, preps body for defibrillation
Atropine - for sinus bradycardia with hemodynamic compromise
Lidocaine - for V-tach, V-Fib, or frequent PVCs, improves response to fibrillation
Oxygen - reverses acidosis
Sodium bicarbonate - reverses acidosis
Medications: Types & Administration Routes
Antiemetics
effective against vomiting and nausea
Zofran, Antihistamines, Benzodiazepines, Steroids
Medications: Types & Administration Routes
Platelet Inhibitor
Meds that decrease platelet aggregation and inhibit thrombus formation
Aspirin (oral), Plavix, Glycoprotein IIb/IIIa (Reopro, Integrilin) *No Intregrillin if diabetic or high creatinine
Medications: Types & Administration Routes
Beta Blockers
Target beta receptors that are found on cells of heart muscles, smooth smuscles, airways, arteries, kidneys & other tissues.
Help manage cardiac arrhythmias, prevents a 2nd MI after a first heart attack and hypertension
IV and Orally
Metoprolol (Lopressor)-also for hypertension & sinus tach
Propranolol (Inderal), Esmolol, Labetalol
Medications: Types & Administration Routes
Calcium Channel Blockers
inhibits calcium ion movement from plasma into cells thru calcium channels, thereby limiting vascular smooth muscle contraction.
Diltiazem (Cardizem) - IV
Verapamil - IV/IC during PCI for vasospasm
Nicardipine - IV/IC
Medications: Types & Administration Routes
Sedatives
Opioids: Morphine (IV, IM or oral), Meperidine (Demerol) (IV, IM or oral), Fentanyl (100x more potent than morphine) (IV, transmucosal, transdermal, spinal and epidural formulations
(Reversal is Naloxone)
Benzodiazepines: Diazepam (Valium), Midazolam (Versed), Lorazepam (Ativan)
(Reversal is Flumazenil)
Medications: Types & Administration Routes
Diuretics
Medication that promotes the production of urine
HIgh ceiling loop diuretic (Lasix), Hydrochlorothiazide (Thiazides), Carbonic anhydrase inhibitors, Potassium-sparing, Calcium-sparing, Osmotic diuretics
Patient Assessment & Monitoring: Vital Signs (10)
Temperature
Obtain for a baseline, can solicit any signs of systemic infection
Internal body temp, 37˚C or 98.6˚F
Oral temp, 36.8˚C (+/- .04˚) or 98.2˚F (+/-.7˚F)
Patient Assessment & Monitoring: Vital Signs
Heart Rate, Pulse Rate
Speed of heart beats, beats per minute (bpm)
Normal Range: 60-100bpm
Bradycardia: <60 bpm
Tachycardia: >100 bpm
Arrhythmias
(may feel palpitations, light headedness, dizziness, fainting)
Newborn HR: 130-150 bpm
Toddlers HR: 100-120bpm
Child HR: 60-100 bpm
Adolescents: 80-100 bpm
Adults: 50-80 bpm
Patient Assessment & Monitoring: Vital Signs
Respirations
12-20 breaths/min
Indicates acidotic states (not enough carbon dioxide leaving the body)
Patient Assessment & Monitoring: Vital Signs
Blood Pressure
Normal BP 120/80, systolic/diastolic
Cuff called Sphygmomanometer in mmHg
Hypertension - 140-160
Hypotension - < 120
Patient Assessment & Monitoring: Access Assessment
Peripheral pulses
Radial, femoral, dorsalis pedis or brachial
3+ pulses: bounding
2+ pulses: feel thru socks
1+ pulses: feel a little
Doppler
Patient Assessment & Monitoring: Access Assessment
Anatomical location
Dependent on patient's anatomy, preferred site is right groin (then left groin, left arm, right arm)
Patient Assessment & Monitoring: Access Assessment
Anatomical location/Femoral Access
Artery palpated, Vein is then medial
Small skin incision with #11 blade & tunnel made thru fascia with hemostat
Entered with 18 gauge 7cm needle, at 30-45˚ angle
Pulsating blood indicates a successful puncture (arterial)
Dark, non-pulsatile blood indicates vein puncture
Wire thru needle, remove needle, sheath with dilator over the wire, then remove dilator
Side arm of sheath flushed
Patient Assessment & Monitoring: Access Assessment
Anatomical location/ Brachial Access
Patients with severe iliac disease or fenoral artery bypasses
Access similar to femoral approach applied
Patient Assessment & Monitoring: Access Assessment
Anatomical location/Radial Access
Using Seldinger percutaneous approach
First, Allen's test administered (to ensure perfusion to the hand could be satisfied by the ulnar artery alone in the event of radial complications)(occlude both radial & ulnar arteries simultaneously, release ulnar artery should allow color to return to hand)
Heparin, Verapamil, and nitrates are injected to reduce vasospasm & thrombotic complications.
