Respiratory Monitoring Protocols

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Questions and Answers

What should be done when a new symptom or sign appears during routine monitoring?

Begin searching for the possible cause. (correct)

Prepare to treat it as a serious condition.

Ignore it unless it persists.

Consult with a specialist immediately.

When should a search for a possible cause of new findings begin?

Immediately after a new symptom appears. (correct)

Only if the new finding is severe.

Following routine monitoring.

Once a specialist has been consulted.

What is the suggested course of action for monitoring findings?

Discuss with a patient what the symptoms mean.

Document the findings without action.

Begin an immediate search for the causative factors. (correct)

Only investigate if multiple symptoms appear.

What is a critical response to newly emerged symptoms during routine health checks?

Initiate an investigation for the underlying cause. Signup and view all the answers

Why is it important to address new signs or symptoms promptly?

Early detection can lead to better treatment outcomes. Signup and view all the answers

What is a potential cause for unilateral decrease in chest wall expansion?

Consolidation due to fluid accumulation Signup and view all the answers

Which of the following indicates a need to monitor asynchrony with the ventilator?

Distressed patient showing signs of discomfort Signup and view all the answers

What condition can cause splinting of the chest wall?

Presence of air, blood, or fluid in the pleural cavity Signup and view all the answers

Which of the following is a potential result of obstruction of a major bronchus?

Development of atelectasis Signup and view all the answers

What might frequent monitoring of a patient indicate when asynchrony with the ventilator is evident?

Potential distress and ventilatory failure Signup and view all the answers

What does a prompt improvement in the patient indicate?

The ventilator or external circuit is the source of the problem. Signup and view all the answers

If a patient does not improve after intervention, what should be the next step?

Check the endotracheal tube (ETT) or assess the patient. Signup and view all the answers

What is the main focus of management if a patient shows no signs of improvement?

Narrowing down potential issues with external equipment or the patient's state. Signup and view all the answers

Which of the following could NOT be considered a reason for a patient's lack of improvement?

Proper function of the ventilator. Signup and view all the answers

If the source of the problem is identified as the ventilator, what is the likely next step?

Investigate or repair the ventilator or external circuit. Signup and view all the answers

What is the recommended frequency for monitoring blood pressure?

Every 1 hour Signup and view all the answers

Which of the following is NOT a cause of hypotension?

Myocardial hypertrophy Signup and view all the answers

Which type of medications are known to contribute to hypotension?

Sedatives and vasodilators Signup and view all the answers

What effect does high external or internal PEEP have on blood pressure?

Can cause hypotension Signup and view all the answers

Which of the following conditions does NOT typically lead to hypotension?

Normal cardiac function Signup and view all the answers

What is the expected capillary refill time after a 5-second compression of the nail bed?

3 seconds Signup and view all the answers

When should End tidal CO2 be monitored in patients?

Every hour if needed Signup and view all the answers

Under which condition is Central Venous Pressure (CVP) monitoring required hourly?

If the patient has a Central Venous Catheter (CVC) Signup and view all the answers

What should happen to the pink color in the nail bed after compression?

It should return within 3 seconds Signup and view all the answers

What does a capillary refill time longer than 3 seconds potentially indicate?

Dehydration or shock Signup and view all the answers

What might lead to copious, thin secretions in a patient?

Infection Signup and view all the answers

How often should breath sounds be monitored in a physical examination?

Every 1-4 hours Signup and view all the answers

What should be checked to assess the condition of secretions?

Color of the secretions Signup and view all the answers

If ventilator tubing contains fluid, what action should be taken?

Reposition the ventilator tubing Signup and view all the answers

What is an appropriate response to an increase in humidity in a patient using a ventilator?

Investigate potential sources of infection Signup and view all the answers

Study Notes

Patient Monitoring in ICU

Monitoring in medicine involves observing a disease, condition, or medical parameters over time.
Monitoring can be continuous (e.g., vital signs using a bedside monitor) or repeated (e.g., blood glucose monitoring).
Monitoring aims to detect problems early and manage them.
Important parameters are monitored regularly and recorded.

Introduction

Monitoring initiates when a new symptom or finding arises.
Crucial parameters for ICU monitoring include cardiac and hemodynamic function, respiratory status, blood glucose, body temperature, renal function, and nutritional status.

