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3007 critical care > exam part 2 > Flashcards

exam part 2 Flashcards

1
Q

what a nurse should know before a trauma patient arrives

A

What type of trauma is it
What are the haemodynaic parameters
Any other parameters
Is there anyone else who needs to be there
Do we need to notify anyone else

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2
Q

primary survey for trauma patients

A

Catastrophic haemorrahge control
Airway and cervical spine
Ensure adequate oxygenation
Face and neck injuries can cause compromised airway
Breathing and adequate ventilation
Circulation and hemorrhage contro
Disability neurology and pupils
Exposure but keep warm

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3
Q

what are causes of airway compromise

A

Hemorrhage
Swelling
Foreign bodies
Decreased loc
Displaced tongue

Signs and symptoms
Change in voice
Noisy breathing
Tachypnoea
Dyspnoa
Bleeding secretions
Agitation and or altered loc

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4
Q

breathing assessment of trauma patients

A

Management of tension pneumothorax
Immediate decompression
Needle decompression
Finger thoracostomy
Chest drain
Promote oxygenation
Insertion of chest drain
Large bore ivc
Transfusion of blood products

Management for all breathing
Promote oxygenation
Cxr
Removal of abnormal air or blood
Analgesia as required
CHip

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5
Q

Open tension pneumothorax
Management

A

Promote ventilation and oxygenation
Cover wound with 3 sided dressing
Insert chest drain
Analgesia
Iv antibiotics

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6
Q

Assessment circulation
in trauma patients

A

Skin colour
Temperature
Cap refill
Pulse
Blood pressure
External bleeding
Alerted mentation
Management
Recognise it
Find out whats causing it
Sto0p it

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7
Q

blood products considerations

A

Determined by clinical parameters and response to mx
Life threatening circulation requires activation of massive transfusion
Massive transfusion defined as >10 units PRBC in 24 hours or more than 4 units in 1 hours
Blood products =tranexamic acid
Aim 1:1:1

Uncontrolled bleeding and >30 min delay to OT 100-200 ml boluses to maintain BP 80-90 mmHG
caution in elderly
Contraindicated in unconscious pts with impalpable bp
Contraindicated in tbi
Does that patient need code crimson
Does the patient require urgent or embolization
Can we manage this patient
Do we need to transfer out
Who do we need to call

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8
Q

disablity for trauma patients

A

Head injury
Effects of alchohol or drugs
Hypoxia
Hypovoemia
Assessment
Pupils size equality reaction
AVPU scale
Glasgow coma scale
Management
Urgent ct scan
Prevent secondary brain injury
Good oxygenation
Good bp
Not too much o2

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9
Q

patient risk factors for sepsis

A

Age over 65
Surgical history
Invasive lines
IDC
Drains and open wounds
Multiple health care professional interaction
Medical history

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10
Q

Deteriorating patient early signs in sepsis

A

RR less than 10 greater than 30
Decrease in LOC less than 2 points
Alteration in mental status
Tachy or bradycardia
hypo/hypertension
Decreased urine
Desat
New uncontrolled pain chest pain
Unexpected increase in output
Family concerns

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11
Q

late symptoms in sepsis

A

Bp less than 80 and over 240
Hr less than 40
Gsc lower 9
Airway obstruction/ stridor
RR less than 5 or greater than 40
Sats above 90
Paco2 greater than 60
Seizures
Bgl 2 vs 25
Anuria

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12
Q

symptoms of sepsis

A

Abo pain
Lung cough sob
Neuro
Altered loc new onset of confusion neck stiffness
Skin
Wound, cellulitis
Urine
Dysuria, frequency, odor

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13
Q

Sepsis risk factors paeds

A

Less than 3 months
Re presented in 48 hours
Immunocompromised
Indwelling medical device
Recent surgery
High level of parental concern

Less than 3 months
Re presented in 48 hours
Immunocompromised
Indwelling medical device
Recent surgery
High level of parental concern

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14
Q

overview of the cardiovascular system

A

Fluid - blood
Adequate volume
Adequate sodium levels
Haemostatic processes

Pump - heart
Dependent on
Strength of contractions
Hr within normal limits to ensure adequate pump
Diastolic function - heart can relax and refill and start again
Venous return to ensure enough circulating volume

Delivery system
Intact vessels to prevent fluid leakeage
Vessels damage loose contractility but have that pressure

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15
Q

ATP cycle

A

Without it cannot survive long
Glucose is required for transfer of atp in a process called cellular respiration
3 main steps in this process
Glycolysis - does not require o2 byproduct of lactic acid
Krebs cycle - aerobic process requires oxygen
Electron transport chain - also aerobic

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16
Q

what is Dysoxia

A

Anaerobic metabolism ineffective atp production
Cellular death

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17
Q

what is shock

A

a failure of the circulatory system to maintain effective tissue perfusion resulting in cellular dysfunction and acute organ failure 4

