ICU Assessment Flashcards
(91 cards)
1
Q
Name 4 critical care areas
A
- Intensive care units
- step down/high acuity/intermediate unit
- Operating rooms
- Recovery rooms
2
Q
Critical care areas have the highest _____
A
staff to patient ratio
3
Q
What are the two more typical patient populations found in the critical care units
A
- Respiratory failure requiring mechanical ventilation
- Cardiovascular instability requiring invasive hemodynamic monitoring
4
Q
3 sources of information for ICU patients
A
Charts
Monitors
Nurses
5
Q
4 questions you consider when first assessing a patient
A
- What brought them in
- Do they have any mobility orders or ROM restrictions?
- What is their current status
- What is the plan for today for them? (i.e. tests, ventilator weaning, OR, dressing changes, etc.)
6
Q
What is a peripheral intravenous line? where is it inserted? how does it work?
A
- Inserted into a peripheral vein
- Enables administration of fluids and meds
- is gravity driven or on a pump
7
Q
What is a PICC line? Purpose? Where does it insert?
A
- Peripherally inserted central catheter
- To give medications that will corrode peripheral veins and require mixing with larger blood volumes quickly such as chemotherapy or antibiotics
- Can also use to take blood samples
- Inserted in peripheral vein but travels all the way into superior vena cava so that it can mix with more blood
8
Q
Why do you need to assess Level of consciousness
A
Need to know how much can this patient participate in treatment vs how much will be passive
9
Q
What are 2 commonly used sedation scales
A
- Richmond agitation sedation scale (RASS)
- Glasgow coma scale
10
Q
Scoring on the RASS
A
Grading -5 to +4.
0 is normal (alert and calm)
+4 is combative violent danger - calling security and police
-5 is unarousable, no response to voice of physical stim
11
Q
What is a useful tool for assessing pain in ICU patients
A
Behavioural pain scale S
12
Q
Scoring of the behavioural pain scale?
A
3-12
12 = most pain
13
Q
What is normal ICP?
A
5-10mmHg
14
Q
What ICP will lead to brain damage
A
> 20mmHg for over 5 minutes
15
Q
What is the purpose of an extraventricular drain?
A
To monitor and drain ICP as needed
16
Q
What are important considerations when working with a patient with a extraventricular drain
A
- Always check physicians orders regarding target ICP and ability to change patients position or do chest physiotherapy
- Activity Will be pretty limited especially if stopcock is open, if we change position and in turn change how gravity is working with these drains we can get into trouble
- always make sure stopcock is closed before any position changes
- Increased BP will increase ICP - be careful what you do
17
Q
What are 3 things you need to know when assessing spinal stability
A
- ASIA
- If injury is stable or not, especially if it is getting worse
- Orders around collar and braces
18
Q
What is very important to screen for when assessment cognition and behaviour? Why?
A
Delirium
The earlier we can catch it the better, has effect of morbidity and mortality
19
Q
70-80% of patients have some _____ at discharge from ICU
A
Cognitive deficit
20
Q
What are some examples of cognitive deficit faced by people upon discharge from ICU
A
- Attention, concentration & memory
- Depression
- High level functioning
- ordering
- Impaired judgement
- Decreased awareness
- Apraxia
21
Q
How do you assess Patients emotional and behavioural changes
A
Ask friend or family is they are different from before the event
22
Q
What is different in an IPPA of a ventilated patient
A
- Inspection: Should include the position/stability or airway and ventilator settings
- Palpation - Passive ventilation will follow path of least resistance and preferentially ventilate upper areas
- Auscultation - On a ventilator all breath sounds will be significantly louder
23
Q
Why do you inspect and palpate the chest and abdomen
A
Because these will both affect diaphragm function, ability to cough and clear, ability to get air in.
24
Q
How are secretion measurements done in ICU
A
Amount: 1,2,3 (small, med, large)
Description: Mucoid (M), Mucopurulent (MP), purulent (P), Bloody (B)
25
What are
- Mucoid (M)
- Mucopurulent (MP)
- purulent (P)
- Bloody (B)
- Mucoid: clear salivary
- Mucopurulent: Clear mixed with gross green stuff
- purulent: gross green stuff
- Bloody - blood
26
How is CO2 monitored in ICU
End tidal COW using monitoring device in vent tubing - dont need to draw blood for ABGs
27
What is normal CO2
Same as PaCO2 in ABGs: 35-45 mmHG
28
What happens to the CO2 monitor when you mobilize a patient
Can disconnect it
29
What does increasing PaCO2 when doing activity indicate
yOu are working them too hard
30
What is the P/F ratio
FiO2 ratio - The ratio of arterial oxygen partial pressure to fractional inspire oxygen = PaO2/FiO2
31
What is normal P/F ratio
>380
Because PaO2 80/0.21
Room air oxygen is 21%
32
What is an arterial line? It's purpose? Where is it inserted?
