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critcial care Flashcards

1
Q

pirmary goal of CPR

A

adquate perfusion to the brain and vital organs

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2
Q

dept of CPR

A

2-2.4

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3
Q

after each compression the

A

chest should recoil completely

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4
Q

hand placement during CPR

A

center of teh chest

lower half of the sternum

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5
Q

drop in o2 stat intevention

A

asuculate

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6
Q

auscultating lung sounds is the first step and quickest intervntion for

A

tube placement

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7
Q

hypothermia occurs when

A

the core temp falls bwlow 95F and body isunable to comprensate for head loss

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8
Q

what happens to the heart when the temp drops

A

prone to dysrthmias

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9
Q

hypothermia and heart

A

handl hently as sponteous VFIB can occur when moved or touched so PLACE THEM ON CARDIAC MOINTOR and anticpate defillation

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10
Q

other intervnetion for hyopterhmia

A 
cover the head oto prevent heat loss
- the trunk should be warmed before ext to reduce the risk of afterdrop 
=blood droaw
-2 bore iv
-BUT MOST IMPORTANT IS CARDIAC MOITOR
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11
Q

recently extubated clients are risk for

A

aspiration, airway obsutrction (laygeal edema or spasms)

-resp distress

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12
Q

extubated pt management

A

high fowler

  • humdified o2
  • oral care
  • cough deepbreath and incentive
  • NPOOOOO-dont give narcotpics because nPOOO
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13
Q

after extubation how to prevent aspiration

A

NPO NOT EVEN ICE CHIPS

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14
Q

IV sedation and defillation

A

not given because pt is already uncousiones but it is often given prior to cardioversion to ease anx and pain

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15
Q

breaths if no compression

A

every 6 seconds

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16
Q

def pads placed on

A

right upper chest and on left lateral chest

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17
Q

allen test

A

intrsuct client to make first
occlude the radial and ulnar arteries
2) instrcutor the client to open fist and the hand should be pallor
3) release pressure on the ulnary and palm should turn pink in 15 seconds indicating patency of the ulnar artery

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18
Q

postive allen test

A

patency of the ulnar arety

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19
Q

if allen test is poistive then

A

the ABG can be drawn

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20
Q

if allen test if negative

A

brachial or femoral artery should be used

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21
Q

prevention of VAP

A

hang hydgeine

  • noniinvase ventilation when possible
  • daily sedation and weaning
  • semirecumbent poistion (30-45)
  • aspuration of secretions
  • endotrach tube ?20 cm h2o
  • oral antisepctcs
  • routine prophalyxis not recommended
  • avoid PPI and anithistamine agents
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22
Q

ET suctioning

A

only when needed to

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23
Q

decerbrate signs

A

arms and legs straight out

  • TOES POINTED DOWN
  • head and eck arched back
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24
Q

what is seen in near drowning clients

A

hypothermia

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25
Q

pulses in near drowning clients

A

weak and thready

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26
Q

PAWP normal value

A

6-12 mmhg

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27
Q

PAWP indicate

A

left centricle preload

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28
Q

increased CVP and PAQP

A

fluid overload

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29
Q

PEEP

A

pressure given at the end of expiration during mechanical ventilation
-helps keep the alveoli open to help with gas exchnage

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30
Q

PEEP is uslaly kept at

A

5cm h2O

but in ARDS it might be higher

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31
Q

high PEEP (10-20)

A

causes overdistention and rupture of the alveoli resulting in barotrauma resulting in ppnuemthroax and sub empahsyema
-hypotension

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32
Q

PEEP allows

A

for the use of lower fio2 which reduces risk of o2 toxicity

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33
Q

peep helps reduce

A

o2 toxiity

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34
Q

an inpaled objct

A

should not be manipulated or removed at the scene as further truma and bleeding can occur
-SO STABILZE IT

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35
Q

Phlebostatic acis anotmial position

A

supine position

4th ICS midway point of the AP th ICS, at the midway point of the AP diameter (½ AP)of the chest wall. diemeter

