monitoring invasive and non invasive

8/9/2019 MONITORING INVASIVE AND NON INVASIVE

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TEAM: Camila Seixas Calina Helena Garrido Isabelle Cristiani Cristinne Susana Costa

INTRODUCTION

Monitoring The

which is

MONITOR: prevent, assess, advise, act. Methodical observation of clinical and laboratory parameters, measurable in an objective way, which will allow continuousmonitoring of a system of the body, providing data for therapeutic and diagnostic approaches.

Visa measurements, frequent and repeated physiological variables.

Hemodynamics The

which isHemodynamic Monitoring

study the movements and pressures from the bloodstream.Study the movement and pressure of blood flow through the methodical observationof clinical and laboratory, which will allow continuous monitoring of a systemof the organism, invasive and noninvasive.

Hemodynamic MonitoringPURPOSE

Assisting the diagnosis of various disorders cardivasculares; Targeting therapies to minimize cardiovascular dysfunction; Forecast data obtained; Treating disorders; evaluate response to therapy; Provides qualitative and quantitative information of intravascular pressures.

Hemodynamic Monitoring

PURPOSE

Recognize and evaluate potential problems in a timely manner, aiming to establish an immediate and appropriate therapy.

Hemodynamic MonitoringMETHODS

Invasive and noninvasive, covering a range of physiological variables.

Hemodynamic MonitoringLIABILITY Nurse Medical Intensive

Evaluation and interpretation of hemodynamic data (qualified assistance)

Invasive monitoringCritically ill patients continuous assessment of your cardiovascular system monitoring systems direct pressure


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Hemodynamic Monitoring

Methods used for pressure measurement

Water or mercury manometers: The intravascular catheter is filled with liquid and connected directly to the water column (Central Venous Pressure) or a column o

f mercury (Systemic Blood Pressure) graduated.


Electronic pressure transducers: The intravascular catheter is filled with liquid and connected to a electromanometry (Straing-Gauge).


As the mechanical impulse is transformed into electrical

Intravascular pressure wave

Mechanical drivesf rm n the air

Diaphragm transducer

to Tr

Electrical impulse

Invasive monitoring

Monitoring

SBP MBP Monitoring Monitoring Monitoring PAP PVC Monitoring of IAP Monitoring PIC

MONITORING OF SYSTEMIC ARTERIAL PRESSURE

MONITORING OF PASBLOOD PRESSUREthat the blood exerts pressure within the arteries during systole and diastole of the ventricles depends on the DC, PVR, blood volume and blood viscosity. BP =CO X PVR (mmHg) PA NORMAL

Ventricular systole

Ventricular diastole

PAS MONITORING STATEMENT:

Postoperative period of cardiac surgery, Post-operative recovery can not occur i

n which large changes in systemic arterial pressure (eg carotid endarterectomy,resection of aortic aneurysm) In situations where there is a need for strict control of blood pressure (eg control hypotension) When a strict control of blood g


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ases is necessary;

MONITORING OF LOCAL PAS DE CATHETER INSERTION:

Radial artery

Pedis artery axillary artery Femoral artery


It is considered:

Pot choice Complications

Radial artery

Located distal

Small diameter

Rather accurate measurement


The puncture of the brachial artery should be avoided due to the potential riskof thromboembolic complications in the forearm and hand.Brachial artery

MONITORING OF LOCAL PAS DE CATHETER INSERTION: The axillary and femoral arteries are the larger vessels available for puncture,and therefore would present the lowest risk of stroke by the presence of an intraluminal catheter.

Axillary artery Femoral artery

The inconvenience of punctures in the axilla and inguinal region are the difficulty of achieving healing and greater potential for contamination of these regions.

MONITORING OF LOCAL PAS DE CATHETER INSERTION: The arterial line can be achieved by: Biopsy; or arterial dissection.It is indicated

Percutaneous puncture with the needle on plastic device that reduces the possibility of arterial injury

The percutaneous catheter on the needle is a nursing procedure. It should be: use aseptic technique, a topical local anesthetic (xylocaine gel) and infiltrationwith 2% xylocaine without vasoconstrictor.


If you are unable to puncture the radial artery: The second choice is the dorsalis pedis artery; And finally, you should try the femoral artery.

