Cardiac Assessment and Ventilation Settings: A Comprehensive Guide, Exams of Career Counseling

Download Cardiac Assessment and Ventilation Settings: A Comprehensive Guide and more Exams Career Counseling in PDF only on Docsity! HFHS Critical Care Exam Over 100 Questions and Answers. Normal Length for PR, QRS, and QT intervals. - Correct answer PR 0.12-0.20 sec, QRS 0.08-0.12 sec, and QT interval less than or = to 450 ms or half the R-R interval Big box on ECG readings = ___ seconds? - Correct answer 0.20 seconds Little boxes on ECG readings = ____ seconds? - Correct answer 0.04 seconds The mA that achieves capture is the _______ _________ - Correct answer pacing threshold Defibrillation energy settings (biphasic and monophasic) - Correct answer biphasic 120- 200 j and monophasic 360 j Synchronized Cardioversion energy settings for SVT or aflutter, for afib, and for monomorphic VT (biphasic and monophasic) - Correct answer SVT or aflutter-biphasic 50-100 j & monophasic 200 j Afib-biphasic 120-200 j & monophasic 200 j Monomorphic VT-biphasic 100 j & monophasic 100 j Vtach treatment - Correct answer Synchronized cardioversion and Antiarrhythmic such as Amiodarone (150-300 mg) and/or lidocaine Vfib treatment - Correct answer Defibrillation also can load them up with Amiodarone SVT treatment - Correct answer Vasovagal maneuvers, carotid massage, Adenosine (if BP is good) 6 mg for first dose and then 12 mg for the second dose, or synchronized cardioversion Torsades treatment - Correct answer Synchronized cardioverison (if regular) or defibrillation (if irregular) and administer Mg (treating underlying cause) Anatomical location of Cardiac Assessment Landmarks - Correct answer Pulse pressure calculation - Correct answer Difference between the systolic and diastolic pressure for example 120/60 the pulse pressure is 60! Cardiac output normal values - Correct answer 4-8 Liters per minute (formula is Stroke Volume x Heart Rate) Cardiac Index normal values - Correct answer 2.5-4 L/min/m2 (formula is Cardiac output divided by Body Surface Area aka need ht and wt) Central Venous Pressure or Right Atrial Pressure normal values - Correct answer 2-6 mmHg or 2-8 cm H2O Pulmonary Arterial Pressure (PAP) normal values - Correct answer Pulmonary Artery Systolic (PAS) 15-30 mmHg Pulmonary Artery Diastolic (PAD) 5-15 mmHg Pulmonary Artery Mean (PAM) 9-18 mmHg Pulmonary Artery Occlusion Pressure (PAOP) AKA Wedge normal values - Correct answer Similar to CVP or RAP and the diastolic pulmonary artery pressure will reflect this value closely... PAOP 6-12 mmHg Systemic Vascular Resistance (SVR) normal values - Correct answer 800-1200 Ejection Fraction normal value - Correct answer 65-75% SVO2 normal values - Correct answer 60-80 PA Pressure considerations - Correct answer Measure PAS and PAD @ the end of expiration Causes of decreased PAP, CVP/RAP, PAOP - Correct answer causes of decreased Hypovolemia and venodilation Causes of increased PAP - Correct answer hypervolemia, increased peripheral vascular resistance (due to decreased PaO2, PE, COPD, ARDS, Pulm HTN), mitral stenosis/insuff, aortic stenosis, LV ischemia, infarct, failure, pericardial tamponade, increased intrapleural pressure due to PEEP, auto PEEP, tension pneumo, increased intra-abdominal pressure, left-to-right intracardiac shunt. Causes of increased CVP/RAP - Correct answer Hypervolemia, impedance to RA emptying due to: tricuspid stenosis, RV ischemia/infarct/failure, increased PVR (due to decreased PaO2, PE, COPD, ARDS, Pulm HTN), mitral stenosis/insuff, Aortic stenosis, LV ischemia/infarct/failure, pericardial tamponade, increased intrapleural pressure due to: PEEP, auto PEEP, tension pneumo, and increased intra-abd pressure Causes of increased PAOP - Correct answer Hypervolemia, impedance to LA emptying: Mitral stenosis/insuff, aortic stenosis, LV ischemia/infarct/failure, & pericardial tamponade. increased intrapleural pressure due to: PEEP, auto PEEP, tension pneumo, intra-abd HTN. Left-to-right intracardiac shunt Swan-Ganz catheter Ports & where they terminate - Correct answer Which port of a Swan Ganz catheter do you draw a SvO2 sample from? - Correct answer the tip of the Pulmonary artery catheter Airway Pressure Release Ventilation (APRV) indications - Correct answer For pts with severely decreased compliance (ARDS) or unresponsive to PEEP that is > 15 cm H2O. To reduce pulm shunt without barotrauma Airway Pressure Release Ventilation (APRV) Advantages - Correct answer Reduces work of breathing and O2 cost of breathing while offering the lung-protective effects of IRV (Inverse Ratio Ventilation). Less cardiac compromise. Need for vasopressors are less Airway Pressure Release Ventilation (APRV) Disadvantages - Correct answer Cannot use in pts w/increased airway resistance (asthma/COPD). Gas trapping can result form the very short periods of exhalation. No studies have shown improved outcome with APRV or IRV Continuous Positive