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CI2 > Assessment & Monitoring in ICU > Flashcards

Assessment & Monitoring in ICU Flashcards

1
Q

Why are patients admitted to ICU?

A
  • For intensive monitoring, support or therapy
  • Acute or potential organ system failure
  • Appears reversible with provision of intensive support
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2
Q

What types of organ failure are referred to ICU?

A
  • CV (shock, cardiogenic pulmonary oedema)
  • Respiratory (hypoxia, hypercapnoea)
  • Coma
  • Liver
  • Renal (kidneys)
  • Gut
  • Major desquamation of skin
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3
Q

What are the types of admission to ICU?

A
  • Elective (major surgery)

- Emergency (major surgery, multi-trauma, management of severe medical conditions with major organ dysfunction)

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4
Q

What does assessment & monitoring in ICU enable?

A
  • Establish precise diagnosis
  • Determine appropriate therapy
  • Monitor response to therapy
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5
Q

What are the types of assessment & monitoring in ICU?

A
  • Non-invasive (e.g. BP cuff)
  • Invasive (e.g. arterial line)
  • Derived (e.g. cardiac index measurement)
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6
Q

What is an APACHE score?

A
  • Acute physiology & chronic health evaluation
  • Completed for each patient on admission
  • Severity of disease classification based on 12 physiological parameters
  • Scores 0-71, higher number = sicker patient
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7
Q

What does CV assessment include?

A
  • Heart rate & rhythm
  • Blood pressure
  • Central venous pressure (CVP)
  • Pulmonary artery pressure
  • Pulse induced continuous cardiac output (PiCCO)
  • Intra-aortic balloon pump (IABP)
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8
Q

How is heart rate & rhythm assessed?

A
  • 4 leads for continuous monitoring
  • Normal 60-100
  • Supplemented by 12 lead ECG if more accurate diagnostic info required
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9
Q

How is blood pressure assessed?

A
  • Cuff (non-invasive, intermittent monitoring)
  • Arterial monitoring (invasive, continuous)
  • Cannula inserted into artery (usually radial)
  • ABGs sampled from cannula
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10
Q

What is the arterial line connected to?

A

Transducer that sits at the level of the patient’s heart

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11
Q

What are the normal blood pressure values?

A
  • 95/60 - 140/90

- MAP = DBP + (SBP-DBP)/3 = 70-90mmhG

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12
Q

What is MAP an indirect measure of?

A

Adequacy of organ perfusion

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13
Q

How is central venous pressure (CVP) measured?

A
  • Central venous catheter (CVC) inserted into superior vena cava
  • Connected to transducer
  • Normal = 3-15 cmH2O
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14
Q

What does CVP reflect?

A
  • Hydration
  • Venous return
  • Right heart compliance
  • Intrathoracic pressure
  • Posture of patient
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15
Q

What is a pulmonary artery catheter (Swan-Ganz catheter)?

A
  • Used in patients with CV instability
  • Passes through right atrium, right ventricle to left/right pulmonary vein
  • Connected to transducer, catheter has balloon
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16
Q

What does a pulmonary artery catheter (Swan-Ganz catheter) measure?

A
  • Pulmonary artery pressure (balloon deflated, monitors pulmonary hypertension, normal = 10-20mmHg)
  • Pulmonary capillary wedge pressure (balloon inflated, estimate left atrial pressure, normal = 6-15mmHg)
  • CO or Cardiac index (via thermodilution technique, normal CO = 51 L/min)
17
Q

What does increased PCWP indicate?

A
  • Poor LV function
  • Hypervolaemia
  • Mitral valve disease
18
Q

What does pulse induced continuous cardio output (PiCCO) monitor?

A
  • CO & other parameters
  • Guides fluid & isotrope management
  • Requires use of CVC & arterial line (continuous monitoring)
19
Q

What is an intra-aortic balloon pump (IABP) used to monitor?

A
  • Inserted through femoral artery into aorta
  • Used for patients with severe left ventricular failure
  • Increases perfusion into coronary arteries during diastole
  • Reduces LV afterload & improves CO during systole
20
Q

What does neurological assessment in ICU include?

