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53 Cards in this Set
- Front
- Back
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Common problems of critical care patients |
Anxiety, pain, impaired communication, sensory perceptual problems, nutrition |
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Hemodynamic monitoring |
The measurement of pressure, flow, and oxygenation within the cardiovascular system. |
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What is the purpose of hemodynamic monitoring in the critical care setting |
To assess heart function, fluid balance, and the effects of fluids and drugs on Co. |
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What are examples of hemodynamic monitoring devices |
They can be either invasive or noninvasive. Examples include systemic and Pulmonary arterial pressures, central venous pressure, pulmonary artery wedge pressure, O2 saturation of the hemoglobin of arterial blood, mixed venous O2 saturation |
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Cardiac output |
The volume of blood and leaders pumped by the heart in one minute |
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Cardiac index |
The measurement of the co adjusted for body surface area. It is a more precise measurement of the efficiency of the heart's pumping pumping action |
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Stroke volume |
The volume ejected with each heartbeat |
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What determines blood pressure |
Cardiac output in the forces of opposing blood flow |
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Systolic vascular resistance svr |
Opposition encounter by the left ventricle |
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Pulmonary vascular resistance or PVR |
Opposition encounter by the right ventricle |
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Preload |
The volume within the ventricle at the end of diastole |
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Frank starlings law |
Explain the effects of preload. It states that the more a myocardial fiber is stretched during filling, the more is short during systole and the greater force of the contraction |
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VASCULAR RESISTANCE |
AKA SVR IS THE RESITANCE OF THE SYSTEMIC VASCUALR BED. |
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TYPES OF INVASIVE PRESSURE MONITORING |
ARTERIAL BLOOD PRESSURE ARTERIAL PRESSURE-BASED CO PULMONARY ARTERTY FLOW-DIRECTED CATHETER CENTRAL VENOUS PRESSURE VENOUS OXYGEN MONITORING |
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ARTERIAL BLOOD PRESSURE |
A NON TAPERED TEFLON CATHETER IS USUALLY SUTURED IN PLACE USING A PERCUTANEOUS APPROACH TP MONITOR B/P AND MAP USING AN ARTERIAL LINE |
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ARTERIAL BLOOD PRESSURE INDICATIONS |
USED FOR PTS IN MANY SITUATIONS ACUTE HYPERTENSION AND HYPOTENSION REPIRATORY FAILURE SHOCK NEUROLOGICAL INJURY CORONARY PROCEDURES |
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WHAT IS AN ARTERIAL BLOOD PRESSURE USED TO MONITOR |
AN ARTERIAL BLOOD PRESSURE AND MAP |
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COMPLICATIONS WITH ARTERIAL LINES |
RISK FOR HEMMORRAGE (MOST LIKELY TO OCCUR IF LINE DISCONNECTS OR DISLODGES) INFECTION THROMBUS FORMATION NEUROVASCULAR IMPAIRMENT LOSS OF LIMB |
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HEMMORRAGE RISK WITH ARTERIAL LINES AND INTERVENTIONS |
MOST LIKELY TO OCCUR IF LINE DISCONNECTS OR DISLODGES. TO AVOID THIS USE A LUER-LOCK ALWAYS CHECK THE ARTERY WAVEFORM ACTIVATE ALARMS |
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INFECTION RISK R/T ARTERIAL LINES AND INTERVENTIONS |
INSPECT INSERTION SITE FOR S/S OF INFECTION MONITOR PT FOR SYSTEMIC INFECTION XHANGE PRESSURE TUBING,FLUSH BAG, AND TRANSDUCER EVERY 96 HOURS OR PER POLICY IN INFECTION IS SUSPECTED, NOTIFY PCP AND REMOVE LINE AND REPLACE EQUIPMENT |
