Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Patient Assessment 3 > Final Review > Flashcards

Final Review Flashcards

1
Q

What Temperature Should the Pt be Before the Apnea Test Begins

A

>34

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Confirmation of the Apnea Test

A

ALL of the following must be present

  1. pH >/= 7.28
  2. PaCO2 >=60 mmHg and a 20 mmHg change from baseline
  3. No spontaneous efforts noted
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

The Apnea Test Should Be Discontinued If

A

Spontaneous respiration noted

SpO2 <90% OR PaO2 <60 mmHg

Significant hypotension refractory to vasopressors

MAP < 60 and Systolic <90 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the Purpose of the First ABG You Draw for the Apnea Test

A

To Make sure that the pt has a normal and stable ABG after you preoxygenate them

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Neurological Determination of Death

A

Testing for brain function from a known irreversible cause

Ex, Apnea test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Code 66 Breathing Criteria

A

<8 or >35

SpO2 <90% on 5 L/min O2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Code 66 Criteria

Other

A

Urine Output <50

Worried about the pt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Code 66 Criteria

Circultaion

A

HR <40 or >140

Systolic <90 or >200

Acute change in systolic pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Categorization of Code 66 Calls

A

Will be categorized with 10 min of arrival and may change over the course of the call

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Categorization of Calls

Level 1 Call

A

The Intensivist is needed to come and help

The team not the MRHP will make this call

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Code 66 Calling Criteria

Airway

A

Threatened airway – e.g. Stridor, gasping for air

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Code 66

Level 3 Calls

A

The MRHP will alway need to be informed that a code 66 was called and have them sign off on the call

The reason for this is in the case of “silent decompensation”, the patient is the MRHPs responsibility and they should be assessing their patient.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Criteria for Code 66

Neurological

A

GCS <8 or Decreased by 2

Sudden and Prolonged Seizures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

The Outreach Team should consider notifying the Intensivist/delegate when:

A

A higher level of intervention and/or adminssion to ICU is needed

Unsure of what to do and pt not responding to therapies

Difficult to communicate with attending staff

–Non-invasive ventilation (NIV) is required

–Cardiac or respiratory crisis is imminent

–A call has lasted more than 1 hour with no apparent resolution

–3 or more calls for the same patient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

MRHP Expectations According to Category of the Call

A

Level 1 – Provide immediate direction of care for the patient in collaboration with the Outreach Team and provide handover to the Intensivist/delegate if/when necessary.

–Level 2 - Provide immediate direction of care for the patient in collaboration with the Outreach Team

–Level 3 – May/may not involve direction of care, however, will be notified of the call.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the Initial Steps when the Call is Categorized as a Code 1

A

–Immediately contact the Intensivist/delegate

–If direct contact cannot be made within 5 minutes of this categorization, a Code Blue may be called

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

GCS-Motor Response

A

Score of 6-Obey Commands

Score of 5-Localized Pain: Will use other appendage to stop the painful stimulus and is higher level response as opposed to withdrawal

Score of 4-Withdrawal: Attempt to pull away from painful stimuli

Score of 3-Abnormal Flexion: Arms come up and curl and toes will curl over tends to be bilateral

Score of 2-Abnormal Extension: Arms extend and tends to be a bilateral extension

Score of 1-Flaccid: No response completely limp

18
Q

GCS-Verbal Response

A

Score of 5-Oriented

Score of 4-Confused

Score of 3-Inappropriate Words

Score of 2-Inappropriate Sounds

Score of 1-No Response

Poorly suited for patients with impaired verbal response (e.g., aphasia, hearing loss, tracheal intubation)

If intubated put a “T” after the level (e.g. 5 T) because it will affect their score as they cant score higher than 1)

19
Q

GCS-Eye Opening Response

A

Score of 4-Spontaneously

Score of 3-To Speech

Score of 2-To Pain

Score of 1-None

20
Q

Head Bobbing

A

Chin up and neck extended on inspiration

Chin falling during expiration

=Respiratory Failure

21
Q

Seesaw Respiration

A

Seesaw respiration indicted by chest retractions and abdomen expanding during inspiration

