Critical Care Nursing Exam 1 (University of Akron)
Criteria for ARF type II 4
-acute dyspnea -PaO2 <50/60 on >50% oxygen (50/50 rule) -PaCO2 >50 -acidotic pH
What would cause a shunt unit 5
-asthma -CNS Issue (head trauma) - sedatives - NM disease - SC injury
What will decrease a SvO2? 4
-decrease in CO -decreased Hgb -Decreased SaO2 -increased O2 consumption
Complications of PEEP/CPAP?
-decreased BP (increased intrathoracic pressure=lower preload= lower CO) -increased ICP -Barotrauma (pneumo, broncho/pleural fistula)
Purpose of PS
-decreases the work of breathing -increases spontaneous tidal volumes
Meds for ARDS 7
-diuretics -inotropes for low CO -antibiotics -bronchodilators -NM blockers -steroids (late stage) -mayyybe prostaglandin inhibitors
Criteria to wean someone from a vent 4
-hemodynamically stable -resolving patho cause of intubation/ventilation -settings at minimal levels -ABG results
What will increase O2 consumption? 5
-increase body temp -increase work of breathing -pain -anxiety/agitation -sepsis
What will increase SvO2?
-increased CO -increase SaO2 -increased Hgb -decrease in tissue O2 extraction of (sepsis)
What is a low dose inotropin used for?
-increases renal and mesenteric perfusion
Interventions for decreased contractility 3
-maintain electrolytes -optimize fluid balance -add possible inotrope (dobutamine)
general principles of Administering vasoactive agents
-monitor close -smallest dose -monitor for infiltration/extravasation -
Complications of central line insertion 5
-pneumo -air emboli - infection - local obstruction -clot embolization
Norepi/levophed 4
-potent vasoconstrictor/sympathomimetic -A1/B1 stimulation/coronary artery dilation -Watch for extravasation -increases BP and SVR
What would cause a dead space unit 4
-pulm embolus -severe anemia -shock -low CO
Prevention of intubation complications 5
-ready oral suction at bedside -lift HOB after procedure -assess for gastric distension -assess for bilateral lung sounds -can cause atelectatic left and RUL lungs
dopamine/inotropin5
-sympathomimetic -drug of choice for maintaining BP - low dose 1-5mcg/kg/min -Mid dose: 510mcg/kg/min -high dose: 10-20mcg/kg/min
NRSG management of art lines 7
-test patency -keep system sterile -assess insertion site -monitor values/trends -consider pt clinical status -document -change bag Q24
Short term complications of intubation 3
-vomit/aspiration -gastric intubation -right mainstem broncos infection
Relative refractory period
-vulnerable time for muscle cell where it is not ready to contract again , if it receives impulse it can cause a dysrhythmia
Nrsg management of art line? 4
-zeroing the transducer Q8-12 -pressurized system -square wave test -change pressure bag Q24
QRS complex
.06-.1sec Depolarization/contraction of ventricles
P-R interval
.12-.2 sec Onset of atrial repolarization to ventricular depolarization
How much pee should a hooman produce?
.5ml/kg/hr
Which steps are polarized?
0
What do the Chem mediators do during ARDS
Alveolar filling Pulm vasoconstriction Bronchoconstriction
Meds for intubation
Anectine/Sux as a neural block Etomidate short acting anaesthetic Versed: benzo to decrease anxiety
What decreases Hgb
Anemia Hemorrhage
How do you treat ARF II caused by pneumonia
Antibiotics
Normal SaO2
Arterial oxygen saturation: >93%
What do you do after setting up a vent or changing the settings?
Assess ABGs again to ensure the settings are adequate
What is a modified allen test?
Assesses the collateral circulation to hand via ulnar artery. Done by holding pressure on ulnar artery and the fingers should turn pink, also done before checking ABGs from art line
A/C mode
Assist controlled mode, breaths are given by vent, not pt. However, pt can trigger additional breaths but will always get the set rate
What should the HOB be at with an artificial airway?
At least 30 degrees
P wave
Atrial depolarization (.08-.1sec)
P-Q
Atrial kick or AV node delay
What is the best way to determine if a pt needs suctioned ?, what bs would you hear?
Auscultate upper airways for coarse Rhonci
What is smart care with drager vents?