2 stage sheath process (.018 and then .035)
6F usually max sheath able to use
Patient Assessment & Monitoring:
Lab Values: Chemistry
Glucose
Normal range for non-diabetics between 70-100 mg/dL
Hyperglycemia is high level (causes heart disease, eye, kidney, & nerve damage)
Hypoglycemia is low levels (may cause lethargy, impaired mental function, irritability, shaking, twitching, weakness, pale, sweating)
Patient Assessment & Monitoring:
Lab Values: Chemistry
BUN
Indication of Renal Health (blood urea nitrogen)
Normal ranges 8-20 mmol/L
BUN-to-creatinine ratios (more complete estimation)
Patient Assessment & Monitoring:
Lab Values: Chemistry
Creatinine
indicator of renal health, easily-measured by-product of muscle metabolism
If kidney function is deficient, creatinine levels rise
GFR (glomerular filtration rate)
Creatinine ranges .5-1.0 mg/dl, 45-90 for women and .7-1.2 mg/dl & 60-110 for men
Patient Assessment & Monitoring:
Lab Values: Chemistry
Electrolytes
Most often ones measured are sodium and potassium
Arterial blood gas interpretation, which is linked to sodium levels
Can lead to lethal arrhythmias
Patient Assessment & Monitoring:
Lab Values: Chemistry
Enzymes
Troponin - released during MI from myocytes. The most sensitive & specific test for MI damage.Can calculate infarct size but the peak must be measured in 3-5 days.
Normal values: 0-7 mg/L
Creatine Kinase (CK-MB) (CK2) - relatively specific, cannot be used for late diagnosis of acute MI, but suggest infarct extension if levels rise again, usually back to normal within 2-3 days
*when enzyme levels decrease the heart is healing
Patient Assessment & Monitoring:
Lab Values: Hematology
Hematocrit
Volume % of red blood cells in the blood.
Normal for men - 45%, women - 40%
Patient Assessment & Monitoring:
Lab Values: Hematology
Hemoglobin
in the blood carries oxygen from the respiratory organs to the rest of the body where it releases the oxygen to burn nutrients to provide energy to power the functions of the organism and collects the resultant carbon dioxide
Patient Assessment & Monitoring:
Lab Values: Hematology
Platelet count
Normal platelet count in a healthy individual between 150,000 and 450,000 per mL (microlitre) 95% people are in this range
Low platelet counts increase bleeding risks
High counts may lead to thrombosis
Patient Assessment & Monitoring:
Lab Values: Hematology
White Blood count (WBC)
Increase (leukocytosis) can be sign of infection
Decrease (leukopenia)

WBC part of CBC (complete blood counts)
Patient Assessment & Monitoring:
Lab Values: Coagulation
Prothrombin time (PT)
PT/INR
Used to determine the clotting tendency of blood, in the measure of warfarin dosage, liver damage, and vitamin K status
Measures he extrinsic pathway of coagulation
Patient Assessment & Monitoring:
Lab Values: Coagulation
Partial thromboplastin time (PTT)
Detects abnormalities in blood clotting, it is also used to monitor the treatment effects with heparin.
