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Critical Care > Exam 2 Key Points > Flashcards

Exam 2 Key Points Flashcards

1
Q

What special procedure is used to show perfusion?

A

Vq scan can show airway obs or vascular emboli

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2
Q

This is used to measure volume of air with each breath

A

Pulmonary Function Test (PFT) measures how big of a breath the pt can take

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3
Q

What is considered a low flow system and how much o2 can be delivered, which is the highest oxygen delivery for mask?

A

Nasal Canula- 1-8L/24-44% o2
Simple mask -5-8L/40-60%
Non-rebreather- 10-115L/80-95%
NON-REBREATHER

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4
Q

What are the steps to rapid sequence intubation?

A 
Prep/postions (meds, equip, etc) 
Preoxygenate 100% 
Pretreatment (LOAD)
Paralysis 
Protection (ensure tube don't move) 
Placement of ETT (confirm )
Post-intubation management
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5
Q

This type of ventilator delivers a constant tidal volume and is the most common

A

Volume Cycles Ventilators

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6
Q

This vent setting allows spontaneous breathing at the patient’s own rate and tidal volume between ventilator breaths. What is pressure support ventilation

A

SIMV
Pressure support ventilation is when the patient cannot breather over the vent. common in acidosis and must be severely paralyzed to need this

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7
Q

This vent setting is used for weening and applies positive pressure. The patient controls the rate, inspiratory flow, and tidal volume

A

CPAP or continuous positive airway pressure which keeps the alveoli open during inspiration and prevents collapse during expiration

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8
Q

This alarm on a vent is when the patient is biting on the tube or has secretions?

A

High Pressure- There is an occlusive blockage

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9
Q

This vent alarm is due to leakage or a cough causing it to come off

A

Low pressure- Disconnect

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10
Q

Venous Stasis
Vascular injury
Hyper-coagulability
These are all risk factors for what complication

A

This is virchow’s triad and are risk factors for a Pulmonary Embolism

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11
Q

What is the gold standard for diagnostics for a pulmonary embolism

A

The gold standard is Pulmonary angiography

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12
Q

What is the earliest sign of internal bleeding

A

Orthostatic hypotension

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13
Q

What are the antidotes for heparin,warfarin, and fribrinolytics

A

Protamine Sulfate
Vitamin K
and clotting factors

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14
Q

While caring for a patient with a closed chest tube the nurse notices whistling noise what is occurring and what will the nurse need to do

A

The tube may be out the nurse needs to place a sterile gauze over the site.

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15
Q

The patient with a chest tube drainage has a drainage measurement of 100ml is this appropriate?

A

The nurse needs to notify the surgeon!! output is measured hourly in the first 24hrs and must be reported if ouput in the collection drainage is more the 70ml/hr

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16
Q

This container must contain 2 cm of water in it al all times, what is it and why must water be in the container? what does bubbling indicate?

A

This is the water seal container, 2 cm of water must be in the container to prevent air from returning to the patient. The nurse needs to assess each hour and add sterile water if needed. Bubbling occurs when air is passing through the chamber

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17
Q

The nurse notices bubbling in the water seal chamber has stopped. what is likely the cause? What does excess bubbling indicate?

A

The tube may be blocked of kinked. Excess bubbling my indicate an air leak which indicates that air has entered the lung. The nurse need to assess is the tube is removed from the pt or if the drainage is unconnected and notify the surgeon

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18
Q

The nurse notices that the water does not rise and fall 2-4 in during inhalation and exhalation in the chest tube what might this indicate?

A

The may indicate a re-expanded lung or obstruction in the chest tube

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19
Q

The is used following an intubation to and measures exhaled CO2

A

Capnography/Capnometer, alveolar and arterial CO2 concentration is equal in presence of normal V/Q relationships

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20
Q

What teaching is needed in a patient with diverticulosis ?

A

Increase fiber in diet (25-35g/day)
Avoid foods that are not easily digested and may get trapped in the pouch (corn, etc.)
Increase fluids
Avoid alcohol

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21
Q

A patient on a vent is being weened is diaphoretic, using accessory muscles, Sa02 of 87% are likely showing signs of?

