CP 2013 Viva study

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jessiekate22
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222469
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CP 2013 Viva study
Updated:
2013-06-04 21:24:50
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Monitoring mechanical support
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Week 6 L1
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  1. Make sure you know all of the things on this ventilator
    • 145- HR
    • 89- MAP
    • 100- SpO2
  2. Why monitor?
    • - evaluate health
    • - guide treatment
    • - evaluate effects of treatment
    • Gives you regular/ continuous recording and evaluation of physiological functioning
  3. What can be monitored?
    • - general systemic observations
    • - cardiovascular system
    • - haemodynamics
    • - respiratory system
    • - CNS
    • - renal/ kidney
    • - other
  4. Why do physios need to know about monitoring?
    • - treating pts who are monitored 
    • - need to use the information from monitoring to guide management decisions
    • - safety with moving pts and handling monitoring equipment (dont want to pull something out)
  5. What are some things you generally observe?
    • - Obs- frequency depends on the status of the pt
    • - obs are on bed chart in general ward setting
    • - obs are on flw chart in critical care setting
  6. How does the monitoring system work?
    • - monitoring involves the sensing of physiological parameters and then turning this into a displace
    • - very complex but involves:
    • * a sensor to pick up physiological change
    • * an amplifier to increase the magnitude of the signal
    • * a recording/ displace of the signal
    • - transducer turn pressure changes into waveform display
    • - pressure transducer- piezoeletric crystal which converts pressure canges into a voltage change then converted to a trace
    • - pressure transducers need to be zeroed against the point at which the catheter tip isassume to rest- for cardiac pressures- normally 4ICS, M.A.L
    • - the transducer needs to be in the right place for it to deliver an accurate reading- haemodynamic messures = RA (point of right atrium when you stand up)
  7. What is a non invasive way to measure the CVS?
    - ECG
  8. What are some invasive ways for haemodynamic monitoring?
    • - CVP
    • - BP
    • - CO and chamber pressures
    • - PAP (pulmonary artery pressure) 
    • - PCWP (pulmonary capillary wedge pressure)
  9. What is the normal pressure for PCWP?
    • - pulmonary capillary wedge pressure
    • - 8-12mmHg
  10. How do you work out MAP?
    MAP = DBP + SBP - DBP/ 3
  11. What is the normal value for MAP?
    90-100mmHg
  12. How do u measure BP?
    - cuff
  13. How do you measure arterial blood pressure?
    • - arterial blood line
    • - transducer needs to be at the level of the right atrium
    • - movt may compromise trace
  14. What are the parts of an arterial waveform?
    • - arterial BP
    • - systolic pressure (peak)
    • - dichrotic notch- need this trace to know if it is an accurate reading
    • - diastolic pressure
    • - pulse pressure is all of the above
    • - MAP- straight line thru reading
    • - for more info look at lecture
  15. Arterial BP picture
  16. What other tests can be done via an arterial line?
    - ABGs
  17. What is CVP?
    - central venous pressure
  18. How is CVP measured?
    - thru a venous line from the SVC (superior vena cava) (right arterial pressure)
  19. What does a measurement of the CVP estimate?
    • - intravascular volume status 
    • - RV preload
  20. What is the usual range for CVP?
    • - 0-5mmHg
    • - 3-15cmH2O
    • Note when dead CVP= 5
    • - not overly useful but good for understanding fluid levels/ balance
  21. CVP picture
  22. What is a type of pulmonary artery catheter?
    - swan ganz catheter
  23. Would you mobilise someone with a Pulmonary artery catheter?
    - at lot of places wont let you
  24. What are some of the things pulmonary catheters measure?
    • - pulmonary artery pressure
    • - pulmonary wedge pressure
  25. Describe the bits of a pulmonary artery catheter
    • - balloon tipped, flow directed catheter
    • - mulitple lumen- along tube
    •    - distal port PA
    •    - proximal part- CVP
    • - indicated when precise measurements of cardiac status are neede
    • - not used alot
  26. PA catheter pictures
  27. When the balloon inflated with a pulmonary artery catheter what is it measuring?
    - once it occludes the PA it is measuring the PCWP
  28. what is the normal PCWP?
    - 8-12mmHg
  29. What is pulmonary capillary wedge pressure?
    • - pressure in the pulmonary capillaries
    • - unrestricted vascular channel thru the PA, pul vasc bed, PV, LA and LV (when mitral open)
    • - reflection of the pressures in the left atrium and therefore left ventricular diastolic (LVEDP)
    • - if LVEDP increases there is an increase is LVEDV - volume
    • - also measure pulmonary fluid overload
  30. What does a high PWCP mean?
    • - pulmonary congestion- 18-20 (interstitual)
    • -pulmonary oedema if >20-30 (fluid in arterial space)
    • - if colloid osmotic pressure is decreased (albium) pulmonary oedema will occur at a lower PCWP
  31. When is pulmonary congestion evident?
    • - PCWP 18-20
    • - interstitual
  32. When is pulmonary oedema evident with PCWP?
    • >2030
    • - fluid in arterial space
  33. What does a low PCWP mean?
    Hypovolaemia
  34. What is hypovolaemia?
    is a state of decreased blood volume; more specifically, decrease in volume of blood plasma
  35. What does it mean if you have a high PAP?
    • - pulmonary disease and pulmonary vascular disease
    • -increased pulmonary blood flow (left to right shunt)
    • - positive pressure ventilation
  36. How is cardiac output measured?
    • - thermodilution
    • - temp change
  37. What is a normal CO?
    4-7l/min
  38. What is the cardiac index in relation to CO?
    approx 3L/min/m2
  39. WHat are some complications of a pulmonary artery catheter?
    • - dysrythmias
    • - pulmonary infection
    • - balloon rupture
    • - damage to PA
    • - thrombolitic effects
    • - infection
    • - kinking or twisting of the line
    • - misplacement
    • These are the reasons why they are moving away from these
  40. What is IABP?
    • - intra- aortic balloon pump
    • - form of cardiac support
    • - used for pts waiting for heart replacements
    • - helps increase pressures
  41. What are the effects of IABP?
    • - increases LVEDP
    • - ↑ coronary blood flow