Termed 'partial' due to the absence of tissue factor from the reaction mixture
Takes a longer time for results than ACT
Patient Assessment & Monitoring:
Lab Values: Coagulation
International normalization ratio (INR)
The results (in seconds) for a prothrombin time.
INR= (PT test/PT normal) to the power of ISI (international sensitivity index)
INR without anticoagulation therapy normal range is .8-1.2
INR with anticoagulation therapy normal range is 2-3 (on warfarin)
Patient Assessment & Monitoring:
Lab Values: Coagulation
Activated Clotting Time (ACT)
Test used to monitor effect of high-dose heparin before, during and shortly after surgeries that require ingest anticoagulant administrations (PTCA, Bypass, dialysis)
Shorter results time than PTT
Patient Assessment & Monitoring:
Lab Values: Arterial Blood Gas (ABG)
Blood test performed using blood from an artery (most common site radial artery)
Test that measures the arterial oxygen tension (PaO2), carbon dioxide tension (PaCO2), and acidity (pH).
Helps to determine gas exchange across the alveolar-capillary membrane
Sample on ice if interpretation is > than 30 min.
Patient Assessment & Monitoring:
Lab Values: Arterial Blood Gas (ABG)
pH (acidity)
pH < 7 = acidic
pH > 7 = basic (alkaline)
Pure water has a pH very close to 7
Blood pH = 7.34-7.45
Acidosis - acid overload in the body, pH falling below 7.35
Alkalosis - blood pH being excessively high
Patient Assessment & Monitoring:
Lab Values: Arterial Blood Gas (ABG)
PaCO2 (Carbon Dioxide Tension)
Partial pressure of gases in blood.
PaCO2 is a by-product of food metabolism and in high amounts has a toxic effects including dyspnea, acidosis, and altered consciousness
In arterial blood 35-45 mmHg
In venous blood 40-50 mmHg
High = under ventilation, respiratory acidosis
Low = Over ventilation, respiratory alkalosis
Patient Assessment & Monitoring:
Lab Values: Arterial Blood Gas (ABG)
HCO2
Normal range 22-26 mEq/L
Indicates whether a metabolic problem is present
Low = metabolic acidosis
High = metabolic alkalosis
Value given when blood gas results calculated by the analyzer
Patient Assessment & Monitoring:
Physiologic Monitoring: ECG (Electrocardiogram)
Represents the electrical activity of the cardiac cells, does not measure the mechanical events.
Normal impulses originate in SA node (cause atria to contract & expel blood into ventricles)
Travel along internodal pathways and converge at AV node (delay impulse to allow atria to complete before ventricle needs to contract to help push blood along)
AV node then to Bundle of His then divide into R and L Bundle Branches into the Purkinje fibers
Flat line is isoelectric, Deflections that record above are considered positive and below are negative deflections
Patient Assessment & Monitoring:
Physiologic Monitoring: ECG (Electrocardiogram)
Patient Prep
Hairless area (better contact) and muscular (optimum signal transmission)
Standard Limb Leads (I, II, III) Bipolar leads, Lead I: upper right to upper left, Lead II: upper right to lower left, Lead III: Upper left to lower left
aVR, aVL, aVF (Augmented or Unipolar leads) With 3rd lead being positive
Precordial Leads (V1, V2, V3, V4, V5, V6)
Precordial Leads V1 start at the 4th intercostal space right sternal boarder, V2 left sternal border, V3 mid clavicular line, 5th intercostal space, V4 axillary line 6th intercostal space, V6 mid-axillary line 6th intercostals space. V5 between V4-V6
Patient Assessment & Monitoring:
Physiologic Monitoring: ECG (Electrocardiogram)
Interpretation
Normal sinus rhythm is 60-100 bpm
P-wave: contraction of the atria positive deflections, .08-.11 sec
P-R Interval:time btwn atrial contraction (P) & Ventrical depolarization (systole), >.20 considered abnormal, elongated are considered 1st degree block
PR segment: represents atrial repolarization
QRS: represents ventricular depolarization, normal .06-.11 sec, IVCD interventricular conduction delay can cause from bundle branch blocks either left or right
QT: time btwn the beginning of ventricular depolarization (Q) to end of ventricular repolarization (T)

Abnormal premature beats in atria: PAC, or PJC
Abnormal premature beats in ventricle: PVC, VT, VF
Heart blocks: 1st degree (PRI >.20, normal rate), 2nd degree Wenkebach, PRI becomes longer until one is dropped leaving unconducted beat (Mobitz I), 2nd degree PR elongated & regular until one unconducted beat is seen. 3rd degree or complete heart block: No SV impulses conduct past the AV node, leading to independent atrial & ventricle rhythms.
