Review 4

  1. Indications for capnography.
    • verify placement of artificial airway
    • assess pulmonary circulation & respiratory status
    • optimize mechanical ventilation
  2. Capnography measures:
    concentration of CO2 in exhaled gas sample
  3. Principle of operation of capnograph
    absorption of infrared light
  4. What is the normal gradient between  PaCO2 and PetCO2?
    ~2-3 torr
  5. Factors affecting use/interpretation of capnograph:
    • patient metabolism: hypothermia, sleep & sedation reduce CO2 production
    • cardiac output: sepsis reduces CO2 production and cardiogenic shock raises CO2 production
    • alveolar ventilation:
  6. Normal PetCO2 =
    35-43 torr
  7. In a patient with cardiopulmonary diseased, the arterial-end tidal gradient will _____?
    widen
  8. A wider than normal arterial-end tidal CO2 gradient indicates:
    abnormal ventilation and/or perfusion
  9. Significance of the arterial-residual end tidal CO2 gradient.
    illustrates how efficiently the CO2 diffuses out of arterial blood into the alveoli during a maximal exhalation.
  10. Normal arterial-residual end tidal CO2 gradient
    4-6 torr
  11. Calculate the percentage of deadspace
    Vd/Vt = (PaCO2 - PeCO2)/PaCO2
  12. Calculate Vd:Vt Ratio
    Uses AVERAGE CO2 not END TIDAL CO2
  13. Normal Vd/Vt ratio
    0.2 to 0.4
  14. What is the significance of a decreased Vd/Vt Ratio?
    • lung resection or pneumonectomy
    • asthma attack
    • ETT or artificial airway
    • Exercise
  15. Whar is the significance of an increased Vd/Vt ratio?
    • vascular tumor in the lung
    • pulmonary embolism
    • circulatory d/o such as shock, sepsis, CHF or CPR
  16. Increased deadspace effect when ventilation is greater than perfusion
    • rapid, shallow ventilation
    • added mechanical deadspace
    • COPD
    • Most common, pulmonary embolism!
  17. Normal adult BP
    120/80
  18. Normal infant/child BP
    60-100/20-70
  19. Hypotension level
    systolic BP < 90 mm Hg
  20. Hypertenison level
    Systolic BP > 140, Diastolic BP > 90 or both
  21. What is CVP?
    pressure measured in superior vena cava
  22. Significance of CVP
    pressure in R Atrium: evaluation of patient's fluid status
  23. Normal  adult CVP
    1-6 mm Hg
  24. Normal Pulmonary adult Pulmonary Artery Pressure
    15-28/5-16 mm Hg
  25. Normal adult Pulmonary Capillary Wedge Pressure
    6-15 mm Hg
  26. Normal adult Cardiac Output
    4-8 lpm
  27. Normal adult stroke volume
    50-120 ml/beat
  28. Normal adult Arterial-Venous Oxygen Content Difference
    3-5.5 Vol%
  29. Normal adult shunt
    5% or less of cardiac output
  30. Normal Adult Pulmonary Vascular Resistance
    80-240 dyn/s/cm3
  31. Peak pressures or PEEP may affect the CVP reading how?
    Increase it
  32. Two main factors affecting Right Atrial Pressure
    • blood volume returning to it
    • functioning of R Ventricle
  33. A decreased CVP usually means
    patient is hypovolemic
  34. Significance of increased CVP
    • fluid overload
    • tricuspid or pulmonic valve problem
    • R Venticular Failure
    • Cardiac Tamponade
    • ASD or VSD
    • Pulmonary Embolism
  35. When the patient's midchest is above the PA transducer,
    the measured pressure will be higher than actual
  36. When the patient's midchest is below the PA transducer,
    the measured pressure will be lower than actual
  37. Indications for Pulmonary Artery Pressure measurment
    • unstable pulmonary or cardiovascular disease
    • pulmonary hypertension
    • MI
    • CHF
    • hypertension
    • hypotension
  38. Elevated Pulmonary Artery Pressure is associated with
    • LV Failure
    • Acute MI
    • Fluid Overload
    • Pulmonary Hypertension Secondary to COPD
  39. Pulmonary Capillary Wedge Pressure is...
    the pressure measured in the pulmonary capillary bed under no flow conditions
  40. Significance of Pulmonary artery Wedge Pressure
    • Reflects downstream pressure from the left heart
    • Elevated Wedge indicates fluid overload, LV dysfunction with CHF, Mitral valve insufficiency
  41. Decreased Pulmonary Capillary Wedge Pressure indicates:
    • hypovolemia
    • sepsis
  42. Cardiac Output defined
    the volume of blood pumped in 1 minute
  43. Calculate Cardiac Output
    CO = (BSA x 125)/0.045
  44. Significance of increased Cardiac Output
    • exercise
    • fever
    • increased metabolism
  45. Significance of decreased Cardiac Output
    • hypovolemia
    • increased peripheral resistance
    • heart failure
  46. Calculate the Stroke Volume
    SV = CO/HR
  47. Define Cardiac Index
    Cardiac Outout per square meter of BSA
  48. Calculate BSA
    BSA = {1 + Wt in Kg + (height in cm - 160)]/ 100
  49. Normal adult Cardiac Index
    2.5-4 lpm/m2
  50. Mixed Venous Blood Sampling Significance
    the pressure of mixed venous oxygen and saturation represents tissue oxygenation
  51. Normal Adult Mixed Venous pO2
    37-43 torr
  52. Normal Adult Mixed Venous O2 Sat
    75%
  53. Significance of Arterial-venous O2 Content
    calculates oxygen consumption by the body
  54. Normal Adult Arterial-Venous O2 Content value
    3-5.5 Vol%
  55. Define Shunt
    the amount of blood pumped by the ehart that does not participate in gas exchange
  56. Significance of Shunt
    measures ventilation to perfusion mismatch
  57. Normal Adult Shunt level
    5% or less of CO
  58. Normal Adult Pulmonary Vascular Resistance
    1-3 mm Hg/lpm
  59. Normal Adult Systemic Vascular Resistance
    15-20 mm Hg.lpm
  60. The waveform sequence seen during insertion of a PAC is:




