Critical Care Flashcards
Q: What is critical care nursing?
A: Critical care nursing involves the specialized care of patients with life-threatening conditions, requiring comprehensive and continuous monitoring and treatment.
Q: What are the three components of circulation?
A: Blood vessels, the heart, and blood.
Q: What was one of the first specialized critical care units developed?
A: The first specialized ICU was the respiratory ICU.
Q: How did World War II impact the development of critical care units?
A: WWII led to the creation of shock wards for critically injured patients, which later evolved into ICUs.
Q: What is a key element of critical care nursing regarding patient monitoring?
A: Monitoring the physiological functions of critically ill patients and ensuring safety and quality of care.
Q: What is the primary goal of holistic critical care nursing?
A: To provide care that considers the patient’s body, mind, and spirit as interconnected and inseparable.
Q: What is beneficence in critical care nursing?
A: The ethical principle of doing good and preventing harm to patients.
Q: How do critical care nurses manage crisis situations?
A: They use their clinical judgment, problem identification skills, and crisis management techniques to stabilize and support patients.
Q: How is hypovolemic shock treated in critical care?
A: Treatment involves fluid resuscitation, controlling bleeding, and restoring blood volume.
Q: What are common conditions managed in critical care settings?
A: Respiratory failure, cardiac arrest, shock (neurogenic, cardiogenic, septic), and severe trauma.
Q: What is the protocol for managing diabetic ketoacidosis (DKA) in critical care?
A: Treatment includes insulin administration, fluid resuscitation, electrolyte monitoring, and addressing the underlying cause.
Q: What interventions are used in managing cardiogenic shock?
A: Interventions include inotropes, vasopressors, mechanical support, and addressing the underlying cardiac condition.
Q: What role do vasopressors play in critical care?
A: Vasopressors are used to raise blood pressure in patients with shock, improving tissue perfusion.
Q: What is the purpose of CPAP in critical care?
A: CPAP (Continuous Positive Airway Pressure) provides a constant flow of air to keep the airways open, often used in patients with sleep apnea or respiratory distress.
Q: How do nurses manage patients on mechanical ventilation?
A: They monitor respiratory status, ensure proper ventilator settings, perform suctioning, and prevent ventilator-associated complications.
Q: What is the role of critical care nurses in family presence during resuscitation?
A: They support the family, facilitate communication, and provide a compassionate environment during resuscitation efforts.
Q: What are the goals of managing dysrhythmias in critically ill patients?
A: To stabilize the heart rhythm, maintain cardiac output, and prevent complications such as stroke or cardiac arrest.
Q: What is anaphylactic shock and how is it managed in critical care?
A: Anaphylactic shock is a severe allergic reaction managed with epinephrine, antihistamines, corticosteroids, and airway support.
Q: What is the protocol for managing septic shock?
A: Early recognition, aggressive fluid resuscitation, antibiotics, vasopressors, and source control of infection.
Q: How is neurogenic shock treated?
A: Treatment includes stabilizing the spine, maintaining blood pressure, and managing bradycardia.
Q: What are the components of the ABCs in CPR?
A: Airway, Breathing, and Circulation.
Q: What is the significance of fluid resuscitation in critical care?
A: It restores intravascular volume, improves cardiac output, and enhances tissue perfusion in shock states.
Q: How is cultural diversity addressed in critical care?
A: Through cultural competence, sensitivity to lifestyle differences, and incorporating cultural needs into care plans.
Q: What are the signs and symptoms of shock in critically ill patients?
A: Hypotension, tachycardia, cold and clammy skin, decreased urine output, and altered mental status.
Q: What is the role of antihistamines in critical care?
A: They are used to treat allergic reactions, including anaphylaxis, by blocking histamine receptors.
Q: How are blood transfusions managed in critical care settings?
A: By ensuring blood type compatibility, monitoring for reactions, and maintaining proper documentation and patient consent.
Q: How is ventilator-associated pneumonia (VAP) prevented?
A: By maintaining proper hygiene, oral care, elevating the head of the bed, and using appropriate ventilator settings.
Q: What are the main challenges in managing critically ill pediatric patients?
A: Challenges include differences in anatomy and physiology, medication dosing, and the need for specialized equipment.
Q: What are the main challenges in managing critically ill pediatric patients?
