N.C.M.

106 PRELIMINARY EXAMS REVIEWER
Nyjil Patrick B. Columbres

JULY 14, 2013
UNIVERSITY OF LUZON Dagupan City

It also measures Right Arterial Pressure (CVP = 0-8mmHg). inside pulse generator is implanted in left front shoulder with 2 leads for atria and ventricle to deliver high energy shock. and malls. pressure. Measures MAP-SBP + (2x diastolic BP) divided by 3. 1 . pulmonary embolism. Systemic Vascular Resistance (770-1500 dynes/sec/cm-5) it measures afterload (The pressure the left ventricles need to exceed to eject its volume – it is increased in hypothermia and shock. M. 4. Automatic External Defibrillator – a computerized defibrillator that analyses heart rhythm and tells the operator when to perform defibrillation. 3. C. Equipment:  Pressure bag  Fluid flush system with Heparin  Tubing Measurement of Hemodynamic Parameters: 1. Pulmonary Artery Pressure – monitors left ventricular function and fluid volume status. Complications include Thrombosis. A device that is controlled by microcomputer. 106 Implantable Cardioverter Defibrillator – placed in patient with recurrent ventricular arrhythmia. Embolism and Hematoma. 3. hypoxemia.N. It is increased in pulmonary hypertension. Right Ventricular Pressure (12-25mmHg/0-8mmHg). temp. and Pulmonary Wedge Pressure (4-12 mmHg) a port attached syringe to inflate the balloon located on the distal lumen. and academia. and sound which change electrical sign. Amplifier – interpret electrical signals with more accuracy. obtain blood samples. used to patient with dopaminiperide. Monitor – records appropriate waveform 2. parks. Pulmonary Artery Pressure (15-25mmHg/6-12mmHg). Transducer – attached to tubing to measure flow. Common is public places such as airports. Pulmonary Vascular Resistance (20-120 dynes/sec/cm-5) it measures afterload affecting right ventricle. Used for indirect measurement of Left Ventricular Function. Intra-arterial Monitoring – continuous display of Blood Pressure. 2. Hemodynamic Monitor: 1. ABG Analysis.

It is less invasive so less accurate. It is used to determine how effective the heart is meeting the demands of their body. it can be obstructed. Technique is to inject 5-10 mL of D5IV or NS to Pulmonary Catheter.5. Criteria:  On Gas Anesthesia  Removal of Copious Secretions  Respiratory arrest and other respiratory compromise Contents of tray:       Laryngeal Scope (Curved or straight) ET Tube Stylet Oral Airway Magill Forceps Syringe 2 . Drainage of CSF can’t be done.  Subdural sensor – is placed post craniotomy for post-operative monitoring.  Comatose patients having below 8 GCS  Abnormal CT Scan Methods of ICP Insertion:  Epidural Sensor – transducer is placed between skull and the Dura. Intracranial Pressure Monitoring – is used to patients who are at risk of developing increased ICP.  Intraventricular catheter – is placed via burr hole into the lateral ventricle. Endotracheal Intubation – it is the passage of tube into the trachea either mouth or nares to maintain airway of patient. Cardiac Output – using thermistor located on the distal part.  Subarachnoid screw/bolt – inserted into the subarachnoid space. this system is unreliable. Criteria of in monitoring ICP:  Risk for increased ICP. Acetazolamide – Drug used to inhibit CSF Secretion. Most accurate and CSF can be drained.

