-
Meds while on vent
(3)
- 1. Sedative/Antianxiety (propofol)
- 2. Neuromusclular Blocker (Norcuron)
- 3. Pain (morphine, fentanyl)
-
Which do meds do you ALWAYS give together in a patient on a vent?
Sedative + Neuromuscluar Blocker
-
Define ARDs
**#1 sign**
- Injury to lungs leads to resp failure
- (pO2 < 60, pCO2 > 45, pH < 7.35)
- **Hypoxemia does NOT respond to O2 therapy**
-
Late signs of decreased neuro
- Loss of consiousness
- Dilated pupils
- Posturing
-
Interventions of stroke during the chronic phase
- - Approach on unaffected side
- - Place objects within visible field
- - Increase mobility
- - Fluids/ High Fiber
- - Need for assistive devices
- - Transfer teaching needed
-
Spinal Cord Injury
Lose ______ input
results in (4)
- Lose sympathetic imput
- Results in: bradycardia, hypertension, venous stasis, loss of temp control
-
What is Cushing's Triad?
What is it a sign of?
Widening pulse pressure, Irregular/slow breathing, Bradycardia
Late sign of increased ICP
-
S/S of ARDS
- Dyspnea
- Tachypnea
- Decreased lung compliance
- Increased PIP
- Alveoli infiltrated on CXR
-
Equipment for A line
(5)
- 1. Invasive catheter
- 2. Noncomplient tubing
- 3. Transducer & stopcocks
- 4. Pressurized flush (hep or non-hep)
- 5. Bedside monitor
-
Indications for arterial line
(4)
- 1. Hemodynamic instability
- 2. Assess efficency of vasoactives
- 3. Frequent ABGs
- 4. Internal BP (more accurate)
-
How do you level the transducer in hemodynamic monitoring?
- Plebostatic Axis
- - 4th intercostal, mid-axillary line
- - Rt atrium (lowest pressure gradient)
-
Formula to configure MAP
MAP=(2)(diastolic)+systolic/3
-
CO2 ____________ the brain?
- vasodilates
- will lead to increased icp
-
Natural chemical mediators in regulation of blood flow
(6)
- 1. epi
- 2. norepi
- 3. adrenocortical hormones
- 4. thyroid hormones
- 5. antidiuretic hormones
- 6. aldosteone balance
-
What disease would cause increased PAP?
- PAP: 25/10 mean: 15
- Anything that decreases compliance in the lungs
- - pulmoary HTN
- - Asthma
- - Increased CVP
-
What would you assess for a fluttered arterial wave form?
- - occlusion
- - bent tubing
- - loose connections
- - empty pressure bag
- - line pulled out
-
PA lumens (white)
- Proximal infusion
- IV fluids, meds, vasoactives
- Passive infusion
-
Interventions for ARDS
- low TV
- PEEP
- High FiO2
- Sedate/paralyze
- O2, lasix, albumin, steroids
-
Interventions for VAP
- - Keep off vent if possible
- - Vent bundle
- - Univeral precautions
- - Aseptic suctioning
-
3 elements of the Calgary Family Assessment Model
- Structural (environmental)
- Developmental (Erikson's)
- Functional (coping, communication)
-
Describe a murmur
- Whooshing sound
- Valves not closing proplerly
- Systolic or Diastolic
- Mitral & Aorta most common (Think: connected to L ventricle)
-
Describe a rub
- Squeaky rubber band sound
- Inflammation/Pericarditis
- SHARP PAIN
-
Lab tests for heart problems
- Electrolytes
- Enzymes (ROMI)
- H&H
- Coags (if trauma)
-
Define stable angina. Treatments? Conservative meds? Surgery?
- Myocardial O2 demand exceeds supply
- No cell death
- Occurs with exertion, relieved on rest
- Treatment: Nitro
- Conservative Meds: Nitro, beta bockers, ccb
- Surgery: Stent/CABG
-
Define unstable angina. Is it part of ACS? Treatments? Meds? Surgeries?
- Clot occurs from rupture of plaque, but some blood flow continues
- Part of ACS
- SEVERE pain, unpredictable, ST decrease, inverted T wave
- Hospital stay, rest, nitro, antiplatelets, revascularization
-
MI patient goes home on Metropolol + Lisinopril why?
