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Surgery > ICU > Flashcards

ICU Flashcards

1
Q

nurse to pt ratio ICU

A

2:1

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2
Q

SDU nurse to pt rati

A

o

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3
Q

3:1 medsurg nurse to patient ratio

A

5:1

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4
Q

indicators for the ICU

A

resp insufficiency
cardio insufficiency
depressed consciousness or coma

(breathing, heart, brain or threat of these things )

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5
Q

Note format in the ICU differs from regular SOAP notes how

A
  1. ID
  2. problem
  3. background information
  4. current problems
  5. physical findings (I and O)
  6. evaluation of patient by system
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6
Q

systems for evaluation daily in the ICU`

8

A 
respiratory
cardiovascular
neurological
GI and nutrition
Hematology
Renal
Electrolytes
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7
Q

respiratory in the ICU

what do we need to learn with regards to the language

A

mechanical ventulation
ballon inflates acting like a cork and also for positive pressure ventilation

having this tube protects the airway

when pts are on ventilators you know that, at least with regards to respiration, you are probably okay

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8
Q

3 main types of ventilation modes

A

refers to the frequency of breaths provided

Assisted-control (AC)

intermitten mandatory ventilation (IMV/SIMV)

spontaneous (spontaneous)

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9
Q

assisted control is used for

A

pts that are unable to take deep breaths on their own

coma
extreme sedation

fixed rate

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10
Q

can pts initiate breaths on AC

A

Yes

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11
Q

what to pts need for AC

A

need to be sedated in order to tolerate

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12
Q

IMV/SIMV

A

intermitten mandatory ventilation

periodic breaths at a set rate
pt can initiate breaths above that set rate

this is usually much more comfortable for people

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13
Q

pressure support ventilation is used when

A

pt initiates every breath

but are supported by positive pressure

least invasive and most comfort

used for weaning mechanical ventialtion

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14
Q

how to talk about mechnaical respiration

A

mode (RR)
TV

FiO2
PEEP

PSV

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15
Q

SIMV 12 (14) 400 50% PEEP=5 PSV=8

A

12 set breaths pts taking 14

Tidal volume is 400

Fio2 OF 50% Required for saturaton

the positive end expiratory pressure

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16
Q

tidal volume normally

A

6ml/kg

480ml

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17
Q

what are we worried about what higher tidal volume

A

associated with barotrauma

with critically ill you usually want low volume ventilation

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18
Q

fraction of oxygen saturation

A

usually expressed as a percentage

start with 100% when beginning and titrate down

when you are round and presenting and the person requires an fIo2 OF 50% THIS IS A SIGNAL THAT THIS PERSON IS REALLY SICK

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19
Q

PEEP

A

positive end expiratory pressure-COPD

keeps the alveoli open and is useful in people with “stiff lungs”

need a higher amount

5cm H20 is helpful in promoting oxygen and reducing barotrauma

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20
Q

pressure support (PSV)- is used to

A

overcomes resistance of the tube
used in iMV and spontaneous ventilation

positive pressure applied with patient-initiated breaths

or else it feels like sucking through a straw

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21
Q

when do you do a tracheostomy

A

allows you to take the breathing tube out and place a whole for positive pressure ventilation without going through the mouth

prevents errosin of the trachea and bacteria infiltration.

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22
Q

cardiovascular support

what does the heart need in the ICU

A

a functioning pump

sufficient fluid volume

regulated resistance of the cardiovascular system

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23
Q

when you have pump dysfunction

A

cardiogenic shock

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24
Q

when you have volume depletion

A

hypovolemic shock

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25
Q

when you have resistance dysfunction

A

septic or neruogenic anaphylactic shock

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26
Q

how do you find out what type of shock the patient might be in

A

hR, rhythm, BP, CP
hx of trauma or illness
EKG echocardiogram

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27
Q

three things we need in managing cariogenic shock

A

cardiac output
cvp
svr

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28
Q

cariogenic shock

A

pump problem with reduced co

increased systemic vascular resistance due to hypovolemia

increased central venous pressure

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29
Q

what do you do for cariogenic shock

A

need to start a inotropic agent

(increased stroke volume leads to increased cardiac output)

