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CVNT2 > ICU Nursing > Flashcards

ICU Nursing Flashcards

1
Q

which patients require critical care nursing?

A

CVS instability

respiratory/neurological distress

multiple trauma (RTA)

systemic disease

extensive wounds/burns

electrolyte imbalances

sepsis/systemic inflammatory response syndrome

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2
Q

what is the aim of triage?

A

quickly assess each patient to establish whether stable or unstable and decide order of treatment

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3
Q

how do we triage?

A

quick physical assessment of the 3 major body systems - cardiovascular, respiratory and neurological

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4
Q

how do patients fail a triage?

A

failing any of the 3 MBS assessments mean they have failed the triage and require immediate intervention

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5
Q

what is involved in the quick initial triage assessment?

A

check whether tachy/bradycardic, pulse quality

any tachypnoea/dyspnoea, increased respiratory effort

excessive bleeding

severely painful

mentation

ambulatory or not

any seizure activity

mm colour and CRT

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6
Q

which patients require constant monitoring?

A

critical patients and those likely to deteriorate

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7
Q

which patients require monitoring every 15-30 mins?

A

GA recovery, those starting a blood transfusion

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8
Q

which patients require monitoring every 1-2 hours?

A

hypoglycaemic patients
monitoring RR
those needing medication

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9
Q

which patients require monitoring every 4-6 hours?

A

stable patients but clinical status may deteriorate e.g. coagulopathies, cardiac disease

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10
Q

how can we measure the cardiovascular system function?

A 
pulse rate, heart rate and quality 
blood pressure 
mm colour and CRT time 
ECG 
heart auscultation
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11
Q

what does it indicate if there are pulse deficits?

A

indicative of arrhythmias - confirm with ECG

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12
Q

what do weak/thready pulses indicate?

A

decreased systolic BP e.g. hypovolaemia/hypoperfusion

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13
Q

what do bounding pulses indicate?

A

sepsis

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14
Q

what do snappy pulses indicate?

A

indicative of anaemia

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15
Q

what is the normal heart rate for large breed dogs?

A

60-100 bpm

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16
Q

what is the normal heart rate for small breed dogs?

A

100-140 bpm

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17
Q

what is the normal heart rate for cats?

A

140-180bpm

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18
Q

what heart rate is considered tachycardic?

A

> 140bpm dogs

>180-200bpm cats

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19
Q

what heart rate is considered bradycardic?

A

<60bpm dogs

<120bpm cats

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20
Q

what is normal MAP?

A

dogs 100mmHg

cats 135 mmHg

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21
Q

what is normal systolic bp?

A

dogs 110-160mmHg

cats 120-170mmHg

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22
Q

what blood pressure values are considered hypotensive?

A

<100mmHg systolic

<60mmHg MAP

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23
Q

what blood pressure values are considered hypertensive?

A

> 170-200mmHg systolic

>120mmHg MAP

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24
Q

what are the 3 methods of measuring blood pressure?

A

doppler
oscillometric
invasive BP

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25
Q

how should we take BP readings?

A

calm quiet environment, allow patient to adjust
lateral recumbency
3-5 readings and average

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26
Q

how large should a BP cuff be?

A

40% circumference of the leg

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27
Q

what do red/hyperaemic mms indicate?

A

sepis

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28
Q

what do bright red/cherry red mms indicate?

A

carbon monoxide toxicity

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29
Q

what do very pale/white mms indicate?

A

anaemia or shock

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30
Q

what do brown mms indicate?

A

paracetamol toxicity

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31
Q

what does petechiation on mms indicate?

A

coagulopathy

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32
Q

what does crt indicate?

A

peripheral perfusion

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33
Q

what is normal CRT?

A

1-2 secs

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34
Q

what does prolonged CRT indicate?

A

> 2.5-3 secs

indicates shock/hypoperfusion

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35
Q

what does rapid CRT plus red/hyperaemic mms indicate?

A

<1 sec
sepsis/SIRS
rapid CRT due to vasodilation

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36
Q

what does pale mms and prolonged CRT indicate?