- Metoprolol: beta-blockers, decreases mortality/infarction size, decreased contractility & rate wich increase myocardial O2 supply.
- Lisinopril: ACE Inhibitor to decrease heart remodeling (watch for cough)
-
Complications of heart cath
(7)
- 1. coronary artery dissection
- 2. bradycardia
- 3. v-fib (code)
- 4. hypotension
- 5. bleeding
- 6. hematoma
- 7. retroperitoneal bleeding restenosis
-
Complications of MI
- dysrhythmias
- heart failure
- thromboembolism
- rupture of heart
- pericarditis
- infarct extension
- cardiogenic shock
-
PA Lumens (Blue)
- Proximal Injectable
- IV pushes - no high alerts (heprin, ect..)
- CO/CI/CVP
-
What is the difference between CO & CI
CI is more awards, measures CO based on body weight
-
What reading obtained by the PA cath measures contractility?
Indirectly via CO
-
PA Lumens (Red)
- Balloon
- Measures PAOP (8-12 mmHg)
- Syringe for inflating attached
-
3 drugs to treat contractility
- 1. digoxin
- 2. dopamine
- 3. milrinone
-
AMI Core Measures
-Meds on arrival
- Meds on d/c
- Door to needle time
- Door to ballon time
- Counsel
- Arrival: Aspirin, ACE Inhibitors
- D/C: Aspirin, LOLs, Statins, ACE
- Needle time: 30 min
- Balloon time: 90 min
- Counseling: STOP SMOKING
-
Causes of heart failure
- Hypertension
- Myocardial Infarction
- Valve replacement
- Cardiomyopathy
- Endocarditis
- IV drugs
-
3 conditions that leads to low lung compliance
- Pulmonary fibrosis
- ARDS
- Pulmonary edema
-
Complications of ET suctioning
- - hypoxemia
- - airway trauma
- - infection
- - increased ICP
- - decreases PEEP
-
Why administer PEEP?
to decrease a high FiO2
-
Vent Bundle
- - HOB elevated 30 - 45 degrees
- - Sedation vacation q 24 hours
- - DVT prophylaxis
- - Peptic ulcer disease prophylaxis
- - Oral care q 4 hours
- - Chlorhexadine q 12 hours
-
Risk factors for ARDS
- - Sepsis (causes decreased CO, leaky vessels)
- - Pneumonia
- - Trauma
- - Aspiration
- - Blood transfusions
-
Complications of mechanical vent
(7)
- 1. intubate right main
- 2. barotrauma (tension pneumo/alveoli rupture)
- 3. O2 toxicity (FiO2 100% no more than 24 hrs)
- 4. Infection
- 5. Hypotension/decreased CO (esp with PEEP)
- 6. Stress ulcer/GI bleeds
- 7. Anxiety
-
Contractility:
affected by __________
measured by __________
using only the __________
- affected by PRELOAD
- measured by CO (4-8 L/min), CI (2.5-4.2 L/min/m2)
- using only the Swan-Ganz
-
Chronotropic Drugs: examples & purpose
- Examples: Inderol, atropine
- Purpose: increase/decrease conduction
- *Will see improvement in BP too*
-
4 mechanisms that regulate heart rate
- SA Node
- Autonomic (symp/parasym)
- pH
- Temp
- (increased: increased metabolic demands, increased heart rate and decreased cardiac output; Decreased: decreased heart rate, decreased cardiac output)
-
Treatments of increased afterload
- **TOO MUCH RESISTANCE***
- - too much vasoconstriction
- - hypertension, pulmonary hypertension
- - vasodilate
- - nitroprusside
- - LDL
-
Define hemodynamics
relationship between heart rate, blood, O2 delivery, tissue perfusion
-
Treatments of decreased afterload
- VASOCONSTRICTION!!!
- -epi
- -norepi - harder on circulatory system
-
CK
- Means_____
- Normal level
- Onset
- Peak
- Means muscles dying
- < 200
- 2-6 hours for onset
- 18 - 36 hours for peak
-
CK-MB
- Means _____
- Normal level
- Onset
- Peak
- Heart dying
- < 5%
- 2-6 hrs onset
- 18-36 hrs peak time
-
S/S of decreased afterload
- **TOO LITTLE RESISTANCE**
- low bp
- decreased urine output
- decreased SVR/PVR
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