Automatic weaning that senses pt parameters (Rate, VT, pCO2) -auto adjusts based on pt data
How do you know a line is obstructed?
Dampened of flattened waveform created
What causes decreased contractility? 4
Decreased SV, LVEF, CO, CI
If a pt core temp is 39.6, you would expect to see what?
Decreased SvO2
Shunt unit
Decreased V but ok Q
Dead space unit
Decreases Q but ok V
High frequency/ jet vent
Delivers 40-70 breaths per min, usually used for high risk pts or neonates
Pressure cycled vent
Delivers air until a certain pressure is built
What are the 3 resistances to blood flow?
Diameter of vessels Viscosity of blood Elastic recoil of vessels
What do you do when the doc orders a water seal order?
Disconnect wall suction from the container
Which is better nasal or oral ETT AND WHY
Oral, less infection risk
Normal DO2
Oxygen delivery about 100ml/min
Normal VO2
Oxygen demand about 250ml/min
What causes the dicrotic notch in PA cath waveforms as opposed to normal arterial waveforms?
PA; closing of tricuspid vavle OTher art lines: pulm/aortic
How to measure preload pressure of left ventricle?
PAWP/PAOP, lungs before L heart
ABG/vent settings goals for ARDS
PO2 >60 spo2 >88% PEEP 5-15 FiO2 <60 PCO2 60-100
Causes of resp alkalosis
Too fast of a RR
If a pt has a glasgow coma scale (GCS) of less than 8 what needs to happen
Pt needs intubated their neural control is not good enough to breathe
Why would you hear a low pressure alarm on a vent?
Pt probably popped off the vent
Normal PAM/MPAP, PAS and PAD
Pulm artery systolic: 20-30mmHg Pulm artery diastolic: 5-10mmHg Pulmonary artery mean: 10-15mmHg
What is a swan-ganz catheter?
Pulmonary artery catheter
What is PAP
Pulmonary artery pressure
What is PP and what does it reflect?
Pulse pressure, SBP-DBP, reflects perfusion pressure, SV and arterial compliance
What 3 things does perfusion count on?
Pumping ability of heart Blood volume Size of vascular space
How do you do a square wave test?
Push the pass button or pull the cord on art line to flush the line and make a square wave on the EKG. Can be normal, overdampened, underdampened
Which way does the wave of depolarization travel?
R-L
Minute volume calculation
RR x TV
What is the most accurate place for art lines?
Radial or femoral artery
What is a RSBI and how do you calc it?
Rapid shallow breathing index RR/TV
What is ARDS characterized by
Refractive hypoxemia
What is the purpose of the suction control chamber on a pleur-evac
Regulates the negative pressure because if the pressure in the pleural space is positive the lung will collapse
What would dopaminergic receptors do
Renal and abd visceral arterioles, can cause vasodilation/vasoconstriction/increased contractility based on dose and place
What is afterload?
Resistance against which the ventricle must work to pump blood
How do you treat ARF II caused by OD
Reverse with narcan
What is the dominant pacemaker of the heart? How often should it fire?
SA node 60-100 times per min
What is automaticity?
SA node leaks Na into heart allowing it to make its own rhythm free of neural simulation
What is the calculation for LVEF
SV/EDV (end diastolic volume)
Afterload for L ventricle
SVR, systemic vasc resistance
How do we set up a swan-ganz catheter?
Same as an art line, hooked to a 500cc bag of pressurized NS
Goals for COPD pt w/ ARF type II, what vent setting do we use to get each goal?
Set FiO2 to get: -PO2 60-80 -SpO2 >88-90 Set rate and TV to get: -PCO2 50-60
What should you do after chest tube insertion?
Set up dressing and get a CXray to confirm placement
What are the V/Q mismatches
Shunt unit Dead space Silent unit
STEMI
St elevated myocardial infarc
What is hemodynamics?
Study of movement of blood and forces contained in the CV system
What are optional PA cath ports?
Svo2 connector (optical module) CO cable
What body chemicals increase the heart rate?
Sympathetic epi/norepi
Normal SvO2
Systemic venous oxygen saturation: 60-80%
MAP calculation
Systolic BP + (Diastolic BP x2)/3
5 things to assess for ARF II 5
-abnormal lung sounds -ABGS -CXR -V/Q, CT for PE -SvO2
Calcium range
8.5-10mg/dl
What is LVEF?
