BKAT 9R GUIDE ALL ANSWERS AND QUESTIONS
SURE A+
✔✔What does CVP measure? Why is it important? - ✔✔Direct measurement of the
blood pressure in the right atrium and vena cava. It reflects ventricular preload and
predicts fluid responsiveness, right ventricular infarction, right heart failure and cor
pulmonale, tamponade, tricuspid regurgitation or stenosis, complete heart block, and
constrictive pericarditis. PEEP > 10 increases CVP due to positive inspiratory pressure
exerted.
✔✔What does PAWP measure? Why is it important? - ✔✔Occurs when balloon is
wedged and reflects left ventricular pressure. Directly measure pulmonary artery
pressure. If there are left ventricular dysfunctions, such as with a myocardial infarct or
cardiomyopathy, a low cardiac output may exist.
✔✔Situations when PAWP > LVEDP - ✔✔Mitral stenosis, atrial myxoma, pulmonary
venous obstruction (e.g. fibrosis, vasculitis), L to R shunt, COPD
✔✔Situations when PAWP < LVEDP - ✔✔Left ventricular failure, raised intra-thoracic
pressure (high PEEP), non-compliant left ventricle (e.g. hypertensive cardiomyopathy),
aortic regurgitation
✔✔CLABSI prevention - ✔✔Hand hygiene, chlorhexidine skin prep, full-barrier
precautions (mask, patient head turned away), avoid femoral vein, take out catheters as
soon as possible, daily assessment of catheters
✔✔Normal ABGs - ✔✔pH: 7.35 - 7.45
PaCO2: 35 - 45
HCO3: 22 - 26
SaO2: 95 - 100
PaCO2: 80 - 100
✔✔Normal vacuum pressure for suctioning - ✔✔-20 mm Hg, low intermittent suctioning
best, 120-140
, ✔✔Biphasic settings for defibrillation - ✔✔150 J
✔✔Goals when responding to ventilator alarm - ✔✔Always check patient first.
✔✔Possible causes of high pressure ventilator alarms - ✔✔Water in vent circuit,
Coughing, Kinking or biting of endotube, Secretions in the airway, Bronchospasm,
Tension pneumothorax
✔✔Possible causes of low pressure ventilator alarms - ✔✔Indicate that either the
ventilator did not reach the pressure it expected or that some of the air it delivered was
not exhaled back into the tubing for measurement. Look for disconnected tubing or an
air leak. The most common places for leaks are around the ET tube cuff, poorly secured
connections, and drainage and access ports on the tubing.
✔✔Verify ET tube placement? - ✔✔At the lip. Needs to be verified with a CXR.
✔✔ET tube problems - ✔✔Check cuff pressure (20-30 cm H20) - higher can cause
necrosis. RT to evaluate cuff leak. Reposition to minimize skin breakdown. Change
tubing every 24 hours. DO NOT exceed 120-140 when suctioning.
✔✔VAP prevention - ✔✔HOB > 30, sedation reduction, weaning, DVT prophyalxis, oral
cares, hand hygiene
✔✔Complications of chest trauma to lungs - ✔✔Pneumothorax, PE, pleural effusion,
ARDS
✔✔Complications of high cervical injury/spinal cord - ✔✔Respiratory dysfunction: loss of
function, loss of drive.
✔✔Protective measures to take for a high cervical injury - ✔✔Protect neck/spine, C4
innervates diaphragm - worry about breathing (probable intubation)
✔✔Components of neuro exam - ✔✔LOC, mental status, cognitive function, cranial
nerves, motor, sensory, coordination, and reflexes
✔✔S/S of increased ICP - ✔✔Early: Change in LOC, agitation, headache, and vomiting.
Late: Pupillary dilation from CN III compression and loss of reflexes.
✔✔Drugs to treat increased ICP - ✔✔Osmotic diuresis (mannitol, 3%, 23%).
Sedation/analgesia. Reduce fever. Antihypertensives. Vasodilators. (Strict management
of SBP.)
