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Critical Care > Final: lectures > Flashcards

Final: lectures Flashcards

1
Q

rule of nines

A

body is divided into areas that are multiples of 9% to calculate burn injury in adults

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2
Q

rule of nine: major sections

A

head
each arm
chest and back
each leg

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3
Q

rules of nine: head

A

-whole head: 9%
front: 4.5%
back: 4.5%

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4
Q

rules of nine: each arm

A

whole: 9%
front: 4.5%
back: 4.5%

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5
Q

rule of nine: chest and back

A

chest: 18%
back: 18%

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6
Q

rule of nine: each leg

A

whole: 18%
front: 9%
back:9%

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7
Q

Parkland/Consensus formula starts calculating at time of:

A

injury

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8
Q

Consensus formula:
1st half given:
2nd half given:

A

(2-4 mL)(kg)(TBSA%)
1st half: first 8 hrs
2nd: 16 hours

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9
Q

primary assessment of burn patients focuses on (5)

A

airway
breathing
circulation
disability
environment

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10
Q

secondary assessment of burn patients focuses on: (6)

A

total body scan to determine extent of burns
fluid resuscitation
labs (BMP, CBC, ABG)
Foley placement
Pain management
Administering tetanus/other necessary vaccines

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11
Q

pain management consideration w/ burn patients

A

higher dose/more frequent administration because metabolic rate will be higher

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12
Q

burn complications (circulatory) (5)

A

Massive edema
-electrolyte imbalances
-decreased cardiac output
-hypotension
-hypovolemic shock

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13
Q

burn complications (non circulatory) (5)

A

carbon monoxide impacts
impaired immunity/infection
impaired temperature regulation
decreased GI motility
stress/injury ulcers (GI)

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14
Q

burn is painful with mild edema

A

superficial

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15
Q

burn is painful with blisters and mild-moderate edema

A

partial-thickness burn

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16
Q

burn causes little to no pain and severe edema

A

full-thickness burn

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17
Q

burn is painless with little to no edema

A

deep-full thickness

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18
Q

burn effects only epidermis layer

A

superficial

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19
Q

burn effects epidermis and 1/3 of dermis

A

superficial partial thickness

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20
Q

burn effects epidermis and more than 1/3 (but not whole) dermis

A

deep partial thickness

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21
Q

burn effects epidermis and all of dermis

A

full-thickness

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22
Q

burn effects all skin layers

A

deep full-thickness

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23
Q

TBI priority action

A

apply C-collar and don’t remove until provider has assess and cleared patient

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24
Q

Glasgow coma scale:
less than 8:
9-12
more than 13:

A

<8: severe head injury/coma
9-12: moderate head injury
>13: minor head trauma

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25
Q

____________ pupils indicate severe brainstem injury and possible brain death

A

bilateral, fixed pupils

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26
Q

assessment for TBI (4)

A

Glasgow coma scale
cranial nerves
pupillary assessment
reflex assessment

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27
Q

_______ and _______ are both posturing indicating life-threatening brain damage with _________ being most severe

A

decorticate and decerebrate
decerebrate more severe

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28
Q

TBI monitoring: (5)

A

ICP
CPP
airway
circulation
neuro

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29
Q

Cerebral perfusion pressure formula

A

MAP - ICP

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30
Q

CPP should always be greater than _______, if less than, indicates _____________

A

60 mmHg
brain ischemia

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31
Q

normal CPP

A

60-100 mmHg

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32
Q

Normal ICP

A

10-15

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33
Q

________ and _______ indicates increased ICP and is a potential sign of brain __________

A

projectile vomiting and severe headache
brain herniation

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34
Q

TBI airway management: if GCS is 8 or less _______

A

intubate

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35
Q

With TBIs NEVER insert ____________

A

nasogastric tube

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36
Q

PaO2 should be over:

A

100 mmHg

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37
Q

_________ is one of the first signs of impending herniation

A

unilateral pupil dilation

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38
Q

Contraindication of HOB being elevated 30 degrees

A

spinal cord injury

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39
Q

_____________ is used if herniation is indicated as its a potent vasodilator and lowers CPP/ICP

A

hyperventilation

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40
Q

medications to reduce ICP (2)

A

Mannitol: osmotic diuretic
Vecuronium: neuromuscular blocking agent

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41
Q

_____ is the most common type of stroke (80-85%)

A

ischemic

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42
Q

ischemic strokes are caused by ________ generally coming from __________ following ___(3)_____

A

local thrombus/emboli
heart or large arteries
a-fib, acute MI, or surgery

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43
Q

Time goal for stroke management ED door - needle

A

60 minutes

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44
Q

NIHSS Score interpretation
0
1-4
5-15
16-20
21-42

A

no stroke
minor stroke
moderate to severe stroke
sever stroke

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45
Q

when to use NIHSS (4)

A

when patient arrives
following any intervention
when significant changes in pt status occurs
prior to discharge from ED