% of blood ejected by heart w/ each contraction
SVR Calculation
((MAP-CVP)/CO )x80
Calc if ml/hr ordered and you need dose/kg/min
((concentration x ml/hr)/60)?Kg
SV calculation
(CO/HR) x 1000ml
What are the spontaneous resp parameters?
-TV around 5-8ml/kg - VC of 3xTV -NIF of -20 to -30cm H2O
What PEEP do you start at?
+5cm H2O
Dobutamine/dobutrex and dose 5
-+inotrope/ adrenergic -B1/B2 stimulation -Decreases SVR, PAWP -increases CO/CI/contractility/HR -dose:2-20mcg/kg/min
what is a high dose inotropin use for?
-A1 stimulation -artery constriction to increase BP/SVR
Nitroprusside/nipride 5
-Anti-HTN, vasodilator -used for severe HTN -dilates the veins/arteries right ****in quick -Side effect: thiocyanate toxicity -drops pre and afterload
Nitroglycerine/tridil 4
-Antianginal vasodilator (affects veins/arteries AND coronary arteries) -decreases pre/afterload -SE: decreased BP, hypotension -Route: sublingual, IV
Assessment of a chest tube? 5, when do you call the doc?
-Auscultate lungs Q1 -SpO2 Q2, Report less than 95% - Cough/deep breathe Q2 -Pain assess -Feel for crepitus (call doc if found)
What is a mid dose inotropin used for?
-B1 stimulation to increase contractility
Nicardipine/cardene 6
-CA channel blocker -severe HTN greater than 180/120 -artery dilations, decreases SVR -Maintains CO -Doesnt cause bradycardia -only IV
Nrsg management of a PA cath? 7
-CXR to ensure placement -pneumo -possible vent arrhythmias during insertion - infection -balloon rupture -PA rupture -valve injury
When calculating a tidal volume what is it important to do?
-Calculate the pts ideal body weight not their actual because obese ppl dont have bigger lungs
What to evaluate when assessing hemodynamic status? 4
-Cardiac function/how strong is the heart -Adequacy of circulating blood volume -vascular pressures -physiologic response to RX
ARF II prognosis with COPD 4
-High incidence of reoccurring -Difficult to wean -Muscle atrophy in vent -May need to be put in a trach before be sent out
Assessment for increased preload
-JVD -dyspnea -increased CVP -crackles -increased pulm pressure
What does SVR measure and what is a normal?
-L side afterload pressure -Systemic Vascular Resistance 800-1400 dynes/sec/cm^-5
What does PAWP/PAOP measure and what is the normal range?
-Left side preload pressure -Pulmonary artery Wedge/occlusion pressure 5-12mmHg
What are some safety concerns with NIVs? (4)
-Make sure to completely take off the mask when giving meds, may need to be put on a cannula -Ensure the seal is complete -Watch for nasal pressure ulcers -make sure to perform mouth care because they get dry real quick
Immediate tx of air embolus 3
-Place pt on left side (to trap air in R atrium) -Trendelenburg position -100% oxygen
What does the proximal port on a PA catheter do?
-Proximal (blue, measures CVP or R side preload pressure): can be given a bolus to measure CO. Can give fluids and meds
What's some EBP for preventing VAP 8
-Q12 teeth brushing -use CHG -HOB -subglottic suctioning -verify OG placement - check TF residual Q4 -closed suction system - daily sedation holiday
What does PVR measure and what is a normal?
-R side afterload pressure -Pulmonary Vascular Resistance <250 dynes/sec/cm^-5
What does CVP and RAP measure and what are their normals?
-Right side preload pressure -Central Venous Pressure 2-6mmHg -Right atrial pressure 2-8mmHg
Extubation criteria 8
-Spontaneous resp parameters -RSBI <105 -muscle strength -occlusion test -ABGs back to baseline -PetCO2 (end tidal volume CO2) - No or lessened sedation -Comatose GCS >8
What is a normal SV
-Stroke Volume (amount of blood pumped from ventricle each beat) -60-100ml/beat
Long term risk of intubations 3
-T/E fistula -sinusitis -vocal cord paralysis
0-4 stages of action potential
0 Na channels open (cell is positive) 1 Na channels close, K open (cell maintains + charge, but decreases a bit) 2 Ca channels open, some K leaves (cell continues to maintain charge) 3 All K channels open (cell becomes negative) 4 Na, K atpase pump filters out Na (cell becomes baseline)
Which steps are the absolute refrac period?