A

vasoconstriction (shock/hypoperfusion)

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37
Q

what does pale mms and normal CRT indicate?

A

anaemia

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38
Q

which conditions are likely to result in arrhythmias?

A

GDV and sepsis

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39
Q

how do we assess function of the respiratory system?

A 
RR and effort 
lung auscultation 
pulse oximetry 
capnography 
arterial blood gases 
oxygen therapy and considerations
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40
Q

what is the normal RR range in dogs and cats?

A

dogs 18-36 brpm (breed size dependent)

20-30 brpm

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41
Q

what is considered bardypnoea?

A

<15 brpm

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42
Q

what are some possible causes of bradypnoea?

A

drugs
hypocapnia
CNS disease (respiratory centre affected)
hypothermia

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43
Q

what is considered tachypnoea?

A

> 45-50 brpm

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44
Q

what are some of the causes of tachypnoea?

A 
hypoxia/hypoxaemia 
hypercapnia 
pain 
hyperthermia 
pyrexia 
stress
compensation for metabolic acidosis
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45
Q

what are some possible causes of apnoea?

A

respiratory or cardiac arrest
drug overdose
neurological complications

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46
Q

what are some of the causes of dyspnoea?

A

upper airway obstruction, flail chest

pleural space disease

pulmonary parenchymal disease

upper airway disease (BOAS, laryngeal paralysis)

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47
Q

what are the indications a patient is dyspnoeic?

A 
increased chest and abdominal muscle movement 
postural changes (orthopnoea) 
open-mouth breathing
48
Q

why might a patient display reduced respiratory effort?

A

head and spinal trauma/ijury
tetanus
end stage respiratory failure/fatigue

49
Q

what does decreased dorsal lung sounds indicate?

A

pneumothorax (air in pleural space)

50
Q

what does decreased ventral lung sounds indicate?

A

pleural effusion (fluid in pleural space)

51
Q

what does borborygmi sounds in the lung field indicate?

A

diaphragmatic rupture

52
Q

what do crackles/wheezes on lung auscultation indicate?

A

bronchopulmonary disease e.g. pulmonary oedema, pulmonary contusions, damage/disease of lung parenchyma

53
Q

where can you place a pulse oximeter?

A 
tongue
lip 
ear
inguinal fold 
prepuce 
vulva
54
Q

what is a normal ETCO2 value?

A

35-45 mmHg

55
Q

which factors can affect the capnography measurement/trace?

A 
system leaks 
ET tube kink 
sensor obstruction 
airway obstructions 
apnoea (aids early detection of cardiac arrest)
56
Q

what is PaO2?

A

amount of O2 dissolved in arterial blood

57
Q

what is PaCO2?

A

amount of CO2 dissolved in arterial blood

58
Q

what is normal PaO2 range?

A

80-100 mmHg

59
Q

what is normal PaCO2 range?

A

35-45 mmHg

60
Q

where do we obtain an arterial blood sample from?

A

dorsal pedal artery

61
Q

what non-invasive methods of oxygen provision are available?

A

flow-by oxygen e.g. mask, tubing held near patients mouth/nose
oxygen cage
nasal prongs

62
Q

what invasive methods of oxygen delivery are available?

A

nasal catheters
trans-tracheal
endotracheal (intubation)
(IPPV or mechanical)

63
Q

how do we assess neurological system function?

A

mentation

cranial nerve function

modified glasgow coma score (MGCS)

increased intracranial pressure

seizures

64
Q

what does obtunded mean?

A

reduced alertness/consciousness, easily roused with non-noxious stimuli

65
Q

what does stuporous mean?

A

unconscious, only rousable with noxious stimuli

66
Q

what does comatose mean?

A

unconscious, no response to any stimuli, including noxious stimuli

67
Q

what are some potential causes of reduced mentation?

A

shock/hypoperfusion
hypoxaemia e.g. severe anaemia
primary neurological disease

68
Q

how can we assess cranial nerve function?

