Critical Care Flashcards
after placement of ETT placement should be verified by
Chest x ray, assessing for equal breath sounds bilaterally
intubate if GCS is less than
8
tracheostomy tubes may be used for
tracheal obstruction, slow vent weaning, tracheal damage, neuromuscular damage
tracheostomy nursing considerations
infection prevention, only suction to pre measured depth, must keep two back up trachs at bedside (one same size, one size smaller)
Peak Inspiratory pressure (PIP)
the highest level of pressure in the lungs during inhalation
Positive end expiratory pressure (PEEP)
amount of pressure in alveoli at the end of expiration
Fraction of inspired oxygen (FiO2)
how much oxygen the client is getting
tidal volume
amount of air inhaled during one respiratory cycle
end-tidal carbon dioxide (ETCO2)
partial pressure of CO2 detected at the end of exhalation
volume controlled ventilator mode
certain volume of air delivered to the client with each breath
pressure controlled ventilator mode
lungs are inflated to a certain pressure
CPAP
there is continuous positive airway pressure while the client control their respiratory rates and volumes
BiPAP
there is positive airway pressure set at different pressures for inspiration and expiration
high ventilator alarm
pressure in circuit is too high; coughing, gagging, bronchospasm, fighting ventilator, ETT occlusion, kink in tubing, increases secretion, thick secretions, water in ventilator circuit
low ventilator alarms
pressure in circuit is too low; tubing is disconnected, loose connections, leak, extubation, cuffed ETT or trach is deflated, poorly fitting CPAP/BiPAP mask
decorticate posturing
damage to midbrain, flexion, arms shaped like C’s moving towards spinal cord, rigid muscles, arms pulled in towards center, clenched fists
decerebrate posturing
damage to deep brain structures (pons), extension, indicates worse, more extensive damage, arms and legs straight out, toes pointed downwards, neck and head arched back, rigid muscles
monro-kellie hypothesis
skull is rigid contained filled with blood, brain, and CSF. If one of those increases, another must decrease
S&S increased ICP
papilledema, pupil changes, impaired eye movement, headache, changes in LOC, seizures, impaired sensory and motor function, changes in speech, decerebrate, decorticate, flaccid, vomiting, increase SBP, decrease pulse, altered resp pattern
S&S increased ICP infants
bulging fontanels, cranial suture separation, increase head circumference, high-pitched cry
Vasoactive Infusions include
inotropes and vasopressors
inotropes
act by increasing the force of myocardial contractility
vasopressors
mimic sympathetic nervous system to cause vasoconstriction
alpha 1 receptors
found in vascular smooth muscles, peripheral vasoconstriction, increased SVR
beta 1 receptors
found in heart and intestinal smooth muscle, increase contractility, increase SV, HR, CO
beta 2 receptors
found in lungs/bronchial vasculature, bronchodilation, coronary artery vasodilation
epinephrine
given in shock, cardiac arrest, asystole
low dose: acts on beta 1 receptors to increase CO
high does: acts on alpha 1 receptors to increase systemic vascular resistance, increase BP
norepinephrine
shock, hypotension
acts on alpha 1 receptors, causes peripheral vasoconstriction, increases BP, increases CO
Phenylephrine
anesthesia induced hypotension, second line agent in some shock clients, only acts on alpha 1 receptors, causes only vasoconstriction (no inotropy), vasoconstriction -> increased BP
dopamine
shock, hypotension, trauma
acts on dopamine receptors
low dose: use in kidney failure to increase renal blood flow (renal dopa), increase contractility -> increase CO
high dose: causes vasoconstriction, increases SVR, increases BP
vasopressin
ADH, less diuresis = more volume in the vascular system, more volume = more pressure = raised BP, secondary line in vasodilatory shock, third line in septic shock
Milrinone
cardiogenic shock, decreased CO, congenital/acquired heart defects, cause systemic and pulmonary vasodilation = decreased afterload, increase contractility