Airway Pressure (CPAP) Description - Correct answer Constant positive pressure is applied thru-out resp cycle to support oxygenation and reduce work of breathing. Patient initiates all breaths Continuous Positive Airway Pressure (CPAP) Indications - Correct answer To wean without removing the ventilator and having to connect to additional equipment. Treatment for Auto PEEP. Also used for spinal cord injury and pts with sleep apnea Continuous Positive Airway Pressure (CPAP) Advantages - Correct answer Offers pt psychological security of the ventilator being there. Can be delivered thru mask. Takes advantage of the ventilator alarm systems Continuous Positive Airway Pressure (CPAP) Disadvantages - Correct answer Not all vents are equipped with this mode. Patient may sense resistance when breathing thru ventilator tubing BiLevel Positive Airway Pressure (BiPAP) Description - Correct answer 2 preset pressures: Insp and exp. Must be able to breathe spontaneously and maintain airway. Requires face or nasal mask BiLevel Positive Airway Pressure (BiPAP) Indications - Correct answer OSA, cardiogenic pulm edema (needs to be hemodynamically stable), weaning from mechanical ventilation, terminally ill resp fail, spinal cord inj, hypercapnic hypoxemic failure BiLevel Positive Airway Pressure (BiPAP) Advantages - Correct answer Non-invasive. Increases FRC by recruiting collapsed alveoli. May be able to avoid intubation which reduces LOS BiLevel Positive Airway Pressure (BiPAP) Disadvantages - Correct answer Mask must fit well and slight leaks will result in blasts of air into eyes. Mask may cause anx and agitation. Cant use on someone who cannot protect their own airway (dec LOC) Intermittent Mandatory Ventilation (IMV) Description - Correct answer Set tidal vol @ a set rate while also allowing the pt to initiate a breath from a reservior of humidified O2. Ventilator rate is set at lowest level that will maintain ABGs and set tidal vol is given regardless of the pts effort and position in the resp cycle Intermittent Mandatory Ventilation (IMV) Indications - Correct answer Pts who temporarily need positive pressure ventilator support but are expected to return to spontaneous unassisted ventilation soon. Commonly used during weaning Intermittent Mandatory Ventilation (IMV) Advantages - Correct answer Allows pt to do some of the breathing. Which having control can reduce anx. Fewer ventilator breaths mean lower intrathoracic pressure and less risk for barotrauma and decreased CO. Lessens the need for sedation and paralysis and Mean airway pressures Intermittent Mandatory Ventilation (IMV) Disadvantages - Correct answer Must set peak insp pressure limit to < 10 cm above the pts peak insp pressure to prevent "stacked breaths" (ventilator breath delivered on top of pt breath) which increases risk for barotrauma. Danger if rate is set low and pts own RR drops or stops Positive End-Expiratory Pressure (PEEP) Description - Correct answer Maintains a preset positive airway pressure during the expiratory phase. Best PEEP: increases PaO2 so that FiO2 can be decreased, Does not reduce CO, Minimizes pulm shunt, and decreases airway resist Positive End-Expiratory Pressure (PEEP) Indications - Correct answer To treat PaO2 < 60 mmHg when FiO2 is > 50 mmHg by recruiting dysfunctional alveoli. Also used to increase intrapulmonary pressure to decrease intrathoracic bleeding (after cardiac surgery) Positive End-Expiratory Pressure (PEEP) Advantages - Correct answer Improves PaO2 and SaO2 while allowing FiO2 to be decreased. Keeps airways and alveoli open during end-expiration, esp in pts with surfactant deficiency. Decreases work of breathing and helps preserve functional residual capacity Positive End-Expiratory Pressure (PEEP) Disadvantages - Correct answer Increases FRC, increasing risk for barotrauma. Contraindicated in those with hypovolemia, drug induced decrease in CO, unlilateral lung disease, COPD. May increase ICP; must ensure CO2 is maintained 30-35 mmHg. Can cause increased dead space Pressure Support Ventilation (PSV) Description - Correct answer Pts with spontaneous respiration. When pt initiates breath, ventilator does not deliver a set volume but rater a set positive pressure for the duration of inspiration. The patient determines the inspiratory flow rate, time, and RR. Helps over come the airway resistance of the ETT Pressure Support Ventilation (PSV) Indications - Correct answer pts on long-term mechanical ventilation. Often used with IMV/SIMV. May reduce work of spontaneous breathing. Useful method of weaning. Pressure Support Ventilation (PSV) Advantages - Correct answer Increases spontaneous tidal volume and reduces work of breathing while maintaining patients respiratory muscle tone. Pt determines insp time, RR, and minute volume, improving patient-ventilator synchrony. PSV limits the distending pressure of the lung. This mode can theoretically benefit pts with acute lung inj Pressure