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46
Q

when to treat BP and BG before giving TPA:

A

-BG: <50mg/dL
-BP: S > 185; D>110 mmHg

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47
Q

Once TPA is initiated ________ can not be done

A

insertion of any tubes (foley, NG, IV, etc)

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48
Q

complications of thrombolytic therapy (4)

A

bleeding
angioedema
anaphylactic reaction
further deterioration in neurological status

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49
Q

assessment before/during/after TPA (6)

A

-Neuro assessment & vitals every 15 minutes for 2 hours than every 30 minutes for 4-6hrs
-Record I&Os
-Don’t administer any thrombotic for first 24 hours
-fall precautions
-telemetry
-monitor hemoglobin and platelets

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50
Q

TIA->stroke risk ABCD assessment

A

Age < or equal to 60
Blood pressure < or equal to 140/90
Clinical TIA features
Duration of symptoms (longer the symptoms, greater the risk of stroke

51
Q

most common cause of hemorrhagic stroke

A

hypertension

52
Q

s/s of autonomic dysreflexia (6)

A

sudden increase in BP
goodebumps
bradycardia
sense of anxiety
blurred vision
pain

53
Q

hypovolemic shock results from

A

inadequate circulating volume

54
Q

carcinogenic shock results from

A

pump failure

55
Q

distributive shock results from

A

abnormal distribution of blood

56
Q

obstructive shock results from

A

obstruction of blood flow

57
Q

major intervention for cariogenic shock

A

position in semi-flowers or high fowlers

58
Q

if cariogenic shock is caused by right sided pump failure, there is an increase in _______ and should be treated with _______

A

increased preload
isotonic fluids

59
Q

Indicators of SIRS (7)

A

-fever + leukocytosis
-hyper/hypothermia
-HR > 90
-RR>20
-pCO2 < 32
WBC > 12000 or < 4000
10% immature neutrophils

60
Q

client diagnosed with sepsis has a higher risk of developing _____ or ______

A

DIC or MODS

61
Q

Risk factors of SEPSIS (6)

A

suppressed immune system
extreme age
people who have received an organ transplant
surgical procedure
indwelling device
sickness

62
Q

Initial stage of septic shock (2)

A

Baseline MAP decreased by <10 mmHg
Vascular constriction and increased HR

63
Q

in the initial stage of septic shock caused by bacterial sepsis, you will most likely see an elevated ____________ normal:

A

prolactin (normal: 0.01 ng/dL)

64
Q

Compensatory phase of septic shock (6)

A

Map decreased by 10-15 mmHg
Urine output decreases
Blood vessel constriction increases
Tissue hypoxia occurs
Thirst and anxiety are subject to changes

65
Q

in septic shock: a MAP <65 after fluid administration indicates:

A

condition is worsening

66
Q

in septic shock, nurse should talk to provider about holding vasopressors if MAP is:

A

55 or less

67
Q

Progressive stage of septic shock (7)

A

-sustained decreased MAP of more than 20 mmHg from baseline
-vital organs develop hypoxia; some tissues die
-rapid, low pulse
-low BP
-pallor; cool, moist skin
-anuria
-decrease in SpO2

68
Q

Condition causing shock must be corrected within _______ of progressive stage onset

A

1 hour or less

69
Q

refractory stage of septic shock (6)

A

-too little oxygen reaches tissues; cell death and tissue damage results
-MODS develops
-Rapid loss of consciousness
-nonpalpable pulse
-cold, dusky extremities
-slow, shallow respirations; unmeasurable SpO2

70
Q

early s/s of septic shock (7)

A

warm flushed skin
hypotension
tachycardia
tachypnea
fever
high cardiac output
restless/anxiety

71
Q

late s/s of septic shock (6)

A

cold and clammy skin
cardiac output decreases
oliguric
hypotension
decreased LOC
hypothermia

72
Q

Treatment for septic shock (7)

A

start antibiotics within one hour
oxygenate
vasopressors
fluids
nutrition
corticosteroids
monitor BG for hyperglycemia

73
Q

for a patient with septic shock, its important to review medications for:

A

diuretics- contraindicated

74
Q

physiologic responses to all types of shocks include (3)

A

activation of inflammatory system
activation of coagulation system
hypoperfusion of tissues

75
Q

patients receiving fluid replacement therapy for shock should be frequently monitored for (3)

A

adequate urinary output
changes in mental status
vital sign stability

76
Q

the main goal of treating septic shock is

A

identification and elimination of infection

77
Q

AKI is a rapid reduction in kidney function resulting in a failure to: (3)

A

maintain waste and elimination
fluid and electrolyte balance
acid-base balance

78
Q

Labs indicating AKI (3)

A

-increase in serum creatinine by 0.3 mg/dL or more within 48 hrs
-increase in serum creatinine to 1.5x baseline in last 7 days
-urine volume less than 0.5mL/kg/hr for 6 hours