MONITORING OF PASBP has a normal characteristic curve with two components: ANACRTICO ejection of b

lood and the systolic pressure. dicrotic dicrotic node represents diastole and the closure of the aortic valve.Arrhythmias, hypotension, aortic valve disease or constrictive pericarditis can


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affect the curve of the PA hematomas, intraluminal thrombus, or impaction of thetip folds may dampen the curve.

MONITORING OF RISKS AND COMPLICATIONS PAS

Vascular compromise (eg thrombosis, hematoma, vasospasm); disconnection and exsa

nguination; accidental injections of drugs, local and systemic infection, nerveinjury (compressive neuropathy), aneurysmal formations, arteriovenous fistulas,necrosis and gangrene of the digits, and distal embolic phenomena Proximal; Embolization of vertebral artery (axillary puncture).

MONITORING OF PASNON-INVASIVELow Easy Easy

INVASIVE High

costcost

application maintenance as low

Personal Risks

Delay

skilledTime Maintenance Precision Speed

Perfusion Drive Positioning

cuff

(Bat - bat)

NURSING CARE IN INVASIVE MONITORING OF PAS

Careful observation of signs and symptoms of complications: Use of radial arteryand dorsalis pedis wherever possible realization of the modified Allen test before radial artery cannulation, use of aseptic technique for puncture; Use of catheter over needle, 20G, avoiding larger catheters; secure catheter fixation andfixation with wrist splint; continuous irrigation catheter system with low flow(heparinized sterile saline solution); The transducers should have disposable hoods; Perform daily check of the site of catheter insertion; Limitation of cannulation blood for the shortest time possible without leaving the catheter for morethan 72 hrs;

MEAN ARTERIAL PRESSURE MONITORING

MONITORING OF PAMMeasurement of blood pressure throughout the cardiac cycle.MAP = PS + (2 X PD)

__________________________

3


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Value trusted only by direct measurement of MAP NORMAL: 70 to 105 mm Hg.

MONITORING OF PAMProcedure:1) catheter inserted into the artery: the Seldinger technique. 2) connected to atransducer mechanical signals (radial pulse) ELECTRICAL SIGNALS 3) curves on th

e monitor - or mercury manometer sphygmomanometer (HOLDERS OF INFECTION)

MONITORING OF PAMCURVE OF BLOOD PRESSURE:1) Represents the LV ejection of blood into the aorta First phase of the pressure wave is preceded by QRS ECG intraventricular pressure falls in relation to aortic pressure - aortic valve closure of the second wave of pressure - dicrotic notch (ECG : end of the T wave, ie at the end of systole and early ventricular diastole) Represents the end of ventricular diastole and continuous fall in the intra-aortic

2)

3)

MONITORING OF PAM1

2

3

NURSING CARE IN THE TECHNIQUE OF CATHETER INSERTION Explain to the client the procedure to be performed; Organize all material nextto the bed; Perform cleansing the skin with the germ solution (circular motion f

rom center to periphery); Remove excess solution with germ SF; Protect Local with sterile gauze or bandage; Assist the physician in the scrub; After insertion of the catheter tip to the nurse provides the system for the physician to make the connection; dressing in place; Level and reset the system for proper reading of the curve pressure, remembering to do this procedure every time you change theclient's position on the bed, dressing Perform daily, inspecting the areas of catheter insertion and adjacent;

NURSING CARE IN THE TECHNIQUE OF CATHETER INSERTION

Communicate changes; Observe end of the member involved; Promote adequate fixation of the catheter; Explain about the withdrawal of the system, the fluid Closeheparinized catheter; Depressurise the system, remove the bandage from the puncture site and remove the attachment point of the catheter (aseptic technique) with sterile gauze and using the index and middle fingers of one hand press about 2cm above the puncture site with the other hand, remove the catheter and despisehim; Press with index finger and average over the puncture site; Decrease manual compression gradually until all bleeding cessse; Make dressing and keep it for12-12 hours.

MONITORING OF CENTRAL VENOUS PRESSURE

MONITORING OF PVCRight atrial pressure


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Preload of the RV

Capacity

Filling up the RV at end diastole

MONITORING OF PVC

What is the main purpose of the measurement of PVC? It is estimate the RV end-diastolic pressure; It is an indication of hydration status and right heart function; Giving information of the need for infusion of fluids.Reserve in patients with heart failure and normal pulmonary vascular resistance,CVP can drive the global hemodynamic handling.

