i bc27f85be50b71b1 (246 page)

Purpose: continuous monitoring of

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Notify the nurse before physical therapy

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heart rare and rhythm and

intervention, as many activities may alter the

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respiratory rate (see Table 1 - 1 0).

rate or rhythm or cause artifact (e.g

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.• chest

Consists of: three to five color-coded

percussion).

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electrodes placed on the chest. either

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If an electrode(s) becomes dislodged, reconnect it.

hard wired to a monitor in a

One way to remember electrode placemenr is

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patient's room or monitored at a

white is right (white electrode is placed on the

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distant site (telemetry). Twelve

right side of the chest superior and lateral to the

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electrodes are used for a formal

right nipple), snow over grass (the green electrode

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ECC.

is placed below the white electrode on the

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anterolateral lower right rib cage). smoke over fire

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(the black electrode is placed on the upper left rib

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cage superior and lateral to the left nipple, and the

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red electrode is placed below the black one on the

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anterolateral left rib cage). The brown electrode is

usually placed more cenrraIJy.

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• Patients on telemetry should be instructed to

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stay in the area monitored by telemetry

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antennas.

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Collaborate with the nurse to determine

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whether patienrs who are "hard wired" to

monitors in their room may be temporarily

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transferred to telemetry for ambulation

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activities or whether the monitor may be

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temporarily disconnected.

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Table flJ-A.3. Continued

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Device

Description

Clinical lmplic3tions

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Pulse oximeter

Purpose: a noninvasive method of mea

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Sp02 S;88% indicates the need for supplemental

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Normal Spo, (at sea level)

suring the percentage of hemoglobin

oxygen.

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" 93-94%

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saturated with 02 in aneriaJ blood.

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The waveform or pulse rate reading should match

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Consists of: a probe with an electrothe ECG or palpated pulse.

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optical sensor placed on a finger, roe,

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Monitor changes in pulse oximetry during

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earlobe, or nose. The pulse oximeter

exercise and position changes.

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emits two wavelengths of light to

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Peripheral vascular disease, sunshine, or nail

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differentiate oxygenated from deoxpolish may lead to a false reading.

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ygenated hemoglobin.

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In low-perfusion states, such as hypothermia,

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hypotension, or vasoconstriction, pulse

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oximetry may understate oxygen saturation.

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Small changes in the percentage of hemoglobin

sites chemically combined (saturated) with

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oxygen (Sa02) can correspond to large changes

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in the partial pressure of oxygen. Refer to Table

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2-4 and Figure 2-7.

AV = arteriovenous; BP = blood pressure; ECG = electrocardiography; Sa02 = arterial oxyhemoglobin saturation; Spo! = measurement of Sa02

with pulse oximetry.

Sources: Data from RR Kirby, RW Taylor, JM Civetta (cds). Handbook of Crincal Care (2nd cd). Philadelphia: lippincott-Raven, 1997;jM

Rothstein (cd). The Rehabilitalion Specialist'S Handbook (2nd ed). Philadelphia: FA Davis, 1998; and MR Kinney, 58 Dunbar, JM Vitello

Cicciu, et al. (cds). AACN's Clinical Reference for Critical Care Nursing (4th ed). St. louis: Mosby, 1998.

Table Ill-A.4. Invasive Medical Monitoring

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Device!Normal Values

Description

Clinical Implicacions

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Arterial line (A-line)

Purpose: to directly and continuously record

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If the A-line is displaced, the parient can lose a

Normal values: systolic,

arterial blood pressure, to obtain repeated

significant amount of blood ar rhe insertion

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100-140 mm Hg;

anerial blood samples, or to deliver medisire. If bleeding occurs from the line,

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diastolic, 60-90 mm Hg;

cations.

immediately apply direct pressure to the sire

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MAP, 70-105 mm Hg

Consists of: an arcerial catheter. It is placed in

while calling for assistance.

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the brachial, radial, or femoral arcery. The

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The normal A-line waveform is a biphasic

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catheter is usually connected to a

sinusoidal curve with a sharp rise and a gradual

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transducer that converts a physiologic

decline (Figure Ill-A.8). A damped (flattened)

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pressure into an electrical signal that is

waveform may indicate hypotension, or it may

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visible on a monitor.

be due ro pressure on the line.

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A patient with a femoral A-line is usually seen

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bedside. Hip flexion past 60-80 degrees is

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avoided. After femoral A-line removal, me

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patient is usually on strict bed rest for 60-90

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mins, with a sandbag placed over the site.

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Upper-extremity insertion sires are usually

splinted with an arm board to stabilize the

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catheter.

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The patient with a radial or brachial A-line can

usually be mobilized out of bed, although the

length of the line lirnirs mobility to a few feet.

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The transducer may be taped to the patient's

hospital gown at the level of the phlebosratic

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axis (see Figure ill-A.7) during mobilization.

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Table Ill-AA. Continued

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Device/Normal Values

Descri prion

Clinicailmplic3rions

Pacemaker (temporary)

Purpose:

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co provide temporary cardiac pacing

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The presence of a temporary pacemaker does

postoperatively, status pOSt myocardial

not, in and of itself, limit functional mobility.