Indwelling catheter
- Constantly monitors arterial BP (SBP, DBP, MAP) on bedside monitor
- Access for direct blood sampling for painless and frequent analysis of ABGs
- inserted radially and femorally in adults, can also be inserted in axillary and pedal arteries
33
Can a patient mobilize with an arterial line?
Yes
34
When mobilizing with an arterial line what comes with you and what stays at bedside
- Arterial line itselt
- transducer
- pressure bag
Left at bedside: monitor
35
Arterial line PT Considerations?
- Measure is not always accurate
- For line to give accurate readings the transducer needs to be at the level of the superior vena cave (4th intercostal space)
- Interference will occur from changes in joint position and resulting compression of line
- Avoid excessive wrist motion or hip flexion
36
How can you tell if the arterial line is working
- A clear waveform on the bedside monitor
| - Can also check with a cuff pressure measurement
37
What is considered normal adult BP
100-140/50-90
38
What BP would you not mobilize a Pt
Higher than 200/100
| lower than 90/60
39
Is a raise in blood pressure or a drop in blood pressure more of a concern
Drop - O2 will not be reaching vital organs
| There is no evidence showing that when patients get hypertensive they are at increased risk of cardiac arrest
40
A sudden drop or rise in BP of ____ is cause for concern
>20mmHg
41
What is Mean arterial Pressure, include equation
Average of SBP and DBP
| MAP = SBP +(2*DBP)/3
42
What is normal MAP
70-110 mmHg
43
A MAP >60 is necessary to perfuse coronary arteries, brain, kidneys
60mmHg
44
Normal HR
60-110
45
What may cause an increase in HR
- Stress
- Fever
- pain
46
What will cause a decrease in HR
sleep or vagal stimulation
47
Why do we care about heart arythmias?
Lets us know how heart is functioning - if it is not pumping effectively we are not getting oxygen to the tissues that require it. On extreme end you can end up in cardiac arrest if you are not getting blood to the coronary arterie
48
What are 4 arythmias to watch
1. Pre-ventricular contractions
2. A-fib
3. Ventricular-Fib
4. Ventricular tachycardia
49
How do pre-ventricular contractions appear on an ECG
Dropping beats
50
How does A-Fib appear on an ECG
many fibrillations between QRSs
51
What is tachycardia? What do you need to consider?
>110 BPM - need to consider Pts max HR based on age and see if they will have a limited cardiovascular reserve
52
What is bradycardia
<60 BPM
| Can they increase the HR enough to pump better and faster if they need to
53
S&S of ventricular fibrillation
- Unresponsive
- ineffective pulse
- No spontaneous respirations
- Cyanosis
- Duskiness, mottled skin
Don't nee d to look at ECG monitor to realize this is going on
54
What occurs at heart during ventricular fibrillations
Heart is only quivering due to the rapid multiple electrical discharges in the myocardium
55
What is a central venous line?
Where is it inserted?
Purpose?
- A pressurized bag and transducer are connected to the indwelling catheter allowing for measurement of central venous pressure.
- Inserted through the subclavian or internal jugular vein int the superior vena cava or through the femoral vein into the common iliac vein
- has multiple lumens to permit the administration of meds that will corrode peripheral veins and require mixing with larger blood volumes, nutrition, and conduct volume and hemodynamic monitoring (central venous pressure)
56
Considerations for central venous lines
Transducer must be level with right atrium to get accurate reading
57
What does central venous pressure tell you
Provides info about cardiac function (right heart function - how well heart is pushing blood out) and the adequacy of circulating vascular volume
58
Normal central venous pressure value
2-7 if self ventilating
| 6-12 mmHg on a ventilator as PEEP affects pressure in thorax
59
What can cause a low CVP?
- Increased HR and decrease BP = decreaded volume in circulation
- Sepsis or shock
- Hemorrhage
- Peripheral vasodilation/venous pooling
- Decreased venous return - often positional
60
What can cause a high CVP
- Increased BP and decrease HR = increase pressure in vasculature
- Ex: Hypervelemia, PE, inotropes
OR
- Decreased HR and decreased BP = poor myocardial function, decreased cardiac output
61
Why do we care about CVP?
- Helps us to assess if fluid in lungs is secretions of pulmonary edema
- Helps us make decisions about how cardiovascularly stable a patient is, how much we can do with them
62
What is a pulmonary arterial line? Where does it enter? What is its course?
