Icu

Question 1

What are the benefits of enteral nutrition over parenteral?

Answer 1

Enteral nutrition preserves the structure and function of gut mucosa and prevents the movement of gut bacteria across the intestinal wall and into the bloodstream.

Question 2

What are indications for parenteral nutrition?

Answer 2

Paralytic ileus, diffuse peritonitis, intestinal obstruction, pancreatitis, gi ischemia, intractable vomiting, and severe diarrhea

Question 3

Cardiac index

Answer 3

Measurement of CO adjusted for BSA. It is a more precise measurement of the efficiency of the pumping action of the heart. (Stroke volume index is a measure of stroke volume adjusted for BSA)
CI=CO/BSA should be 2.2-4l/min/m2

Question 4

CVP

Answer 4

2-8

Question 5

PAWP

Answer 5

6-12

Question 6

CO

Answer 6

SV x HR should be 4-8L/min

Question 7

What does CVP represent?

Answer 7

Right ventricular pressure

Question 8

What does PAWP represent?

Answer 8

LV end diastolic pressure

Question 9

Preload

Answer 9

Increases CO but requires increased O2 delivery to myocardium.

Question 10

Milrinone (primacor)

Answer 10

Vasodilator to reduce after load

Question 11

Epi, ne (levophed), isoproterenol, dopamine (inotropin), dobutamine (dobutrex), dig, calcium, and milronone function to

Answer 11

Improve contractility

Question 12

Negative inotropes

Answer 12

Alcohol, CCB, beta blockers, acidosis

Question 13

If preload , heart rate, and after load remain constant, yet CO changes, what has changed?

Answer 13

Contractility

Question 14

Referencing

Answer 14

Means positioning the transducer so that the zero reference point is at the level of the atria.

Question 15

Zeroing

Answer 15

Confirms when pressure in the system is zero, the monitor reads zero. Open the reference stop cock to room air (off to the patient) observe the monitor for a zero reading. Zero the transducer during initial set up, immediately after insertion of the arterial line

Question 16

Perform a dynamic response test

Answer 16

Square wave test q8-12 hours and when the system is opened to air. It involves activating the fast flush and checking that the equipment produces a distortion free signal.

Question 17

Change pressure tubing, flush bag, and transducer

Answer 17

Q96h

Question 18

To maintain line latency and limit thrombus formation

Answer 18

Assess the continuous flush system q1-4h to determine that the pressure bag is inflated to 300 mm Hg, flush bag contains fluid, and system is delivering 3-6 mL/hr. Assess neurovascualr status distal to the arterial insertion site hourly.

Question 19

PAD and PAWP increase during

Answer 19

Heart failure or fluid volume overload.

Question 20

Monitoring PA pressures (PAD and PAWP) permits

Answer 20

Precise therapeutic manipulation of preload allowing CO to be maintained without putting the patient at risk for pulmonary edema.

Question 21

Contraindications to pulmonary artery catheterization

Answer 21

Coagulopathy
Endocardial pacemaker
Endocarditis
Mechanical tricuspid or pulmonic valve

Question 22

Swan ganz lumens

Answer 22

Standard is 7.5 Fr, 43”, with 4-5 lumens
Distal port (catheter tip) is in PA: measures pressures and for mixed venous blood sampling
Right atrium port: measure CVP and injection of fluid for CO determination. Also for withdrawal of blood specimens.
Right ventricle port: infusion of fluids or drugs or blood sampling.
A thermistor is located near the distal tip to measure core temp and for the thee modulation method of measuring CO.

Question 23

Before pa catheter insertion, assess what?

Answer 23

Electrolyte, acid-base, oxygenation, and coag status. Imbalances such as hypocalcemia, hypomagnesemia, hypoxemia, or acidosis can make the heart more irritable and increase the risk for ventricular dysthymias. Coagulopathy increases risk for hemorrhage

Question 24

Prep for PA insertion

Answer 24

Arrange monitor, cables, infusion and pressurized flush solutions

Question 25

Following PA catheter insertion

Answer 25

Chest X-ray confirms
Secure at point of entry
Note and record the measurement at the exit point
Apply occlusive dressing.

Question 26

For accurate data, when do you record PA measurements?

Answer 26

At the end of respiration

Question 27

When measuring PAWP, do not

Answer 27

Inflate the balloon more than four respiratory cycles or 8-15 s.

Question 28

What if the waveform in the PA looks wedged spontaneously, when less than 1mL is needed to wedge the tracing, or an overwedge tracing is obtained?

Answer 28

Risk for rupture of PA if the catheter moves distally into a smaller vessel or if the balloon is overinflated.

Question 29

Patients often exhibit early and subtle signs of deterioration suck as mild confusion and tachycardia how long before cardiac and or respiratory arrest?

Answer 29

6-8 hours

Question 30

Intubation pre-meds

Answer 30

Midazolam (versed) if pt is agitated, disoriented, or combative
Fentanyl (sublimaze) blunts pain
Succinylcholine (anectine) paralytic
Atropine reduces secretions

Question 31

Pre ET Tube procedure

Answer 31

Preoxygenate client with BVM and 100% O2 for 3-5 mins. Each intubation attempt is limited to less than 30s.

Question 32

How do you confirm ET tube placement at bedside (before you get the CXR)?

Answer 32

Inflate the cuff
Manually vent patient
Place detector between BVM and ET tube.
Auscultation for lung sounds B/L and confirm no sound in epigastrum.
Observe chest for symmetric rise and fall.
SpO2 should be stable or improved.
If these assessments are positive, connect to oxygen and secure. Suction et tube and pharynx, insert bite block. Order CXR
Record measurement at lip, teeth
Obtain ABG’s within 25 mins

Question 33

What is ideal cuff pressure for ET tube?

Answer 33

20-25 mm Hg