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Neuro Eval II > ICU/Acute > Flashcards

ICU/Acute Flashcards

1
Q

Review minimal skills list

A

First 3 slides - too much to type :(

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2
Q

Also review essential elements of a medical record review

A

still too much to type

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3
Q

good lord review joint commission annual patient safety goals

A

theres so many lengthy lists on this lecture

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4
Q

standard precautions

A
  • Treat all patient situations as potentially infectious.
  • Wash Hands before and after each patient contact.
  • Wear different set of gloves with each patient.
  • If splashing of body fluids is likely, wear a mask or face shield, and a gown
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5
Q

Airborne Precautions

A

A mask is required in situations when contagious pathogens can be transmitted by airborne droplet nuclei
(TB)

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6
Q

Droplet Precautions

A
  • A mask or face shield or both are required when large particle droplet transmission is likely
  • Droplet transmission includes contact of the conjunctiva or mucous membranes of the nose or mouth
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7
Q

Contact Precautions

A

Gown and gloves are required when pathogens are transmitted by direct person to person contact or person to object contact.
(C-Diff, C-Aureus, Active COVID)

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8
Q

Putting on PPE

A
  1. Gown
  2. Mask
  3. Goggles
  4. Glove
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9
Q

Taking off PPE

A
  1. Gloves
  2. Goggles
  3. Gown
  4. Mask
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10
Q

Aerosol Generating Procedures

A

When an activity is performed with a patient that has potential for mobilizing contents for airway into an aerosol in the open environment

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11
Q

Aerosol Generating Procedures Examples

A
  • Airway Surgery
  • Intubation/Extubation
  • Chest Compressions
  • Cpap, Bipap (consider how many patients may be on CPAP due sleep apnea)
  • Suctioning Endoscopy Venturi mask with humidification
  • Pulmonary Care
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12
Q

Use of restraints may be indicated for:

A
  1. Unconscious
  2. Altered mental status and at risk for wandering or pulling out lines and tubes
  3. Not safe and mobile
  4. Physically aggressive
  5. So active or agitated that the essential care can not be completed
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13
Q

Use of restrains requires….

A

an order for a licensed practitioner and must be updated every 24 hours

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14
Q

Common restraints

A

wrist restraints, pelvic posey, full wheelchair desk, Vail Beds, mitt restraints, all four rails

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15
Q

Where are restraints NOT allowed?

A

subacute or skilled nursing centers

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16
Q

What other methods of safety management should be trailed before restraints?

A

chair alarms, bed alarms, remote monitoring, frequent check ins

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17
Q

Can members of the team remove constraints?

A

Yes
Unless specifically ordered not to
Responsible for patient safety when restraints are removed

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18
Q

Nasal Canula

A
  • Deliver supplemental O2 mixed with room air, usually 1-6 LPM
  • Flow rates of greater than 6 LPM usually consider alternative delivery methods
  • Adequate lengths of tubing for mobility
  • Monitor for skin irritation and dryness of mucosa
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19
Q

Tracheostomy mask or collar

A
  • Provides supplemental, humidified air at tracheostomy site
  • Mask placed over stoma or tracheostomy
  • Humidification is very important as trach site bypasses normal humidification methods
  • Mask can easily shift, especially with mobility
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20
Q

Non-Rebreather

A
  • Provides patient with highest concentration of supplemental O2
  • Closed face mask covers the nose and mouth and is attached to a reservoir bag which collects 100% O2
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21
Q

Arterial Line

A
  • Direct and continuous record of systolic, diastolic, and mean arterial blood pressure, to obtain repeated arterial blood samples, or to deliver medications
  • Nontapered catheter at brachial, radial, or femoral artery
  • If femoral line in place- usually seen bedside and hip flexion past 60-80 degrees is avoided
22
Q

What is the purpose of intraventricular catheter?

A

to directly monitor ICP and provide access for sampling/draining of CSF

23
Q

How is an intraventricular catheter placed?

A
  • Small catheter placed in the anterior horn of the lateral ventricle by burr hole
  • Transducer must be repositioned to the appropriate level with position changes
24
Q

What does an AV Graft provide access for?

A

hemodialysis

25
Q

What is an AV graft?

A
  • artificial blood vessel;
  • fistula is surgical joining of peripheral artery and vein, allowing arterial blood to flow directly to vein
26
Q

What should you do and not do when AV Graft is placed?

A
  • Elevate and avoid weightbearing on extremity for 24 hours after placement
  • Do not take blood pressure in involved extremity
  • Avoid pressure to site
27
Q

What is a PEG tube for?