A 
Failure to tolerate weening. other signs include
Decrease Level of Consciousness
PVCs or V-tach
ST segment changes
TV <250 mL
Paco2 changes (apnea increases     tachypnea decreases) 
pH < 7.30
SaO2 < 90%
Accessory muscle use
Diaphoresis
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22
Q 
Elevate HOB at least 30 degrees
Daily Sedation Vacation and Weaning
DVT prophylaxis
Oral care regimen
Stress Ulcer prevention
Suctioning

These are all components of to prevent what?

A

Preventing Ventilator- associated pneumonia.

The ventilator bundle set and hand hygiene are ways to prevent VAP

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23
Q

The nurse is caring for a patient that suddenly has chest pain and dyspnea. what priority interventions does the nurse need to take?

A

The nurse should immediately notify the rapid response/provider. elevate the HOB, and administer oxygen. Assess ABG and monitor the patient for changes in status (cognition, pallor, and cyanosis) are otehr important things.

24
Q

What should the nurse administer to correct hypotension in a patient with impaired tissue perfusion due to a PE once IV fluid replacement with crystalloids are unsuccessful?

A

The nurse will need to administer vasopressors such norepinepherine (levophen), epinepherine, and dopamine

25
Q

What are the priority interventions for a patient with a PE? What will the nurse anticipate to administer for a patient with a massive PE/hemodynamically unstable?

A

Oxygen delivery and Anticoagulants immediately
(unfractionated heparin, low molecular weight heparin, fondaparinux). For a patient with a massive PE the nurse can expect to administer a fibrinolytic Alteplase (tPA).
Heparin and oral anticoags continue together until INR is 2-3

26
Q

What type of ventilation setting should the nurse expect for a patient with ARDS? what is ARDS?

A

ARDS is an acute respiratory distress syndrome triggered by a systemic inflammatory response that causes inflammation in the alveoli decreasing lung compliance resulting in alveloar collapse. . The nurse can expect PEEP and low tidal volumes to prevent lung injury in theses patients.

27
Q

On assessment on a chest x-ray the is diffuse haziness “white out”/ ground glass appearance, metabolic acidosis, and refractory hypoxemia. This patient most likely has what? What position should the nurse expect to place this patient in?

A

ARDS. This patient needs to be placed prone to allow the lungs to expand completely and decrease pressure on the heart and major organs

28
Q

A patient with diverticulitis has a rigid board-like abdomen, tenderness and distension what is the patient experiencing and what interventions should the nurse suspect to do?

A

This patient is experiencing peritonitis from the perforation of the diverticulum. The nurse can expect to administer broad spectrum abx (metronidazole), analgesia, IV fluids to correct dehydration and electrolyte imblances. NGT for decompression to remove air or fluid in abd

29
Q

What teaching is important for a patient with diverticulitis?

A

LOW fiber diet/clear liquids,

NPO in severecases with. Avoid laxatives and enemas, and lifting, straining, coughing, or bending.

30
Q

When caring for a patient with an NGT and IV PCA following an open resection what are 3 important things the nurse must assess for?

A

Bowel sounds with suction odd
Tube placement and proper functioning
N/V. abdominal distension- may indicate displacement.

31
Q

The nurse is caring for a patient following a colostomy and notices dark stoa with unusual bleeding and mucocutanous seperation, and no active bowel sounds 2-3 days post op. what will the nurse need to do. How will this patient bowl function be?

A

Immediately notify the surgeon these are signs of ischemia/necrosis. Bowel functioning will begin with gas then progresss to liquid stool

32
Q

What is the treatment for a patient with an infection with H.Pylori?

A

Triple therapy or Quadruple therapy:
2 abx + PPI or
2 abx + ppi + Bismuth

33
Q

What teaching is important for a patient with gastric ulcers?

A

Bland diet to relieve symptoms
Avoid substances that increase gastric acid secretion (caffeine)
NO bedtime snacks, alcohol, or tobacco (these increase gastric acid secretion

34
Q

A patient with an upper GI bleed is showing s/s of hypovolemic shock, what are important interventions the nurse must take?