A: Fluid management, infection control, pain management, and wound care.
Q: What are the indications for tracheostomy in critical care?
A: Indications include prolonged mechanical ventilation, airway obstruction, and secretion management.
Q: How is pain managed in critically ill adults?
A: Through regular pain assessments, appropriate use of analgesics, and non-pharmacological interventions.
Q: What are the roles of respiratory therapists in critical care?
A: They manage ventilators, provide breathing treatments, perform pulmonary hygiene, and assist with airway management.
Q: How is hyperglycemia managed in critically ill patients?
A: With insulin therapy, regular glucose monitoring, and adjusting nutrition and medications.
Q: How is cardiac catheterization used in critical care?
A: For diagnostic purposes and interventions like angioplasty or stent placement in patients with cardiac conditions.
Q: What is the purpose of thrombolytics in stroke and cardiac care?
A: To dissolve blood clots and restore blood flow in conditions like ischemic stroke and myocardial infarction.
Q: What are the primary goals of nutritional support in critical care?
A: To meet the caloric and protein needs of critically ill patients, support healing, and prevent malnutrition.
Q: How is acute kidney injury managed in critical care?
A: By managing fluid balance, avoiding nephrotoxic drugs, and using renal replacement therapy if necessary.
Q: What interventions are used to prevent pressure ulcers in immobile patients?
A: Regular repositioning, use of pressure-relieving devices, and skin assessments.
Q: How is end-of-life care managed in critical care settings?
A: Through palliative care approaches, discussing goals of care, and respecting patient and family wishes.
Q: What are common signs of sepsis in critical care patients?
A: Fever, increased heart rate, elevated respiratory rate, and signs of organ dysfunction.
Q: How do critical care nurses manage fluid and electrolyte imbalances?
A: By monitoring laboratory values, adjusting IV fluids, and managing medications that affect fluid balance.
Q: What are the roles of nephrology nurses in critical care?
A: Managing patients with kidney conditions, dialysis, and monitoring for complications related to renal failure.
Q: How is quality improvement implemented in critical care units?
A: Through data monitoring, implementing evidence-based practices, and ongoing evaluation of care processes.
Q: How are multidrug-resistant organisms managed in critical care?
A: By using strict infection control measures, isolating patients, and using appropriate antibiotics.
Q: How is bronchodilation achieved in critical care patients?
A: Through the use of bronchodilators like albuterol, epinephrine, or anticholinergics.
Q: How do critical care nurses manage hyperactive delirium?
A: By assessing the underlying cause, using medications like antipsychotics, and creating a calm environment.
Q: What interventions are used for patients with trauma injuries?
A: Stabilization, pain management, surgical interventions, and continuous monitoring.
Q: What are common complications of immobility in critical care patients?
A: Pressure ulcers, muscle atrophy, deep vein thrombosis, and respiratory complications.
Q: How is acute respiratory distress syndrome (ARDS) managed?
A: With supportive care, mechanical ventilation, prone positioning, and managing the underlying cause.
Q: What is the purpose of guided imagery in critical care?
A: To reduce stress, anxiety, and pain through mental visualization techniques.
Q: What is the impact of psychosocial issues on healing in critical care?
A: Psychosocial issues can affect recovery, stress levels, and overall patient outcomes.
Q: What are the signs of ineffective coping in critical care patients?
A: Anxiety, depression, refusal of care, and lack of participation in treatment plans.
Q: How do critical care nurses manage the risk of delirium?
A: Through regular assessment, minimizing sedatives, and promoting sleep and orientation.
Q: What is the importance of effective communication in critical care?
A: It ensures clear understanding among the care team, patient, and family, reducing errors and enhancing care.
Q: How are anticoagulants used in critical care?
A: To prevent clot formation in conditions like deep vein thrombosis, atrial fibrillation, and during mechanical ventilation.
Q: What are the primary objectives of critical care nursing?
A: To stabilize patients, prevent complications, promote recovery, and provide support to patients and their families.
What is the main goal of Critical Care?
To support organ function and treat life-threatening conditions in patients requiring intensive monitoring.
What are the common causes of respiratory failure?
Pneumonia, ARDS, COPD, trauma, and neuromuscular disorders.
What is the PaO2/FiO2 ratio indicative of ARDS?