MONITORING OF PVCINDICATIONS guide for fluid replacement; Assessment of cardiac function; Aspiration of air in neurosurgery; Collection of blood; Infusion drugs; Passage of a pacemaker; Pass the pulmonary artery catheter.

MONITORING OF PVCPROCUREMENT OF PVC It is usually obtained through a catheter located in superior vena cava; The pulmonary artery catheter can also measure the PVC through the proximal hole that leads to AD.

MONITORING OF PVCPROCUREMENT OF PVC The main veins used CVP monitoring are: to

Brachial vein

Subclavian vein

Jugular vein

MONITORING OF PVCPREVIEW

MONITORING OF PVCPREVIEW

It is checked radiographically to ensure that the catheter is properly positioned and not within the right atrium.

MONITORING OF PVCHow can the pressure be monitored?Gauge water (intermittently) Transducer Electronic (continuously)

MONITORING OF PVCWhat are the average normal PVC? 3-6 6-12 cmH2O mmHg or vary

It is measured through the midaxillary line as zero reference.

MONITORING OF PVCMaterials needed to monitor a PVC water column: to

MONITORING OF PVCFactors that affect the real value of PVC: For the patient: Changing position in bed; Handling excessive; large and laborio


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us breathing movements (inspiratory or expiratory) Patients connected to mechanical ventilators with inspiratory pressure or PEEP, it will decrease venous return and consequently levels modified PVC.

MONITORING OF PVCFactors that affect the real value of PVC: In relation to the catheter and systems

connection: Bad positioning of the catheter tip; clot in the catheter; Catheterstoo thin or high-complacency; Presence of air bubbles in the system; Cathetersbent or bottlenecks;

MONITORING OF PVCFactors that affect the real value of PVC: Regarding the measurement system: Zero reference improperly positioned, inadequate electrical zero; Change in membrane transducer; improperly calibrated transducer and amplifier; Small response range of the water column in relation to hemodynamic parameters.

MONITORING OF PVC

Changes in the values of PVC:PVC PVC Hypervolemia (bradycardia) Hypovolemia (tachycardia) The venodilation caused by sepsis, drugs or neurological causes, may also decrease the PVC. Drugs vasoconstrictor norepinephrine Severe RV; Cardiac tamponade; Overload volume of liquid; pulmonary hypertension Disease of the tricuspid valve, chronic left ventricular failure. Drugs vasodilator

NURSING CARE IN INVASIVE MONITORING OF PVC

Check

radiological catheter position before installing the PVC; Fill the system with saline; Remove any air bubbles of the measurement system;

NURSING CARE IN INVASIVE MONITORING OF PVC

Measure the PVC through the water column in cm or graduated measuring through atransducer and monitor calibrated in mmHg; observe the oscillation of the watercolumn or from baseline on the monitor electric; Keep the puncture site with sterile dressing; Use aseptic technique for handling the system; Observe puncture site for the presence of pain, heat, redness and swelling, do not let the catheter for more than five days;

MONITORING OF THE PULMONARY ARTERY PRESSURE

MONITORING OF PAP OBJECTIVES:

Assess right ventricular function or indirectly from the left; evaluate the pulmonary vascular function of the state; Monitor the changes of hemodynamic status;Targeting therapy with pharmacological agents and nonpharmacological; provide data indicative of prognosis


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MONITORING OF PAP PAP pulmonary artery pressure curves of PAP is divided into three phases: Systolic Diastolic Average

MONITORING OF PAP PAP pulmonary artery pressure Systolic Phase

VEM RV fast blood flow

PAPS = RVSP

Opening of the pulmonary valve

AFTER

Pulmonary artery

MONITORING OF PAPPVD


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Description of the Catheter:

There in sizes newborn (3 French), children (5 French) and adult (7F). catheteradult varies in two lengths: 85 and 110 cm.

Swan-Ganz

Structures of Catheter:Via Proximal gauge PVC and harvestblood. blood.

Via Distal measure PAP and harvest Via Balloon assists in the migration andwedged catheter. thermistor measures the temperature of blood in the pulmonary artery.