0-2
6 steps to analyzing an EKG
1 Reg rhythm? R-R 2 Determine HR (count QRS in 6 sec) 3 Identify that all the P waves are the sam 4 Measure PR interval (count the small squares then x .04) 5 Measure QRS complexes (small squares x .04) 6 Measure QT
4 Purposes of a chest tube 4
1 Removal of air, pus, or blood 2 restore negative pressure to pleural space 3 Re-expand a collapsed lung 4 Drain blood from around heart
What usually causes a pneumothorax in the ICU?
1 Vent barotrauma 2 trauma due to central placement, after thoracentesis, post lung biopsy/CPR or after chest trauma
ARDS assessment findings
1 acute dyspnea with dry cough 2 SPO2 and po2 trend 3 increased resp rate 4 crackles rhonci wheezes 5 increased HR BP and CO 6 anxious 7 mottled skin
3 things Dx of ARDS
1 assessment 2 ABGS 3 CXR
Nursing priorities with ARF II
1 correct hypoxemia 2 mechanical vent 3 tx underlying problem 4 turn the good lung down
Intervention for ARDS 6 (Vent settings?, Strict hygiene for what?, Allow for ?, Q2 what?, manage?, maintain hgb where?)
1 increase FiO2 and PEEP 2 strict pulm hygiene 3 allow rest 4 Q2 turns 5 fluid management 6 maintain Hgb >8-9g
End stage ARDS 6 (Profound what?, PH?, What will hapen to the heart? MODs when?, BP?)
1 profound refractory hypoxia (>20% shunt) 2 resp/met acidosis 3 systemic infection 4 cardiac dysrhythmias 5 hypotension 6 multi system organ failure after 2-10 days
Tx goals for ARDS 7 (Tx what?, Reverse what?. Open what?, Ph?, Tv?, PCO2?, Fluids?)
1 treat precipitating factor 2 reverse hypoxia 3 distend alveoli 4 pH > 7.25 5 TV <6ml/kg 6 pco2 60-100 permissive hypercapnea 7 don't fluid overload but maintain BP
Which steps are depolarization?
1-2
When performing a weaning evaluation what is the max acceptable RR
10 above baseline
What PS do you start on?
10 cm H2O
When someone comes in with ARF II What is a common oxygen amount it start them on
100%
What is the normal size of a chest tube?
14 french
What to do when intubating? 4 (Remove what? Know what? Preoxygenate how?)
1get supplies -remove dentures -know code status -preoxygenate with 15L O2 in bag mask device, get to 100% saturation
When performing a weaning evaluation what is the max acceptable HR
20 above baseline
After how many days on intubation is it recommended to insert a trach ?
21
What is the FiO2 of room air?
21%
Normal PHCO3
22-26
How long does it take for the kidneys to compensate for acidosis
24-48hrs
Which steps are repolarization?
3-4
Proper spot for end of ETT tube
3-5cm above carina
How much pressure does an Art. line fluid bag need to be under?
300ml
How much pressure do you need to perfuse capillary beds?
30ml
Normal PCO2
35-45
Nutritional needs for ARDS
35-45 kcal/kg/day. Use TPN if needed
How many more times at risk is an intubated pt for pneumonia?
3x
How many ports are there on a PA catheter ?
4 -proximal/distal - one port to inflate balloon w/ air to measure PAOP - Thermos connector to measure temp
Normal CO
4-8L/min
What is the phlebostatic axis?
4th intercostal space, mid axillary line
Normal minute volume
5-10L/min
How much higher is an arterial line pressure than standard cuff?
5-10mmHg
Normal blood volume for a 75kg adult
5-6L of blood
Normal size of a nasal/oral ETT
6-8, 7 is best
What % of blood is in the venous system?
64%
Normal pH
7.35-7.45
Q-T interval
<.44 sec
Normal lactic acid
<2
What pH is lethal?
<6.8 and >7.8
What pH requires aggressive management?