    B) RA,RV,PAP,PCWP
  61. When evaluating a patient's SV, which of the following is true?




    B) it has a range of 50-120 ml, in the adult
  62. A patient with chronic bronchitis is being monitored with regular measurements of ABG's and capnography. The following data are available: PaCO2  53; PaO2  67; PetCO2  33; PeCO2  20. Calculate the patient's Vd/Vt.




    A) 0.62
  63. A 40 YO patient recovering from ARDS is receiving mechanical ventilation with a Vt of 650 ml. The patient has an arterial line, a PAC and capnometry for monitoring. THe following information is gathered after a change in PEEP level:  PaCO2  43; PaO2  79; PmvO2 32; PetCO2  38;  PeCO2 22. Calculate the patient's Vd.




    C) 319 ml
  64. A 35 YO patient is in the ICU and has the following hemodynamic data. Which of the following indicates a problem with the patient?




    B) SVR of 600 dyn/s/cm-5
  65. A patient with a hx of CHF is inadvertently given IV fluid of 2000 ml instead of 200 ml. Which of the following is most likely to be seen?




    A) increased pulmonary capillary wedge pressure
  66. A patient hospitalized with leg vein thrombosis experiences sudden SOB. Which of the following should be recommended to evaluate the patient;s situation?




    D) Vd/Vt
  67. Capnography will be used to monitor a patient's recovery from anesthesia. What gas should be used for the zero calibration?




    C) RA for 0% CO2
  68. Hypovolemia in an adult patient would be indicated by a PCWP of:




    D) 2 mm Hg
  69. An adult patient has a PAC inserted. A normal PAP pressure on this patient would be:




    D) 25/10
  70. Which of the following would describe the principle of operation of a capnometer?




    A) absorption of infrared light by CO2
  71. Calculate a patient's pulmonary artery dystolic-PCWP (Pad-PWCP) gradient if the PAP is 30/12 mm Hg and the PCWP is 8 mm Hg.




    C) 4 mm Hg
  72. A pateint has an end tidal CO2 pressure of 30 torr and a P(a-er)CO2 gradient of 4 torr. The alveolar to end tidal gradient is in the usual direction. Based on this, the patient's PaCO2 would be estimated as:




    A) 34 torr
  73. A patient is known to have advanced COPD. When checking the Vd/Vt ratio, what would be expected?




    D) increased
  74. A patient is being mechanically ventilated and has a reflectance oximetry PAC in place. What mv O2 Sat value would indicate the patient is oxygenating adequately?




    B) 75%
  75. The normal range for the p(a-et) CO2 gradient is:

    A) <1 torr="" br="">B) 1-5 torr
    C) >15 torr
    D) -40 torr
    B) 1-5 torr
  76. An adult patient has been admitted for observation after suffering a concussion in a fall. The patient's arterial BP is found to be 115/78 mm Hg. How should these results be interpreted?