A

Long term access for nourishment to patients who are unable to tolerate food by mouth or supplement

28
Q

What is a PEG tube?

A
  • Feeding tube inserted into stomach through abdominal wall
  • PEG tubing may be running continuously or tapered to larger portions near meal times as patient is more acclimated to feeding
29
Q

Precautions for PEG tube feedings

A

During tube feedings and 30 minutes following head of bed is to be at 30 degrees or higher to minimize risk of aspiration

30
Q

IV Line

A
  • Provides temporary access for delivery of medications, fluids, electrolytes, nutrients, or blood transfusion products
  • Avoid taking blood pressure on involved extremity
  • Monitor positioning to avoid occluding flow
31
Q

What is a PICC Line?

A

Peripherally Inserted Central Catheter Line

32
Q

What is PICC Line used for?

A

long-term intravenous (IV) antibiotics, nutrition or medications, and for blood draws

33
Q

PICC Line movement precautions

A
  • General movement and ADLs are okay with a PICC Line
  • Heavy Lifting and strenuous activity should be avoided
34
Q

Foley catheter

A
  • Temporarily drains and collects urine from bladder
  • Tube inserted through urethra into bladder and drains to collect bag
  • Be aware of catheter with mobility
  • Collection bag should be below the level of the bladder to allow drainage, kept off the floor, and emptied when full
35
Q

Are progressive mobilizations of adult ICU ventilated patients safe?

A

Yes
its feasible, safe, and may result in benefits including improved functional outcomes, and reduced ICU and hospital length of stay

36
Q

Prior to mobilizing ventilated person, what should the clinician do?

A

make sure that the artificial airway is correctly positioned and secure

37
Q

What should be available during mobilization of ventilated adults?

A
  • Any supplemental oxygen should be available along with adequate reserve that
    exceeds the expected needs for the duration of the activity
  • Fraction of inspired oxygen of less than .6 was safe criterion for mobility if no other
    contraindications (above .6 ok
38
Q

cautions for getting mechanically ventilated adults out of bed

A
  • Level of consciousness: minimal is ok
  • Craniectomy
  • subgaleal drain
  • acute spinal cord injury
  • subarachnoid hemorrhage with unclipped aneurysm
  • Vasospasm post clipping
  • Uncontrolled seizures
39
Q

Red flags for getting mechanically ventilated adults out of bed

A
  • open lumbar drain
  • spinal precautions: clearance needed
40
Q

What is delirium?

A

Disturbance in consciousness characterized by acute onset and fluctuating course of inattention

41
Q

What is delirium accompanied by?

A

either change in cognition or perceptual disturbance – person’s ability to receive, process, store, and recall information is impaired

42
Q

How does delirium develop?

A

over a short period of time, is usually reversible, and is a direct consequence of medical condition, substance use or withdrawal, medication, toxin, or combination

43
Q

ICU Delirium

A

Predictor of increased mortality, increased length of stay, increased time on vent, increased cost, increased chance of re-intubation, increased change of long-term cognitive impairment, and increased likelihood of discharge to long term care

44
Q

delirium =

A

Think: rapid onset, inattention, clouded consciousness (bewildered), fluctuating

45
Q

What is dementia usually characterized by?

A

a state of generalized cognitive deficit, usually develops over weeks, months, to years

46
Q

Dementia =

A

gradual onset, intellectual impairment, memory disturbance, personality/mood change, no clouding of consciousness

47
Q

What is PICS

A
  • Post intensive care syndrome
  • Comprised of impairment in cognition, psychological health, and physical function of the intensive care unit (ICU) survivor
  • Can also be PICS-Family
48
Q

What is PICS defined as?

A

new or worsening impairment in physical (ICU-acquired neuromuscular weakness), cognitive (thinking and judgment), or mental health status arising after critical illness and persisting beyond discharge from the acute care setting

49
Q

Risk factors for developing psychiatric illness after discharge from intensive care

A

female gender, lower education level, pre-existing disability and the use of sedation and analgesia in ICU

50
Q

Common physical symptoms of PICS

A

The common symptoms include generalized weakness, fatigue, decreased mobility, anxious or depressed mood, sexual dysfunction, sleep disturbances, and cognitive issues (memory disturbance/loss, slow mental processing, poor concentration and so on)

51
Q

ABCDE Bundle - Good Preventative Rates

A

A= Awakening (using light or minimal sedation);
B= Breathing (spontaneous breathing trials);
C= Coordination of care and communication among various disciplines;
D= Delirium monitoring, assessment, and management;
E= Early ambulation in the ICU

Neuro Eval II (16 decks)

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