A

Maintain Airway, Breathing, Circulation.
The nurse will provide oxygen or ventilatory support, initiate 2 large bore IV (fluid or blood), and NGT placement and lavage to remove excess and clottted blood. After theses interventions are initiated the nurse can expect the patient to for to EGD to isolate the artery and embolize it or intervetnional radiology for pt with a missive bleed who are not candidates for surgery

35
Q

When performing lavage the nurse should follow what steps?

A

 Place patient on left side
 Instill 200 to 300 ml of room temperature sterile saline or sterile water into abdomen
 Solution and blood are repeatedly withdrawn manually until returns are clear or light pink without clots
 NGT may remain in place or removed

36
Q

The nurse is caring for a patient post EGD what are 3 things to assess when caring for this patient?

A

 Monitor vital signs and oxygen saturation
 Assess the ability to swallow
 Assess for the return of the gag reflex

37
Q

The nurse is caring for a patient 2 days post op pyloroplastyand notices the NGT is out. What should the nurse do?

A

The nurse needs to immediately notify the surgeon.

Never remove or irrigate an NGT post gastric surgery
Educate pt to not touch
If pulled out assess pt for hypovolemia and bleeding, contact surgeon, and DO NOT PUT BACK IN

38
Q

A patient is experiencing mid abdominal cramping/pain with localized steady pain, and profuse foul-smelling vomiting. What type of obstruction is the patient likely experiencing?

A

This patient may be experiencing a small bowel obstruction.

39
Q

A patient is experiencing intermittent colicky pain, lower abd distentions with a palpable abdominal mass, and ribbon like stools most likely has what type of bowel obstruction?

A

Lower

40
Q

A patient has severe, constant diffuse pain, colicky cramping and abdominal distension with decreased then absent bowel sounds and vomiting this patient is experiencing what type of bowel obstruction?

A

Non-mechanical bowel obstruction. This needs to be reported immediately and can indicate ischemia/dead bowel.

41
Q

What non-surgical interventions can the nurse suspect when caring for a patient with lower gi obstruction?

A

Lower Fecal Impaction=disimpaction and enema
Intussusception= barium enema
Post-op ileus = alvimopan (Entereg), Octreotide acetate (Sandostatin) -stimulates GI motility
IV fluid replacement- needed for all patient due to capillary leak and hypovolemia
Blood products as needed
IV nutrition if NPO time is extended
Mouth care and oral hygiene
Opioids may be withheld during the diagnostic period – can mask where obs is coming fro
Positioning-semi-fowlers
IV antibiotics if strangulation is suspected

42
Q

In weaning a patient off an NGT to suction that had a bowel obstruction surgery the nurse turns off the suction, the patient has no complaints of N/V for 3 hrs once offered a small amount of liquid the patient states they feel sick what should the nurse do?

A

The nurse should turn the NGT back on to suction.
Wean NGT- turn off the NGT off to suction for about 2-4hrs to assess for any complaints N/V. If present turn NGT to suction back on.
If no N/V offer a small amount of liquid and reassess. If still no N/V after small liquid advance diet slowly

43
Q

A patient with rigid board like abdomen, gaurding, rebound tendernesss, sepsis, hypotnesion, and hypovolemic shock most like is experiencing what? what is are the 3 main interventions?

A
  1. Decreasing potential for infection
    - Assess vital for septic shock (hypotension, decreased pulse pressure, tachycardia, fever, chills, skin changes, tachypnea)
    - Administer broad spectrum abx and oxygen
  2. Restoring fluid volume balance
    - Hypertonic IV fluid immediately (3 or 5%NS )
    - NPO w/ NGT decompression
  3. Managing pain
    - IV analgesics

This patient needs to refrain form lifting for 6 weeks!!

44
Q 
A patient with cirrohsis is showing signs of 
•	Personality changes
•	sleep disturbances
•	mood disturbance
•	mental status changes
•	speech problems
•	asterixis (liver flap/ hand writing changes seen)
What stage(s) is this patient  in?
A

Stage I and II

45
Q 
A patient with cirrohsis is showing signs of 
•	Altered level of consciousness
•	impaired thinking
•	Neuromuscular problems
•	Asterixis to no asterixis
•	Fetor hepaticus (liver breath- sweet malodorous breath)
•	Coma
•	Positive Babinski’s sign

What stages is this patient in?

A

Stage III and IV

46
Q

What labs are suspected in a patient with cirrohsis? what will definitively dx the pt?

