Critical Care II
Card Set Information
Critical Care II
Mechanical Vents Setting
Total Volume V
Volume of gas delivered to the pt during each ventilator breath.
Oxygen concentration (FIO
Fraction of inspired oxygen to be delivered to the patient.
Room air is 21% or .21
is set between 21% and 100% (.21-1.0)
Adjust to maintain PaO
greater than 60mmHg and SpO
greater than 90%.
Positive end-expiratory pressure
Positive pressure appplied at the end of expiraton of ventilator breath.
Usual setting is 5cm of water.
Assists in the prevention of alveolar collapse.
Controlled Mandatory Ventilation
Ventilator delivers a preset number of breaths/min of a preset volume.
Additional breath CANNOT be triggered by the patient.
Used in patients who are paralyzed either by chemical means or by spinal cords injury or neromuscular disease.
The are unable to initiated spontaneous breaths.
Assist/Control or Assist/Mandatory Ventilation
Ventilator delivers a preset volume at a preset rate andd when patient initiates a breath.
Pt can breathe faster than the rate, but not slower.
Every breath is supported by the ventilator.
Risk for Hyperventilation, if pt breathis spontneously.
*Pay close attention to pts breaths
Synchronized intermittent mandatroy ventilation.
Delivers a preset volume at a preset rate.
Permits spontaneous beathing.
The ventilator will synchronize the madatory breaths with the pt's own breath.
In between "mandatory breaths" (breaths delivered by the ventilator due to the preset rate), the pt can breathe aat their own rate and volume.
*Good for weaning
Pressure support ventilation
Fixed amount of pressure augments each breath.
When pt initates a breath, a high flow of gas is delivered at the preselected pressure level and this pressure is maintained throughout the inspiration.
Pt controls rate, inspiratory time and flow rate.
Often used when weaning from the ventilator.
Positive End-Expiratoroy Pressure
Positive pressure is applied at the end of exhalagtion in the mechanically vented pt.
Restoresfunctional residual capacity by keeping alveoli open at end of expiration and between breaths.
: Maintain/improve oxygentation while decreasing risk of oxygen toxicity.
If PEEP is used, FiO
can usually be decreased.
Continuous Positive Airway Pressure
Continuous postive airway pressure to prevent upper airway collapse.
Pressure is continuous during spontaneous breathing.
Frequently used for sleep apnea.
Its is usually administered through a tight fitting mask as humidified oxygen or aas a ventilator setting.
The presure of flow is constant during both exhaling and inhaling and he level of pressure is determined based on each individual .
Mechanicl ventilation increases intrathoracic pressure
Thoracic vessels are compressed
Decreased venous return to the the heart
Berotrauma and Volutrauma
Fluids and protens can move inot the alveolar space.
Ventilator Associated Pneumonia VAP
Pneumonia that occurs 48h or more after ET intubation.
ET bypasses upper airway defenses.
Aspiration of bacteria from oropharynx is leading cause.
Occurs with inappropriate ventilator setting; leakage of air from ventilator tubing, around ET tube or cuff; lung secreation/obstruction; or low ventilation-perfusion ratio.
Respiratory acidosis, cardiac dysrythmias, atelectasis.
Mechanical overventilation or pt hyperventilating.
Spontaneous corrects the problem
Mechanical vent pt baseline should be the therapeutic goal.
Can be difficult to wean pts who require long term ventilation (COPD, neuromuscular disease.
PPV and PEEP can increase intracranial pressure by impeding venous drainage.
Elevate HOB and keep head in alignment.
Proper positioning to prevent contractures, pressure ulcers, foot drops, and external rotation of hips and legs.
Prevent problems associated with immobility(PE, DVT).
Stress Ulcer and GI bleeding
r/t serioius illness, immobility, discomfort of ventilator, decreased CO to gastric mucosa, steroids, pre-existging ucler.
Peptic uler prophylaxis.
Change in thoracic and abd cavity pressure
Affects absorption of nutrients.
Physical and emotional stress
Pt is unable to eat, speak, move, or breathe normally.
Pain, fear, anxiety
Ordinarry ADLs are extremely difficult.
The overwhelming need of ICU pt is to feel safe.
Pt will feel safe if communication, reassurance, decision-making (control), Build a truisting relationship.
