Exam 1 - FAST HUGS BID

Question 1

What does the “F” stand for in FAST HUGS BID?

Answer 1

feeding

Question 2

Explain the importance of feeding in the ICU?

Answer 2

malnutrition can impair immune function affecting infection susceptibility, wound healing, etc.

Question 3

List the considerations for feeding in the ICU?

Answer 3

enteral preferred over parenteral, pay attention to NPO status

Question 4

What does the “A” stand for in FAST HUGS BID?

Answer 4

analgesia

Question 5

Explain the importance of analgesia in the ICU?

Answer 5

optimizes patient comfort and minimizes agitation and the acute stress response (that can lead to a bevy of issues)

Question 6

What are the validated ICU pain scales? (2)

Answer 6

critical care pain observation tool (CPOT), behavioral pain scale (BPS)

Question 7

List the considerations for analgesia in FAST HUGS BID?

Answer 7

type of pain (neuropathic and nociceptive), duration

Question 8

What does the “S” stand for in FAST HUGS BID?

Answer 8

sedation

Question 9

What are the validated ICU sedation scales? (2)

Answer 9

Richmond agitation-sedation scale (RASS), sedation agitation scale (SAS)

Question 10

What are the preferred sedative agents in the ICU? (2)

Answer 10

propofol, dexmedetomidine

Question 11

What does the “T” stand for in FAST HUGS BID?

Answer 11

thromboembolism prophylaxis

Question 12

Explain the importance of thromboembolism prophylaxis in the ICU?

Answer 12

critically-ill patients have been shown to be at higher risk for VTE than general medical patients

Question 13

List the considerations for thromboembolism prophylaxis in the ICU?

Answer 13

VTE prophylaxis should be given to all patients, most common = LMWH, high risk patients = mechanical prophylaxis with graduated compression stockings

Question 14

What does the “H” stand for in FAST HUGS BID?

Answer 14

head of bed

Question 15

Explain the importance of head of bed in the ICU?

Answer 15

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

Question 16

What does the “U” stand for in FAST HUGS BID?

Answer 16

ulcer prophylaxis

Question 17

Explain the importance of ulcer prophylaxis in the ICU?

Answer 17

critically ill patients develop stress-related mucosal damage (SRMD) potentially leading to clinically significant bleeding

Question 18

List the risk factors for GI bleeding?

Answer 18

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

Question 19

What are treatments for stress ulcer prophylaxis? (2)

Answer 19

PPIs, H2RAs

Question 20

What does the “G” stand for in FAST HUGS BID?

Answer 20

glycemic control

Question 21

Explain the importance of glycemic control in the ICU?

Answer 21

proper control decreases incidence of complications with wound healing and infections

Question 22

What is the goal blood glucose for patients in the ICU?

Answer 22

140-180 mg/dL

Question 23

What does the “S” stand for in FAST HUGS BID?

Answer 23

spontaneous breathing trial

Question 24

Explain the importance of of a spontaneous breathing trial in the ICU?

Answer 24

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

Question 25

What does the “B” stand for in FAST HUGS BID?

Answer 25

bowel regimen

Question 26

What are treatments for bowel regimens?

Answer 26

for standing regimens = docusate, sennosides, PEG; for rescue options = bisacodyl, enemas, magnesium citrate

Question 27

What does the “I” stand for in FAST HUGS BID?

Answer 27

indwelling catheters

Question 28

Explain the importance of indwelling catheters in the ICU?

Answer 28

checked routinely to assess for signs of infection and if general removal is warranted

Question 29

What does the “D” stand for in FAST HUGS BID?

Answer 29

de-escalation of antibiotics

Question 30

Explain the importance of de-escalation of antibiotics in the ICU?

Answer 30

antimicrobial stewardship