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HOW IS CIRCULATORY IMPAIRMENT CAUSED BY ARTERIAL LINES |
CAN RESULT FROM THROMBUS FORMATION AROUND CATH, RELEASE OF EMBULUS,SPASM, OR OCCLUSION |
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WHAT TEST NEEDS TO BE DONE PRIOR TO INSERTION OF A LINE INTO A RADIAL ARTERY OR ARTERIAL LINE? |
ALLEN TEST THIS CONFIRMS THAT ULNAR CIRCULATION TO THE HAND IS ADEQUATE APPLY PRESSURE TO THE RADIAL AND ULNAR ARTERY AT THE SAME TIME.THEN ASK PT TO OPENA DN CLOSE HAND REPEADITLY. THE HAND SHOULD BALNCH. THEN RELEASE PRESSURE TO THE ULNAR ARTERY WHILE MAINTAINING PRESSURE ON RADIAL ARTERY. IF PINKNESS FAILS TO RETURN WITHIN 6 SECS THE ULNAR ARTERY IS INADEQUATE AND RADIAL ARTEY SHOULD NOT BE USED FOR LINE INSERTION |
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WHAT ARE WAYS THAT THE NURSE CAN MAINTAIN AN ARTERIAL LINES PATENCY AND PREVENT THROMBUS FORMATION |
ASSESS FLUSH SYSTEM Q 1-4 HOURS TO ---_--DETERMINE THAT THE PRESSURE IS INFLATED TO 300MM FLUSH BAG CONTAINS FLUID SYSTEM IS DELIVERY CONT SLOWFLUSH |
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WHAT SHOULD BE USED TO FLUSH ARTERIAL LINES |
PER COMPANY POLICY HOWEVER KEEP IN MIND THE RISK OF HEPARIN INDUCED THROMBOCYTOPENIA(HIT)...THEREFORE NORMAL SALINE IS BEST |
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NEUROVASULCULAR IMPAIRMENT INTEVENTIONS |
ASSESS NEUROVASCULAR STATUS DISTAL TO THE ARTERY SITE HOURLY. MONITOR FOR COOL,PALE EXETREMITY ASSESS CAP REFILL MONITOR FOR THE 5 P'S |
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WHAT ARE THE 5 P'S |
PARATHESIA PAIN PARALYSIS PALLOR PULSELESSNESS |
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ATERIAL PRESSURE-BASED CARDIAC OUTPUT |
A MINIMALLY INVASIVE TECHNIQUE USED TO DETERMINE CONTINOUS CARDIAC OUTPUT (CCO) AND CONTINOUS CARDIAC INPUT (CCI) ALSO USED TO ASSESS PTS ABILITY TO TO RESPOND TO FLUIDS BY INCREASING SV (STROKE VOLUME VARIATION) |
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PULMONARY ARTERY FLOW DIRECTED CATHETER |
MONITORS PULMONARY ARTERY PRESSURE OF SELECTED PTS WITH HEART AND LUNG ISSUES. ARE SENSITVE INDICATORS OF HEART FUNCTION AND FLUID VOLUME STATUS |
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PULSE OXIMETRY |
AN NON INVASIVE METHOD OF MONITORING AND DETEMINING THE 02 SATURATION OF HEMOGLOBIN. NORMALLY 95-100 |
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IMPEDANCE CARDIOGRAPHY (ICG) |
A CONTINUOUS OR INTERMITTENT NONINVASIVE METHOD OF OBTAINING CO AND ASSESSING THORACIC FLUID STAUS |
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HOW DOES ICG WORK |
USES FOUR SETS OF EXTERNAL ELECTRONODES TO DELIVER A HIGH FREQUENCY,LOW ALTITIUDE CURRENT. |
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INDICATIONS FOR ICG |
EARLY S/S OF PULMONARY OR CARDIAC DYSFUNCTION DIFFERENTIATION OF CARDIAC OR PULMONARY CAUSE OF SOB EVAL OF ETIOLOGY AND MANAGEMENT OF HYPOTENSION |
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ARTIFICAL AIRWAYS |
ENDOTRACHEAL TUBE OR INTUBATION. MANY PATIENTS NEED MECHANICAL ASSISTANCE TO MAINTAIN AIRWAY PATENCY. tHIS IS DONE BY INSERTING A TUBE INTO THE TRACHEA, BYPASSING THE UPPER AIRWAY TRACHEOTOMY |
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TRACHEOTOMY |
A SURGICAL PROCEDURE THAT IS PERFORMED WHEN THERE IS A NEED FOR A ATIFICAL AIRWAY THAT IS EXPECTED LONG TERM |
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ORAL INTUBATION |
AN ET TUBE IS PASSED THREW THE MOUTH AND VOCAL CARDS AND INTO THE TRACHEA WITH THE AID OF A LARYNGOSCOPE |
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NASAL ET INTUBATION |
THE ET TUBE US PLACED BLINDLY THROUGH THE NOSE, NASOPHARNYX , AND VOCAL CORDS. IS RARELY USED BUT MAY BE NEEDED WHEN ORAL INTUBATION IS NOT POSSIBLE. (UNSTABLE CERVICAL SPINE,DENTAL ABSCESS, EPIGLOTITITIS) |