Machine disconnection or malfunction
Ensure alarms or ON
Have a plan for manual ventilation
Cardiac Output vs. Cardical Index
Cardiac Output (CO) = HR X SV
Volume of blood pumped b the heart in 1 min
Cardiac Index (CI)
Measurement of CO adjusted for body size.
More precise measurement
: Hyperdynamic states (fever, sepsis)
: Hypovolemia, cardiogenic shock, heart failure.
Amount of muscle fiber stretch at the end of diastole
Volume in the ventridcle at the end of diastole
PAWP reflexts L ventricle and diastolic pressure = left ventricular preload.
Pressure or resistance of blood flow out of the ventricle
Aterial blood pressure is a major factor affecting afterload
Sytemic Vascular Resistance (SVR)
Opposition encountered by left ventricle.
Preload, afterload, & contractility determine SVR
SVR and aterial BP = comoponents of left bentricular afterload.
Pulmonray Vascular Resistance
Opposition encountered by right ventricle
PVR and pulmonary artery pressure = components of rt ventricular afterload.
Force of heart contractiosn
Increased contractility means increased SV and increased myocardial O
Decreased contractility occurs in a failing heart.
Increase or improve contractility
Epinephrine and Norepinephrine (Levophed)
Decrease or diminish contractility
Calium Channel Blockers
Continuous Atrerial Pressure Monitoring
Acute hyper or hypotensioin
Acute respiratory failure
Coronary interventional procedures
Continuous infusion of vasoactive medication
Cannulate a peripheral artery (radial or femoral)
Suture cath in place
Insertion site MUST be immobilized (prevents dislodging of cath line, Line are not kinked)
Types Of Measurements:
Systolic, diastolic and mean BP
Catheter dislodges or line becomes disconnnected.
Prevention (use Leur-Lock connections, Check arterial Waveform, Ensure alarms are on.
Inspect for local signs of systemic infection
Pressures tubing, flush bag, and transducer should be changed every 96 hour.
circulatory impairment can occure from ( clot, spasm, occulusions of circulation from cath)
If limb is compromised, it will appear pale, cool, and cap refill less 3 sec; pt may feel tingling, pain, or paresthesia.
Loss of Limb
If neurovascular circulation is not restored to the affected limb, pt may loose limb.
Compromised neurovascular status is an emergency.
Art line Interventions
Assess continous flush bag every 1-4 hrs
maintain line patency andlimit thrombus formations
ensure bag is inflated to 300mmHg
ensure bas has fluid in it
ensure system is delivering 3-6ml/hr of fluid 1-2gts/min
evaluate neurovascular status distal to the arterial insertion site hourly
Pulmonary Artery Flow Directed Cath
Management of acute, complicated cardiac, pulmonary, and intravascular volume problems.
Used to measure pulm artery (PAP) pressure and pul ater wedge pressure (PAWP)
: heart failure, fluid volume overload, embolism, pulmonary edema, pulmonary HTN
: fluid volume depletion and pulmonary valve stenosis.
Cental Venous Pressure Measurement
CVP = measurment of rt ventricular preload
Norm = 2-8 mmHg
Measured witha PA cath or a central venous cat (CVC)
CVP reflects fluid volume problems
: Rt ventricular failure, volume overload.
Mixed Venous Oxygen Saturation (SvO
% of Hgb bound to O
in venous blood
Norm = 60-80
Procedure = take specimen form distal prot of PA cath, or can be done continuously
Reflects pt's ability to balance O
supply and demand at tissue level.
: Over 80% adequate supply, but decreased consumption
: Less 60% decreased O
supply, increased O
Decreased CO can be a cause
Measurement of PWAP
Measures left ventrical end diastolic presssure or left ventricular pre load
NORMAL RANGE 6-12mmHg.
: LV failure, cardiac temponade, pulmonary edema, mitral valve regurgitation of stenosis, hypervolemia.
: hypovolemia, vasodilators
Complications of PA Cath
Infection & Sepsis
PA cath cannot be wedged
Pulmonary infarction or PA rupture.
Never inflate balloon more than 8-15 sec.
Monitor PA pressrue waveforms for evidence of cath occlusions, dislocation, or spontaneous wedging.
Cont flush with heparinized saline to reduce risk of thrombus formation.
Maintain proper functioning of the monitoring system
collect, document and interpret data accurately
recognized early clues of complications
Baseline data obtained
General appearance, LOC, sking color/temp, VS, peripheral pulses, urine output.