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Medical Nursing > ICU equipment > Flashcards

ICU equipment Flashcards

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1
Q

What ICU equipment can you use?

A 
Blood gas 
NIBP
ECG
Pulse oximetry
capnograph 
IBP(arterial catheters via transducers)
CVP (central line, haemodynamic changes)
Multiparameter monitors
Glucometer 
Lactate monitor 
Microscope
Heamotology and bichem
centrifuge
syringe drivers and infusion pumps
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2
Q

What are the normal blood gas paratmeters for pH, PaO2 PaCO2, HCO3-
BE
Anion gap

A 
ph. 7.35-7.45
PaO2- 80-100mmHg
PaCO2; 35-45mmHg
HCO3- 21-24
BE +2 or -2
Anion gap 
Cats 13-27mEq/L
Dogs 12-24mEq/l
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3
Q

What is metabolic acidosis?

A

ph <7.35

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4
Q

What is metabolic alkalosis?

A

pH >7.45

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5
Q

what compensatory factors are used to impact on metabolic acidosis and alkalosis?

A

HCO3- low in acidosis high in alkalosis

CO2 high in alkalosis low in acidosis

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6
Q

What can a rise in lactate cause?

A

Metabolic acidosis

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7
Q

What is respiratory acidosis?

A

High CO2>45mmHg

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8
Q

what is respiratory alkalosis?

A

Low CO2 <35mmHg

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9
Q

What can cause metabolic acidosis?

A 
diabetic ketoacidosis
Diarrhoea
renal failure
addisons disease 
lactic acidosis (sepsis\)
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10
Q

what can cause metabolic alkalosis?

A

Vomiting
Hypoalbuminaemia
Upper GI obstruction

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11
Q

What is kirbys rule of 20?

A

A list of parameters that should be checked in critical care patients.
should be done hourly or daily

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12
Q

What critical parameters should be checked daily in a critically ill patient (kirbys rule of 20)?

A 
Fluid balance
Glucose 
Blood pressure 
TLC 
Haemoglobin 
WBCs (Immune status)
Pulse quality/arrythmias/murmur
Renal function 
Nutrition 
Mobilisation 
Oncotic pull/albumin
Electrolytes and acid base
oxygenation and ventilation 
Level of consciousness
temperature
Coagulation
GI motility 
Drug dose and metabolism
Pain 
wound care
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13
Q

How should fluid balance be monitored?

A

assess hydration at triage
calculate fluid therapy levels and an appropriate solution
Bolus may be required if hypovolaemic

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14
Q

How should oncotic pull/albumin be monitored?

A

maintain above 20
TS can be measured using a refractometer
low levels can lead to odema higher risk of mortality
can increase them by administration of blood, plasma and nutrition.

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15
Q

How should glucose be monitored in the critically ill patient?

A

Hypotensive and septic animals closely monitored. Be aware of the stress response in cats. anorexia=hypoglycemia
starving young animals for procedures = hypoglycemia

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16
Q

How should electrolytes and acid base be monitored in the critically ill patient

A

Often low potassium in ill patients (renal disease, GI disease, sepsis).
High potassium indicative urinary obstruction or addisons bradycardia may develop.
Sodium low and high levels can lead to CNS signs
Hypophosphataemia can lead to RBC heamolysis
repeat measurements several times a day same with scid base
Metabolic acidosis due to sepsis (lack of perfusion)

17
Q

Why should oxygenation and ventilation be monitored in a critically ill patient and how?

A

Assess for hypoxaemia
Hypoventilation
o2 therapy or mechanical ventilation can be used
Observe patients resp effort pattern and rate
SpO2 PaO2 PaCO2

18
Q

Why should levels of consiousness and mentation be monitored in a critically ill patient?

A

may be a result of hypotension, hypoglycema, hyperammonaemia
normal, obtunded, stuporous and comatosed
Assess via the glassgow coma sacle
a drop of 2 should be flagged up to the vet

19
Q

Why should blood pressure be monitored in the critically ill patient and how?

A

IBP, NIBP always maintain systolic BP above 90mmHg
Fluid therapy may be enough to support BP
give vasopressors via CRI

20
Q

Why should you assess heart rate and quality in a critically ill patient?

A

Monitor pulse quality and pulse deficits, listen for heart murmurs ECG for arrythmias
cardiac output is essential to maintain in critically ill patient

21
Q

Why should temperature be monitored in a critically ill patient?

A

Measure regularly sepsis and hypothermia main reasons for fluctuations in hypothermia

22
Q

Why should coagulation and clotting times be monitored in the critically ill patient and how is it done?

A

ACT, PT, APTT and thrombocytes can be measured
Risk of developing DIC and thrombocytopenia
If septic likely to be hypercoagulable may result in multiple organ dysfunction or pulmonary thromboembolism

23
Q

Why should you measure Hb in the critically ill patient and how?

A

frequent sampling can lead to anaemia
most significatn factor responsible for o2 concentration
manual PCV more useful along side TS
O2 therapy can help but blood transfusion may be required
O2 carrying capactiy is compromised

24
Q

Why should renal function be assessed in the critically ill patient?

A

Shock, dehydration, hypotension and hypoxia can contribute to renal dysfunction
measure urine output 1-2ml/kg/hr
urinary dipstick
Urinary catheterisation in recumbent animals

25
Q

Why should the immune status of critically ill patients be assessed?

A

Neutropenic patients should be barrier nursed
Iv versus oral AB
Treat infectiosn with specific AB to reduce resistance

26
Q

Why should GI motility be assessed in the critically ill patient?

A 
ileus and gastric ulceration are common 
may be due to stress or opioid therapy 
V and D should be medically managed 
anti-emetics or proton pump inhibitors 
Bowels can be auscultated for sounds 
care risk of aspiration pneumonia
27
Q

Why should drug doses and metabolism be assessed in the critically ill patient and how?

A

Liver plays key role in metabolism
drug accumulation should be considered
Body weight changes so drugs should be calculated on a daily basis

28
Q

Why should nutrition be assessed in the critically ill patient?

A

Cats require arginine and taurine
risk of catabolism an hepatic lipodosis(cats)
RER calculated on daily bases 70(BW)0.75
feeding tube slow refeeding

29
Q

How should pain be controlled in the critically ill patient?

A 
pain can manifest as restlessness tachycardia or mental depression 
Assess Glasgow composite pain scale
1-4 hours
multimodal analgesia
constant rate infusions
avoids accumulation
30
Q

How should patient mobilisation be controlled in the critically ill patient?

A 
minimal restraint 
check iv lines 
turn recumbant patients every 4 hours maintain in sternal where possible
complete a physio plan 
appropriate bedding 
prevent faecal and urine scalding
31
Q

How should wound care be managed in the critically ill patient?

A

observe on daily basis

any strike through change in aseptic manner

32
Q

Why is TLC important in a critically ill patient?

A

Bath grooming regular owner visits cat boxes to hide in

allow times of quiet and dark so animals can rest and sleep

33
Q

How should the ventilator patient be nursed?

A 
Eye care 
Mouth care 
Airway 
Humidification 
Physio and positioning 
urination and defecation 
lines, drains and tubes 
drugs 
treatment underlying diseases 
communication 
record keeping 
acid base 
blood gases 
electrolytes

Medical Nursing (22 decks)

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