A 
pupillary light reflex 
pupil size and symmetry 
oculocephalic reflexes 
menace relfex 
nystagmus 
strabismus
69
Q

what is miosis?

A

constricted pupils

70
Q

what is mydriasis?

A

dilated pupils

71
Q

what is nystagmus?

A

eyes making repetitive, uncontrolled movements - may be horizontal/vertical/rotational

72
Q

what is strabismus?

A

one or both eyes deviated from normal position

73
Q

what can absent PLRs or changes in pupil size indicate?

A

raised ICP - trauma or intra-cranial lesions (tumour, inflammation)

74
Q

what are the 3 sections of the modified glasgow coma score?

A

motor activity
brainstem reflexes
level of consciousness

75
Q

what is cushing’s reflex?

A

marked hypertension and bradycardia

76
Q

what does cushings reflex indicate?

A

raised ICP - emergency

77
Q

what can be given to try and lower ICP?

A

mannitol

hypertonic saline

78
Q

which patients are most at risk of raised ICP?

A

head trauma
seizures
meningoencephalitis patients

79
Q

how can we help manage raised ICP?

A

elevate head and thorax up by 15-30°

sternal recumbency to aid respiratory ventilation, provide O2

no jugular sample

avoid stimulation to sneeze/gag/vomit

80
Q

how can we manage seizure patients?

A

may require active cooling

provide flow-by oxygen during/after seizures

elevate head and thorax once safe to do so

make sure in padded kennel with seizure medications readily available

81
Q

what other considerations are there for patients with lesions of cervical region?

A

closely monitor respiratory function

82
Q

what other considerations are there for spinal trauma patients?

A

spinal board for transport and movement for potentially unstable spines
keep flat, minimise movement

83
Q

what other considerations are there for patients with decreased consciousness?

A

monitor gag reflex, regurgitation

may require airway protection

physiotherapy

hygiene e.g. eye and oral care

84
Q

what are the areas of a critical care ward?

A 
triage station 
high dependency (critical) patient area 
emergency crash station 
feline-friendly area 
nursing station 
laboratory area
85
Q

what should there be in the triage area?

A

oxygen supply

portable ultrasound machine (free fluid checks)

consumables

examination table

portable monitoring equipment

telemetry for ECG

blood pressure machine

good space to move

86
Q

what equipment should there be in the high dependency area?

A 
oxygen supply 
monitoring equipment 
chart for observation and recording 
pumps and syringe drivers 
heat source for patient
moveable trolley 
ventilator/anaesthetic machine 
easy access/space for constant patient monitoring
87
Q

what are the features of a feline friendly ward?

A

glass doors - easy to see through but provides noise reduction

glass cover - cats cannot see dogs walking past

oxygen and electricity wall access

separate oxygen cages

88
Q

what are the important features of a critical care nursing station?

A

list of important contact numbers
computer access for charging/px records/emergency details
able to observe whole room
patient records to hand

89
Q

which equipment might feature in the laboratory area?

A 
blood gas/electrolyte machine 
microscope
centrifuge 
diff-quik stain 
haematology machine 
biochemistry machine 
coagulation times 
SNAP tests
90
Q

what type of laboratory work might be carried out in critical care?

A 
minimum database (PCV/TS, electrolytes, lactate, oxygenation/ventilation, glucose) 
biochemistry and haematology 
urinalysis 
coagulation profiling 
blood typing
blood cross-matching 
SNAP tests
91
Q

what information should be on the hospital sheet?

A 
patient and owner details 
date 
problem list 
tubes/drains/IV lines 
IVFT and medications due 
clinical notes 
admin weight and daily weight record 
daily record of RER and food intake 
clinicians notes
clinician in charge and contact details 
patient temperament
92
Q

what categories of nursing considerations must be attended to in critical care?

A 
infection control 
hygiene 
body temperature 
lines/tubes/drains 
physio 
nutrition 
pain and stress 
fluid balance 
TLC
93
Q

what are the basic principles of infection control?