✔✔Normal ICP - ✔✔0-15
SURE A+
✔✔What does CVP measure? Why is it important? - ✔✔Direct measurement of the
blood pressure in the right atrium and vena cava. It reflects ventricular preload and
predicts fluid responsiveness, right ventricular infarction, right heart failure and cor
pulmonale, tamponade, tricuspid regurgitation or stenosis, complete heart block, and
constrictive pericarditis. PEEP > 10 increases CVP due to positive inspiratory pressure
exerted.
✔✔What does PAWP measure? Why is it important? - ✔✔Occurs when balloon is
wedged and reflects left ventricular pressure. Directly measure pulmonary artery
pressure. If there are left ventricular dysfunctions, such as with a myocardial infarct or
cardiomyopathy, a low cardiac output may exist.
✔✔Situations when PAWP > LVEDP - ✔✔Mitral stenosis, atrial myxoma, pulmonary
venous obstruction (e.g. fibrosis, vasculitis), L to R shunt, COPD
✔✔Situations when PAWP < LVEDP - ✔✔Left ventricular failure, raised intra-thoracic
pressure (high PEEP), non-compliant left ventricle (e.g. hypertensive cardiomyopathy),
aortic regurgitation
✔✔CLABSI prevention - ✔✔Hand hygiene, chlorhexidine skin prep, full-barrier
precautions (mask, patient head turned away), avoid femoral vein, take out catheters as
soon as possible, daily assessment of catheters
✔✔Normal ABGs - ✔✔pH: 7.35 - 7.45
PaCO2: 35 - 45
HCO3: 22 - 26
SaO2: 95 - 100
PaCO2: 80 - 100
✔✔Normal vacuum pressure for suctioning - ✔✔-20 mm Hg, low intermittent suctioning
best, 120-140
, ✔✔Biphasic settings for defibrillation - ✔✔150 J
✔✔Goals when responding to ventilator alarm - ✔✔Always check patient first.
✔✔Possible causes of high pressure ventilator alarms - ✔✔Water in vent circuit,
Coughing, Kinking or biting of endotube, Secretions in the airway, Bronchospasm,
Tension pneumothorax
✔✔Possible causes of low pressure ventilator alarms - ✔✔Indicate that either the
ventilator did not reach the pressure it expected or that some of the air it delivered was
not exhaled back into the tubing for measurement. Look for disconnected tubing or an
air leak. The most common places for leaks are around the ET tube cuff, poorly secured
connections, and drainage and access ports on the tubing.
✔✔Verify ET tube placement? - ✔✔At the lip. Needs to be verified with a CXR.
✔✔ET tube problems - ✔✔Check cuff pressure (20-30 cm H20) - higher can cause
necrosis. RT to evaluate cuff leak. Reposition to minimize skin breakdown. Change
tubing every 24 hours. DO NOT exceed 120-140 when suctioning.
✔✔VAP prevention - ✔✔HOB > 30, sedation reduction, weaning, DVT prophyalxis, oral
cares, hand hygiene
✔✔Complications of chest trauma to lungs - ✔✔Pneumothorax, PE, pleural effusion,
ARDS
✔✔Complications of high cervical injury/spinal cord - ✔✔Respiratory dysfunction: loss of
function, loss of drive.
✔✔Protective measures to take for a high cervical injury - ✔✔Protect neck/spine, C4
innervates diaphragm - worry about breathing (probable intubation)
✔✔Components of neuro exam - ✔✔LOC, mental status, cognitive function, cranial
nerves, motor, sensory, coordination, and reflexes
✔✔S/S of increased ICP - ✔✔Early: Change in LOC, agitation, headache, and vomiting.
Late: Pupillary dilation from CN III compression and loss of reflexes.
✔✔Drugs to treat increased ICP - ✔✔Osmotic diuresis (mannitol, 3%, 23%).
Sedation/analgesia. Reduce fever. Antihypertensives. Vasodilators. (Strict management
of SBP.)
✔✔Normal ICP - ✔✔0-15
