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55 Cards in this Set

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Accidental Decanulation
1. Call for help
2. Reinsert the tube, if possible
3. Call a respiratory arrest
4. Auscultate for BS
5. Maintain ventilation and oxygenation by bag and mask
The client's biggest concern about weaning is:
fear of not being able to breathe.
Clinical assessments indicating respiratory distress during the weaning process
1. abnormal rr & pattern
2. use of accessory muscles
3. abnormal P & BP
4. abnormal skin & muscous MB color
5. abnormal ABG levels or O2 sats
4 functions of heart
automaticity
conductivity
excitablility
contractibility
Places to avoid placing leads:
joints, pacemaker, breast tissue, significant muscle mass, scar tissue
Artifact:
rhythmic moving on a strip
P-R interval facts:
should be 3-5 squares (0.04 per square) or not more than a big block. > than 1 block is 1st degree HB
0.12-.20
QRS wave facts:
0.04-0.12 Mike says 0.06-0.10 or 1 1/2 to 2 boxes
A-flutter:
can be as high as 300, 250-350 is common; can have 4:1 Pwave:QRS
controlled: <100
uncontrolled: >100
Idioventricular

AIOV
20-40 BPM

40-100 BPM
Focus on increase HR & CO
NO lidocaine!!!

Can use epi, adenosiene, nitro
Asystole
ventricular standstill (inadequate blood flow to heart)
TX: CPR
check 2 different leads; check the "gain" button--rarely pulls out of this rhythm
Documentation
label name, date, time
time of onset
s/sx
methods of tx
pt teaching
If QRS aren't coming @ regular intervals, most likely it is
A-fib
tx of 3rd degree HB
pacer
if P-R is extended?
first degree HB
definition/s/sx of hypoperfusion
diaphoresis
confusion
CP
dizzy
open IV & give bolus
tachy is how many BPM

PSVT is how many BPM
>100 bpm

>180 bpm
A-fib
no P distinquishable
no QRS after
decreased BP & filling time
s/sx of hypoperfusion
Stable tachy? what do you do?
administer O2
start iv
attach monitor
obtain 12-lead ecg
obtain portable cxr
sample of 3rd degree
complete heart block

Atrial rate 80
Vent rate 35
totally unique rhythms
normal pH equals?
20:1 ratio of base to acid
If pH goes one way and the PaCO2 goes another it is
a respiratory problem!
If pH and PaCO2 are going the same way, it is
a metabolic problem!
Pressure Support
A positive inspiratory pressure that “pushes” air into the lungs as the patient inhales.
Used to reduce the work of breathing, reduce respiratory fatigue, and i respiratory rate.
PS of 10 mimics atmospheric breathing.
Positive End Expiratory Pressure (PEEP)
A positive back pressure as the patient exhales.
Keeps the alveoli open longer during exhalation.
Used to h sats when h O2 doesn’t help.
FiO2:
Fraction of inspired oxygen, as a percentage.

Room air = 21% FiO2. 5L/NC = 40% FiO2.
Frequency (f):
# of breaths/min (resp. rate)
Range: 16-25 <12 or >38 not good.
End Tidal Volume (Vte):
the size of each breath in mL.
Range: 8-10mL/kg. (500-800mL)
Minute Ventilation (Ve tot):
The amount of air in/out of the lungs in 1 minute.
Range 6-10 L/min.
Peak Inspiratory Pressure (Pi end):
Range 16-25 mmHg, >30 Tx and watch, >40 ouch!
Volume Controlled Ventilation (VCV):
Machine breath volumes are constant, lung pressures are variable.
As lung gets sicker, PIPs will increase, so watch!
Pressure Controlled Ventilation (PCV):
Machine breaths pressures are constant, lung volumes are variable.
As lung gets sicker, Vte will decrease, so watch!
Pressure Support Ventilation (PSV, CPAP, or SPONT).
No machine breaths (rate
of 0).
Will use PS and/or PEEP to help a pt breathe.
Synchronized Intermittent Mandatory Ventilation (SIMV):
Some machine breaths (set a rate).
PCV or VCV, will use PS and/or PEEP.
If pt. over breathes the rate, won’t get machine breath
Assist Controlled Ventilation (AC):
All machine breaths (set rate), PCV or VCV.
If pt. over breathes the rate, still get machine breath.
Weaning From the Ventilator
Move from invasive modes to less invasive modes (i.e. A/C a SIMV a SPONT)
Wean PEEP and PS to atmospheric levels.
Can do a “room air trial” and/or weaning parameters.
Extubate patient (Yea!).
Monitor the healing process:
Watch VS/sats to see if pt. tolerates settings.
Evaluates vent wean for pt decompensation.
Troubleshoots vent alarms (suction, sedation
Prevents further injury:
Prevents VAP by oral care, suctioning.
Positions pt to prevent immobility, VAP.
Disadvantages of Mechanical Ventilation--immediately
Immediate complications
Pneumothorax
Tracheal trauma/bleeding
Disadvantages of Mechanical Ventilation--long term
Long-term complications
Ventilator Assisted Pneumonia
Aspiration
Immobility Deficits
Failure to wean
Pressure Monitor Set Up
1. Pressure bag
2. IV solution
3. IV tubing (with 1,2,3 chambers)
4. Transducer with flush & monitor connection
5. Tubing- art line (rigid), PA line IV tubing
6. Catheter & sutures
7. Pressure monitor
ARTERIAL LINES
Arterial Lines: Catheters are placed in the radial or femoral artery and allows for direct monitoring of the
arterial blood pressure.
Purpose: 1) provides direct continuous observation of SBP, DBP, MAP; 2) allows for frequent blood
sampling.
Preparation of ART LINE
1. Location:
Normal findings on art lines
1. Usual Pressures
SBP (120): compliance
DBP (80) elasticity
MAP (95): SBP + 2(DBP)/ 3
Ex: 120 + 2 (80)/3= 120 + 160/3= 280/3= 93
Pulmonary artery pressure monitoring
(PA pressures, Swanz-Ganz catheter monitoring, right-sided
cardiac catheterization, hemodynamic monitoring)is the placement of a flow-directed catheter into the
right side of the heart and pulmonary artery.
art lines--high pressure systems
PA pressure monitoring provides information about left
ventricular function and allows for direct cardiac measurements.
Possible complications of art lines
Hemorrhage is #1
pulmonary artery lines--low pressure system
Purpose: to measure several variables that provide information related to:
1. Cardiac pressures
Serves as a central line and can be used for:
Watch for complications
phlebostatic axis
marks the location of the right atrium and the PA catheter tip
zero-referenced stopcock must remain____
at the level fo the phlebostatic axis
most common complication associated with insertion
ventricular arrhythmias
preventing injury is a primary goal w/temporary pacemaker pts because
at risk for microshock--minute electrical charges deliver to the heart through the pacing electrode that could cause lethal v-fib