dobutamine is one such drug

will relax the SVR and decrease it due to baroreceptor response

does not increase arterial bp so they made need drugs for this as well

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30
Q

hypovolemic shock picture

what does venous pressure look like

A

decreased CO

decreased central venous pressure

increase systemic vascular resistance

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31
Q

what do you do for the hypovolemic pt

when will loss lead to shock

A

need fluids

can lose up to 15% of blood volume and compensate

after 30% will go into shock

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32
Q

what is the amount of total body fluid

of a 80 kg man
of a 60 kg woman

what is blood volume

A

80kg man 48
60kg women 3.6 L

blood volume

  1. 3L
  2. 6L
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33
Q

volume replacement looks like

A

calculate fluid loss

giving 4 times the loss in IV crystallous

percent blood loss times total blood x4

35% x 5.3=1.9 so replace 7.5-8L

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34
Q

target CVP is between

A

5-10 mm Hg

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35
Q

what does fluid overload look like

A

12-15 mm Hg

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36
Q

septic or neurogenic shock picture

A

unable to maintain resistance
increased co
Decreased systemic vascular resistance

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37
Q

how does dopamine help with neurogenic shock at a low dose

A

low dose (1-5mcg)

increases blood flow to renal, mesenteric, and cerebral regions, by increasing SVR in other regions.

38
Q

pressures put pts at risks for

A

ischemic necorosis

39
Q

hypertensive emergency tx

A

give anti-hypertensices

drips of nitroprusside, nicardipine, celvidipine, esmolol

use CCB now (pines)

the goal is to get them back on oral medications

40
Q

Swan Ganz cathter

A

No longer used

first reason to have person in the ICU
invasive monitor that could detect wedge pressure in the heart

but doesn’t really seem to make a difference in outcome

41
Q

neurological problem

what exam are we using to evaluate decline

how often do they need to be checked

A

With neuro issue in ICU, need q1hr neuro checks (can only be done in the ICU with pt:RN ratio 2:1)

glasgow coma score

pupils

reflexes

need to document what is normal for this patient

42
Q

CPP what is the equation and how do you monitor

A

Cerebral perfusion pressure (CPP)

so, for critical head injuries, have to monitor/control both intracranial pressure & BP)

MAP-ICP

43
Q

CPP goal

A

cerebral profusion goal is around 60 mmHg

44
Q

gold standard for invasive intracranial pressure monitoring

A

Ventriculostomy

45
Q

Licox monitor

A

inserted like a camino bolt

measures O2 content of blood
considered more useful than camino because it measures direct oxygenation rather than perfusion pressure (which correlates with oxygenation)

46
Q

goal CPP is often around

A

60 mm HG

47
Q

Goal ICP should be

A

generally less than 22 mm Hg

48
Q

to maintain CPP we can …

A

lower ICP (preferable) or raise MAP (last resort)if

49
Q

if a person is borderline with CPP

A

if the ICP is within normal limits you know the brain probably has good circulation (unless hypotensive)

50
Q

a weak point in the cerebral artery

often asymptotic

usually devastating

A

50% never make it into the hospital

Subarchanoid hemorrhage

51
Q

management of subarachnoid hemorrhage

A

critical BP control, neuro checks, seizure and vasospasm prophylaxis

need to be on seizure medication because of lowered threshold

need to repair the aneurysm

52
Q

repair of the aneurysm

A

endovascular coiling

catheter is inserted in the groin, snaked up the artery into the brain and placed into the aneurysm
filled with a thread and keeps from rupturing

(does not occur at highland)

53
Q

what is the F/U care for repair of a aneurysm

A

very high risk of vasospasm need to stay in the ciu

HHH tx

hypervolemic hypertensive hemodilution

pump them up so there is no chance of vasopsasm (will be experienced as stroke)

54
Q

nutrition in the ICU

short term

A

most ICU ptaients are too obtuned to eat and are NPO

use thick NG tube

not dobhoff usually because they can inserted into a lung if not done right

55
Q

g-tube

A

long term solution goes to the stomach

many times you need a PEG which is like a G tube

56
Q

hematology concerns in ICU

when would you consider a transfusion for a pt in the ICU

A

many pts are ANEMIC
can be consuming RBC
may be malnourished

if HMG falls below 8 can consider a transfusion
can wait till it falls to round 6

need to follow coags (INR) and correct as needed

57
Q

electrolyte concerns in the ICU

A

need to follow I and Os very closely

insensate fluid loss is also of concerned

58
Q

healthy people lose how much water

A

400 mo H20 from longs and 400mL from the skin

in the ICU you need to follow I and O over multiple days

59
Q

renal concerns

A

need to follow urine output
BUN and Cr

these numbers hould not be climbing

60
Q

three kinds of renal problems and the most common

A

person in shock will have pre renal

intrinsic damage can occur through durg intake and IV contrast

post obstruction from stones and BPH is uncommon in the ICU but is not unheard of

