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