Helps to keep alveoli open to participate in gas exchange. SIMV – ventilator will deliver a preset Tidal Volume or pressure for every breath. Pressure Control Ventilation – delivers breaths at a preset target pressure. This determined by patient weight range from 4-12 ml/kg c. Give anxiolytics and paralytic Agent 2. Hyperoxygenate patient to 100% 3. When patient inspires independently. d. CPAP (Continuous Positive Airway Pressure) – adds to FRC in patient with spontaneous breathing given by mask or ventilator. 6. Inflate cuff with Syringe. the ventilator does not deliver pressure/volume which may result to respiratory muscle fatigue. Positive Pressure Ventilation – common type of ventilator support use in ICU. PEEP (Positive End Expiratory Pressure) – it adds pressure at the end of expiration on ventilation breaths. 8. Secure ETT by tape and document cm marking for the depth at the patient lip. This is used for weaning. 9. Use to augment spontaneous breath during weaning process. CMV – deliver a minimum preset RR to the patient. Volume Control Ventilation – solves this volume gas exchange roblem. b.Steps in Endotracheal Intubation: 1. Place patient in sniffing position. Used to patient with sleep apnea. Example: If the order is 12 breaths/min. the ventilator will deliver 12 breaths. There is always a risk that the inspiration pressure will climb high. let RT auscultate bilateral lung air entry. d. Suction excess secretions in the oropharynx 5. c. This is titrated according to patient pulse oximeter. 3 . Inspiration decreases as the alveolar pressure nears the pressure on the airways. Air is forced into the lungs via ETT and deliver air according to preset volume/pressure by mode. FIO2 (Fraction of Inspired Oxygen) – this is the preset. FIO2 maybe set to 21-100%. Give PEEP 5cm H2O routine to keep functional residual capacity. Insert ETT thru the vocal cords just 2-3cm above the carina 7. Insert Laryngoscope to view vocal cord 4. Breath is delivered according to the timing of patient own respiratory effort. 10. b. Use to patients with chronic respiratory problems. Tidal Volume – amount of air exchanged or delivered with each inspiration and expiration. Different Ventilator Settings: a. Lubricate ETT with KY Jelly and place stylet on the center of the ETT. Once done. Chest X-Ray to verify proper alignment. a.

e. Proportional Assist Ventilation – this allows the ventilator to act in response to the patient work of breathing on breath by breath basis. Suction as needed. Used as Weaning. Monitor ABG and adjust ventilator setting. 3. Provide oral care every 2 hours. Give bronchodilators. 9. 15. Apply soft restraint if needed. Monitor patient volume status. 2. Healing Process:  Inflammatory process – formed – 4 hours. Mandatory Minute Ventilation – this monitors the minute ventilation and deliver additional breaths when patient falls below the minimum. 6. Nursing Management: 1. Pressure Support Ventilation – used to support patient breath and help increase Tidal Volume. Turn patient every 2hours. Patient requires sedation or paralysis because patient feels uncomfortable. Monitor ETT pressure once per shift. Secure artificial airway and monitor tube movement. Signs and Symptoms:  Chest pain – last 30 minutes.  Necrotic zone – 4-10 days – it is well defined. Provides positive pressure as patient is taking breath that ultimately helps to reduce work of breathing. g. 14. Position patent semi-fowlers if possible. Wash hands before and after procedures. Acute Myocardial Infarction – totally occluded of a coronary artery which leads to shock or death. Monitor ETT and ventilator circuits turning and repositioning patient. Inverse Ration Ventilation – Delivered as pressure controlled. The ventilator adjust the support it provides depending on patient effort. Review and respond to ventilator alarms promptly. f. Hyperoxygenate before. 7. Auscultate lung every 4hours. 5. during and after procedure. h.  Anxiety – because of impending doom 4 . If orally intubated secure tube alternating sides of mouth daily. 11. Comparison of the inspiration and expiratory time. Monitor set and titrate FIO2 8. Airway Pressure Release Ventilation – unites two levels of CPAP (P high – help patient increase lung volume during spontaneous breath) and P low – allows reduction of airway pressure. 4. 10. 13.  Scar tissue – Forms within 10-14 days. i. 12.