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36
Q

if transfucer is placed low or high

A

if placed low–> high reading

placed high—>low reading

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37
Q

fever is not an

A

emergnecy situation that requires rapid response team

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38
Q

respid response teams cirteria

A

sudden signifcant changes

-changes in pulse rate radily, RR, SBP, o2 sat, LOC, UOP

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39
Q

resp acidosis

A

COPD
OBESIT HYPOTVENTIATION
resp dep due to narcotics

40
Q

met alkalosis

A

vomitng

direuesis

41
Q

ouse o2 readings more accurate when

A

sesor is placed on the forehead rather than the finger

42
Q

torsades de pointes

A

qrs complex changes in size and shape in a twisting pattern

43
Q

torsades de pointes us uslaly due to

A

prolonged QT interval

44
Q

Porlonged QT interval is due to

A 
electlyte inabalces (HYPOMAGNESIUM)
-meds
45
Q

first line treatment in torsades de pointes

A

IV mag

-other treatments include defib and disocntinue WT prolonging meds

46
Q

comon to do what ater ventilator change

A

measure ABG

47
Q

what can changE abg resulrs

A

suctioning prior
changes in client actv
o2 setting change
POSITING WILL NOT AFFECT ABG

48
Q

SVT are generally treated with

A

vagal neurvers (act of bearing down)
IV adenosine
but vagal and adenosine is the best treatment
-cardioversion if med prob

49
Q

adenosine

A

treats SVT
5-6 second half life
-PLACE IV AS CLOSE AS POSSIBLE NOT DISTALLLLLLL to the heart
- give quickly 1-2 seconds then do rapid 20 ml normal saline flush

50
Q

rapid response

A

An acute change in any of the following:

    Heart rate <40 or >130/min
    Systolic blood pressure <90 mm Hg
    Respiratory rate <8 or >28/min (Option 4)
    Oxygen saturation <90 despite oxygen
    Urine output <50 mL/4 hr
    Level of consciousness (Option 5)
51
Q

intervention for blunt force head injury

A

first checks if the client is breathing and has a pulse (using the rule of airway, breathing, and circulation [ABCs]). Spinal injury should be presumed, and the cervical spine should be stabilized (eg, cervical collar). The jaw-thrust maneuver may be used to open the airway.

52
Q

superfical frostbite maestiation

A

mottled
blue
waxy yellow skin

53
Q

deep frostbite

A

white, hard and unable to sense touch

54
Q

treatment of frostbite

A
  • remove lothing and jelwry to orevent constriction
  • do not massage , rub or squeeze the area
  • immerse in warm water
  • avoid heavy blanket or clothing
  • provide angesia because rearming is EXTREMLY PAINFUL
  • as thawing occurs, injured area qill become edmatour and blister so elevateeee to reduce edema
  • KEEP wounds open after bathh and allow them to dry before applying loose onadherent sterile dressing
  • look for comparmtent sydnrome
55
Q

most common morality in clients who had cardiac arrest

A

neurolgic

56
Q

improve mortality rates and improve neuro outcomes in clients with cardiac arrest

A

inducing theputic hypothermia within 6 hours and mainting it for 24 hours has shown to decrease mortality and neuro- DO IN pt who are comatose or do not follow commands

57
Q

inducing hypothermia steps

A

client is cooled to 89-93 F

  • cooling accomplished by cooling blankets, ice placed in groin, axillae, sides of neck, cold IV fluids
  • mointor for bradycardia, bp (MAP should be kept at >80)
  • skin for themal injury
  • keep HOB 30 degreee to protect head
  • after 24 hours client is rewarmed
58
Q

during hypotehrmia and rewarming clients should be kept

A

npo so no ng

59
Q

gastric lavage is performed using

A

orogastric tube to remove igested toxins and irrigate the stomach after drug overdose