<7.2 and >7.55
How much shunting is occurring based on P/F ratio
>300 <5%shunt 200-300 about 15% 100-200 about 20% <100 about 30%
What is a sub-glottic suction?
A special tube that has the ability to suction secretions that lay on top of the inflated cuff
What are the actions of alpha 1, beta1 and beta 2 receptors?
A1: vasoconstriction B1: increase contractility B2: bronchodilator
Escape pacemakers of the heart? How fast does it beat?
AV node and bundle of His, backup pacemakers. 40-60 a min
which is the step of relative refrac period? and absolute
Absolute: beginning of QRS to Peak of T Refractory: Peak of T to bottom of T
What do our bodies tolerate better, acidosis or alkalosis
Acidosis
What is the purpose of the water seal chamber on a pleurovac
Acts as a one-way valve allowing air in but not out
ARF type II criteria 4
Acute Resp failure -acute dyspnea -PaO2 <50/60 -PaCo@>50 -Acidotic pH
What is ARDS
Acute respiratory distress syndrome, severe ARF that follows a precipitating event that causes decreased diffusion.
What is ARF
Acute respiratory failure, that adversely affects diffusion and perfusion that causes inability of cardiopulmonary system to provide adequate oxygenation to meet needs of body
PEEP
Adds pressure upon expiration +5-+20 (+15 is high as you should go for), keeps some pressure at the end (basically it stops before all the air is expired)
Nurse is caring for a pt that CVP is -1mmHg, what tx is most helpful?
Administer additional IV fluids
What is an air leak in a chest tube?
Air that causes the tidaling, normal only if the tube is for pneumothorax
What is a barotrauma and volutrauma?
Baro=pressure induced injury Volu=volume induced injury
Isoelectric line
Baseline of EKG strip
With ARDS why do you initially see resp alkalosis
Because CO2 passes through fluid but oxygen does not
ECMO
Blood is taken out of body and put through a oxygenator
What are colloid fluids?
Blood products that increase osmotic pressure
Meds for COPD w/ ARFII
Bronchodilators Steroids if they wheezing Mucolytics
3rd backup pacemaker, ventricular cells
Bundle branches and purkinje fibers 30-40 a min
What are the 3 major components of oxygen supply/delivery?
CO SaO2 Hgb
DO2 calculation
CO x arterial O2 content (Hgb x SaO2 x 1.34)
CI calculation
CO/BSA (body surface area)
What lung sounds would you hear for ARF type II, for COPD and nonCOPD
COPD: distant wheezes and crackles Non-COPD: diminished
How to measure preload pressure of right ventricle?
CVP/RAP, superior vena cava before the R heart
Normal CI
Cardiac index 2.2-4L/min
What happens if the tissues are not receiving adequate oxygen?
Cells switch to anaerobic metabolism and produce lactic acid
What is a CVP and how can you assess it with a central line?
Central venous pressure, directly monitors pressure of superior vena cava. Can be assessed by attaching monitor to brown port on triple lumen central line
What is CPAP?
Constant airway pressure, no Vt or rate, just PEEP/PS. Pt takes own breaths
What is contractility and what electrolyte is it most influenced by?
Contractile force or inotropy of the heart, independent of preload/afterload. Calcium
CMV Mode
Control mode vent, all breaths are given by vent, rate and depth. Pt has no control at all
Late signs of acidosis 3
Cyanosis in lips and mucous membranes Coma Death
What does the distal port on a PA catheter do
Distal (yellow, PA pressure or L side preload pressure): Always connected to pressure flush system and transducer. No fluid or meds
Interventions for increased preload
Diuretics Venous dilators
What is a occlusion test?
Done if airway swelling is suspected, does the air flow around the cuff when deflated? If not the pt airway wont support extubation
S/s of air embolism 5
Dyspnea, tachypnea, coughing, cyanosis, hypotension
What would increase CO? 2 drugs/disease
Early sepsis Intoropic drugs
St segment, when is it abnormal?
Early vent repolarization, abnormal if greater than 1mm from baseline
How to confirm ETT tube placement 3
End tidal CO2 detector Auscultate Portable CXR
How do we level an art line?
Ensure that the transducer is at the 4th intercostal space, mid axillary line (phlebostatic axis). Tape that shit to the outer arm.