Via extra Medication

Swan-Ganz

Swan-Ganz

Catheter insertion: It is a sterile procedure and must be performed by the physician.

Insertion site: internal jugular and subclavian

Remarks: The integrity of the cuff should be tested After insertion of the catheter should be made an x-ray to confirm position.

Swan-Ganz

Indication:

Acute heart failure right ventricle infarction, congestive heart failure refractory pulmonary hypertension Situations circulatory hemodynamic instability complex (burned) Emergencies (ARDS, sepsis) Determination of cardiac output (thermodilution) venous blood collection and infusion solutions

Swan-Ganz Contraindications:Patients with recurrent sepsis patient with hypercoagulable patients with abnormal heart rhythm Wolff-Parkinson-White

Swan-Ganz

Complications: A) Related venipuncture:- Pneumothorax - Horner's syndrome - transient phrenic nerve injury

B) relating to the passage of the catheter:- Arrhythmias - Rupture of the pulmonary artery - Drilling RV


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Swan-GanzC) relating the presence of a pulmonary artery catheter:- Venous thrombosis at the site - pulmonary infarction - Sepsis

Video Insertion of catheter SwanGanz

Swan-Ganz

The purple curve represents the central venous pressure characterized by the presence of waves AEV defined by atrial contraction and filling, respectively.

Swan-Ganz

The extent to which the catheter is introduced, there is the pressure curve andright ventricular diastolic pressure value is usually low, as in purple in the picture.

Swan-Ganz

After the catheter reaches the right ventricle to pulmonary artery pressure curve which is characterized by an increase in diastolic pressure and the presence of the dicrotic notch.

Swan-Ganz

Once the pulmonary artery catheter, progress carefully to obtain the pressure curve of pulmonary artery occlusion also characterized by the presence of waves aand v.

Swan-Ganz

The end of the procedure should perform the aseptic dressing and chest X-ray control, which can observe the proper placement of the catheter and no complications.

Intracath

It is a catheter for introduction by vein puncture, usually the internal jugularor subclavian vein, aimed at positioning its distal end in the right atrium. Excellent way to administer drugs and volume as well as to record the right atrialpressure, also called central venous pressure (CVP).

MONITORING OF INTRA-ABDOMINAL PRESSURE

MONITORING OF PIAreduction of DC normal values 0-12 mm Hg increase in respiratory pressure decreased urine output Respiratory failure and reduced cardiac output are caused by chest compression. The reduction in cardiac output is also influenced by decreased venous return caused by compression of the inferior vena cava and portal vein.

15-20 mmHg

MONITORING OF PIA

PRESSURE MONITORING OF INTRA - CRANIAL


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MONITORING OF PIC It

the pressure exerted by the volume of the braincase BloodAmendment of vol. cerebrospinal fluid (CSF) Element Cap

PIC

Ability to adapt, adjust to maintain normal ICP (10 mmHg)

Cause of death ECA

Intracranial hypertension

High volume

MONITORING OF INTRACRANIAL PRESSURE Classification

- ICP


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that affect the application of the method:Lateral ventricle to brain parenchyma and subdural space and subarachnoid membrane (dome) Metallic Fiber

Mechanic

Electronic (chip)

Water

Optical fiber

Equipament the specific

Invasive pressure

MONITORING OF INTRACRANIAL PRESSURE INDICATION

severe TBI; postoperative cerebral edema; ischemic and hemorrhagic stroke, subarachnoid hemorrhage serious; Encephalitis; Hydrocephalus; Post-cardiorespiratoryarrest extended.

MONITORING OF INTRACRANIAL PRESSURE CATHETER

PIC OF

CARE NURSING IN INVASIVE MONITORING THE PAS careful handling and collectively; Head centralized patient body alignment to avoid compression of jugular veins; Decubitus lateral prevent hip flexion; Patients with TOT fixture over the ears to

avoid compression of the jugular ; Register values of ICP and MAP hourly; MAP and ICP values near or equal brain death blood flow; Perform daily change of dressing;

NON-INVASIVE MONITORING

NON-INVASIVE MONITORINGOBJECTIVE

Reduce complications associated with the techniques used for invasive hemodynamic monitoring.