61
Q

hypophosphatemia could effect breathing in what ways

A

makes it harder to wean off ventilator because of the decreased smooth muscle strength

effects the diaphragm

62
Q

infectious disease concrens in the ICU

A

we are worried mostly about all the tubes

need to track temp and WBC every day

if they are being treated from infection need to documetn

63
Q

If pt has a new fever or ↑WBC GET A

A

panculture

blood
sputum
urine

64
Q

why are we worried about pneumonia in the icu

A

Because of the ventilator

need a CXR

65
Q

prophylaxis for ICU pt

A

GI/nutrition

hematology-

66
Q

what is the reason we really need to worry about prophylactic GI nutrition

A

feed as soon as possible need protein to heal and decreased risk of ulcers

need PPI

stool softener (these pts are constipated–> leads to BO and electrolyte abnormalities)

suppository

67
Q

hematology prophylaxis

A

out them on prophylactic heparin or LMWH when pt is hemodynamically stable

68
Q

which meningitis vaccine do we give

A

ACYW

teenagers 11-18 yo

(1st dose 11 and second does 16 years old)

anyone younger can get the vaccine if worried about exposure and you would need it for prophylaxis

69
Q

Men B vaccine

A

against serogroup B meningitides is given to young children in England

given the low incidence here is is not routine

given to kids going off to collage or kdis going over seen where there are high rates of meningitis

70
Q

what oxygen saturation is toxic

A

> 60% for 48 hours can be toxic

71
Q

at an intermediate dose how dose dopamine work

A

) stimulates beta receptors in heart, increased cardiac output

72
Q

At a high dose how does dopamine work

A

(>10mcg)

stimulates alpha receptors in systemic and pulm circulation, increasing SVR while preserving CO, thus helping to correct hypotension

73
Q

complications with dopamine

A

 Complications: tachycardia at intermediate doses, ischemic limb necrosis (consider alpha blocker)

74
Q

goal ICP

A

generally <22 mm HG

75
Q

goal MAP

A

> 8- mm Hg

76
Q

two ways to maintain CPP

A

o To maintain CPP, can lower ICP (preferable) or raise MAP (less preferable)

77
Q

screwed into skull to rest just under dura, provides real time ICP data

A

o Camino Bolt

78
Q

measures O2 content of blood, more useful than Camino since it measures direct

A

o Licox monitor

79
Q

if a pts with aneurysm ahs a vasospasim requires

A

Vasospasm requires emergent transluminal balloon angioplasty

will be experienced as a stroke

80
Q

BIG THREE

kill your pt quickly

A

respiratory insufficiency,
CV insufficiency
and neuro injury

know all their stats form before

81
Q

small stuff that can kill your pt slowly

A 
GI/nutrition
hematology
 electrolytes
renal,
infectious dz
82
Q

Minimum UOP should be

A

Minimum UOP should be ≥20ml/hr and BUN/Cr should not be climbing

83
Q

Pre-renal:

A

↓blood flow to kidney (hypovolemia, renal artery obstruction

84
Q

Intrinsic: renal causes

A

: damage to kidney (drugs, ischemia, infection)

CT

85
Q

Post-renal:

A

obstruction of urinary tract (stones, catheter, BPH)

86
Q

electrolyte imbalance that makes it difficult to wean someone off the ventilator

A

Hypophosphatemia

d/t decrease in smooth muscle strength including the diaphragm

87
Q

Hypomagnesemia

what is normal and what kind of problems does it cause

A

normal range is 1.7-2.3, and low levels <0.7 can cause fatal arrhythmias

88
Q

Most ICU pts need to be on these meds

A

stool softeners
PPI- prevent ulcers
Heparin or LMWH

89
Q

PROPHYLAXIS for DVT

A

: DVT and PE, every pt should be wearing sequential compression devices on their legs

Every patient should get prophylactic heparin or LMWH when hemodynamically stable.

90
Q

when would you want to start prophylactic heparin in a pt with a brain bleed

A

 Brain bleed generally wait until 72 hours later but it depends on the brain bleed and how bad it was

91
Q

overall impressions of the pt in the ICU

A 
Respiratory
Cardiovascular
Neuro
GI/Nutrition
Heme
FEN/Renal
ID
Prophylaxis

and monitor medication sedation (propofol or versed) and integumentation

Surgery (18 decks)

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