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WHA IS THE PREFERRED METHOD OF INTUBATION IN EMERGENCIES |
ORAL - BECAUSE THE AIRWAY CAN BE SECURED RAPIDLY AND A LARGER DIAMETER TUBE IS USED. A LARGER BORE ET TUBE REDUCES THE WORK OF BREATHING |
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CONTRAINDICATIONS FOR ORAL INTUBATION |
UNSTABLE CEVICAL SPINE DENTAL ABSCESS EPIGLOTITTIS |
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RISK ASSOCIATED WITH ORAL INTUBATION |
DIFFICULT TO PLACE IF HEAD AND NECK MOVEMENT IS LIMITED(SUSPECTED SPINAL CORD INJURY) TEETH CAN BE CHIPPED OR ACCIDENTALLY REMOVED SALIVATION IS INCREASED AND SWALLOWING IS DIFFICULT PT OBSTRUCTION BY BITING DOWN (BITE BLOCK AND SEDATION CAN PREVENT THIS) MOUTH CARE CAN BE A CHALLANGE |
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ENDOTRACHEAL INTUBATION PROCEDURE |
UNLESS EMERGENCY, CONSENT MUST BE OBTAINED. EXPLAIN TO FAMILY PROCEDURE AND THAT PT WILL NOTE BE ABLE TO SPEAK. PT IS PLACED IN SUPINE POSITION WITH HEAD AND NECK FLEXED TO ALLOW VISUALIZATION OF VOCAL CORD PT IS PRE OXYGENATED USING 100% 02 FOR 3-5 MINS ATTEMPTS ARE LIMITED TO LESS THAN 30 SECS |
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EQUIPMENT THAT NEEDS TO BE AVAILABLE DURING INTUBATION PROCEDURE |
SELF INFLATING BAG VALVE MASK (AMBU BAGE)ATTACHED TO 02 IV ACCESS |
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BAG VALVE MASK |
AMBU BAG- CONTAINS A RESERVOIR THAT IS FILLED WITH 02 SO THAT CONCENTRATIONS OF 90-95% ARE DELIVERED. |
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RAPID SEQUENCE INTUBATION(RSI) |
THE RAPID, CONCURRENT ADMINISTRATION OF BOTH A SEDATIVE AND PARALYTIC DRUG DURING THE EMERGENCY AIRWAY MANAGMENT TO DECREASE THE RISK OS ASPIRATION AND INJURY TO THE PATIENT. NOT INDICTED FOR PTS IN CARDIAC ARREST OF HAVE A KNOWN DIFFICULT AIRWAY |
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HOW IS PLACEMENT VERIFIED WITH ET TUBE |
USE AN END TIDAL C02 DETECTOR BY NOTING THE PRESENCE OF EXHALED C02. THE DETECTOR IS PLACED BETWEEN THE BMV AND ET AND LOOK FOR COLOR CHANGES (OR A NUMBER) IF NO C02 IS DETECTED THE TUBE IS IN THE ESOPHAGUS AND THE TUBE MUST BE REINSERTED. AUSCULATE FOR THE ABSENCE OF BREATH SOUNDS SP02 SHOULD IMPROVE. CHEST XRAY IS USED TO CONFIRM PLACEMENT. |
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WHAT MUST BE DONE IMMED AFTER ET TUBE PLACEMENT |
THE CUFF IS INFLATED VERIFY PLACEMENT WITH ASSESSMENT AND CXR OBTAIN ABG'S WITHIN 15-30 MINS |
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WHAT FINDINGS SUPPORT PROPER PLACEMENT OF ET TUBE |
PRESENCE OF EXHALED C02 BREATH SOUNDS ABSENCE OF BREATH SOUNDS OVER EPIGASTRUM IMPROVED SP02 |
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NURSING MANAGEMENT OF ET |
1. MAINTAIN PROPER PLACEMENT 2.MAINTAINING PROPER CUFF PLACEMENT 3.MONITORING OXYGEN 4.MAINTAINING PATENCY 5. PROVIDING ORAL CARE AND SKIN INTEGRITY 6. FOSTERING COMFORT AND COMMUNICATION 7. ASSESSING FOR COMMUNICATIONS |
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MAINTAINING CORRECT TUBE PLACEMENT |
OBSERVE FOR SYMMETRIC CHEST MOVEMENTS AUSCUALTE TO CONFIRM BILATERAL BREATH SOUNDS |
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NURSING RESPONSIBILTIES IN EVENT TUBE BECOME DISLODGED |
THIS IS A MEDICAL EMERGENCY STAY WITH PT MAINTAIN AIRWAY SUPPORT VENTILATION WITH BMV AND 100% 02 |
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MAINTAINING CUFF INFLATION |
INFLATE THE CUFF WITH AIR AND MONITOR PRESSURE. MAINTAIN PRESSURE AT 20-25 CM MEASURE AND RECORD PRESSURE Q 8 HOURS USING THE MOV AND MLT TECHNIQUE |
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MINIMAL OCCLUDING VOLUME MOV |
1.PLACE STETOSCOPE OVER TRACHEA |
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MONITORING OXYGENATION AND VENTILATION |
ASSESS CLINICAL FINDINGS ABGS,SP02 ASSESS FOR HYPOXIA |
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B |
B |