A ratio less than 300 mmHg is indicative of ARDS.
What are the key features of septic shock?
Persistent hypotension requiring vasopressors to maintain MAP ≥65 mmHg and serum lactate >2 mmol/L despite adequate fluid resuscitation.
What is the first-line treatment for septic shock?
Early administration of broad-spectrum antibiotics and aggressive fluid resuscitation.
Define Multiple Organ Dysfunction Syndrome (MODS).
Progressive dysfunction of two or more organ systems due to an uncontrolled inflammatory response to a severe illness or injury.
What are the criteria for Systemic Inflammatory Response Syndrome (SIRS)?
Two or more of the following: temperature >38°C or <36°C, heart rate >90 bpm, respiratory rate >20 breaths/min, or abnormal white blood cell count.
List the common types of shock.
Hypovolemic, cardiogenic, obstructive, and distributive shock.
What are the hallmarks of cardiogenic shock?
Decreased cardiac output and increased systemic vascular resistance.
What is the function of vasopressors in shock management?
To increase blood pressure by vasoconstriction and improving cardiac output.
Name an example of a commonly used vasopressor in shock.
Norepinephrine.
: What is the importance of maintaining Mean Arterial Pressure (MAP) in critically ill patients?
To ensure adequate organ perfusion, typically keeping MAP ≥65 mmHg.
What are the components of the Glasgow Coma Scale (GCS)?
Eye opening, verbal response, and motor response.
What is the most common cause of hospital-acquired infection in ICU patients?
Ventilator-associated pneumonia (VAP).
What is the function of a central venous catheter (CVC)?
To deliver medications, fluids, blood products, and parenteral nutrition, and to monitor central venous pressure.
What is the normal range for central venous pressure (CVP)?
2-6 mmHg.
What is a key intervention for managing increased intracranial pressure (ICP)?
Elevating the head of the bed to 30 degrees and ensuring adequate sedation and analgesia.
What is the Monro-Kellie doctrine?
It explains that the cranial cavity has a fixed volume, and an increase in one of its components (brain tissue, blood, CSF) must be compensated by a decrease in another to maintain normal ICP.
What is the Cushing’s Triad and what does it indicate?
Cushing’s Triad consists of hypertension, bradycardia, and irregular respirations, indicating increased intracranial pressure and potential brain herniation.
What are the initial management steps for a patient with traumatic brain injury (TBI)?
Stabilization of the airway, breathing, and circulation (ABCs), followed by neuroimaging and ICP monitoring.
What is the role of sedation in patients with elevated intracranial pressure (ICP)?
Sedation reduces metabolic demand and prevents agitation, which can lower ICP.
What is permissive hypotension, and when is it used?
Permissive hypotension is a strategy where blood pressure is kept lower than normal to reduce the risk of bleeding in trauma patients, especially those with uncontrolled hemorrhage.
What is Disseminated Intravascular Coagulation (DIC)?
A condition where small blood clots develop throughout the bloodstream, leading to organ damage and increased risk of bleeding.
What are the common triggers for DIC in critical care?
Sepsis, trauma, malignancy, and obstetric complications.
What is the treatment approach for DIC?
Treat the underlying cause, supportive care, and sometimes blood product transfusion like platelets or fresh frozen plasma.
What is a common complication of mechanical ventilation?
Ventilator-associated pneumonia (VAP), caused by bacteria entering the lungs through the endotracheal tube.
What are preventive strategies for Ventilator-Associated Pneumonia (VAP)?
Elevating the head of the bed, daily sedation vacations, oral hygiene with chlorhexidine, and using subglottic suctioning.
What is the ABCDE bundle in critical care?
A bundle of interventions that stands for Awakening, Breathing coordination, Delirium monitoring, Early mobility, and Exercise.
What is the goal of early mobilization in the ICU?
To reduce the risk of muscle atrophy, delirium, and ICU-acquired weakness.
What are the signs of acute delirium in ICU patients?
Confusion, agitation, hallucinations, and altered consciousness.
What are some risk factors for ICU delirium?
Advanced age, pre-existing cognitive impairment, use of sedatives, and prolonged ICU stay.
How is delirium managed in the ICU?
Through minimizing sedative use, ensuring proper sleep-wake cycles, and using antipsychotics if necessary.