After intubation the RN hears no breath sounds anteriorly bilaterally, where do you suspect the tube is
Esophagus
What vent settings affect PaO2
FiO2, PEEP
Normal FiO2
Fraction of inspired oxygen <50% is goal, 21-100% is range
What should you do before chest tube insertion?
Give analgesic, set up pleurovac
Causes of metabolic alkalosis (Too much of what drip?, Loss of what due to what?, Excessive...?)
Given Excess HCO3, excess acid loss due to vomiting, GI suctioning
CO calculation
HR x SV/1000ml
How do you treat ARF II caused by PE
Heparin
Blood flows from an area of ________ pressure to _________pressure
High, low
Nrsg priorities for a artificial airway 5
Humidification , suctioning (auscultate), communication, safety (restraints), comfort
What are crystalline fluids and how do they affect osmotic pressure?
IV fluids like Lactated ringers, NS etc that decrease osmotic pressure
What would increase SaO2?
Increased FiO2
What are the top 4 causes of ARDS
Indirect Sepsis (#1) Trauma Direct Aspiration Pneumonia
Causes of resp acidosis
Interference in gas exchange, drug OD, COPD, CHF, low RR/TV on machine
What is IRV
Inverse ratio ventilation, inspiration over expiration
How to assess brain perfusion
LOC
What is a normal LVEF/EF
Left ventricular ejection fraction/ejection fraction (amount of blood ejected from the heart each contraction) -50-70%
How much pressure should be in a ETT cuff
Less than 20 mmHg
What is refractive hypoxemia
Low oxygenation despite high FiO2 levels
If you increase PEEP what else can be expected
Lowered BP due to decreased venous return
What will decrease CO? 6
MI CHF Hypovolemia Arrhythmias increased PEEP cardiac depressant drugs
Tx for sinus bradycardia
Make sure they aren't an athlete, this could be their baseline.
What is tidaling in the chest tube container?
Occurs when the fluid level in the chamber fluctuates, normal when there is an opening between the chest and pleurovac. This is normal but when it stops it could mean the lung has re-expanded
Normal MAP
Mean Arterial Pressure 70-105 mmHg
Which position should the wrist be in to insure accuracy of art line pressure reading?
Mild extension
What is a mixed disorder and what type of failure usually causes it?
Mixed metabolic and respiratory acidosis due to resp/renal failure. Causes excessive pH drop, increased PCO2 and decreased HCO3
What is a NIF
Negative Inspiratory force, the output of the inspiratory muscles measured in negative cm H2O (can they take a good breath?)
Silent unit
No V OR Q
Can you infuse meds or fluids through art line?
No bitch, only the pressurized NS
What are NIVs ?
Non invasive vents: BiPap, CPAP/PEEP,
NIV
Non-invasive vent
Afterload for R ventricle
PVR, pulm vasc resistance
What is a normal P/F ratio
PaO2/FiO2 -measures oxygen transfer ->300 is awesome can be as low as below 100 -200-300 mild shunt -100-200 moderate shunt, ARDS -<100 severe shunt
ABG goals for a pt with ARF II and COPD
PaO2: 60-80 SpO2: >90% Pco2: 50-60 Normal pH
Normal PO2 or PaO2
Partial pressure of oxygen: 80-100mmHg
What would increase Hgb?
Polycythemia Blood transfusion
What happens if you over inflate a ETT cuff
Possible esophagotracheal fistula
ARDS patho
Precipitating factors-- 24-48 hrs later Chem mediators are released --AC membrane inflammation and decreased permeability--hypoxia and type II pneumocytes damaged (decreased surfactant makes alveoli collapse)--R to L shunt of blood --refractory hypoxemia
What 3 things make up SV
Preload, afterload, contractility
What is the best mode for ARDS
Pressure controlled is the best for hemodynamics stability
Why do we have to routinely zero and level the transducer on an art line?
Pressure of our environment changes every 8-12hrs
PS
Pressure support, adds pressure upon inspiration (start at 10, increase by 5-10cm H2O)
Purpose of PEEP
Prevents alveolar collapse, and supports weaning of FiO2
What is a bite block?
Prevents pt from biting down on the tube
What does asynchronis mean?
