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00NCLEX > Critical Care > Flashcards

Critical Care Flashcards

1
Q

Stridor

A
  • indicates respiratory distress
  • immediately reported to the health care provider
  • high-pitched and coarse
  • heard over the trachea
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2
Q

Slightly pink sputum is _______ after removal of an endotracheal tube

A

normal

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3
Q

Complication associated with DKA treatment with regular insulin

A
  • hypokalemia and hypoglycemia
  • stop insulin for low potassium
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4
Q

Assist-control (AC)

A
  • senses for a spontaneous breath
    • delivers fixed preset tidal volume at set intervals
  • most common mode
  • full airway protection
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5
Q

PEEP

A
  • pressure added at exhalation (spontaneous)
  • increases thoracic pressure
    • decreases cerebral perfusion
      • will INCREASE ICP
  • 15 is highest setting
    • will increase ICP
  • keeps small airways open
  • mitigate atelectasis
  • risk for hypotension
  • can cause ulcer
  • decrease CO and preload
    • monitor for decreased MAP
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6
Q

Indicators of pain

A
  • Resistance with passive movements, muscle tension, and restlessness
  • ventilator asynchrony
  • tachypnea
  • pupil dilation
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7
Q

DIC

A
  • caused by eclampsia, gram-negative sepsis, and cancer
  • abnormal clotting
  • depletes clotting factors and platelets
  • extensive bleeding
  • emergency
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8
Q

DIC results in

A
  • pain
  • ischemia
  • stroke like symptoms
  • dyspnea
  • tachycardia
  • reduced kidney function
  • bowel necrosis
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9
Q

DIC treatment

A
  • packed red blood cells and fresh frozen plasma transfusions (clotting factors)
  • Heparin may be prescribed
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10
Q

Hallmarks of DIC

A
  • thrombocytopenia
  • coagulopathy
    • increased prothrombin time
    • increased partial thromboplastin time
    • decreased fibrinogen
  • hemolysis
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11
Q

Central/PICC line care

A
  • aspirate each lumen for blood return
    • then pulsatile flush with 10 mL saline
  • change dressing every 7 days unless soiled
    • aseptic technique
    • nurse and pt wear mask during change
  • clean with chlorhexidine daily
  • do not lift objects greater than 5 pounds
  • cover in shower

high risk for infection!

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12
Q

Critical care increased risk of infection

A
  • central lines
  • non-tunneled catheters
    • used for short-term access
    • good for 5-7 days
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13
Q

Tracheostomy equipment

A
  • inner cannula
  • obturator
  • suction equipment
    • ensure placement = withdraw 1-2 cm before applying suction
    • catheter size = 12-14 Fr
    • 80-120 mmHg (adult —> older than 2)
    • 80-100 mmHg (infant)
    • 10-15 seconds
  • oxygen source
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14
Q

Hemolytic reaction

A
  • back pain
  • instable vital signs
  • apprehension/restless
  • hemoglobinuria
    • hemoglobin in urine
    • causes red/brown urine color
  • stop blood transfusion
  • leave VAD to flush with saline
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15
Q

Infiltration

A
  • catheter outside vein
  • nonvesicant*
  • swelling
  • coolness*
  • discomfort
  • treatment
    • discontinue vascular access
    • elevate extremity
    • monitor hemoglobin+hematocrit
    • alternate hot and cold
    • start new VAD on other side
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16
Q

Extravasation

A
  • infiltration but with vesicant
  • stop and elevate
  • use phentolamine or topical nitroglycerin
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17
Q

ICU oral hygiene

A
  • decreases risk of aspiration + ventilator pneumonia
  • promotes well-being
  • decreases cavities
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18
Q

Hypothermia

A
  • mild
    • 32-35 C
    • slurred speech
  • moderate
    • 28-32 C
  • severe
    • less than 28 C
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19
Q

Angiography

A
  • bed rest to allow affected extremity to remain straight
  • requires contrast media
    • increase fluids
    • assess kidney function via lab testing
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20
Q