What is the role of enteral nutrition in critically ill patients?
To provide essential nutrients directly into the gastrointestinal tract, helping to maintain gut function and reduce infection risks.
What are the indications for parenteral nutrition in critically ill patients?
When enteral feeding is contraindicated or insufficient, such as in cases of severe bowel injury or prolonged ileus.
What is the difference between total and partial parenteral nutrition?
Total parenteral nutrition (TPN) provides all daily nutritional needs intravenously, while partial parenteral nutrition (PPN) supplements some enteral nutrition.
What is the significance of glycemic control in critically ill patients?
Maintaining tight glucose control helps prevent hyperglycemia-related complications like infection and impaired wound healing.
What is the target blood glucose range in critically ill patients according to current guidelines?
140-180 mg/dL.
What are the potential complications of overfeeding in critically ill patients?
Hyperglycemia, fatty liver, increased CO2 production, and electrolyte imbalances.
Define Acute Coronary Syndrome (ACS).
A range of conditions associated with sudden, reduced blood flow to the heart, including unstable angina and myocardial infarction.
What is the primary treatment for STEMI (ST-Elevation Myocardial Infarction)?
Immediate reperfusion therapy, either through percutaneous coronary intervention (PCI) or thrombolytic therapy.
What is the difference between NSTEMI and STEMI?
NSTEMI involves a non-ST elevation myocardial infarction, typically less severe than STEMI, which presents with ST-segment elevation on ECG.
What are the first-line drugs used in the management of ACS?
Antiplatelets (aspirin), nitrates, beta-blockers, and anticoagulants.
What is the function of beta-blockers in myocardial infarction treatment?
Beta-blockers reduce heart rate, myocardial oxygen demand, and blood pressure, helping to limit heart damage.
Define Heparin-Induced Thrombocytopenia (HIT).
A rare but serious immune-mediated reaction to heparin causing low platelet counts and increased risk of thrombosis.
How is Heparin-Induced Thrombocytopenia (HIT) managed?
Stop all heparin products and start alternative anticoagulation, such as direct thrombin inhibitors (e.g., argatroban).
What is the common side effect of prolonged corticosteroid use in critically ill patients?
Immunosuppression, hyperglycemia, muscle weakness, and osteoporosis.
What is the role of corticosteroids in septic shock?
Corticosteroids may be used in patients with septic shock unresponsive to fluids and vasopressors, especially in adrenal insufficiency.
What is the most common cause of acute liver failure in the ICU?
Acetaminophen overdose.
What is the primary treatment for acetaminophen overdose?
Administration of N-acetylcysteine (NAC) to prevent liver damage.
What is the definition of cardiac tamponade?
A life-threatening condition where fluid accumulates in the pericardium, compressing the heart and limiting its ability to pump.
What are the signs of cardiac tamponade?
Hypotension, distended neck veins, and muffled heart sounds (Beck’s triad).
How is cardiac tamponade treated?
Emergency pericardiocentesis to remove fluid from the pericardium.
Define Pulmonary Embolism (PE).
A blockage in one of the pulmonary arteries in the lungs, typically caused by a blood clot that has traveled from the legs (deep vein thrombosis).
What is the gold standard for diagnosing Pulmonary Embolism (PE)?
CT pulmonary angiography.
What is the treatment for massive Pulmonary Embolism (PE)?
Thrombolytic therapy (e.g., tPA) or surgical embolectomy for life-threatening cases.
What is the function of a Swan-Ganz catheter in critical care?
It measures pulmonary artery pressures, cardiac output, and other hemodynamic parameters to guide fluid management and vasopressor therapy.
What are common complications associated with central venous catheter insertion?
Pneumothorax, infection, bleeding, and thrombosis.
What are the three main types of burns?
Thermal burns, chemical burns, and electrical burns.
How is the Rule of Nines applied in adults?
Head and neck: 9%, each arm: 9%, anterior trunk: 18%, posterior trunk: 18%, each leg: 18%, and genital area: 1%.
How are burns classified based on depth?
Superficial (1st degree), partial-thickness (2nd degree), and full-thickness (3rd degree).
What are the characteristics of a superficial (1st degree) burn?
Red, painful skin without blisters, typically involving the epidermis only.