Pt is fighting the vent
What is Vt and normal range for healthy person and intubated pt
Tidal volume, volume of air inspired and expired. -6-8ml/kg (usually about 500-700ml) if pt is intubated we are happy with anything above 5ml/kg
When would you do a modified allens test?
To assess patency of ulnar for an art line insertion
What is the purpose of a mediastinal chest tube?
To drain blood from around the heart
Why would you hear a high pressure alarm on a vent? 5
Too much resistance, couldnt get volume in -coughing -Secretion obstruction -biting -Bronchospasms (dont suction) -Anxious or fighting the vent
What is TC
Tubal Compensation Vent adjusts PS to support proper amount by taking into account the size of the airway device (Larger tube = less airway resistance=vent adjusts)
How would you know that a tube has gone too deep and entered the right lung?
Unequal, chest rise and unilateral breath sounds
IMV/SIMV mode
Used often for weaning, allows pt to take some breaths on own but gives assistance (sometimes breathes for pt)
Interventions for decreased afterload
Vasopressors
3 primary lung functions
Ventilation perfusion and diffusion
Patho of ARF II
Ventilatory failure-hypoxemia and hypercapnia (headache, CNS changes, confusion, decreased LOC) -agitation (SNS HR, RR, Increased BP)
What happens during systole?
Ventricular volume decreases
What should always be done before initially using any central line?
Verify its placement with a chest xray
Normal VC
Vital Capacity >10-15ml/Kg (max volume of exhalation after max inhalation)
What should you not hear if the ETT tube is in the correct place ?
Vocal noises
Volume cycled vent
Volume given until a certain amount (tidal volume is set as a goal for pt delivery)
What is stroke volume?
Volume of blood ejected from left ventricle each contraction
What is cardiac output
Volume of blood ejected from left ventricle over 1 min
Causes of metabolic acidosis (Loss of what and how?, Build up of what lab?, failure of what organ?, OD of what drug?, 2 conditions)
Vomiting, diarrhea, wound drainage, lactic acidosis (hypo ventilation), renal failure, DKA, trauma, ASA OD
What vent settings affect PaCO2?
Vt, PS, mode, rate
What is preload?
Wall tension created by volume in ventricle at end of diastole (RVEDV, LVEDV)
If you insert a mediastinal chest tube and drain blood from around heart can you reinfuse it back into the body?
Yes w/in 4 hrs
Do you love this quizlet and me?
Yes: Well u should help a brother out too (venmo: Evan-Dillon-1) No: Sorry better luck with another quizlet
Why is it not recommended to to "milk" or strip chest tubes?
You can increase intrapleural pressure and cause trauma
Positive deflection
above isoelectric line P,R, T, U
What valves must open for the heart to empty?
aortic/pulmonic
Which has higher pressure, arteries or veins?
arteries
DOC of bradycardia
atropine
Negative deflection
below isoelectric line Q,S
Av block
blockage of Av node causing the heart to use 3rd backup, need to ablate the block
Calc is dose/kg/min ordered and you need ml/hr
dose x kg x 60/concentration
ETT
endotracheal tube
preload pressure is also called wht?
filling pressure
Interventions for low preload
fluids
What does a Sv O2 depend on
hgb, SaO2, CO
What is an early sign of decreased preload?
increased HR
Which bundle branch is stronger L or R
left
Normal MAP
mean arterial pressure 70-105mmHg
What part of the brain controls respiratory rate to regulate PCO2?
medulla oblongata
What is MMV
minimum minute volume Used as a weaning mode, pt breaths on own. Used near extubation
What valves must open for the heart to fill?
mitral and tricuspid (AV valves)
Inside of the muscle cell is ______ charged and outside is _______ charged
negative/positive
When a person breathes rapidly what is the primary effect on ABGs?
pCO2 will decrease
What body chemicals decrease the heart rate?
parasympathetic acetylcholine
What is the antidote for an infiltrated or extravasated vasoconstrictor?
phentolamine/rigitine SQ
What do you monitor in the water seal chamber?
that the water is filled to the 2cm water line
What does "wringing of the heart" mean?
the heart contracts bottom to top
Interventions for increased afterload
vasodilators
VAP
ventilator associated pneumonia
2 types of Pleurovacs
wet and dry suction