60
Q

gastric lavage should be initated

A

within one hour of overdose

61
Q

gastric lavage is

A

rarely performed as it is assoicated with high risk complications

62
Q

complications of gastric alvage

A

aspiration
esophageal or gastric perforation
dysrthmias

63
Q

what should be at bedside when doing gastric lavage

A

intubation and suction supplies

64
Q

gastric lavage is uslaly performed through

A

large bore so water or saline can be instilled in and out of the tube

65
Q

poistion for gastric lavage

A

placed on their side or with HOB elevated to minimize aspiration risk

66
Q

drug overdose

A

gastric decmopress first and then lavge within one hour

67
Q

nursing interventions to control ICP

A 
elevate HOB 30 and head and neck neutral poistion
-adm stool softner
-manage pain
-managing fever
-maintaing a calmn env
-adq o2
-hyperventilating and peroxygenating
-AVOID CLUSTERS intervention
only suction for max of 10 secods
68
Q

guillain barre most often accompained by

A

asending muscle paralysis and absence of relfexes

-neuromuscular resp failure

69
Q

gold start of assessing early ventilation failure

A

serial bedside forced vital capaicty

70
Q

stages of shock

A

inital
compensatory
progressive
irrversible

71
Q

hypovoemic shock can occur

A

after abdominal trauma or surgery

72
Q

et cuff leak

A

asuculate

73
Q

oral care with suctioning

A

every 2 hours

74
Q

et usctioing

A

only when needed

75
Q

cirtcially ill clients are at risk for

A

aspiration

76
Q

what should be avoided in critcally ill pt

A

bolus because it causes risk for aspiration

77
Q

what can prevent aspiration in ill high risk clients

A

assessing gastric risduals
level of sedation
checking enteral feeding tube
adm continual rather than bolus feeding

78
Q

clients in vtach can have

A

pulse or no pulse

79
Q

unstable pt in VT with pulse

A

cardioversion

80
Q

stable pt with pulse

A

antiarrymatic *amidarone, procainde, sotaolol)

81
Q

oulselss pt

A

CPR or defib

82
Q

vfib.pulsess vtach

A

shock, spr 2 min, iv access,

83
Q

E[INPEHRINE

A

after CPR and def

84
Q

malignant hyperthermia

A

rate life thereaning mucle abnormaility triggered by certain drugs used to induce gerneal anesthesis and succinycholine (paralytic agent)

85
Q

ealiest sign of maigligant hyperthermia

A

hypercapnia
tacypnea
tacycardia
rigid jaw or generalized ridigity

86
Q

other signs of malugnant hypertermia

A

muscle ridigity (njaw, trunkm ext)
-hypertermia (later sign)
-high fever
muscle tissue break down–>hyperkalemia, cardiac dsythrmia, myoglobinuria

87
Q

treatment for malginat hyperthermia

A

dantrolene
cooling blanke
fluid resucatation

88
Q

after anestehsia what is usual

A

diff to arouse
small pupil size
hyphtermia

89
Q

best way to visualize airway

A

jaw thrust in SUPINE

90
Q

postive pressure ventilation causes

A

increased intrathoriacic pressure during inspiration
-reduced venous return, ventricular preload, CO
all resulting in hypotension

91
Q

maligant hypterhmia requires treatment with

A

IV dantrolene to revere process by slowing metablosm

-syccinlycholine should be discontinued

92
Q

priority after placing subclavin central vesous cathter

A

check results of the chest xray to ensure the catheter tip is placed correctly

93
Q

incorrect placement of the subclavin central venous catheter

A

ca result in iatrogenic pneumothroax or hemothroax

94
Q

other priorites for subclavin Central venous catherter

A

attaching a filter to the IV tubing

  • mointoring baseline and fingerstick BG q 6 hours
  • programming electronic infusion decice to esnure an accurate and consistent hourly infusion rate.
95
Q

bg in hospitalized client

A

140-180

96
Q

asytole / pulsesness electrical activ (PEA)treatment

A

CPR
O2
EPI IV
–Defibrillation is not effective for treatment of asystole or pulseless electrical activity.

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