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Med Con III > ICU > Flashcards

ICU Flashcards

1
Q

What is included in the first step: review medical history?

A

-past medical and surgical history
-medication that may impact mental status, wakefulness, ability to follow commands
-medication that my impact HR and blood pressure
-previous level of functional independence and activity tolerance

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2
Q

what is included in the mental status/congitive decision point?

A
  1. is the patient awake and alert
  2. can the patient follow simple commands
  3. is the metal status stable? rule out delirium
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3
Q

Explain the RASS scale

A

0 is the goal pt is alert and calm if not need to increase or decrease sedation medication
+4 combative- overly combative or violent
-4 no response to voice but any movement to physical stimulation
-5 unarousable no response to voice or physical stimulation

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4
Q

What is AAO x4

A

pt knows
what their name is
where they are
what the date is
what the cause or circumstance of their hospitalization

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5
Q

what are dejonghes 5 orders? to follow commands

A
  1. open your eyes
  2. look at me
  3. open your mouth and stick out your tongue
  4. nod your head
  5. raise your eyebrow when i have counted up to 5

pt must follow greater than 3 out of 5 of the commands

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6
Q

a disturbance of consciousness that is accompanied by a change in cognition that cannot be better accounted for by a pre-existing dementia

A

delirium

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7
Q

explain signs of hyperactive delirium

A

-increases motor activity
-loss of control of activity
-restlessness
-wandering

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8
Q

explain signs of hypoactive delirium

A

-decreased activity
-decreased action speed
-decreased speed of speech
-decreased amount of speech
-reduced awareness of surroundings
-withdrawl

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9
Q

can delirium and type of delirium fluctuate throughout the day?

A

yes it can

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10
Q

is delirium= brain dysfunction

A

yes

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11
Q

with delirium there is an increased risk of 6 month mortality
increased risk of depression and PTSD

A

true

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12
Q

explain the 4 steps of CAM-ICU

A
  1. acute changes or fluctuating mental state in the last 24 hours
  2. inattention- squeeze hand with each letter A
  3. current RASS level
  4. disorganized thinking
    -will a stone float on water
    -are there fish in the sea
    -does one pound equal 2 pounds
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13
Q

what is normal MAP

A

70-110mmhg

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14
Q

when should we be concerned about MAP

A

below 60 mmhg for prolonged periods of time, tissue will not get enough blood flow and organ ischemia may occur

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15
Q

equation for MAP

A

DBP+1/3 (SBP-DBP)

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16
Q

what are the main concerns if the patient has Afib

A
  1. Clotting
  2. lower BP

is pt on an anti-coagulant

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17
Q

what value do you need to look for in:
Heparin
Coumadin/warfarin

A

Heparin- PTT
Coumadin/warfarin- INR

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18
Q

what are the main complications with cardiac monitoring equipment? and when could it happen?

A
  1. infection
  2. thrombosis
    -putting the catheter in and taking it out
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19
Q

what is an indwelling catheter the provides measurement of systolic, diastolic and mean arterial pressure continuously?

A

Arterial catheter
-allows access for arterial blood gas sampling

20
Q

What are the main pre-cautions when working with a patient who has an arterial line?

A
  1. high pressure system- if it pulls out—> hemorrhage/bleeding
  2. transducer height- the transducer is specifically calibrated for a certain height
21
Q

If a pt has an arterial line their BP is 120/80 when lying and you dont change the transducer height and when they are sitting BP is still 120/80? is that okay?

A

no pt is most likely hypotensive because the transducer if below the patient will measure a higher reading

22
Q

if a transducer is too low it will display a _____ BP
if a transducer is too high it will display a _____ BP

A

too low it will display a high BP
too high it will display a low BP

23
Q

what are central venous catheters used for?

A
  1. monitoring pressure and heart function
  2. venous access for hemodialysis, nutrition and or medication administration
24
Q

how would central venous pressure (CVP) change with dehydration?

A

lower CVP

25
Q

how would central venous pressure change with volume overload (hypervolemia)

A

increased/greater CVP

26
Q

if someone has a Central venous catheter what do you need to ask yourself?

A

why do they have it
is it due to hemodynamic instability
do i need to be seeing this patient right now

27
Q

what are the most common complications of a Central venous catheter?

A

pneumothorax or dysrhythmias

28
Q

what is a concerning pulse ox reading?

A

below 89%

29
Q

what is a concerning RR

A

24-35

30
Q

what is a concerning PaO2 level?

A

below 50% tissue begins to die

31
Q

when is mechanical ventilation used?

A

when there is inadequate gas exchange

type 1: paO2 low hypoxemic respiratory failure

Type 2: paCO2 increase with decreased pH

32
Q

how does a negative pressure ventilation work (iron lung)?

A

creates a negative pressure in the environment around the patients chest thus pt has to suck air into lungs

33
Q

how does a positive pressure ventilation work?

A

application of super-atmospheric pressure to the upper airway to assist inspiration this forces air into the lungs

34
Q

why might a mechanical ventilator alarm for higher pressure needed

A

mucus plug, bronchospasm (cough), condensation

35
Q

why might a mechanical ventilator alarm for lower pressure?

A

machine is disconnected, tube leak, trach leak

36
Q

why might a pt RR be high on a mechanical vent

A

pain, agitation, exercise

37
Q

why might a pt RR be low on a mechanical vent

A

fatigue, medication

38
Q

what lab values would you be concerned about:
Patient with MI?
Pt with HF?
pt with respiratory failure?
pt with COPD?
pt with renal disease?
pt with diabetes?

A

MI: troponin
HF: BNP
respiratory failure/COPF: PH, PaO2
Renal disease: creatinine
diabetes: Hb-A1c- long term
blood glucose- current

39
Q

cut off for hemoglobin

A

> 7 with out cardiovascular disease and no signs of bleeding

40
Q

cut off for hematocrit

A

> 25%

41
Q

cut off for platelets

A

> 20,000 cells/mm3

42
Q

white blood cells cut off

A

<5,000 cells/mm3 consider limiting patient to infection risk
>10,000 consider active infection

43
Q

ranges for potassium

A

3.5-5.3 meq/L

44
Q

ranges for sodium

A

135-148 mEq/ L

45
Q

ranges for calcium

A

8.5-10.5 mg/dl

46
Q

ranges for magnesium

A

1.8-2.7 mg/dl

47
Q

glucose range

A

> 60 mg/dl but <300 mg/dl

Med Con III (27 decks)

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