What are the characteristics of a partial-thickness (2nd degree) burn?
Blistered, red, and painful, involving both the epidermis and part of the dermis.
What are the characteristics of a full-thickness (3rd degree) burn?
Charred or leathery skin, with damage to the entire epidermis and dermis, often painless due to nerve damage.
What is the Parkland Formula for fluid resuscitation in burn patients?
4 mL of lactated Ringer’s solution X kg of body weight X % of TBSA burned, administered in the first 24 hours.
Why is fluid resuscitation critical in burn management?
To prevent burn shock, a type of hypovolemic shock caused by fluid loss from damaged skin and increased capillary permeability.
What are the signs of inadequate fluid resuscitation in burn patients?
Hypotension, tachycardia, decreased urine output, and altered mental status.
What is an escharotomy, and when is it performed?
A surgical procedure to relieve pressure by making incisions through burned tissue (eschar), often necessary in circumferential burns to restore circulation.
What is the purpose of a fasciotomy in burn patients?
To relieve compartment syndrome by cutting the fascia to reduce pressure from swelling in deep tissue burns.
What is carbon monoxide poisoning, and how is it related to burn injuries?
A common complication in fires, where carbon monoxide binds to hemoglobin, reducing oxygen delivery to tissues.
What is the treatment for carbon monoxide poisoning in burn victims?
High-flow 100% oxygen therapy or hyperbaric oxygen therapy to displace carbon monoxide from hemoglobin.
First Aid for Burns
Cool the burn with cool (not cold) water; cover with sterile cloth.
Signs of Inhalation Injury
Singed nasal hairs, soot in the mouth, hoarse voice.
Burn Complications
Hypovolemic shock, infection, contractures.
Signs of Sepsis
Fever, chills, rapid heart rate, confusion, and low blood pressure.
Common Causes of Sepsis
Bacterial infections, pneumonia, urinary tract infections (UTIs), and skin infections.
Sepsis Management
Early antibiotics, IV fluids, oxygen, and monitoring of organ function.
SIRS Criteria (Systemic Inflammatory Response Syndrome)
Body temperature >38°C or <36°C, heart rate >90 bpm, respiratory rate >20 breaths/min, white blood cell count >12,000/mm³ or <4,000/mm³.
Prevention of Sepsis
Hand hygiene, timely treatment of infections, vaccination.
Caused by a loss of blood or fluids (e.g., bleeding, burns, diarrhea).
Hypovolemic Shock
Early Signs of Shock
Rapid heart rate, pale skin, cold and clammy skin, dizziness.
Shock Management
Ensure airway, provide oxygen, IV fluids, medications (vasopressors).
Complications of Shock
Organ failure, acidosis, death if not treated promptly.
First Aid for Burns
Cool the burn under cool running water for at least 10 minutes.
Pain Management for Burns
Use of analgesics like acetaminophen, NSAIDs, or opioids for severe burns
Airway Management in Burns
Endotracheal intubation may be required for smoke inhalation or facial burns
Initial Management of Sepsis
Rapid administration of broad-spectrum antibiotics within the first hour.
Fluid Resuscitation in Sepsis
IV fluids, typically crystalloids (e.g., normal saline or lactated Ringer’s), to maintain blood pressure.
Vasopressors in Septic Shock
Drugs like norepinephrine to raise blood pressure if fluids are not enough.
Corticosteroids in Sepsis
Low-dose steroids like hydrocortisone may be used if blood pressure remains low despite treatment.
Cardiogenic Shock Treatment
Use of inotropes (e.g., dobutamine) to strengthen heart contractions and improve blood flow.
Septic Shock Treatment
Fluids, antibiotics, and vasopressors like norepinephrine.
Neurogenic Shock Treatment
IV fluids and vasopressors (e.g., dopamine) to maintain blood pressure.
Anaphylactic Shock Treatment
Epinephrine to reverse allergic reactions, along with antihistamines and steroids.
Vasopressors in Shock
Drugs like dopamine, epinephrine, or norepinephrine used to constrict blood vessels and raise blood pressure.
Monitoring in Shock
Continuous blood pressure, heart rate, urine output, and oxygen levels to assess response to treatment.
Treating Acidosis in Shock
Sodium bicarbonate may be administered if severe metabolic acidosis occurs due to shock.