Non-fatal drowning

A
  • causes pulmonary edema
  • water washes out alveolar surfactant
  • hypoxia
  • hypercarbia (increased carbon dioxide)
  • acidosis
  • vent/perfuse mismatch
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21
Q

Compensatory stage of shock

A
  • AKA nonprogressive
  • first stage
  • hypotension
  • decreased bloow to lungs
  • cold/clammy skin
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22
Q

Progressive stage of shock

A
  • second stage
  • anasarca
    • generalized edema
  • decreased LOC
  • decreased urine
  • weak pulses
  • hypotension
  • tachycardia
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23
Q

Irreversible stage of shock

A
  • final stage
  • decreased perfusion due to decreased cardiac output
  • hypotension
  • hypoxemia
  • cyanotic skin
  • bradycardia*
  • unresponsive
24
Q

External Ventricular Drain

A
  • maintain same level as clients head (tragus)
  • elevate HOB to 30 degrees
  • clamp before repositioning client
  • flush only when needed
25
Q

Facial trauma

A
  • nasal fracture
  • can cause brain trauma
  • monitor for increased intracranial pressure!!
    • vomiting!!
    • restlessness
    • altered LOC
    • headache
  • elevate HOB 30-45 degrees
  • neutral head position
26
Q

Chest trauma

A
  • shallow respirations is an expected finding
27
Q

Bronchoscopy

A
  • expected
    • sore throat
    • green sputum
    • coughing when sipping water (indicates return of gag relflex)
  • adverse
    • short of breath
      • indicates respiratory distress
    • pneuomothorax
      • decreased breath sounds on affected side
      • tachypnea
      • tachycardia
28
Q

Pneumonectomy

A
  • surgical removal of entire lung
  • post care
    • early ambulation
    • coughing, deep breathing is GOOD
    • only supine or operative side
    • ## pulmonary function normal after 1 week
29
Q

Anthrax

A
  • caused by bacteria (give antibiotic)
  • risk for hypoxia
    • continuous pulse oximetry is essential
  • x-ray for abnormalities in lungs
30
Q

Tracheostomy care

A
  • shower shield
  • do not remove old ties before applying new ties
  • do not deflate cuff first 24 hours
  • do not inflate before suctioning
  • do not wash inner cannula with water
    • instead use 1/2 strength hydrogen peroxide
    • and saline
  • only suction when needed
31
Q

Post femoral angioplasty care

A
  • neurovascular
  • assess extremities’ distal pulse/temperature
  • report signs of decreased sensation and paresthesia
    • can be arterial occlussion
  • give antiplatelets to prevent occlusion
32
Q

Kock pouch care

A
  • client will have wound drain, medena catheter in stoma, and urinary cathether
  • monitor urine output
  • check for ostomy pouch leaks
  • note size/shape/color or stoma
33
Q

Ostomy care

A
  • use mild soap, not moisturizing
  • regular gloves, not sterile
  • don’t use alcohol
  • empty when 1/3 - 1/2 full
  • cut pouch 1/16 - 1/8 inch around stoma
34
Q

Healthy stoma

A
  • protudes 2.5 cm with open lumen on top
  • pink/red
  • moist
35
Q

Stoma ischemia

A
  • dry
  • dusky
  • red/purple
36
Q

Retracted stoma

A
  • concave
  • bowl shaped
37
Q

Stoma stenosis

A
  • narrow
  • flattened
  • constricted
38
Q

Hemodialysis complication

A
  • hypotension
    • too much fluid being removed
  • dizziness
  • fall risk
39
Q

Peritoneal dialysis

A
  • constipation is common
    • causes outflow failure
      • drainage volume is less than inflow volume
    • reposition and encourage bowel movement
      • give laxative or enema
40
Q

Vaginal coposcopy

A
  • intercourse not adviced first 48 hours
  • first intercourse will be painful
41
Q

Lung lobe removal care

A
  • closed chest drainage system
  • incensitive spirometer during recovery
42
Q