    • - decreases LV afterload
    • - increases CO
    • - decreases work- decrease oxygen consumption
    • - increase diasotlic pressure for blood to get around
    • - guided by an ECG
  42. Where does the IABP sit?
    • - in the arch of the aorta
    • - inflated balloon- on a systolic contraction
  43. Is pulmonary artery pressure higher or lower than normal artery pressure?
    -lower
  44. What is pulmonary artery pressure more influenced by?
    • - respiratory status and right heart function than PCWP
    • - Not PAPD is closely related to PCWP
  45. What do you need to be careful about with pts with IABP?
    • - moving ECG lines
    • - Dont do percs and vibes
    • - Don't sit up past 30 degrees hip flex
  46. What will you see with both PAP and PCWP in relation to primary cardiac disorder?
    • - both will be affected
    • - heart failure
  47. What are the indications for cardiac support- IABP?
    • - heart failure
    • - failure to wean from CPB (cardiopulmonary bypass) eg post cardiac curgery
    • - prophylatic- transplant
  48. What are some complications of cardiac support IABP?
    • - limb ischaemia
    • - vascular trauma- dissection of artery
    • - infection
    • - balloon rupture
    • - haematological complications
    • - malposition- kinking
  49. What are the different types of Cardiac support?
    • - IABP
    • - VAD
    • - ECMO
  50. What is VAD cardiac support?
    • - ventricular assist device
    • - helps the ventricles work
    • - temporary device- can be external or implantable
    • - can be a continuous flow or not
  51. How does the VAD cardiac support work?
    • - blood withdrawn from the heart chamber
    • - pumped through device
    • - returned to outflow (aorta/PA)
  52. What are the indications for VAD?
    • - bridge transplant
    • - post op heart failure
  53. What is the cardiac support ECMO?
    • - extra corporeal membrane oxygenation
    • - bi- ventricular bypass
    • - used recently for influenza outbreaks
    • - being used more and more
    • - if pt very ill place them on their belly
  54. Things monitored with respiratory system
    • - saturation
    • - arterial blood gases
    • - end tidal CO2
    • - ventilator settings
  55. What is measure with the CNS?
    - ICP
  56. Why is ICP measured?
    • - traumatic brain injury
    • -trying to prevent secondary complicaitons
  57. Where does the catheter sit to measure ICP?
    • - near the site of the lesion
    • - it is linked to a transducer which converts pressure to a plethymographic trace and number
  58. What are your options when measuring ICP?
    • - Epidural - not a accurate
    • - subarachnoid/ subdural
    • - intraventricular 
  59. What is another was CNS can be monitored?
    • - CPP (MAP- ICP)
    • - glascow coma scale
  60. How do you calculate CPP?
    MAP - ICP
  61. What is ARF?
    - acute renal failure
  62. What is CRF?
    - chronic renal failure
  63. When is renal replacement therapy conducted/ indications
    • - spesis
    • - mulitorgan failure
    • - hypoglycemic 
    • - if urea and creatine are rising above normal levels
  64. What are the aims of renal therapy?
    • - control fluid balance
    • - control electrolyte balance
    • - control acid base
    • - get rid of toxins and drugs
  65. What is dialysis based on?
    - the removal of solutes and water via a semipermeable membrane- either biological or artificial
  66. WHat are your options for renal replacement therapy?
    • - arterial or venous
    • - external pump or own driving pressure
    • - haemofiltration or haemodialysis
  67. WHat does conventional haemodialysis involve?
    • - blood pumped through extracorporeal system, separated by a semipermeable membrane from a dialystate soution- diffusion of substances across an electrochemical gradient, fluid goes across by haemostatic pressure
    • - 4-6hrs
    • - poorly tolerated by critically ill pts
    • -take out and clean then put back in
  68. What is haemofiltraion (HF)?
    • - removal of water and solutes by diffusion and convection 
    • - hydrostatic pressure drives filtrate through the membrane and solutes are taken across
    • - lost liquid is replaced with plasma
    • - slow- takes 24hrs
    • - pressure changes affect how well it works
    • - can be used continuously
  69. What is haemofiltration also known as?
    • - CVVHD- continuous, veno- venous haemofilations with dialysis
    • - CAVHD- continuous, arteriovenous haemofiltration with dialysis
    • - CRRT- continuous replacement therapy
  70. What is peritoneal dialysis?
    • - use the peritoneum as a semipermiable membrace
    • - not as effective as HD- therefore not used in critically ill patients
  71. What are complications with peritoneal dialysis?
    • - infection
    • - impair diaphragm function
    • - cant walk around with it
  72. What are some important points?
    • - know what the monitors are- ask and what info u can get from them
    • - the equipment itself doesnt have CI to physio- the underlying pathology might be
    • - dont pull stuff out
    • - alarms- know what to do if they go off
    • - treating pts- make sure transducers are at the right level, monitor pt, safety, stop and check etc
    • Head down tip CI for highICP

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