A
  • Glascow coma scale
  • Intracranial pressure (ICP)
  • Cerebral perfusion pressure
21
Q

What does intracranial pressure (ICP) measure?

A
  • Pressure in the skull
  • Influenced by volume of blood, CSF & brain tissue
  • Normal <10mmHg
  • Critical >20mmHg
22
Q

How is ICP measured?

A
  • Intraparenchymal sensor

- External ventricular drain (EVD)

23
Q

What is the dual purpose of an EVD?

A

Monitors ICP (drain closed) & drains excess CSF/blood from ventricle (drain open)

24
Q

What is increased ICP?

A

Potentially fatal cause of secondary brain injury from lack of perfusion to brain tissue

25
Q

What are the causes of increased ICP?

A
  • Cerebral mas
  • Oedema/infection
  • Obstructed venous drainage
  • Hypercapnia
  • Hyperaemia
  • Increased production, decreased reabsorption or obstruction of CSF flow
  • Posture
26
Q

What is cerebral perfusion pressure?

A

CPP = MAP - ICP

  • Normal value >70mmHg
  • Critical value <55mmHg
27
Q

What does respiratory assessment of non-ventilated patients include?

A
  • Daily CXR
  • ABGs every few hours if arterial line
  • High-flow oxygen for very hyperaemic patients
  • SpO2
  • RR
28
Q

What does respiratory assessment of ventilated patients include?

A
  • Mode of ventilation (record SIMV)
  • RR, TV, FiO2
  • PEEP
  • PIP
  • Humidification
  • Interface (mask, ETT, trachy)
  • Ability to DB/huff on ventilator
  • Amount/quality of sputum on suction
29
Q

What does GI assessment include?

A

Type of nutrition

  • Nil
  • Oral
  • Enteral (NG/PEG tube)
  • Total parenteral nutrition (TPN) directly into CVC
30
Q

What does renal assessment include?

A

Urine output

  • Helps to reassess renal perfusion
  • Guides adequacy of CO
  • Acute renal failure: Rapid rise in urea/creatinine concentration, drop in urine output
31
Q

What is continuous renal replacement therapy/dialysis?

A
  • Used short term in ICU for patients with acute renal failure
  • Removes waste products from the blood
32
Q

What are the considerations for physio for patients on dialysis?

A
  • Pulmonary oedema may be common (fluid retention)
  • Patients may experience a drop in BP after dialysis as fluid is removed
  • Dialysis apparatus may be very sensitive to changes in position & intrathoracic pressure
33
Q

How is fluid balance assessed?

A
  • Measures of intravascular volume (HR, MAP, CVP etc)
  • Daily weight
  • Daily CXR (check for PO)
  • Assessment of peripheral perfusion
  • Net fluid balance on ICU flowchart = intake-output
34
Q

What does haematological & immunological assessment include?

A
  • Coagulation studies (blood tests)
  • Prolonged bleeding time (risk of bleeding/bruising during physio)
  • Low platelet count
  • Low white cell count
  • Sepsis
  • Malignancy
  • Drug therapy
35
Q

What does musculoskeletal assessment include?

A
  • Muscle length/strength
  • Joint integrity
  • Presence of fractures
  • Neuromuscular function (balance, coordination, sensation)
36
Q

What are some of the effects of ICU on patients?

A
  • Sleep deprivation/fragmentation
  • Fear/anxiety
  • Sensory deprivation
  • Discomfort
  • Sensory overload
  • Communication difficulties
  • Helplessness
  • Dependency & depression
  • Loss of privacy, dignity & identity
  • Sensory monotony & loss of time
37
Q

What are some of the after effects of ICU on patients?

A
  • Impaired mobility
  • Continuing pain
  • ICU syndrome
  • PTSD
  • Compression neuropathies
  • ICU acquired weakness
  • Fear of falls
  • Anxiety/depression
  • Decreased fitness
  • Inspiratory muscle weakness
38
Q

What is the role of physio in ICU?

A
  • Respiratory
  • Exercise, strengthening, positioning (early rehab)
  • Mobilisation

CI2 (17 decks)

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