Blood pressure, lines, tubes and equipment
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| What does systolic BP measure | force (pressure) that's exerted on the walls of the blood vessels as it passes through them while the heart is beating
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| What does diastolic BP measure | The blood pressure while the heart is relaxed
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| How much does systolic BP increase with exertion | At a rate of 8-12 mm Hg per metabolic equivalent in a linear progression. And ceases to increase with sustained activity
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| If systolic BP doesn't increase with increased workload what can this indicate? | That the functional reserve capacity of the heart has been exceeded
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| How much does diastolic pressure increase or decrease with peripheral vasculature adaption | 10 mm Hg
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| When should a exercise session be terminated | If the systolic pressure exceeds 210 mm Hg or if the diastolic exceeds 110 mm Hg
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| What is pulse pressure | Its the difference between systolic and diastolic BP. It generally increases in direct proportion to the intensity of exercise
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| What happens with systolic and diastolic BP during exercise | Systolic increases around 40-50 mm Hg with intense exercise, while diastolic stays the same.
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| What can excessive pulse Pressure indicate? | Stiffening of the aorta secondary to atherosclerosis
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| Normally how much higher is systolic BP in the legs than in the arms(brachial artery) | 10-20%.
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| BP readings that are lower in the legs as compared to the arms are abnormal and may indicate what? | Peripheral vascular disease. In some cases an ankle brachial index value of greater than 1.0 is still considered to be normal
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| What happens with BP with advancing age? | The same amount of blood fills the ventricles but the pumping mechanism is less effective and the body compensates by increasing BP to attempt homeostasis
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| During exercise testing, a systolic BP that doesnt increase or decrease with increasing workloads may signal what | A plateau or decrease in cardiac output
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| As a general guideline, the 3 minute post exercise systolic BP should be what % less than at its peak | 90%
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| What are 4 precautions for arterial (A lines) | Avoid applying BP cuff above the infusion site, grasp IV line pole so the infusion site is at heart level', avoid activities that require the site to be above the level of the heart for prolonged periods of time, avoid disturbing the site during exercise
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| Total Paranetral Nutrition, Hyperalimentation Devices (intravenous Feeding) info. (4) | Alarm sound indicates fluid source is empty, or the system is unbalanced, disruption or disconnection may result in an air embolus, shldr flex. Ans and abd may be restricted, mobility may need to be restricted near the catheter insertion
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| Intracranial monitoring precautions (6) | Avoid isometric or valsalva maneuver, avoid neck flexion, hip flexion > 90 degrees, and lying in prone, venous drainage is maximal with HOB elevated to 30 degrees, momentary elevation of intracranial pressure is normal, but sustained are not
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| Gastrostomy tube (G tube) precautions (2) | Enternal feelings should be turned off prior to and during tx., can be disconnected temporarily for mobility
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| Chest tube precaution (3) | When gait training, collection bottles should be kept below the level of the inserted tube location, monitor the pt. for changes in breath sounds before and after intervention, avoid pressing directly on chest tubes
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| Mechanical ventilation precautions (3) | Alarm indicates disconnected tube, coughing or respiratory changes, develope nonverbal means of communication, pt. is at greater risk of contractures, skin ulcers, and deconditioning
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| Supplemental O2 precautions (2) | Beware of signs of respiratory distress (dyspnea, cyanosis, cramping), monitor SaO2, PaO2, and hemodynamics prior to, during, and post tx.
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| What is a swan-ganz catheter | Pulmonary artery catheter
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| What is the purpose of the swan-ganz catheter | Used to detect heart failure, sepsis, monitor therapy, and evaluate the effects of drugs. It measures R atrium/ventricle, pulmonary artery, and filling pressure
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| What is a central venous pressure catheter | Is a catheter placed into a large vein in the neck, chest, groin to administer meds, fluids, obtain blood tests and measure central venous pressure
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| Indwelling right atrial catheters | Administers parenteral fluids or meds, measure venous circulation
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| Pulmonary embolism clinical presentation, risk factors, dx. | Presents: difficulty breathing, chest P, rapid pulse, circulatory instability, death.
Risk factors: Sx., long periods of inactivity, increased levels of clotting factor in blood, abnormal factors in vessel wall
Dx.: pulmonary angiography, chest X-Ray
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| Hypovolemic shock description, presentation, risk factors, Dx. | Life-threatening condition caused by insufficient circulating blood volume caused by hemorrhage or severe burns
Presentation: Hypotension, anxiety, altered mental status, clammy skin, rapid pulse, thirst, fatigue
Dx.: through clinical presentation
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| Hypovolemic tx. | Activate emergency medical system, position pt. in supine with legs elevated 12". Controll any bleeding, provide infusion of balanced salts or blood in severe cases
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| What is cardio genie shock | Failure of the heart to pump effectively. Management includes oxygen therapy and cardiac meds.
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| What is septic shock | Overwhelming infection leading to vasodilation. Management includes restoring intravascular volume and ID and controlling the source of infection
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| What is anaphylactic shock | Severe and sometimes fatal reaction to an allergen, antigen or drug which causes vasodilation leading to hypotension. Management includes I'd and removing antigen and administering anti-histamines
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| What is autonomic dysreflexia | A massive sympathetic discharge that can occur in association with spinal cord injury or disease. The condition is triggered by a variety of noxious stimuli including bladder dissension, UTI, skin ulcers, & bowel impact ion
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| What is the clinical presentation of, risk factors, Dx. And tx. Of autonomic dysreflexia | Presentation: sweating above the level of the lesion, flushing of the skin above the level of the lesion, elevated BP and blurred vision
Risk: spinal injuries @ or above T6
Tx.: removing stimuli, sitting pt upright, remove tight clothing, vasodilators
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