A..  Monitor infections signs. expanded by balloon which improve lumen diameter. and Calcium Channel blockers. Morphine Sulfate. Maintain anticoagulant because of secondary thrombus formation may occur. Metal stent . Nausea and vomiting  Syncope  Blood pressure maybe Low or High Acute Care Management:  Improve myocardial oxygen supply by giving oxygen  Decrease myocardial oxygen demand by bed rest. Percutaneous Trans-luminal coronary angioplasty .stainless steel slotted wire device designed to mechanically support coronary artery to prevent acute restenosis after P. Anticoagulant is required before the procedure. Level of Consciousness.  Decrease preload and after-load by drugs (Morphine Sulfate. Beta-Blockers. iv) and calcium channel blockers)  Increase heart contractility (dopamine)  Maintain electrophysiological activity  Maintain hemodynamic stability. Intake and Output. Insertion of balloon tipped catheter permits inflation and deflation during diastole and systole triggered from the ECG. Maintain Oxygen Therapy. mechanical devices. Nursing management:       Assess pain and skin Continue monitoring 12 lead ECG Check Vital Signs. C. Balloon is inflated to compress atherosclerotic plaque to increase lumen diameter. aspirin. O. N.a catheter with balloon is inserted thru a guide wire during coronary angiogram via femoral artery. T. Pulmonary Artery Wedge Pressure.  Detect/prevent complications. Stent is placed in lesion site. Obtain Central Venous Pressure. 5 . Cardiac output. Surgical Management: Intra-aortic Balloon Pump – is a counter-pulsation device. It increases coronary artery perfusion and decrease myocardial consumption. nitroglycerin (oral. P. It is inserted via femoral artery and advanced through aorta confirmed by chest X-ray. patch. Give drugs like nitroglycerin.

Patient will receive Aspirin or Clopidogrel for 3-6 months to prevent Endothelization of stent surfaces. Right Side Heart Failure Signs and Symptoms:             Jugular vein distention Weight Gain Ascites Hepatomegaly Anasarca Nausea and vomiting Bloating Low urine output High Central Venous Pressure Nocturia Electrolyte Imbalance Dyspnea Left Side Heart Failure Signs and Symptoms:             Cardiomegaly Extra Heart Sounds Adventitious Breath Sounds (Crackles and Wheezing) Decreased Systolic Blood Pressure Orthopnoea Nocturia Night productive cough Irritability Dusky skin and nail beds Tachycardia Restlessness Ventricular ectopic beats 6 . Ischemic Heart Disease. These are impregnated with antiproliferative agents (Rapamycin. Valvular disease.inability of the heart to pump/maintain adequate amount cardiac output into the systemic circulation to meet tissue metabolic and oxygen demands. Heart failure . Cardiomyopathies. Paclitaxel). Risk factors:       Myocardial infarction. Coronary Heart Disease. Fluid Overload.Drug-Elutent stent – It is inserted to reduce in-stent restenosis.

Pulmonary Edema – It is an abdominal accumulation of fluid both in interstitial and alveolar spaces.  Assess skin  Review Blood Urea Nitrogen and Creatinine level. echocardiogram results. and Arterial blood Gas. Pulmonary Artery Wedge Pressure. and Cardiac Output.  Paroxysmal nocturnal Dyspnea Diagnostic tests: ECG Findings:  Left or right ventricle hypertrophy and ischemia Chest X-Ray Findings:  Cardiomegaly  Pleural effusion  Pulmonary venous congestion Acute care management:     Improved myocardial function Reduce circular volume Reduce myocardial work Detect/prevent complications Nursing management:  Analyze ECG and Echocardiogram results  Check Vital Signs  Monitor Central Venous Pressure. Decreased cardiac output.  Increased Pulmonary Artery Wedge Pressure. A life threatening situation that needs immediate treatment Risk factors:         Hypertension Ischemic Heart Disease Myocardial Infarction Valvular disease Cardiomyopathies Congestive Heart Failure Over-hydration Acute septal defects 7 .

