Exam 1 - FAST HUGS BID Flashcards
What does the “F” stand for in FAST HUGS BID?
feeding
Explain the importance of feeding in the ICU?
malnutrition can impair immune function affecting infection susceptibility, wound healing, etc.
List the considerations for feeding in the ICU?
enteral preferred over parenteral, pay attention to NPO status
What does the “A” stand for in FAST HUGS BID?
analgesia
Explain the importance of analgesia in the ICU?
optimizes patient comfort and minimizes agitation and the acute stress response (that can lead to a bevy of issues)
What are the validated ICU pain scales? (2)
critical care pain observation tool (CPOT), behavioral pain scale (BPS)
List the considerations for analgesia in FAST HUGS BID?
type of pain (neuropathic and nociceptive), duration
What does the “S” stand for in FAST HUGS BID?
sedation
What are the validated ICU sedation scales? (2)
Richmond agitation-sedation scale (RASS), sedation agitation scale (SAS)
What are the preferred sedative agents in the ICU? (2)
propofol, dexmedetomidine
What does the “T” stand for in FAST HUGS BID?
thromboembolism prophylaxis
Explain the importance of thromboembolism prophylaxis in the ICU?
critically-ill patients have been shown to be at higher risk for VTE than general medical patients
List the considerations for thromboembolism prophylaxis in the ICU?
VTE prophylaxis should be given to all patients, most common = LMWH, high risk patients = mechanical prophylaxis with graduated compression stockings
What does the “H” stand for in FAST HUGS BID?
head of bed
Explain the importance of head of bed in the ICU?
specific to patients receiving mechanical ventilation, elevating the head and thorax to a 30-45 degree angle to reduce occurrence of GI reflux and nosocomial pneumonia, chlorhexidine 0.12% to prevent endotracheal tube bacterial growth
What does the “U” stand for in FAST HUGS BID?
ulcer prophylaxis
Explain the importance of ulcer prophylaxis in the ICU?
critically ill patients develop stress-related mucosal damage (SRMD) potentially leading to clinically significant bleeding
List the risk factors for GI bleeding?
mechanical ventilation (>48 hours), coagulopathy, drugs that increase bleed risk (warfarin, heparin, steroids), shock/sepsis/hypotension/vasopressors, hepatic/renal failure, multiple trauma, burns >35% BSA, organ transplant, head/spinal trauma, history of upper GI bleed/PUD
What are treatments for stress ulcer prophylaxis? (2)
PPIs, H2RAs
What does the “G” stand for in FAST HUGS BID?
glycemic control
Explain the importance of glycemic control in the ICU?
proper control decreases incidence of complications with wound healing and infections
What is the goal blood glucose for patients in the ICU?
140-180 mg/dL
What does the “S” stand for in FAST HUGS BID?
spontaneous breathing trial
Explain the importance of of a spontaneous breathing trial in the ICU?
should be performed daily to determine a patient’s extubation readiness with the goal of weaning off of mechanical ventilatory support as early as possible
What does the “B” stand for in FAST HUGS BID?
bowel regimen
What are treatments for bowel regimens?
for standing regimens = docusate, sennosides, PEG; for rescue options = bisacodyl, enemas, magnesium citrate
What does the “I” stand for in FAST HUGS BID?
indwelling catheters
Explain the importance of indwelling catheters in the ICU?
checked routinely to assess for signs of infection and if general removal is warranted
What does the “D” stand for in FAST HUGS BID?
de-escalation of antibiotics
Explain the importance of de-escalation of antibiotics in the ICU?
antimicrobial stewardship