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18
Q

treatment of shock

A

Recognize
Respond
Treat
Prevention is better than cure
Lactact is important measure absence of other cv symptoms

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19
Q

what is the sepsis 6

A

Oxygen
Blood culture
Lactate
Antiobitocis
Fluids
Monitor urine

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20
Q

what is the function of the skin

A

Temp reugaltion
Sensory
Interface
Immune system
Control or fluid loss
Metabolic function
Pscyh-social function

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21
Q

jacksons burn wound model

A

from deepest to highest

zone of hyperamia
zone of stasis
zone of coagulation

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22
Q

Severity of burn

A

Depth = time and temp
Severity of local injury
However depth is not the most important predictaor

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23
Q

circulatory effects of burns

A

Increase in cap permeability
Loss of fluid

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24
Q

what parts of the body do burns affect

A

Affects all major organ vessels
Heart and blood vessles
Lungs
Gut
Immune system
Neuro humeral regulation
Kidney
Bone mineralisation and growth

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25
Q

Metabolic effects of burn

A

Secretion of stress hormones - tachycardia
Neural response via sympathetic nervous system and hypothalamus - hyperthermia
Suppression of anabolic hormones and development of massive catabolic response - protein wasting
Depression of immune response - susceptibility to infection

26
Q

first and immediate response to burns

A

Stop drop cover roll
Cool the burn
Asap
Avoid hypothermia
Cdontinue 20 mins
If chemical irrigate copiously with water

27
Q

assessment of depth

A

epidermos
dermis - capillaries and nerves
fat

28
Q

burn depth assessment color

A

epidermal red
superficial pale pink
mid dermal dark pink
deep dermal blotchy red
full thickness white

29
Q

epidermal burn

A

Skin intact red brisk capillary refill
erythema not included
Heal spontaneously

30
Q

Superficial dermal burn

A

Blisters present
Pink brisk cap refill
Should heal within 7-14 days
With minimal dressing requirements

31
Q

Mild dermal burn

A

Heterogeneous
Dark pink sluggish cap refill
Should heal within 14-21 days
Deeper areas over a joint may need surgical intervention and referral

32
Q

Deep dermal burn

A

Heterogeneous variable depth
Blotchy red white sluggish to absent cap refill
Surgical intervention

33
Q

Full thickness burn

A

Outer skin and some underlying tissue dead
White brown red black
No cap refill
Surgical intervention and long term scar

34
Q

what is the rule of 9 and palmar methods

A

relating to burns
9% of body parts to compromise the entire body

palm and fingers of the patient useful for small and scattered burns

35
Q

Fluid management

A

Increased cap permeability persist for 24 hours
How to give
Large canulas

fluid resus
give hartmans solution
half in first 8 hours of injury and second halfd in next 16 hours

Extra fluid is required in
Inhalation injury
Electrical injury
Delayed resus
Dehydration
Intoxcitarted patients and fire fighters

36
Q

how to monitor fluid resus

A

Urine output reflects perfusion
Desired hourly output
Assess output over several hours for adequacy

37
Q

what is an inhalation burn

A

Can be caused by heat chemical compounds in the atmosphere
Upper airway supra glottic
Lower airway subglottic
Systemic intoxication (CO, HCN, poisoning)
Obtain history
Give o2
Examine signs of airway burn
Consider intubation early
Monitor o2 saturation

38
Q

what is circumferential burns

A

Brunt skin -rigid
Around limbs - venous occlusion
Venous occlusion -arterial occlusion
around chest - restricted expansion
Childs front - restrict diaphragm
Elevation reduces swelling

39
Q

how to transfer a patient with burns

A

Analgesia
Plastic wrap
Contact burn
Clean dry sheet
Keep warm prevent hypothermia
Consult and transfer to burn unit
Documentation

40
Q

what is a catergory 1 triage

A

Obstructed airway
Severe respiratory distress
Severe haemodynamic compromise
No pulse
Skin pale moist mottled
Uncontrolled hemorrhage
HR less than 60
Ecg
Gsc lower than 8

41
Q

what is a category 2 triage

A

Patent airway
Moderate respiratory distress
Moderate haemodynamic compromise
Thready pulse
Cap refill 2-3 seconds
Gsc 9-12
Severe pain

42
Q

what is a category 3 moderately severe

A

Mild respiratory distress
Mild haemodynamic compromise
Altered vital signs
Skin warm pale
Gsc 13
Moderate pain
Moderate neurovascular compromise

43
Q

what is a category 4 or 5 in triage

A

Airway patent
No respiratory distress no haemodynamic compromise
Normal gsc
Mild pain
Mild neurovascular compromise

44
Q

mental health approach to triage

A

Primary survey approach
Consideration to appearance, behavior and conversation
Based on clinical criteria acute behavior disturbances and risk of harm to self or others