22
Q

Oxygen Therapy and Cardiac Anomalities

A

These babies may be dependant on intracardiac shunts and increased saturation will promote the constriction of these shunts

Hyperoxia can increase aortic pressure and systemic vascular resistance decreasing the cardiac index and O2 transport in children with acyanotic congenital heart disease

23
Q

Nebulizer Treatment

A

If more than one tx is needed it is common to give 3 onsective treatments

If a patient continues to be symptomatic continuous bronchodilators therapy may be delvered with a nebulizer attached to an infusion pump set to administer a bronchodilator continuously

24
Q

What is the BORG Scale

A

Exertional scale for Dyspnea and Respiratory Distress

25
Q

Transfer to Hospice

A

Patient feels/is unsafe at home

Steep rapid decline over 2 weeks

Gradual decline but increasing care needs with family exhaustion

Death expected within 3 months

26
Q

Hospice Care

A

When remaining at home is no longer possible, and a hospital admission is no longer required

24 hr palliative care

Family are included as part of the team “ to whatever extent they are comfortable”

No daily accommodation fee

Oxygen is provided (some costs covered by AADL)

Pharmacy-Alberta Blue Cross Palliative Coverage Program (30% of the cost to a max of $25 per prescription. Lifetime maximum an individual will pay is $1000)

27
Q

End of Life Care in COPD

Pt Profile

A

Very Severe Airflow obstruction (FEV1 <0.30 % Predicted) and hyperinflation

Poor functional status

Poor nutritional status

Older age

Recurrent AECOPD

Pulmonary Hypertension

28
Q

MRC Dypnea Scale

A

Grade 0: Only get breathless with strenous activity

Grade 1: I get short of breath when hurrying on level grounf or walking up a slight hill

Grade 2: On level ground I walk slower becuase of breathlessness or have to stop for breath

Grade 3: I stop for breath after walking about 100 yeard or after a few minutes on level ground

Grade 4: I am too breathless to leave the house

29
Q

Sudden Changes in COPD in EOL

A

SOB with any activity (eating, talking etc.)

Cachectic, very frail

Bilateral ankle edema

Sleeping much of the day

SpO2 becoming refractory to increasing oxygen

30
Q

Sudden Changes in ALS/NM in EOL

A

Swallowing

Nausea/vomiting

Discomfort / transferring

Communication

Constipation

Anxiety

Breathing (dyspnea)

Infection

Restlessness

31
Q

Medications for Dyspnea

A

Opioids e.g. morphine, fentanyl, other

Lorazepam (Ativan)

Midazolam (Versed)

32
Q

Medications for a Cough

A

Opioids e.g. codeine, morphine

33
Q

Medications for Retained Scretions

A

Anticholinergics e.g. glycopyrolate, scopolamine, atropine

Acetylcycsteine (mucomyst)

34
Q

Dyspnea and O2 saturation in EOL

A

No correlation between dyspnea and hypoxemia in chronic diseases

Asses for dyspnea on using intervention other than O2 to mange SOB

O2 when already in use should be titrated carefully to manage dyspnea and not necessarily the O2 saturation.

35
Q

Pallitaive Sedation

A

Medication to induce and maintain deep sleep

Purpose is to relieve symptoms when all other interventions are:

  1. inadequate of providing relief OR
  2. Associated with intolerable side effects OR
  3. Cannot provide relief in an acceptable time frame

AND

When the patient is expected to die imminently

36
Q

Pallitaive Sedation Versus MAID

Goal

A

Goal

  • PS: Decreased suffering
  • MAID: Decrease suffering
37
Q

Pallitaive Sedation Versus MAID

Timeline

A

Palliative Sedation: Unpredictable

MAID: Immediate

38
Q

Pallitaive Sedation Versus MAID

Immediate Outcome

A

Palliative Sedation: Decreased level of consicouness

MAID: Death

39
Q

Pallitaive Sedation Versus MAID

Process

A

Palliative Sedation: Administration of sedation drugs, titrated to effect

MAID: Administration of a lethal dose of drugs

40
Q

Pallitaive Sedation Versus MAID

Intent

A

Palliative Sedation: To Sedate

MAID: To Euthanize

Patient Assessment 3 (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions