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Advanced Cardiopulmonary Monitoring

Advanced Cardiopulmonary Monitoring. CRT 2? = 1% RRT 3?. Pulmonary Artery Catheter: Waveform.

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Advanced Cardiopulmonary Monitoring

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  1. Advanced Cardiopulmonary Monitoring CRT 2? = 1% RRT 3?

  2. Pulmonary Artery Catheter:Waveform

  3. A 3-daypostoperative open-heart surgery patient has an arterial catheter in the right radial artery for continuous blood pressure measurements. Because of retained secretions, the respiratory therapist places him into a head down position for postural drainage therapy. The nurse notices that the patient’s blood pressure is less than before being placed into this new position. After the patient is returned to the original position, the blood pressure is the same as it was originally. How can the therapist explain the blood pressure changes? • There was an air bubble in the arterial catheter • There was a clot in the arterial catheter • The patient’s body was below the level of the pressure transducer • Postural drainage positions always cause the blood pressure to decrease

  4. A patient with advanced emphysema is admitted to the respiratory intensive care unit. He is placed on a 24% Venturi-type mask and has a pulmonary artery catheter inserted. His initial pulmonary vascular resistance (PVR) is 300 dynes/sec/cm-5, and the PaO2 is 57 torr. The physician orders him increased to 28% oxygen. The resulting PVR is 220 dynes/sec/cm-5, and the PaO2 is 63 torr. Based on this information, what would you recommend? • Decrease the oxygen to 24% • Place the patient on a ventilator • Administer a bronchodilator • Keep the patient on 28% oxygen

  5. Capnography will be used to monitor a patient’s recovery from anesthesia. What gas should be used for the “zero” calibration? • Room air for 0% carbon dioxide • Room air for 21% oxygen • 5% carbon dioxide • The same concentration of anesthetic gas as used with the patient

  6. Your patient is in the intensive care unit and is being monitored with a pulmonary artery catheter. She has the following parameters: PAP 35/20 mmHg; PCWP 9 mmHg; CVP 10 mmHg. You would interpret the data to indicate that she: • Has right ventricular failure/ cor pulmonale • Has left ventricular failure • Has increased pulmonary vascular resistance • Is hypovolemic

  7. A 40-year old patient receiving mechanical ventilation has an arterial line in place. It is noticed that a significant difference exists between the blood pressure taken by cuff on the left arm and the blood pressure taken by arterial line on the right arm. What could explain this difference? • A clot is at the tip of the catheter • There is an air bubble in the arterial line • The ventilator’s peak pressure is too high • The patient has a ventricular septal defect • I and II • II and III • I, III, and IV • I, II, III, and IV

  8. An adult patient is receiving mechanical ventilation when the following data are gathered: • 9:00 am 11:00 am • PaO2 75 53 mmHg • PVR 120 340 dynes/sec/cm-5 • PCWP 8 10 mmHg • PAP 25/10 42/21 mmHg • How should the results be interpreted • Pulmonary edema • Pulmonary embolism • Pneumonia • Cardiac tamponade

  9. A 35-year-old patient in the intensive care unit has the following hemodynamic data. Which of them indicates a problem with the patient? • SVR of 600 dynes/sec/cm-5 • CI of 3 L/min/m2 • PvO2 of 38 torr • Shunt of 4%

  10. An unconscious 25-year-old patient is admitted with viral pneumonia, vomiting, and diarrhea. Mechanical ventilation is initiated, and flow-directed pulmonary artery (Swan-Ganz) catheter is inserted. The following data are gathered: Pulmonary artery pressure, 22/8 mm Hg; Pulmonary capillary wedge pressure, 3 mm Hg; Central venous pressure, 0 mm Hg; blood pressure, 90/60 mm Hg; Pulse, 142/min. • What is the most likely cause of these findings? • Hypovolemia • High ventilating pressures • Bronchospasm • Rupture of the balloon on the catheter

  11. The End

  12. Which of the following clinical observations is most commonly associated with right heart failure? A. peripheral edema B. muscle wasting C. tracheal deviation D. skin flushing EXPLANATIONS: (c) A. Right heart failure inhibits venous return and results in edema in the periphery. (u) B. Muscle wasting has no direct relationship to right heart failure. (u) C. Tracheal deviation results from asymmetrical changes in pressures or volumes in the thoracic cavity and is not related to right heart failure. (u) D. Skin flushing is peripheral vascular dilation and is not related to right heart failure.

