Transcript Advanced Cardiopulmonary Monitoring

Advanced Cardiopulmonary
Monitoring
CRT 2? = 1%
RRT 3?
Pulmonary Artery Catheter:
Waveform
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?
A. There was an air bubble in the arterial catheter
B. There was a clot in the arterial catheter
C. The patient’s body was below the level of the pressure
transducer
D. Postural drainage positions always cause the blood
pressure to decrease
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?
A. Decrease the oxygen to 24%
B. Place the patient on a ventilator
C.Administer a bronchodilator
D.Keep the patient on 28% oxygen
Capnography will be used to monitor a
patient’s recovery from anesthesia. What
gas should be used for the “zero”
calibration?
A.Room air for 0% carbon dioxide
B.Room air for 21% oxygen
C.5% carbon dioxide
D.The same concentration of anesthetic gas
as used with the patient
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:
A.Has right ventricular failure/ cor pulmonale
B.Has left ventricular failure
C.Has increased pulmonary vascular
resistance
D.Is hypovolemic
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?
I. A clot is at the tip of the catheter
II. There is an air bubble in the arterial line
III.The ventilator’s peak pressure is too high
IV.The patient has a ventricular septal defect
A. I and II
B. II and III
C. I, III, and IV
D. I, II, III, and IV
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
A.Pulmonary edema
B.Pulmonary embolism
C.Pneumonia
D.Cardiac tamponade
A 35-year-old patient in the intensive care
unit has the following hemodynamic data.
Which of them indicates a problem with
the patient?
A. SVR of 600 dynes/sec/cm-5
B. CI of 3 L/min/m2
C. PvO2 of 38 torr
D. Shunt of 4%
An unconscious 25-year-old patient is admitted with
viral pneumonia, vomiting, and diarrhea.
Mechanical ventilation is initiated, and flowdirected 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
The End

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.

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.

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.

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.
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.

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.
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