NON-INVASIVE MONITORINGWhy choose noninvasive monitoring? less invasive procedure; Easy handling; Reproducibility of results; Cost-benefit in the ICU invasive procedures, use of

Confirmation by imaging studies.

NON-INVASIVE MONITORINGWhat are the physiological variables monitored? arterial blood pressure, heart rate , Temperature; Respiratory rate; Electrocardiogram; Non-invasive respiratorymonitoring; Doppler echocardiography (DC); Rating neurological non-invasive.

SSVV

NON-INVASIVE MONITORINGVITAL SIGNS


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Variables are simple and commonly used in inpatient units. Vital signs Temperature Fc Respiratory rate Blood pressure

NON-INVASIVE MONITORINGVITAL SIGNS-HEART RATE It is told by manual palpation of the radial artery for aperiod of one minute.

Places where the pulse can be checked

NON-INVASIVE MONITORINGVITAL SIGNS-HEART RATE What can evaluate with the CF? Rhythm Frequency Waveformpulse; Feature own vessel;

NON-INVASIVE MONITORINGVITAL SIGNS-HEART RATE

100bat/min

Deficits in blood flow and blood volume;

FC

Infection Anxiety, stress, exercise, pain, malaise, fever.

The faster heart rate, greater hypovolemia or cardiac deficit.

NON-INVASIVE MONITORINGVITAL SIGNS-HEART RATEFC slow

Ischemia; Blocking the sinoatrial node, coronary heart disease, coronary blood flow insufficient.

Should evaluate the pace, where disordered rhythm may indicate arrhythmia requiring electrocardiogram.

NON-INVASIVE MONITORINGVITAL SIGNS-HEART RATE The shape of the wrist often conveys important information such as Determine if there is aortic valve stenosis (decreased pulse and weak), aortic valve insufficiency (elevation of pulse wave abrupt and sudden loss).The ideal pulse to be observed is the palpation of the carotid artery.

NON-INVASIVE MONITORINGVITAL SIGNS TEMPERATURE- It is usually found in the rectum (ill patients), or mouth; The core body temperature can be checked in the tympanic membrane or mesoesfago; The temperature of the pulmonary artery (= core temperature) can be taken bythermodilution catheter - invasive - pulmonary artery.

NON-INVASIVE MONITORINGVITAL SIGNS-TEMPERATURE

Hyperthermia Infection Tissue necrosis; Carcinomatosis; Diseases hypermetabolic.

Hypothermia Trauma surgery; Or accidental.

NON-INVASIVE MONITORINGVITAL SIGNS RESPIRATORY FREQUENCY It is given by the movements of inspiration and expiration, corresponding to the metabolic process of gas exchange with the en

vironment. During the evaluation it should be noted: Frequency; Depth; Rhythm;



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VITAL SIGNS RESPIRATORY FREQUENCY How to tell?

DURING

1 MINUTE


VITAL SIGNS RESPIRATORY FREQUENCY The breath can be: Superficial; Normal; Deep.

The pace and character of breathing are seen through the movements of the chestand pulmonary auscultation.

NON-INVASIVE MONITORINGVITAL SIGNS, BLOOD PRESSURE movement reflects the general situation, but it requires specific diagnostic data. of the

It refers to the pressure that blood exerts within the arteries. It is associated with: When blood volume, and the circulatory system.

NON-INVASIVE MONITORINGVITAL SIGNS, BLOOD PRESSUREBlood pressureAmount of blood released by the heart with each contraction

Force of contraction of the heart ventricle depends on the ability to pump blood

The greater the capacity of heart pump blood, more blood will be ejected.

NON-INVASIVE MONITORINGVITAL SIGNS, BLOOD PRESSURE What can alter blood pressure? Decreased circulatingblood volume (PA) Changes in elasticity of the muscular layer of blood vessel walls; Blood viscosity;

NON-INVASIVE MONITORINGVITAL SIGNS, BLOOD PRESSURE What is the normal value of arterial blood pressure?Systolic pressure is equal to 120mmHg and 80mmHg diastolic

Hypertension: 140/90 mmHg

NON-INVASIVE MONITORINGVITAL SIGNS, BLOOD PRESSUREMean blood pressure: one third of the sum of SBP + 2 x PAD

Provide information on: systemic vascular resistance; Work heartbeat LV Cardiacoutput.