45
Q

What does the triage nurse do

A

Perform quick accurate assessments
Prioritize
Function under stress
Communication
Think ahead
Control patient flow
Diffuse conflict
Initiate first aid

46
Q

The skills required in triage

A

Possess good public relation skills
Possess good crisis intervention skills
Deal with barriers to communication
Process referrals
Know the operational policy of the ED
Have a working knowledge of the pre hospital system

47
Q

times when you need to alter communication for patients

A

An intoxicated patient
Verbally abusive person
Confused elderly person
Prisoner in police custody
Intellectually disabled person
Non english speaking person
Sexually abused

48
Q

what is an endocrine emergency

A

Endocrinology refers to hormones
Collection of glands
Responsible for sending chemical signals
Hormones fall into 2 major classifications
Amino acids derived
Lipid derived eg steroids
Then you have catecholamines

49
Q

what is the endocrine systems responsibilities include

A

Responsibilities include
Aiding with metabolism growth sleep reproduction mood
Responds to external stimulus flight or fight
Interal
Ay be product of an organ
Thyroid is one of the most primary glands
Most common endocrine disturbance is diabetes

50
Q

most common endocrine emergencies

A

DKA
HYPOGLYCEMIA
Thyroid storm
Acute adrenal crisis

51
Q

T1 vs T2 diabetes

A

Autoimmune
Lack of insulin
Destruction of insulin producing beta cells in pancrea
Cannot be prevented
Developed resistance
Insulin resistance
Unable to transfer glucose

52
Q

what is DKA

A

Lifethreanting metabolic state characterised by high bgls ketosis and acidosis
If untreated with result in severe dehydration, cerebral oedema, coma and eventually death
Insulin deficency - hypergylcermia prolonged hyperglycemia activates a acascade of events
Cellular starvation causing release of counter -regulatory hormones
These hormones produce more glucose in an attempt to supply energy to cells
Bgls exceed kidneys ability to reabsorb glucose- resulting to glucose in urine and polyuria
High glucose spills into urine porcess of osmotic diuresis
Polyuria, polydispia, hyperkaemia
Counter regulatory hormone activate lipolysiss
Fats and proteins transferred to glucose called beta oxidation
Weight loss
Ketone production (mainly acetone)
Fuel for brain during glucose stravation
Large amounts of ketones result in metabolic acidosis
Weight loss polyphagia keto-breath
Initially - body buffers acidosis with bicarbonate buffering system but this system is quickly overwhelmed and nother mechanisms
Eg hyperventilation to lower the blood co2 leveles compensatory respiratory alkolisis
Kussmaul breathing

53
Q

presentation of DKA

A

Severe dehydration
Weight loss
Hyperventilation
Acetone breath
Flushed cheek
Abdo pain
Disorientation
Shock
poly dipsia and polyuria
Cerebral oedema
Severe dehydration
Prolonged hyperkaelmia
Thrombosis
Hyperglycemia hypermosolar state
High bgl

54
Q

management of DKA

A

Abcdgef
Minimum 2 large bore IVC
Symptomatic mangemange
Treat the cause
CXR
FBC
UA NSU
Weight
ECG ongoing cardiac monitoring

Nursing responsibilities
Assess and manage threats to life
Symptomatic treatment
Idc
Strict fbc
Insulin
Check ketones
Check k
Fluid replacement

55
Q

what is hypoglycemia

A

Bgl less than 4 mild to severe
Symptoms
Hunger
Shakiness
Anxiety
Relestness
Decreased loc
Diaphoretic dizziness
Changes in sensrioum most common

56
Q

treatment of hypoglycemia

A

have 15 grams of fast acting carbohydrate
6-7 jelly beans
fruit jucie
recheck bgl 15 mins

57
Q

what is the thyroid gland

A

Responsible for growth and metabolism
Secretes 3 mian hormones
T3 t3 and calcitonin
T3 and t4 increase metabolic rate for growth when we are cold
Relies on pituitary gland to tell it to make it more or less
Could be overactive or underactive

58
Q

what is a thyroid storm and presentation

A

Life threatening
Excess amounts of thyroid
Mutil organ dysfunction
Common in young teenage and women

Presentation
Thermoregulatory dysfunction
Altered loc seizure coma psychosis
Cardiovascular af tachycardia hypertension
Tachypnea
Diarrha abdo pain nausea vomiting

59
Q

precipitating factors and treatment of thyroid storm

A

Severe infection
Undertreated hyperthyroidism
Dka
Surgery
Trauma to thyroid
Pulmonary embolism
Surgical manipulation of thyroid gland
Radiotherapy

Treatment
Early intervention
A-g immediate management prn
Symptoms management and supportive care

60
Q

what is the adrenal gland

A

Secrete hormones to regular metabolism bp and stress response
Cortisol aldersterone adrenaline and noradrenaline

3007 critical care (2 decks)

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