restlessness.Diagnostic tests:  Arterial Blood Gas: Respiratory Acidosis with Hypoxemia  Increased Brain Natriuretic Peptide  Chest X-Ray Signs and Symptoms:           Sudden onset of Dyspnea and Orthopnoea. Pulmonary Vascular Resistance  Monitor Vital Signs. Fatigue Cool moist skin Tachycardia and Tachypnea Moist cough with pink blood tinged frothy sputum. Thrombus which affected blood flow and cause platelet aggregation thus forming a clot. Emboli –Rheumatic Heart disease Mitral Stenosis. Chest discomfort Palpitations Fatigue severe coughing Jugular vein distention Acute care management:     Reduce preload and after-load Improve heart contractility Give high concentration Oxygen Mechanical ventilation Nursing management:     Care of Ventilated patient on Continuous Positive Airway Pressure with PEEP. ECG strips. BUN. Give drugs as prescribed Pulmonary/oral hygiene Obtain Central Venous Pressure. Cardiac Output. Systemic Vascular Resistance. irritability. Pulmonary Artery Wedge Pressure. Atrial Fibrillation. heart and lung function  Review echocardiogram results Stroke – It is the sudden loss of brain function resulting from disruption of blood supply to an area of brain resulting in tissue necrosis. caused by: a. b.damage to brain due to clogged artery. Stroke is characterized by symptoms more than 24 hours with permanent neurologic deficit. 8 . Main types of stroke:  Ischemic stroke . Severe anxiety. and Brain Natriuretic Peptide  Assess skin.

arteriovenous malformations. arms. Internal carotid artery  Contralateral paresthesia.identifies areas of ulceration. blindness  Dysphasia in dominant hemisphere involvement.visualize areas of ischemia or infarction 3 hours after vascular occlusion. Anterior cerebral artery  mental impairment  contralateral hemiparesis  sensory loss of toes  ataxia  incontinence C. B. Brain tissue most common site of hematoma is the basal ganglia Transient Ischemic Attack . Diagnostic tests: CT scan . occlusion.  hemiparesis of face. Middle cerebral artery  level of consciousness varies from confusion to coma  contralateral hemiparesis to hemiplegia greater to arms and face than leg  aphasia  Dysphasia  homonymous hemianopsia  inability of turn eyes toward the paralyzed side D. Posterior cerebral artery  contralateral hemiplegia with sensory loss  confusion. stenosis. and displaced arteries. thrombus. It does not cause infarction but a warning sign of impeding stroke.when blood vessel burst leaking blood into the surrounding spaces or brain tissue. Haemorrhagic stroke . Signs and symptoms: Depends on the area of the infarct. A. and legs  contralateral hemiplegia. hemianesthesia  visual blurring or hemianopsia. Cerebral angiogram .Brief episode of Neurologic deficits that resolve less than 24 hours. memory involvement  homonymous hemianopsia 9 .

corticosteroids. PTT. CVP. and Glucose. Dexamethasone (dexadron) prevents cerebral Edema. anti-platelets Prevent hyperglycaemia/hypernatremia Prevent further haemorrhagic events.anticoagulants.drain CSF. Reduce increased ICP . I&O. Vertebrobasilar artery  Dizziness. 10 .seizures. loop diuretics Prevent complications . VS. osmotic diuretics. herniation. Vertigo and Nausea  Ataxia  Syncope  Blindness or diplopia  visual disturbances  Nystagmus  Numbness  paresis of the face. Phenytoin (Dilantin) . tongue.  Assess factors increasing ICP  Elevate height of bed  Give drugs as ordered. ABG.E. Electrolytes.to prevent seizure Nursing management:  Monitor GCS. Acute care patient management:       Thrombolytics Prevent additional thrombotic events . Oxygen Saturation. mouth  dysphagia and dysarthria Physical assessment:      Blood Pressure maybe normal or high mild tachycardia cheyne-stokes respiration afebrile/febrile Peripheral pulses maybe diminished. ECG. PT.