critcial care Flashcards
pirmary goal of CPR
adquate perfusion to the brain and vital organs
dept of CPR
2-2.4
after each compression the
chest should recoil completely
hand placement during CPR
center of teh chest
lower half of the sternum
drop in o2 stat intevention
asuculate
auscultating lung sounds is the first step and quickest intervntion for
tube placement
hypothermia occurs when
the core temp falls bwlow 95F and body isunable to comprensate for head loss
what happens to the heart when the temp drops
prone to dysrthmias
hypothermia and heart
handl hently as sponteous VFIB can occur when moved or touched so PLACE THEM ON CARDIAC MOINTOR and anticpate defillation
other intervnetion for hyopterhmia
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
recently extubated clients are risk for
aspiration, airway obsutrction (laygeal edema or spasms)
-resp distress
extubated pt management
high fowler
- humdified o2
- oral care
- cough deepbreath and incentive
- NPOOOOO-dont give narcotpics because nPOOO
after extubation how to prevent aspiration
NPO NOT EVEN ICE CHIPS
IV sedation and defillation
not given because pt is already uncousiones but it is often given prior to cardioversion to ease anx and pain
breaths if no compression
every 6 seconds
def pads placed on
right upper chest and on left lateral chest
allen test
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
postive allen test
patency of the ulnar arety
if allen test is poistive then
the ABG can be drawn
if allen test if negative
brachial or femoral artery should be used
prevention of VAP
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
ET suctioning
only when needed to
decerbrate signs
arms and legs straight out
- TOES POINTED DOWN
- head and eck arched back
what is seen in near drowning clients
hypothermia
pulses in near drowning clients
weak and thready
PAWP normal value
6-12 mmhg
PAWP indicate
left centricle preload
increased CVP and PAQP
fluid overload
PEEP
pressure given at the end of expiration during mechanical ventilation
-helps keep the alveoli open to help with gas exchnage
PEEP is uslaly kept at
5cm h2O
but in ARDS it might be higher
high PEEP (10-20)
causes overdistention and rupture of the alveoli resulting in barotrauma resulting in ppnuemthroax and sub empahsyema
-hypotension
PEEP allows
for the use of lower fio2 which reduces risk of o2 toxicity
peep helps reduce
o2 toxiity
an inpaled objct
should not be manipulated or removed at the scene as further truma and bleeding can occur
-SO STABILZE IT
Phlebostatic acis anotmial position
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
if transfucer is placed low or high
if placed low–> high reading
placed high—>low reading
fever is not an
emergnecy situation that requires rapid response team
respid response teams cirteria
sudden signifcant changes
-changes in pulse rate radily, RR, SBP, o2 sat, LOC, UOP
resp acidosis
COPD
OBESIT HYPOTVENTIATION
resp dep due to narcotics
met alkalosis
vomitng
direuesis
ouse o2 readings more accurate when
sesor is placed on the forehead rather than the finger
torsades de pointes
qrs complex changes in size and shape in a twisting pattern
torsades de pointes us uslaly due to
prolonged QT interval
Porlonged QT interval is due to
electlyte inabalces (HYPOMAGNESIUM) -meds
first line treatment in torsades de pointes
IV mag
-other treatments include defib and disocntinue WT prolonging meds
comon to do what ater ventilator change
measure ABG
what can changE abg resulrs
suctioning prior
changes in client actv
o2 setting change
POSITING WILL NOT AFFECT ABG
SVT are generally treated with
vagal neurvers (act of bearing down)
IV adenosine
but vagal and adenosine is the best treatment
-cardioversion if med prob
adenosine
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
rapid response
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)
intervention for blunt force head injury
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.
superfical frostbite maestiation
mottled
blue
waxy yellow skin
deep frostbite
white, hard and unable to sense touch
treatment of frostbite
- 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
most common morality in clients who had cardiac arrest
neurolgic
improve mortality rates and improve neuro outcomes in clients with cardiac arrest
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
inducing hypothermia steps
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
during hypotehrmia and rewarming clients should be kept
npo so no ng
gastric lavage is performed using
orogastric tube to remove igested toxins and irrigate the stomach after drug overdose
gastric lavage should be initated
within one hour of overdose
gastric lavage is
rarely performed as it is assoicated with high risk complications
complications of gastric alvage
aspiration
esophageal or gastric perforation
dysrthmias
what should be at bedside when doing gastric lavage
intubation and suction supplies
gastric lavage is uslaly performed through
large bore so water or saline can be instilled in and out of the tube
poistion for gastric lavage
placed on their side or with HOB elevated to minimize aspiration risk
drug overdose
gastric decmopress first and then lavge within one hour
nursing interventions to control ICP
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
guillain barre most often accompained by
asending muscle paralysis and absence of relfexes
-neuromuscular resp failure
gold start of assessing early ventilation failure
serial bedside forced vital capaicty
stages of shock
inital
compensatory
progressive
irrversible
hypovoemic shock can occur
after abdominal trauma or surgery
et cuff leak
asuculate
oral care with suctioning
every 2 hours
et usctioing
only when needed
cirtcially ill clients are at risk for
aspiration
what should be avoided in critcally ill pt
bolus because it causes risk for aspiration
what can prevent aspiration in ill high risk clients
assessing gastric risduals
level of sedation
checking enteral feeding tube
adm continual rather than bolus feeding
clients in vtach can have
pulse or no pulse
unstable pt in VT with pulse
cardioversion
stable pt with pulse
antiarrymatic *amidarone, procainde, sotaolol)
oulselss pt
CPR or defib
vfib.pulsess vtach
shock, spr 2 min, iv access,
E[INPEHRINE
after CPR and def
malignant hyperthermia
rate life thereaning mucle abnormaility triggered by certain drugs used to induce gerneal anesthesis and succinycholine (paralytic agent)
ealiest sign of maigligant hyperthermia
hypercapnia
tacypnea
tacycardia
rigid jaw or generalized ridigity
other signs of malugnant hypertermia
muscle ridigity (njaw, trunkm ext)
-hypertermia (later sign)
-high fever
muscle tissue break down–>hyperkalemia, cardiac dsythrmia, myoglobinuria
treatment for malginat hyperthermia
dantrolene
cooling blanke
fluid resucatation
after anestehsia what is usual
diff to arouse
small pupil size
hyphtermia
best way to visualize airway
jaw thrust in SUPINE
postive pressure ventilation causes
increased intrathoriacic pressure during inspiration
-reduced venous return, ventricular preload, CO
all resulting in hypotension
maligant hypterhmia requires treatment with
IV dantrolene to revere process by slowing metablosm
-syccinlycholine should be discontinued
priority after placing subclavin central vesous cathter
check results of the chest xray to ensure the catheter tip is placed correctly
incorrect placement of the subclavin central venous catheter
ca result in iatrogenic pneumothroax or hemothroax
other priorites for subclavin Central venous catherter
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.
bg in hospitalized client
140-180
asytole / pulsesness electrical activ (PEA)treatment
CPR
O2
EPI IV
–Defibrillation is not effective for treatment of asystole or pulseless electrical activity.