Balloon tipped catheter used on very sick patients
- Enters subclavia, internal jugular, femoral or brachial veins then threaded via the vena cava into right atrium, into the pulmonary artery, and possibly a pulmonary capillary where it sits and monitors
63
What is the purpose of a pulmonary arterial line
- Allow sampling of mixed venous blod to calculate a-v O2 difference
- Monitor pulmonary arterial pressure, pulmonary capillary wedge pressure, and right atrial pressure
- Allows a measurement of cardiac output
64
Pulmonary arterial line concerns
- Very easily dislodged from correct position, usually only insitu with very cardiovascularly unstable patients and has ability to cause serious damage so usually no physiotherapy intervention when it is in place
65
What do you do if a line is pulled ou
Notify others
Elevate + put pressure on it
Wait for someone to reinsert
66
What are some ICU conditions that can cause chest pain/discomfort?
- Infection
- PE
- Rib fracture
- Trauma
- Pneumothorax
67
Cardiac pain S&S
- Pressure, fullness, burning, or tightness in chest
- Crushing or searing pain that radiates to their back, neck, jaw, shoulders, and one or both arms
- Pain that comes on suddenly, lasts more than a few minutes, gets worse with activity, goes away and comes back, or vairies in intensity
- SOB
- Cold sweats
- Dizziness or weakness
- Nausea or vomiting
68
2 types of pacemakers
Internal and external
69
What are internal pacemakers
They implant a small electronic device that is usually placed in the chest (just below the collarbone) to help regulate slow electrical problems with the heart - used for long term use
70
What is an external pacemaker? What are special considerations for it
External wires come out of thebody and are attached to an external unit. Used for temporary packing.
Patients are often on bed rest - Because if wires are pulled out they may not be able to maintain rhythm i.e. they could go into cardiac arrest
71
What are the precautions following the insertion of an internal pace maker
For first 4-6 weeks
- <90 degrees of shoulder flexion or abduction of arm on the same side as heart device
- Do no do any activities where you are repeatedly pushing and pulling, swinging
- Do not lift anything more than 5kilograms or 10lbs
72
What is an IABP
Intra Aortic Balloon Pump
- Pup that goes into aorta - balloon inflates when heart is in diastole and it will push some fluid back up into heart and into coronary arteries - used to get more coronary blood flow. If they have one in not a patients you will be seeing as a PT.
73
Name 6 electrolytes
- K
- Na
- Magnesium
- Ca
- Creatinine
- Urea
74
What does albumin do?
- Fights infection
- Helps wound healing
- helps body maintain plasma volume
75
What is the white cell count used for
to detect presence of infection or leukemia
76
High levels of WBC =
| Low levels of WBC =
- Indicated infection
| - Increased risk of bruising, using appropriate infection control standards, fatigue during ax/rx
77
Low Hb =
| High Hb =
Low = Fatigue, dizziness, headache, lack of concentration, collapse. Can lead to cardiac damage
High = increased risk of clotting
78
What do platelets do
Allow blood clots to occur
79
Decreased platelets =
Increased platelets =
Dec: Thrombocytopenia, causing bruising, increased risk of bleeds
Inc: Clotting risk (DVT, PE_
80
Platelet levels ;
<100 =
<50 =
<20 =
```
<100 = Care with Rx
<50 = Question if we should Rx
<20 = risk of spontaneous bleeding
```
81
What does INR Stand for ? what is it?
International normalized ratio - A ratio of clotting time of blood compared to normal
82
What does PTT stand for? What is it?
Partial thromboplastin time
| Time taken for blood to clot
83
Normal INR
| Therapeutic range of INR if on anticoagulants?
0.9-1.3
2-3
84
PTT normal
24-40 seconds
85
Low INR/PTT levels =
| High INR/PTT levels =
Low: There is increase risk of clots. Watch out for DVTs/PEs maybe on bedrest
High = At risk of bruising and bleeding. this may require more stringent safety measures when you are treating
86
What is troponin
A substance released into the blood when heart muscle is damaged
87
What troponin levels indicate cardiac muscle injury
<0.05 ug/L
88
Following heart muscle damage Troponin rises for ____, peaks at ___, declines over _____
4-8 hours
10-24 hours
10 days
89
What is albumin
A blood protein that fights infection and helps wound healing. It also prevents swelling as it plays a part in maintenance of plasma volume
90
What are normal albumin volumes
3.5-6 g/dL
91
What causes a decreased in Albumin? What does this decrease lead to?
Caused by malnutrition, sepsis and liver failure
Leads to body wide interstitial edema
