ICU Flashcards
What is included in the first step: review medical history?
-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
what is included in the mental status/congitive decision point?
- is the patient awake and alert
- can the patient follow simple commands
- is the metal status stable? rule out delirium
Explain the RASS scale
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
What is AAO x4
pt knows
what their name is
where they are
what the date is
what the cause or circumstance of their hospitalization
what are dejonghes 5 orders? to follow commands
- open your eyes
- look at me
- open your mouth and stick out your tongue
- nod your head
- raise your eyebrow when i have counted up to 5
pt must follow greater than 3 out of 5 of the commands
a disturbance of consciousness that is accompanied by a change in cognition that cannot be better accounted for by a pre-existing dementia
delirium
explain signs of hyperactive delirium
-increases motor activity
-loss of control of activity
-restlessness
-wandering
explain signs of hypoactive delirium
-decreased activity
-decreased action speed
-decreased speed of speech
-decreased amount of speech
-reduced awareness of surroundings
-withdrawl
can delirium and type of delirium fluctuate throughout the day?
yes it can
is delirium= brain dysfunction
yes
with delirium there is an increased risk of 6 month mortality
increased risk of depression and PTSD
true
explain the 4 steps of CAM-ICU
- acute changes or fluctuating mental state in the last 24 hours
- inattention- squeeze hand with each letter A
- current RASS level
- disorganized thinking
-will a stone float on water
-are there fish in the sea
-does one pound equal 2 pounds
what is normal MAP
70-110mmhg
when should we be concerned about MAP
below 60 mmhg for prolonged periods of time, tissue will not get enough blood flow and organ ischemia may occur
equation for MAP
DBP+1/3 (SBP-DBP)
what are the main concerns if the patient has Afib
- Clotting
- lower BP
is pt on an anti-coagulant
what value do you need to look for in:
Heparin
Coumadin/warfarin
Heparin- PTT
Coumadin/warfarin- INR
what are the main complications with cardiac monitoring equipment? and when could it happen?
- infection
- thrombosis
-putting the catheter in and taking it out
what is an indwelling catheter the provides measurement of systolic, diastolic and mean arterial pressure continuously?
Arterial catheter
-allows access for arterial blood gas sampling
What are the main pre-cautions when working with a patient who has an arterial line?
- high pressure system- if it pulls out—> hemorrhage/bleeding
- transducer height- the transducer is specifically calibrated for a certain height
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?
no pt is most likely hypotensive because the transducer if below the patient will measure a higher reading
if a transducer is too low it will display a _____ BP
if a transducer is too high it will display a _____ BP
too low it will display a high BP
too high it will display a low BP
what are central venous catheters used for?
- monitoring pressure and heart function
- venous access for hemodialysis, nutrition and or medication administration
how would central venous pressure (CVP) change with dehydration?
lower CVP
how would central venous pressure change with volume overload (hypervolemia)
increased/greater CVP
if someone has a Central venous catheter what do you need to ask yourself?
why do they have it
is it due to hemodynamic instability
do i need to be seeing this patient right now
what are the most common complications of a Central venous catheter?
pneumothorax or dysrhythmias
what is a concerning pulse ox reading?
below 89%
what is a concerning RR
24-35
what is a concerning PaO2 level?
below 50% tissue begins to die
when is mechanical ventilation used?
when there is inadequate gas exchange
type 1: paO2 low hypoxemic respiratory failure
Type 2: paCO2 increase with decreased pH
how does a negative pressure ventilation work (iron lung)?
creates a negative pressure in the environment around the patients chest thus pt has to suck air into lungs
how does a positive pressure ventilation work?
application of super-atmospheric pressure to the upper airway to assist inspiration this forces air into the lungs
why might a mechanical ventilator alarm for higher pressure needed
mucus plug, bronchospasm (cough), condensation
why might a mechanical ventilator alarm for lower pressure?
machine is disconnected, tube leak, trach leak
why might a pt RR be high on a mechanical vent
pain, agitation, exercise
why might a pt RR be low on a mechanical vent
fatigue, medication
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?
MI: troponin
HF: BNP
respiratory failure/COPF: PH, PaO2
Renal disease: creatinine
diabetes: Hb-A1c- long term
blood glucose- current
cut off for hemoglobin
> 7 with out cardiovascular disease and no signs of bleeding
cut off for hematocrit
> 25%
cut off for platelets
> 20,000 cells/mm3
white blood cells cut off
<5,000 cells/mm3 consider limiting patient to infection risk
>10,000 consider active infection
ranges for potassium
3.5-5.3 meq/L
ranges for sodium
135-148 mEq/ L
ranges for calcium
8.5-10.5 mg/dl
ranges for magnesium
1.8-2.7 mg/dl
glucose range
> 60 mg/dl but <300 mg/dl