A

Elevated AST, ALT, and LDH- (AST/ALT >40= Liver issues)

Liver Biopsy- increased risk for bleeding = definitive dx for cirrohsis

47
Q

What complication is important to assess that had the TIPS procedure? what is this procedure?

A

This is a Stent placed in the portal vein which allows for the the return of blood and fluid to heart quickly to increase preload.

The nurse should o Monitor for complication: hepatic encephalopathy, sudden increase in PAP

48
Q

What meds can the nurse expect the patient to be taking with hepatic encephalopathy/

A

• Lactulose- prevents hepatic encephalopathy by binding with ammonium in the intestines and is eliminated through the stool
• Nonabsorbable antibiotics- intestinal antiseptics that destroy normal flora which decreases ammonia
-neomycin, metrondiazole, and vancomycin
• Thiamine and benzodiazepines may be needed for alcohol withdrawal

49
Q

A patient with Sudden, severe mid-epigastric or left upper quadrant pain, may radiate to back, flank, or left shoulder—worse when lying down,Cullen’s and/or Turner’s signs -blue discoloration in abd and s/s of shock is likely experiencing? What labs are suspected? What precautions should the nurse take?

A

Acute Pancreatitis
• Elevated amylase, lipase, trypsin, elastase (exocrine function
• Elevated bilirubin
• Decreased calcium and magnesium

NPO to decrease GI activity, isotonic fluids, electrolyte replacement
PPI + NGT to suction and antiemetics

50
Q

What is the most sensitive indicator for severe malnutrition? what are complications of severe malnutrition?

A

Pre albumin

edema, poor wound healing, infection, decreased activity intolerance, intolerance to cold, and death

51
Q

This type of specialized nutrition must be infused through a central line with a filter and on a pump. what care and maintenance is necessary for this type of treatment.

A

Total Parenteral Nutrition (TPN).
o Check each bag of TPN by comparing the order or pharmacist orders with another RN
o Monitor to the rate of infusion
o If TPN becomes unavailable, infuse D10W or D20W
o Monitor daily I/O, weight, electrolytes, and glucose
o Asses IV site for infection or infiltration (high sugar = high bacteria)
o CHANGE THE IV TUBING NAD FLUID EVERY 24HRS
o CHANGE IV DRESSING EVERY 48-72 hrs

52
Q

Priority Complications with Total enteral nutrition to remember!

A

o Clogged Tube (Review Chart 60-5)
 Flush with 20-30ml of water before and after interventions or at least once per shift
o Refeeding Syndrome ~ life threatening metabolic complication when nutrition is started after starvation
 Osmotic shift (fluid overload and electrolytes shift)
 Monitor for Loc
o Tube misplacement/dislodgement may cause aspiration and possible death
o Abdominal distention/N/V/D~ prevent overfeeding
o Fluid and electrolyte imbalances~ hyperosmolarity results in osmotic dehydration, Fluid volume overload, and Hyperkalemia and hyponatremia

53
Q

_____ drug decrease appetite
_____ absorb fat and excrete through the stool
_____ increase metabolism

A

Anoretic
Lipase inhibitors
Short term medications SNS stimulants

54
Q

After 30 min of eating the patient with a LAGB starts having o N/V/D
o Feeling of abdominal fullness and cramping
o Palpitations and tachycardia
o Perspiration, Weakness, Dizziness
o Borborygmi
what is the patient experiencing, what teaching/interventions is important?

A

This patient is experiencing Dumping syndrome, where undigested food enter the small intestine too quickly

Important teaching includes:
o Avoid sugar, salt, and milk
o High protein, high fat, low carbohydrate diet
o Eat small meals
o Avoid fluids with meals
o Lie down after meals and do not drink with meals!!
o Take antispasmodic medications for cramping

55
Q

Post-op care when caring for a patient with LAGB, LSG, and RNYGB include? can the nurse adjust the NGT and what will their feeding schedule look like?

A

NEVER REPOSITION NGT!!! Fowlers postion with bipap/cpap at night
PCA morphine 1st 24 hrs
NPO unil bowel sounds return
Clear liquids (1oz at a time) -> pureed for 6 weeks -> solids

Critical Care (6 decks)

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