Patient Assessment & Monitoring:
Physiologic Monitoring: Pulse Oximetry
non-invasive method of allowing the monitoring of the saturation of a patient's hemoglobin.
On fingertip or earlobe.
Light of 2 wavelengths is passed through the patient to a photodetector, the changing absorbances at each of the wavelengths is measured, allowing determination of the absorbances due to the pulsing arterial blood alone.
Patient Assessment & Monitoring:
Physiologic Monitoring: Invasive Hemodynamics
Waveform recognition/Normal abnormal values
Pressure exerted on the blood is transmitted by the catheter to the transducer (same at catheter tip as to end of tubing)
When pressure is exerted at catheter tip, some of this will be absorbed by this suspended gas, causing a damping of the curve. (bubbles does this)
Blood and contrast can slow down, well flush pressure line.
Catheter overfling or whip effect (hard to avoid in pulm arteries)
Wave deflection: higher pressure readings in peripherals than in aorta (those arteries help contract heart and waves of pressure bounce off bifurcations & artery walls)
Respiratory artifacts (in RHC), ask to hold breath to stabilize hemodynamic readouts
Patient Assessment & Monitoring:
Physiologic Monitoring: Invasive Hemodynamics
Waveform recognition/Normal abnormal values (cont)
Damping- wildly oscillating waveform that cannot be used for measurement purposes
Level the transducer at patient's heart level, especially RHC
Patient Assessment & Monitoring:
Physiologic Monitoring: Invasive Hemodynamics
Waveform recognition/Normal abnormal values (cont)
RIGHT ATRIUM
RIGHT ATRIUM (central venous pressure) 2-8 mmHg
a,c, and v waveforms
a= rise in pressure in the atrium during atrial contraction (found shortly after the p wave)
c= on the downfall from the a wave (1/2 way down), its the closing of the tricuspid valve which causes a small in crease in pressure in atrium. (found in line with QRS complex)
v = the rise in pressure as atria begins to fill again, normally lower than the a wave (valve closes, atria begins to fill under low pressure during passive filling stage) as v wave peaks, atrium is filled with blood at same pressure as is present in venous system, and right ventricle is in diastole
High a waves: Tricuspid Valves, Pulmonic Valves, R Vent hypertrophy, pulm art hypertension
Patient Assessment & Monitoring:
Physiologic Monitoring: Invasive Hemodynamics
Waveform recognition/Normal abnormal values (cont)
RIGHT VENTRICLE
Responsible to pump blood from the venous system into the pulmonary circulation.
Peak of Rt Vent waveform is at the height of systole (pushing blood thru valve into pulm artery), which peaks at the ECGs T wave. Shows normal contractility & whether its pumping into a normal artery bed.
End diastolic pressure (end of the a wave) taken from R wave on ECG. This shows how well the ventricle is filling, how hydrated the pt is and how elastic the myocardium is.