79
Q

phase of AKI where patient is sickest

A

oliguric phase

80
Q

phase of AKI that is most dangerous/life threatening

A

diuretic phase

81
Q

phase of AKI where there’s a return to normal function while healing takes place

A

recovery phase

82
Q

indications of CRRT (3)

A

-sepsis
-MODS
-clients aren’t able to tolerate intermittent dialysis

83
Q

DKA is characterized by (4)

A

profound dehydration
electrolyte losses
ketonuria
acidosis

84
Q

priority treatment of DKA (3)

A

potassium changes
fluid replacement (NS->D5W)
regular insulin drip

85
Q

DKA is more common in type ____ and HHS is more common is type ____

A

DKA: type 1
HHS: type 2

86
Q

treatment of HHS

A

Potassium changes
fluid replacement (NS-> D5W)
regular insulin drip

87
Q

Type of insulin: lispro, aspart, glulisine

A

rapid-acting

88
Q

peak of rapid-acting insulin

A

one hour

89
Q

regular insulin peak

A

2-4 hours

90
Q

what type of insulin: NPH, detemir

A

intermediate-acting

91
Q

intermediate acting insulin peak

A

4-12 hours

92
Q

what type of insulin: glargine, degludec

A

long-acting

93
Q

long acting insulin starts working within ______ and lasts ______

A

2 hours, 24 hours

94
Q

most common s/s of pulmonary embolism

A

coughing up blood

95
Q

complications of PE (5)

A

cardiac arrest
arrhythmia
pulmonary effusion
pulmonary hypertension
pulmonary infarction

96
Q

treatment of PE (5)

A

thrombolytics
anticoagulants
clot removal
inferior vena cava filter placement
balloon angioplasty

97
Q

treatment of pulmonary hypertension (4)

A

anticoagulants
diuretics
oxygen
digoxin

98
Q

procedure performed to remove fluid from the thoracic cavity; for both diagnostic and therapeutic purposes

A

thoracentesis

99
Q

minimally invasive procedure that lets doctors look inside airways and lungs

A

bronchoscopy

100
Q

common causes of type 1 respiratory failure (7)

A

trauma
pneumonia
lung disease
smoke, chemical, or water inhalation
blood clot
sepsis
heart attack

101
Q

common causes of type II respiratory failure (5)

A

stroke
spinal cord injury
drug/alcohol overdose
sepsis
cardiac arrest

102
Q

treatment of acute respiratory failure (4)

A

oxygen therapy
breathing treatments
fluid
ECLS

103
Q

takes over the function of the heart and lungs, supplying oxygen and removing carbon dioxide
gives lungs a break, allows for time to recover

A

Extracorporeal life support (ECLS)

104
Q

ventilator bundle (6)

A

oral care q2hrs
HOB 30 degrees
sedation holiday
GI prophylaxis
DVT prevention
daily assessment for extubation/weaing

105
Q

complications of mechanical ventilation (6)

A

barotrauma
hemodynamic instability
Ventilator associated pneumonia (VAP)
aspiration
immobilization
anxiety/pain/delirium

106
Q

degree of STRETCH of cardiac muscle fibers at end of diastole

A

preload

107
Q

RESISTANCE to ejection of bleed from ventricle

A

afterload

108
Q

STRENGTH/ABILITY of cardiac muscle to shorten in response to electrical impulse

A

contractility

109
Q

percent of end diastolic volume ejected with each heart beat

A

ejection fraction

110
Q

amount of blood pumped by ventricles in L/min

A

cardiac output

111
Q

cardiac output formula

A

stroke volume x hr

112
Q

normal cardiac output

A

4-8 L/min

113
Q

normal cardiac index

A

2.5-4 L/min

114
Q

normal central venous pressure

A

2-6 mmHg

115
Q

central venous catheter contraindications (2)

A

recurrent sepsis
hypercoagulable state

116
Q

MAP formula

A

(SBP + (DBPx2)) / 3

117
Q

non-pharmacologic pain intervention (7)

A

ET suctioning
Repositioning
Oral Care
Reassurance/ family presence
Heat/Cold therapy
massage, acupuncture, relaxation
Music, low lights, adequate room temp

118
Q

common sedatives (5)

A

dexmedetomidine
lorazepam
propofol
midazolam
barbiturates

119
Q

Roles of RN with sedation (5)

A

Daily sedation holiday unless contrainidcated
educate family
skin management
DVT prophylaxis
pain control

120
Q

management of delirium (6)

A

treat the cause
mobilize patient if possible
provide sleep enhancement
antipsychotic meds
manage withdrawal symptoms
family involvement

121
Q

goals of neuromuscular blockade

A

decrease oxygen consumption
decrease total body work
decreasing pain and anxiety
decreasing temperature

122
Q

golden rule of sedation

A

never start without sedation

123
Q

types of neuromuscular blockades

A

vecuronium
pancuronium
rocuronium

Critical Care (4 decks)

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