Blood compatibility

A
  • O+
    • can give to any other +
    • can receive only O +/-
  • O- (universal receiver)
    • give to everyone
    • receive only O-
  • A/B+ (universal donor)
    • give to matching +
    • receive matching + or -
  • A/B/O-
    • give to matching + or -
    • receive from matching -
43
Q

Positive blood and giving

A
  • Postive only wants to GIVE rides to other positives
    • (A+) is morning class, can give rides to other positive morning classes (A+) or (AB+) because they have morning class
    • (B+) is evening class, can give rides to other positive evening class (B+) or (AB+) because they also have evening class
    • (AB+) is A Big girl, can only fit Another Big positve girl (AB+)
    • (O+) is a skinny girl. Can fit all other positives in her car
44
Q

Negative blood and giving

A
  • negative GIVES rides to anyone (+/-)
    • (A-) is morning class, can give rides to other morning classes (A+/-, AB+/-)
    • (B-) is evening class, can give rides to other evening classes (B+/-, AB +/-)
    • (AB-) A Big girl can only fit Another Big girl (AB+/-)
    • (O-) skiiny girl who gives rides to everyone
45
Q

Positive blood and receiving

A
  • If youre recieving a ride, you dont have a choice who is in the car
    • (A+) is morning class, can receive a ride from other morning classes (A), but no choice who’s in the car (A+/-, O+/-)
    • (B+) is evening class, can receive ride from other evening classes (B), but no choice who’s in the car (B+/-, O+/-)
    • (AB+) is A Big girl, doesnt matter who offers ride, youll accept anyone (universal receiver)
    • (O+) is skinny girl, wants to ride with other skinny girls (O+/-)
46
Q

Negative blood and receiving

A
  • when negative and receiving a ride, you want another negative person
    • (A-) is morning class, will take rides with other morning class (A-), or skinny girl (O-), as long as theyre also negative
    • (B-) is evening class, will take rides with other evening class (B-), or skinny girl (O-), as long as theyre also negative
    • (AB-), A Big girl whose negative, will accept ride from anyone if theyre also negative (AB-,A-,B-,O-)
    • (O-) negative skinny girl will only take ride from another negative skinny girl (O-)
47
Q

Blood types rules

A
  • giving
    • positives only give rides to other positives
      • AB+ can fit only one more AB+
    • negatives dont care if you’re positive or negative
      • AB- gives rides to other AB, dont care if youre positive or negative
  • receiving
    • positives willing to receive rides from anyone
    • AB+ will receive ride from everyone (universal donor)
    • negatives receivce ride from only other negatives
    • AB- will receive ride from anyone, as long as theyre negative
48
Q

Femoral vein catheter care

A
  • central line
  • do not sit more than 45 degrees
  • no soap to clean
  • clean every 7 days unless soiled
  • chlorhexidine to clean
49
Q

Chest physiotherapy (CPT)

A
  • loosen secretions
  • give bronchodilator 15-30 min BEFORE
  • perform at least 30 min before meals
  • dont do with rib fracture, increaed ICP, or on anticoagulants
50
Q

Homan’s sign

A
  • detects DVT
  • low reliability
  • positive result is pain foot dorsiflexion
51
Q

Ventriculoperitoneal (VP) shunt

A
  • drains cerebrospinal fluid
  • used in hydrocephalus
  • monitor for abdominal distention or discomfort
52
Q

Prevent febrile reaction with blood transfusion

A
  • use leukocyte reduced blood
53
Q

Rewarm slowly

A
  • to prevent cardiac arrhythmia’s
  • A.fib
  • V.fib
54
Q

Sengstaken-Blakemore tube

A
  • used in tamponade therapy
    • gastro/esophageal bleeding
    • gastric balloon used
  • KEEP SCISSORS AT BEDSIDE IF BALLOON SHIFTS
    • used to rapidly deflate balloon
55
Q

Mechanical ventilation care

A
  • supine
    • elevate HOB to MORE than 30 degrees
    • High-Fowlers

00NCLEX (30 decks)

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