High Peak systolic caused by: LH failure, mitral stenosis, pulmonary hypertension, pulm valve stenosis, left to right shunt, COPD
High EDP caused by: plum valve insufficiency, myocardial disease, endocardial fibrosis, constrictive pericarditis, cardiac tamponade
Patient Assessment & Monitoring:
Physiologic Monitoring: Invasive Hemodynamics
Waveform recognition/Normal abnormal values (cont)
PULMONARY ARTERY
Channels blood from the right heart into the lungs.
During systole, pressure in RV> pulm art, the pulm valve opens and the pressure rises. (T wave on ECG)
Dichrotic notch - end of systole, onset of vent relaxation, the pulmonic valve closes
Gradual decrease due to blood being dispersed over large area equalizing pressure
High pulm artery pressures caused by: pulm emboli, MV stenosis, COPD, pulm hypertension, LV failure
Low diastolic pressure caused by plum valve insufficiency
Patient Assessment & Monitoring:
Physiologic Monitoring: Invasive Hemodynamics
Waveform recognition/Normal abnormal values (cont)
LA/PULMONARY CAPILLARY WEDGE PRESSURE (PCWP)
Wedging a Swan-Ganz catheter in the pulmonary artery or wedging a 'front-hole-only' catheter in an arteriole. This allows to measure the pressure on the left side of the heart if the right side is wedged or blocked
a wave found just after QRS, likewise rest of waveform found later than true atrial waveforms
a wave- contraction of LA
c wave - closure of the mitral valve
v wave - rise in pressure of the filling of the LA with oxygenated blood.
Low PCWP caused by hypovolemia
High PCWP caused by LH failure, Mitral stenosis, Tamponade, Hypervolemia, Ischemia
High v-wave cause by mitral insufficiency
Patient Assessment & Monitoring:
Physiologic Monitoring: Invasive Hemodynamics
Waveform recognition/Normal abnormal values (cont)
LEFT VENTRICLE
Healthy person's peak systolic pressure is 120mmHg
LV waveform similar to RV but steeper up and down stroke
During systole the aortic valve doesn't open until the ventricle pressure exceeds that of the aorta
EDP is gradual increase, filling of ventricle until its pressure is the same as the atrium (a wave, notch in upward stroke, where the mitral valve closes)
Low LV pressure caused by: LH failure, inadequate filling
High systolic pressure caused by: Hypertension, Aortic valve stenosis, PAD
High EDP caused by: Aortic valve insuff. hypertrophy
Patient Assessment & Monitoring:
Physiologic Monitoring: Invasive Hemodynamics
Waveform recognition/Normal abnormal values (cont)
AORTA
Similar to PA waveform
Peak systolic is the aortic valve opening
Dicrotic notch is the aortic valve closing
High Peak Systolic caused by: PAD
Low diastolic press caused by: Sepsis, Aortic valve insuff
Low mean pressure caused by: Hypovolemia (decreased blood volume)
Patient Assessment & Monitoring:
Physiologic Monitoring: Invasive Hemodynamics
Waveform recognition/Normal abnormal values (cont)
GRADIENTS
Gradient = Blood flow X Resistance

Peak-to-peak gradient: take the peak systolic value (or average of several peaks) of one waveform and subtract it from the peak systolic (or average) of the other
Mean gradient: average difference between 2 waveforms (more accurate of the 2)
Patient Assessment & Monitoring:
Maintaining Accessory Medical Devices
Oxygen Delivery Systems
Nasal cannulas (2-6 LPM)
Simple Face Mask (6-12 LPM)
Non-rebreather masks (10-15 LPM)
Patient Assessment & Monitoring:
Maintaining Accessory Medical Devices
Chest tubes
Used to remove air, fluid, or pus
Free of loops, kinks, and obstructions which may prevent damage.
In general chest tubes should never be clamped
Patient Assessment & Monitoring:
Maintaining Accessory Medical Devices
In-dwelling catheters
Perm Caths
Foley Catheters
G, J-tubes