Support Ventilation (PSV) Disadvantages - Correct answer Tidal volume varies depending on the resistance and elasticity of the resp system. Danger if pts RR slows or stops. PSV is therefore used with IMV/SIMV. Can be used with PEEP or CPAP by increases risk for decreased CO and for barotrauma Vent Bundle - Correct answer HOB 30-40 degrees, mouth care with chlorhexidine, lung protective ventilator strategies, plan to d/c ASAP, appropriate analgesia and sedation, daily awakening, early mobilization, DVT prophylaxis, GI stress prophylaxis, Balanced IV fluid administration Dobutamine (Dobutrex) - Correct answer synthetic catecholamine with direct inotropic effect due to beta receptor stimulation, and with mild chrontropic and vasodilatory effects. Improves CO by improving SV. For short term treatment of deoressed contractility in the absence of shock. Half-life is 2 minutes. Dopamine (Inotropin) - Correct answer Catecholamine precursor of norepinephrine with inotropic, chrontropic, and vasoactive effects. For shock due to HF, cardiac surgery, and for hypotension non-responsive to fluid. No longer recommended for acute oliguric renal failure. Treatment of atropine resistance bradycardia Norepinephrine (Levophed) - Correct answer Potent alpha-1 (Vasoconstriction) and beta-1 agonist (inotropic effect and coronary vasodilation). Vasoconstrictive effects are used to treat hypotension due to low SVR (anesthesia or septic shock). Avoid in those with ischemic heart disease due to increased MVO2, SVR, and HR Nitroglycerin (NTG) - Correct answer Dilates peripheral & coronary arteries by relaxing vascular smooth muscle. Tx of angina in suspected ischemic pain. In HF, decreases preload, afterload, and pulmonary congestion. In post op cardiac surgery pts increases coronary perfusion and control BP. Preferred over Nipride in pts with CAD. Nitroprusside (Nipride) - Correct answer Potent peripheral vasodilator. Its effect is immediate and ends when the infusion is stopped. For refractory HTN. For afterload Complications of Autonomic Dysreflexia - Correct answer result from a sudden marked rise in blood pressure, which may be severe enough to rupture single or multiple cerebral blood vessels or lead to a considerable increase in intracranial pressure. Hypokalemia S&S - Correct answer Flat or inverted T wave, Depressed ST, peaked P wave, asystole, ventricular arrhythmias, decreased myocardial contractility, muscle weakness>flacidity>apnea, weak or absent reflexes, leg cramps, paresthesia, N/V, paralytic ileus, abd distention, anorexia, digoxin sensitivity or toxicity Hyperkalemia S&S - Correct answer tall peaked T waves, wide QRS, depressed ST, flattened P, prolonged QT, escape beats, VT/VF, heart block, idioventricular rhythm, bradycardia. When K > 8.5 diastolic cardiac arrest, N/V, diarrhea, ileus, intestinal colic, hyperactive reflex, weak, ascending paralysis, resp fail Hypomagnesemia S&S - Correct answer T wave changes, prolonged QT, PVCs, torsades, VF, anorexia, nausea, tremor, hyperactive reflexes, muscle cramps, tetany, ataxia, seiz, death Hypermagnesemia - Correct answer 2-4: N/V, weak/fatigue 4-5: decreased deep tendon reflexes 5-6: decreased BP, vasodilation 8-10: paralysis, afib, first degree AV block, ventricular conduction delay, heart block, asystole, stupor, coma, resp arrest Hyponatremia S&S - Correct answer HA, confusion, lethargy, nausea, muscle cramps, hyperactive reflexes, disorientation, malaise, seiz, cerebral edema increasing ICP leading to herniation, resp arrest, death Hypernatremia S&S - Correct answer cellular dehydration (including the brain), fever, restlessness, irritability, delirium, lethargy, stupor, seiz, spasticity, coma, weakness Hypochloremia S&S - Correct answer Metabolic Alkalosis with shallow slow breathing (resp compensation), musc excitability, hyperirritability, tetany, hypotension due to fluid loss Hyperchloremia S&S - Correct answer Metabolic Acidosis with fast breaths like Kussmaul's (resp comp), weak, lethargy, diminished cognitive ability, progressing into coma Hypocalcemia S&S - Correct answer iCa less than < 2.5 tingling, carpopedal spasms, hyperactive reflexes, musc cramps, tetany, twitch, seiz. long QT & ST segments, heart block, HF, decreased HR & BP, prolonged clotting time, bleeding, prolonged contraction of resp and laryngeal muscles (bronchospasm), stridor, cyanosis Hypercalcemia S&S - Correct answer Hypoactive reflexes, confusion, memory loss, stupor, coma, shortened QT, prolonged PR & QRS, bradycardia, increased BP, weakness, fatigue, anorexia, nausea, constipation, decreased K/Mg/Na. Diabetes Insipidus - Correct answer large output of dilute urine caused by the posterior pituitary's decreased secretion of antidiuretic hormone Complications of Spinal Cord Injury - Correct answer - infection - DVT - orthostatic hypotension - skin breakdown - renal complications - depression and substance abuse - autonomic dysreflexia - Correct answer