    A) WNL
  77. A patient with advanced emphysema is admitted to the ICU. The patient is placed on a 24% venturi mask and has a PAC inserted. The patient's initial PVR is 9 mm Hg/l/min and his PaO2 is 57. The physician orders an increase to 28% oxygen. The resulting PVR is 5 mm Hg/L/min and the PaO2 is 63 torr. Based on this information, what would you recommend?




    A) keep the patient on 28% oxygen
  78. An adult patient is in the ICU and is being monitored with a PAC. The patient has the following parameters:  PAP 35/20 mm Hg; PCWP 9 mm Hg; CVP 9 cm H20. The data show that the patient:




    D) has increased PVR
  79. A 40 YO patient receiving mechanical ventilation has an arterial line in place. It is noticed that there is a significant difference between the BP taken by the cuff on the L arm and the BP taken by the arterial line on the R arm. What could explain the difference?




    B) a clot is at the tip of the catheter and there is an air bubble in the arterial line
  80. An adult patient is receiving mechanical ventilation when the following data are gathered:
                       9 am          11 am
    PaO2           75               53
    PVR             120            340
    PCWP            8                10
    PAP            25/10         42/21
    How should these results be interpreted?




    A) pulmonary embolism
  81. A patient is receiving mechanical ventilation with a mandatory rate of 10/min. End tidal CO2 monitoring is being done and the following data are recorded:
                           4 pm           6 pm
    Set Vt               700 ml        700 ml
    Set Rate            10              10
    PetCO2              33              41
    PaCO2               42              43
    How can this data be explained?




    D) alveolar ventilation has decreased
  82. A patient has an arterial line inserted. What should be done to ensure accurate BP readings are obtained?




    A) open the stopcock to RA to zero the transducer & have the patient lie flat & fill the pressure tubing with saline solution
  83. An unconscious 25 TO patient is admitted with viral pneumonia, vomiting & diarrhea. Mechanical ventilation is initiated and a flow directed PAC is inserted. The following data are gathered:  PAP  22/8;  PCWP 3 mm Hg;  CVP  0 mm Hg;  BP 90/60; Pulse 142. What is the most likely cause of these findings?




    B) hypovolemia
  84. A 3-day post op open heart patient has an arterial catheter in the R radial artery for continuous BP measurements. Because of retained secretions, the therapist places the patient in a head down position for PD. The nurse notices that the patient's BP is less than before being placed in this position. After the patient is returned to the original position, the BP is the same as it was originally. How can the therapist explain the BP change?




    D) the patient's body was below the level of the pressure transducer
  85. A 65 YO patient has been sick with vomiting and diarrhea for several days. Arterial and PA catheters are placed for monitoring ABGs and hemodynamic parameters. ABG values on 30% O2 show the following:  pH 7.44  PaCO2  41  PaO2 80  HCO3 27. PAC parameters show the following: PAP 22/8  PCWP 3 torr. In addition electrolytes show the following:
    potassium 4.5  chlorine 120   sodium 156. Based on these data, what should be recommended?




    B) administer IV fluids
  86. A pateint with HF and pulmonary edema has an initial PmvO2 of 35 torr. After the patient is mechanically ventilated and given digitalis, the PmvO2 is 41 torr. How should this be interpreted?




    C) improved tissue oxygenation
  87. A neonatal patient is suspected of having a CSD. What could be done to confirm or R/O this condition?




    B) Check the PmvO2 from the R atrium and R Ventricle
  88. An adult patient with CHF needs to have his fluid management and O2 consumption monitored. What type of catheter should be used for these measurements?




    D) a triple lumen ScvO2 CVP catheter
  89. As the therapist assigned to ICU, you are caring for the following 4 persons: Mr. Boone is a 28 YO male being observed after an appendectomy. Mrs. Decker is a 74 YO female with sepsis. Mrs. Dylan is a 48 YO female with gastritis who is receiving IV fluids for dehydration. Mr. Zawinal is a 42 male with diabetes. The following BP measurements were taken:
                     10am     12pm      2 am
    Boone        125/80  122/82    120/78
    Decker       96/60     105/40    85/45
    Dylan        88/70       94/75    105/78
    Zawinal    135/98    129/94    125/89
    In which of these patients should an arterial line be placed?




    B) Mrs. Decker
  90. A patient with HF had an ScvO2 of 65% an hour ago. The patient is now showing an ScvO2 level of 60%. How should these results be interpreted?




    B) tissue hypoxia
Author
n1297f
ID
315989
Card Set
Review 4
Description
review 4
Updated