NON-INVASIVE MONITORINGVITAL SIGNS, BLOOD PRESSURESystolic blood pressure: the pressure corresponding to the end of systole. It isdetermined by (the): LV systolic volume; Speed ejection of blood; Elasticity ofthe aortic wall.

NON-INVASIVE MONITORINGVITAL SIGNS, BLOOD PRESSUREDiastolic blood pressure: the pressure corresponding to the relaxation of the ventricle. It is established by: Peripheral Resistance; And by the FC.

Pulse pressure is the difference between the SBP and DBP.



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VITAL SIGNS, BLOOD PRESSURE How to measure the blood pressure?

Esfingmomanmetro Stethoscope + It is recommended that you use the invasive methodin patients in critical condition and / or in shock.

Electrocardiographic monitoring

Electrocardiographic monitoring FUNCTION:

Frequency measurement; Measurement of cardiac rhythm; detect arrhythmias, ischemia cardiac pacemaker function

Electrocardiographic monitoring OBJECTIVES:

Produce and display faithfully the signal and eliminate unwanted signals - noise

or interference;Electrocardiographic monitoring AREAS

Problems:

Patient Intallation electrode; Preparation of the skin, or oily skin moist, hairy sue; Skin; Interference muscle; Movements;


Positioning of electrodes: V1 - fourth intercostal space, right edge D1 - MSD and MSE sternum D2 - MSD and MIE V2 - 4th EI, board left sternal D3 - MSE and MIEV3 - between V2 and V4 avr - MSD V4 - 5th EI , midclavicular line aVL - MSE V5 -5 EI, anterior axillary line aVF - MIE V6 - 5 EI, midaxillary line

Electrocardiographic monitoring AREAS

Problems:

Electrodes: type electrode, the electrode gel dry, wrapping the electrodes, electrodes cold- low adhesion; Skin;


Problems:

wires: fasteners loose or worn; Links shoddy; breaks in wires; Movement of the cable;e stripped wire Do not leave loose strands hanging over motors, lamps or electric instruments;


AREAS

Problems:


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Environment: electrosurgical equipment; Must withstand discharges issued by the defibrillator; keep out the patient, drivers and cables of known sources of 60Hz;


Problems:

Patient Cables: Loose; bare wires or loose;

NON INVASIVE MONITORING RESPIRATORY

NON-INVASIVE RESPIRATORYCritically ill patients suffer circulatory disorders that alter the perfusion and tissue oxygenation. Parameters to monitor this variable: Arterial blood gases(INVASIVE) Oxygenation - pulse oximeter and transcutaneous oxygen measurement an

d Ventilation - capnography and transcutaneous measurement of carbon dioxideNON-INVASIVE RESPIRATORYOxygenation - pulse oximetry detect the presence of hypoxemia in patients with potential respiratory disorders who are on mechanical ventilation and oxygen therapy in patients with neurological deficits that can affect breathing.

Oxygen saturation => amount of hemoglobin bound with oxygen.

NON-INVASIVE RESPIRATORYOxygenation - pulse oximeter two technologies for calculating the oxygen saturation of arterial hemoglobin:

Plethysmography optical pulse information Espectrofitometria Deduct the vascularbed

NON-INVASIVE RESPIRATORYOxygenation - pulse oximeter plethysmography optical technology that produces forms where the blood pulsing through different amounts of light absorbed. Changesthat occur in the absorption of light by the blood pressure is reproduced graphically: FORMS OF PULSE WAVE

NON-INVASIVE RESPIRATORYOxygenation - pulse oximeterSpectrophotometry Represents quantitative measurements through the wavelengths of light which are absorbed and passed directly through a given substance. The absorption and light transmission by this substance can be determined by two lightemitting diodes (LEDs)

NON-INVASIVE RESPIRATORYOxygenation - pulse oximeter sensor pulse oximeter: Source of light photodetector receives light from the sensors and detects the difference in transmitted light, which was absorbed by hemoglobin molecules.