  13. While assisting the physician using a synchronous defibrillator for cardioversion, the unit does not discharge. The respiratory therapist should check the   I. charge level of the defibrillator.  II. presence of a P wave. III. chest lead connections. IV. contact gel on the paddles. A. I, II, and III only B. I, II, and IV only C. I, III, and IV only D. II, III, and IV only EXPLANATIONS: I. True. The defibrillator will not function if it is not properly charged. II. False. The defibrillator must identify an R wave to synchronize the discharge. III. True. The defibrillator will not discharge if the chest leads are disconnected. IV. True. Contact between the body surface and the paddles is necessary to complete the circuit and allow discharge. (u) A. Incomplete and incorrect response. (u) B. Incomplete and incorrect response. (c) C. Correct response. (u) D. Incomplete and incorrect response.

  14. A patient's chest radiograph shows diffuse alveolar infiltrates. The following data are available: Which of the following should be used to differentiate between cardiac and noncardiac etiology for these results? A. right atrial pressure B. central venous pressure C. mean pulmonary artery pressure D. pulmonary capillary wedge pressure EXPLANATIONS: (u) A. Right atrial pressure could be elevated or normal with either etiology. (u) B. Central venous pressure could be elevated or normal with either etiology. (u) C. The mean pulmonary artery pressure may be elevated because of increased pulmonary vascular resistance, as well as left ventricular failure. Therefore, it does not distinguish between cardiac and noncardiac etiologies. (c) D. An elevated PCWP is an indicator of left ventricular failure as a cause of the edema and suggests a cardiac etiology.

  15. A patient with an acute myocardial infarction may have which of the following clinical findings?   I. jaw pain  II. diaphoresis III. nausea and vomiting IV. digital clubbing A. I, II, and III only B. I, II, and IV only C. I, III, and IV only D. II, III, and IV only EXPLANATIONS: I. True. Pain can radiate to the shoulders, jaw, neck, arms, or back. II. True. Diaphoresis in the presence of an acute myocardial infarction suggests activation of the sympathetic nervous system. III. True. Other symptoms include nausea, vomiting, syncope, and general malaise. IV. False. Digital clubbing is associated with chronic suppurative pulmonary and congenital cardiac disease. (c) A. Correct response. (u) B. Incorrect and incomplete response. (u) C. Incorrect and incomplete response. (u) D. Incorrect and incomplete response.

  16. RRT • After attaching a cardiac monitor to a patient's chest, the respiratory therapist notes the ECG recording contains artifact. Which of the following could cause artifact in this situation?    I. inadequate electrode contact   II. improper electrode placement  III. the patient scratching the electrodes IV. disconnected leads A. I and III only B. I and IV only C. II and III only D. II and IV only EXPLANATIONS:    I. True. Poor electrode contact could produce artifact.   II. False. Improper electrode placement could produce inappropriate complexes for the lead displayed but not artifact.  III. True. The patient scratching or moving the electrodes could cause artifact. IV. False. Disconnected leads would produce no variability in electrical charge or a flat line, which is different than artifact. (c) A. Correct response. (u) B. Incomplete and incorrect response included. (u) C. Incomplete and incorrect response included. (u) D. Incorrect response.

  17. The respiratory therapist discovers a patient with severe peripheral vascular disease has QRS complexes on the monitor, but no palpable pulse. The automated blood pressure is 40/0 mm Hg. Which of the following is the most appropriate? A. Check pulses with a Doppler. B. Perform cardiac compressions. C. Obtain an arterial blood gas sample. D. Insert a temporary pacemaker. EXPLANATIONS: (u) A. A Doppler may be able to detect a pulse in a patient with severe hypotension, but it would not help correct the problem. See explanation B. (c) B. The patient has PEA (pulseless electrical activity) requiring immediate cardiac compressions. (u) C. Obtaining an arterial blood gas sample in a patient with severe hypotension may be extremely difficult and will delay appropriate treatment. See explanation B. (h) D. A temporary pacemaker is indicated for a patient without electrical activity. See explanation B.

  18. A patient hospitalized with a deep-vein thrombosis in the leg experiences sudden shortness of breath. Which of the following should be recommended to evaluate the patient’s situation? • Lung compliance • Electrocardiogram • Chest radiograph • VD/VT

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