A 
hand hygiene - wash before and after each patient 
wipe equipment after use 
appropriate use of gloves 
prevent HAIs 
PPE if barrier nursing
94
Q

how can we keep the patient warm?

A 
incubator 
bubble wrap 
heat mats (not directly under patient!) 
hot hands 
bair hugger 
fleece blankets/vet beds 
warmed IV fluids
95
Q

how can we cool a hyperthermic patient?

A 
fan/air conditioning 
ice under bedding 
cooling mats 
cold damp bedding/towels 
tepid water bath 
frequently re-check temperature!
96
Q

how often should we check lines/tubes/drains of critical cate patients?

A

minimum twice daily

remove as soon as no longer required

97
Q

what are the general aims of physiotherapy for critical care patients?

A

decrease chance of complications e.g. recumbent patients

improve circulation

allow muscle/tendon relaxation

aid pain management

reduce inflammation

promote recovery

98
Q

what are the indications for physiotherapy?

A 
pressure sores/decubitus ulcers 
muscle contractions/spasm 
buildup of pulmonary secretions 
muscular weakness/atrophy 
joint stiffness
limb swelling 
pain 
depression/boredom/stress
99
Q

what are the contraindications for physiotherapy?

A 
unstable critical patients 
unstable limb/spinal fractures or spinal injuries 
head trauma 
blood disorders 
very stressed/painful patients
100
Q

what happens if there is no nutrients in the GI tract for >3 days?

A

cells will start to die - creates weakness in the GI tract barrier

101
Q

what does weakness of the GI barrier lead to?

A

increased intestinal permeability - bacteria and endotoxins can cross barrier and enter systemic circulation (translocation)
impaired immune function of GIT

102
Q

how do you avoid refeeding syndrome in anorexic patients?

A

1/3 RER on day 1, 2/3 RER on day 2 etc

103
Q

what are the different types of enteral feeding tube?

A

NG/NO tube

oesophagostomy tube

percutaneous endoscopic gastrotomy (PEG) tube

jejunostomy tube

104
Q

what are the considerations for patients with enteral feeding tubes?

A

check tube in correct location before every feed

check insertion site at least BID, clean site

sit in sternal/elevate thorax to prevent regurgitation and aspiration

J tube must have specific jejunal diet only

105
Q

how long must PEG/J-tubes be left in? why?

A

minimum of 10-14 days

allows adhesions to form to reduce risk of peritonitis upon removal

106
Q

what is parenteral nutrition?

A

nutrients are provided directly into patients blood stream, avoiding GIT

107
Q

what is total parenteral nutrition?

A

all nutrients parenterally
high osmolality
given via central line/peripherally inserted central catheter (PICC line)

108
Q

what is partial parenteral nutrition?

A

40-70% of nutrients given parenterally

may be given via central or peripheral route

109
Q

what are the considerations for parenteral feeding?

A

strict aseptic technique - can cause sepsis

TPN NOT peripherally - can cause thrombophlebitis

new bag and giving set every 24 hours

110
Q

what can we use to assess pain in cats?

A

feline glasgow pain score/colorado cat pain score

111
Q

what can we use to assess pain in dogs?

A

canine glasgow composite pain scale

112
Q

how can we minimise stress in critical care patients?

A

TLC - strengthen nurse/patient bond

sedative drugs to allow periods of rest

take your time/go slow with nervous patients

reassurance

feliway cat diffuser

hiding areas

113
Q

how can we monitor urine output?

A

closed system IDUC

weight incontinence sheets/bedding/litter

weight at least once daily - fluid balance responsible for rapid changes in patients weight

114
Q

what is a normal UOP?

A

1-2 ml/kg/hr

115
Q

how can we provide TLC to critical care patients?

A 
quiet time and lights out time 
grooming/bathing/affection 
toys (if appropriate) 
time outside the kennel 
hand-feeding

nursing care plans
owner visits

116
Q

what is the purpose of a nursing care plan?

A

standardisation of nursing care -
ensures patients needs met and all areas of nursing are covered
highlights any problems/potential complications

CVNT2 (47 decks)

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