NON-INVASIVE RESPIRATORY

Oxygenation - pulse oximeter

Chills, pressing activities, patient restless in bed, low perfusion and edema


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Interfere with oximeter readings

NON-INVASIVE RESPIRATORYMeasurement of transcutaneous oxygen tension

The skin is suitable for measuring oxygen tension - PtcO2. The oxygen tension isa variable for the perception of early disturbances in the systemic circulationand assessment of tissue perfusion. Clark electrodes and heated miniturizados => Non-invasive measurements of PtcO2. Heated electrodes were used as substitutesfor measurements of oxygen partial pressure - PaO2 in newborns, in order to reduce the need for arterial puncture.

NON-INVASIVE RESPIRATORYMeasurement of transcutaneous oxygen tension

PtcO2 enables continuous monitoring and real-time location of oxygen transport.PtcO2 depends on: O2 partial pressure in arterial blood, and DC BLOOD FLOW. RN hemodynamically stable satisfactory. Infants with circulatory problems PtcO2

PtcO2


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- Two electrodes on the anterior chest capture electrical axis running from themonitor - Monitor weight height sex date 6 digit printer - Control of the electro magnetic environment

MONITORING OF DC

Thermodilution catheter arterial diameter 4F, through the femoral artery and con

nected to a computer for analysis of the pulse wave for assessment of left ventricular cardiac output and thus determine the remnant right ventricular function.

MONITORING OF DC

Advantages

Method

- - -

Low cost Ease of installation Continuous data with precise interpretations - no

risk of morbidity and mortality.Neurological monitoring

Neurological monitoring

Held every hour depending on the patient's condition What's the point? To reduce morbidity and mortality in the ICU, without jeopardizing patient care.


TERMS: transcranial spectroscopy; Ecoencefalografia; Electroencephalography, Transcranial Doppler; Potential wrong


Transcranial spectroscopy; Monitor the supply of O2 and cerebral hemodynamics Utilizes an injection verdeindocianina marker that displays intense infrared absorption

Neurological monitoring Ecoencefalografia; It is the record of echoes inside the skull through ultrasound; transcribed Theimages are stored on the oscilloscope; It determines the position of brain structures and delinha average distance from it to the wall of the lateral ventricleor the wall It detects the third ventricle midline shift caused by cerebral subdural hematoma, intracerebral hemorrhage, neoplasms

Neurological monitoring Electroencephalography: Record of electrical activity generated in the brain Provides physiological assessment of brain activity; It is useful in the diagnosis of seizures, Assessment of

coma or brain syndromes and somo indicator of brain death



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Doppler

Transcranial:

It measures the flow velocity of middle and anterior cerebral arteries Diagnostic cerebral vasospasm resulting from subarachnoid hemorrhage


Potential

evoked:

It is used to define the absence of structural lesions in the toxic and metabolic comas and to localize lesions of the brainstem, and reports on post-traumaticcoma

Assistance NURSING

PLAN OF CARE nursing diagnosis Risk for decreased cardiac output related to vascular resistance, blood vessel constriction, myocardial ischemia, hypertrophy / ventricular stiffness. Expected Outcomes Patient present stable cardiac rhythm and frequency within the normal range of the individual; Maintain BP within the range acceptable spoke individually Monitor PA; Observe the presence and quality of peripheralpulses Auscutar heart sounds and breath sounds; Observe skin color, moisture, temperature, Observe edema; Monitor responses to medication to control blood pressure. Check vital signs

Nursing diagnosis

Expected Results

Interventions Conduct procedure aseptic technique; Wash hands using the technique before and after invasive procedures Check the vital signs of 2/2h (8:00, 10:00, 12:00, 14:00, 16: 00, 18:00, 20:00, 22:00, 24:00, 02:00, 04:00, 06:00) Use PPE before procedures Carry out general hygiene 12/12h Observe the general hygienein the hours established.

Patient risk for infection not related to infection present performance of invasive procedures

Nursing diagnosis related to perceptual change sensory cranial edema characterized by absence of pupillary reaction

Expected Outcomes Patient recover sensory perception reacting to sensory stimuli

Speakers Maintain dialogue with the patient during procedures (where necessary) Administer analgesics that do not mask the level of consciousness as prescription; Apply cold compress to eye with saline in the morning, noon and night; Request Evaluation neurological.

Nursing diagnosis

Expected Results

Speakers

Cerebral tissue perfusion altered: less than body requirements related to inabil


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monitoring invasive and non invasive

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