__Brittany Rowe__________________
ICP Monitoring
1.
What is a normal ICP?
<15mmHg
2.
Where can catheters to measure ICP be placed?
Catheters can be placed in the lateral (nondominant preferred) ventricular, the subarachnoid space, the subdural space, the epidural space or epidural.
3.
At what point on the patient is the ICP device leveled?
The device should be leveled at the foramen of Monroe (the tragus of the ear).
4.
If your patient has an elevated ICP, what can/should you do?
For an elevated ICP the nurse should decrease stimuli-minimal lights, limit stress, separate out activities and allow rest in between each. The nurse should also focus on keeping on top of pain medication and limiting unnecessary painful procedures.
During suctioning lidocaine should be used.
Nausea and vomiting should be controlled with zofran, and FVO can be decreased with
Lasixs. The nurse should avoid valsalva with stool softeners and neck, hip and knee flexion. The patient should not be warm, so setting the room temperature low or using ice packs. Infection control should be implemented, hand washing, antibiotics, proper cleaning techniques. Sedation and paralytics should also be considered.
PAP/CVP/Arterial Line Monitoring
1.
Where in the heart are CVPs measured and which port in the pulmonary artery catheter measures CVP (distal or proximal)?
CVPs are measured in the tip of the right atrium. The proximal port measures CVP.
2.
Where in the heart are PAPs measured and which port in the pulmonary artery catheter measures PAP (distal or proximal)?
PAPs are measured in the pulmonary artery with the distal port
3.
Which type of line do you need to obtain CO and SVR readings?
A swan line.
4.
In which port in the pulmonary artery catheter may you NOT administer fluids?
The distal port.
5.
Your arterial line show the following reading: 136/84 (101). What does the
(101) represent?
The MAP
6.
How can you trust an arterial line reading based on what you have on the monitor screen?
The arterial waveform should match with the QRS on the ECG
7.
What actions need to be taken at the start of each shift to make sure that pressure lines (PAP/CVP/ART) are accurate?

The pressure lines need to be zeroed and leveled to the phlebostatic axis (mid auxillary and 4 th intercostal line).
Blood Products
1.
What all do you check between the patient and the unit of blood before giving it?
In front of patient:
Identify Pt Name, DOB, compare request form information with that on the pt band including, Rh, blood type, pt #, type of transfusion, blood unit #, expiration date,
The nurse should stay with the patient for the first 15 minutes when an adverse reaction is most likely to occur. Then assess vitals and signs of adverse reaction in #5.
5.
How do you know if someone is having a reaction to a blood product? color and consistency of blood. Also, make sure the patient has understood and signed the consent form.
This all needs to then be done by a second nurse.
2.
What kind of solution do you hang blood products with?
Normal Saline
3.
What assessments need to be made prior to giving blood products?
Vitals, patency of IV, LOC, check color and consistency of blood (no clumps or bubbles), pt lab values
(Hgb, Hct, RBC count, platelets), and for pallor
The patient may experience, headache,
SOB/dyspnea, N/V, itching, fever, rash, chills, wheezing, palpitations, abdominal/chest/back pain, burning, oozing at IV site, restlessness, tachycardia, tachypnea, low Sa02, respiratory distress, altered LOC, hypotension, unexplained bleeding
Level of knowledge- teach about the signs of a reaction in #5
4.
How often do the assessments in #3 need to be made?
Vitals:
Pre-transfusion (less than 30 min before)
At the start of transfusion
15 minutes into transfusion
Every 30 minutes
At end of transfusion

Chest Tubes
1.
What is the purpose of a chest tube?
Chest tubes are used to rid of excess air, blood or fluid from the thoracic cavity. Their use helps prevent respiratory compromise. They can be used when a pneumothorax, tension pneumothorax, hemothorax is present. Chest tubes can also be used after open-heart surgery, or chest trauma.
2.
What safety devices need to be at the patient’s bedside with a chest tube?
Kelly clamps are needed in case there is an air leak. There should also be a stopcock turned to open for air to escape. Tape, pulse ox, oxygen and a blood pressure cuff should also be present. If the system breaks there should be a cup with sterile water and a new system available.
3.
Which chamber should there be bubbling if suction is applied?
Suction Control chamber
4.
Which chambers should not have bubbling?
The reservoir and water seal should not bubble, but there maybe tidal movement in the water seal.
5.
If there is bubbling in a chamber where there should not be bubbling, what should you do? Is this ever normal?
There may be bubbling when the pt forcefully deflates the lungs, as in coughing. However, if there is constant bubbling it could indicate a leak. If this happens two clamps should be used to find the leak. Start at the patient and move the clamps towards the chambers to find the leak. If no leak is found the chest tube may be broken and should be replaced.

HEMODYNAMICS WORKSHEET
1.
Your patient is in cardiogenic shock—what do you expect their hemodynamic readings to be (increased or decreased)? a.
HR- increase b.
BP/MAP- decreased c.
CO/CI- decreased d.
CVP/PAP- increased e.
SVR-increased
2.
For each of the following hemodynamic abnormalities, list the drugs (by name), and/or intervention (like fluids) that would be used to make the hemodynamic normal: a.
Decreased HR
Atropine, Dopamine (5mcg), Epinephrine, Olsoproterenol,
Increased HR
Adenosine, Digoxin,
Beta blocker- Propranolol/Atenolol
Calcium Channel - Diltiazem b.
Decreased BP
Dopamine (10mcg)
Fluids/Blood
Increased BP
ACE inhibitor- Captopril
Beta Blocker- Atenolol
Calcium Channel blocker-Diltiazem
Diuretics- Lasix
Nitroglycerin c.
Decreased CO/CI-
Digoxin, Dopamine, Dobutamine, Milirnone d.
Decreased CVP/PAP-
Fluids/blood e.
Increased CVP/PAP-
Diuretics (Lasix), dialysis,

Venous dilators- MS, NTG, Amrinone
ACE inhibitor-Captopril
Aldosterone blockers- Aldactone f.
Decreased SVR
Epinephrine, Vasopressin, Phenylephrine
Increased SVR-
Fluids- so SVR can stop trying to compensate for low BP and fluids
Nipride/ NTG, treat CO (above) so SVR doesn’t have to compensate
Beta blockers- Atenolol
Calcium channel blockers- Cardizem