Patient Behaviors

Monitor for anxiety, fear, restlessness, and agitation, also patient's response to the environment and medical devices.
Assess comfort and use sedatives when needed.
Check Pao2 and Spo2, and evaluate the patient-ventilator system.
Check for and manage pain.
Use the Glasgow Coma Scale (GCS) to assess alertness/consciousness levels.
Evaluate perfusion to the brain by checking blood pressure and looking for acute events like strokes.
Monitor ABGs if PaCO2 increases.
Note and manage medication use.
Track sleep adequacy.

Patient Behaviors (continued)

Monitor for twitching, convulsions, and tetany, especially if anticonvulsant levels are low in patients with known seizures.
Check for PaCO2 changes with rising pH.
Observe for breathlessness, anxiety, decreased oxygen (↓PaO2), decreased ventilation, and pneumothorax.

Inspection

Evaluate chest wall movements and look for paradoxical chest movement, inward chest movement during inspiration, or asynchronous chest and abdominal movement.
Observe for unilateral decrease in chest wall expansion. This could be due to bronchus intubation, pain, air, blood, or fluid in the pleural cavity, atelectasis, or consolidation.
Look for airway obstruction at the endotracheal tube (ETT) level.
Assess for in-line continuous nebulization and monitor for secretions.
Check for fluid accumulation in the ventilator circuit.
Inspect for inappropriate ventilator settings (flow rate, I:E ratio, FiO2). Watch out for leaks in the system at ETT levels or the circuit itself.
Observe for pneumothorax by looking for decreased oxygen levels (↓PaO2) and increased carbon dioxide levels (↑PaCO2). If no cause is found, disconnect from the ventilator and use manual ventilation with 100% oxygen.

Vital Signs

Blood Pressure: Monitor hourly. Hypotension may indicate decreased intravascular volume, high external/internal PEEP, cardiac failure, or certain medications (sedatives and vasodilators). Check drainage systems and for IV site leaks. Hypertension may be due to anxiety, inadequate sedation, high carbon dioxide (↑PaCO2), or medications like vasopressors
Heart Rate and Rhythm: Monitor frequently (hourly) for new arrhythmias or changes (tachycardia or bradycardia). Evaluate for anxiety, sedation, drug use, low oxygen/high carbon dioxide levels, and low intravascular volume. Check other hemodynamic parameters to evaluate perfusion.
Urinary Output: Monitor and calculate hourly. Decreased output points to low kidney perfusion, low intravascular volume, and acute renal failure. Increased output (over 100 mL/hr) indicates possible overhydration. Normal ranges exist for adults and children
Temperature: Monitor every 4-8 hours. Fever could be due to overheating humidifiers, atelectasis, infection, and high metabolic rates. Lower temperatures might be seen in the elderly. Observe if the axillary temperature is lower, or if the rectal temperature is higher than the oral temperature.
Respiratory Rate: Monitor every 1-4 hours for changes related to ventilator settings, metabolic needs (anxiety, stress, infection, edema), low oxygen (↓PaO2), and high carbon dioxide (↑PaCO2) levels. Note use/potential effect of medications (sedatives, narcotics, anesthetics). Watch out for weaning complications and raised intracranial pressure

Physical Examination

Breath Sounds: Monitor hourly or every 1-4 hours. Listen for unilateral decreased sounds, suggesting ETT blockage or fluid in the pleural space, blocked ETT, or issues like pneumonia. Look for late inspiratory crackles, which point to atelectasis or restrictive lung issues. Also check for decreased or absent breath sounds accompanied by mediastinal shift, which is a possible sign of tension pneumothorax. This is especially important in patients who are difficult to ventilate during CPR or those who worsen during ventilation.
Air Leaks: Consistently inspect ETT and its cuff for leaks (hourly or every 1–2 hours) as this can lead to deflated/ruptured cuffs or ETT positioning above the vocal chords.
Airway Secretions: Regularly check and evaluate airway secretions (with each suction). Thick secretions may indicate low humidity levels, while copious, thin secretions could suggest infection or fluid drainage into the trachea.

Lab Investigations

Arterial Blood Gas (ABG): Evaluate with changes in ventilator settings or unexplained changes in the patient's condition.
Serum Electrolytes: Daily or every other day.
Blood Urea and Serum Creatinine: Twice weekly or Daily if needed.
Cultures: As needed based on the patient's condition.

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Description

This quiz explores the protocols for monitoring new symptoms during routine health checks, particularly in respiratory care. Questions cover the importance of addressing new signs, potential causes for changes in the patient’s condition, and appropriate responses to asynchrony with the ventilator. Test your knowledge on critical monitoring practices and interventions in respiratory management.