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Clinical Nursing May Exam > Intensive care nursing > Flashcards

Intensive care nursing Flashcards

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1
Q

define critical care nursing

A

field of nursing focusing on care of critically ill patients

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2
Q

what are potential causes of life threatening illness?

A

surgery
illness
injury

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3
Q

list patients in need of critical CCN

A 
CV unstable
respiratory distress
neurological disease
multiple trauma
systemic disease
extensive wounds
electrolyte imbalances
sepsis
neonates and adolescents
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4
Q

what is the aim of triage for critical patients?

A

quickly assess patient to determine order of treatment for patients

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5
Q

describe the steps of triage for critical patients

A

assess 3 MBS
if fail any of MBS assessments need immediate attention
usually takes place in reception with owner

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6
Q

what are the 3 MBS?

A

neurological
CV
respiratory

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7
Q

what should you make sure to communicate with owners of critical patients during triage?

A

introduce self and what you will do
ask patients temperament
if stable keep with owner, if not take for treatment and explain someone will be out soon to explain

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8
Q

what is assessed in the quick assessment of triaging critical patients?

A 
HR
pulse quality
RR and effort
bleeding
pain
mentation
ambulation
seizure signs
MM
CRT
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9
Q

what are considerations when monitoring critical patients?

A

tailor to individual
monitoring equipment can be unreliable
trends more important than results

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10
Q

when do patients need constant monitoring?

A

critical patients

patients likely to deteriorate

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11
Q

which patients should be monitored every 15-30 minutes?

A

GA recovery

starting blood transfusion

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12
Q

which patients should be monitored every 1-2 hours?

A

hypoglycaemic patients
if monitoring RR
when need medication

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13
Q

which patients are monitored every 4-6 hours?

A

stable patients but may deteriorate

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14
Q

which pulse points are used most for cats and dogs?

A

dogs- femoral and dorsal pedal

cats- femoral

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15
Q

how is pulse assessed?

A

feel rate and quality

listen for deficits as indicate arrhythmia

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16
Q

what is suggested by weak and thready, bounding or snappy pulses?

A

weak or thready- low systolic BP
bounding- sepsis
snappy- anaemia

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17
Q

what needs considering when assessing patients heart rates?

A

pain
stress
drugs

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18
Q

state normal heart rate for dogs large and small

A

60-100bpm- large

100-140bpm- small

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19
Q

state HR when tachycardic in dogs

A

over 140 bpm

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20
Q

state HR when bradycardic in dogs

A

less than 60bpm

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21
Q

state normal HR in cats

A

14-180bpm

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22
Q

state HR when tachycardic in cats

A

over 180-200bpm

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23
Q

state HR when bradycardic on cats

A

less than 120bpm

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24
Q

what are normal systolic, diastolic and MAP in dogs?

A

systolic- 110-160mmHg
diastolic- 55-110mmHg
MAP- 100mmHg

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25
Q

what are normal systolic, diastolic and MAP in cats?

A

systolic- 120-170mmHg
diastolic- 70-120mmHg
MAP- 130mmHg

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26
Q

what BP are classed as hypotensive?

A

less than 100mmHg systolic and 60mmHg MAP

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27
Q

what BP are classed as hypertensive?

A

over 170-200mmHg systolic and 120mmHd MAP

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28
Q

how do you respond to hypotension?

A

give IVFT bolus and vasopressors to cause vasoconstriction

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29
Q

how do you manage hypertension?

A

give antihypertensive drugs such as amlodipine

investigate cause

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30
Q

how does doppler measure BP?

A

sound waves detect arterial blood flow

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31
Q

how does oscillometric BP work?

A

machine reads BPs

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32
Q

what is the benefit of arterial BP measurement?

A

continuous monitoring of systolic, diastolic and MAP

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33
Q

what colour are normal MM?

A

pink

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34
Q

what do red/hyperaemic MM suggest?

A

sepsis

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35
Q

what colour are MM from CO toxicity?

A

bright red

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36
Q

what do white MM suggest?

A

anaemia

shock

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37
Q

what do cyanotic MM suggest?

A

hypoxia

hypoxaemia

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38
Q

what colour do MM go from paracetamol toxicity?

A

brown

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39
Q

what causes icteric MM?

A

liver disease

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40
Q

what causes petechia in MM?

A

coagulopathy

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41
Q

what do dry MM suggest?

A

dehydration

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42
Q

what is normal CRT?

A

1-2 seconds

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43
Q

define CRT

A

amount of time for colour to return to capillary bed after digital pressure applied

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44
Q

what is shown by CRT?

A

peripheral perfusion

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45
Q

what causes prolonged CRT?

A

shock
hypoperfusion
vasoconstriction

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46
Q

what causes rapid CRT?

A

sepsis

vasodilation

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47
Q

what is the purpose of ECG?

A

measure electrical activity of the heart

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48
Q

what conditions can make patients prone to cardiac arrhythmias?

A

GDV

sepsis

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49
Q

what are examples of heart abnormalities from auscultation?

A

murmurs
gallops
pulse deficits

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50
Q

state normal RR for dogs

A

18-36brpm

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51
Q

state normal RR for cats

A

20-30brpm

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52
Q

what is considered bradypnoeic?

A

less than 15brpm

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53
Q

what is considered tachypnoeic?

A

over 45-60brpm

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54
Q

what can cause bradypnoea?

A

drugs
hypocapnia
CNS disease
hypothermia

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55
Q

what can cause tachypnoea?

A 
hypoxia
hypercapnia
pain
hyperthermia
pyrexia
stress
metabolic acidosis
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56
Q

define apnoea

A

absence of ventilatory effort

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57
Q

what can cause apnoea?

A

respiratory or cardiac arrest
drug overdose
neurological complications

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58
Q

what is seen for normal respiratory effort?

A

gentle chest movement

minimal abdominal movement

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59
Q

what signs indicate dyspnoea?

A

increased chest and abdominal muscle movement
orthopnoea
open mouth breathing

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60
Q

what can cause dyspnoea?

A

airway obstruction
pleural space disease
pulmonary parenchymal disease
upper airway disease

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61
Q

what are signs of reduced respiratory effort?

A

reduced chest and abdominal muscle movement

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62
Q

what is the danger of reduced respiratory effort?

A

high risk of cardiac and pulmonary arrest

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63
Q

what can cause reduced respiratory effort?

A

head injury
spinal cord injury
tetanus
end stage respiratory failure

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64
Q

define stridor

A

dry noise on breathing

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65
Q

define stertor

A

wet noise/snore on breathing

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66
Q

what should you listen for when auscultating lungs?

A 
noise on inspiration
noise on expiration
stridor
stertor
decreased lung sounds
abnormal lung sounds
67
Q

how should you auscultate lungs?

A

symmetrically
divide each lung into dorsal, middle and ventral portions and move cranial to caudal
compare each side

68
Q

what is suggested by decreased lung sounds?

A

pneumothorax

pleural effusion

69
Q

what is the purpose of pulse oximetry?

A

measures oxygenation of blood

70
Q

what are advantages and disadvantages of pulse oximetry?

A

adv- non-invasive, continuous monitoring

disadv- doesn’t measure tissue perfusion or ventilation

71
Q

where do you place pulse oximetery?

A

tongue
lip
ear
inguinal fold

72
Q

state normal ETCO2

A

35-42mmHg

73
Q

state hypercapnic ETCO2

A

over 50mmHg

74
Q

state hypocapnic ETCO2

A

less than 30mmHg

75
Q

what makes ETCO2 an indirect assessment of ventilation?

A

ETCO2 is roughly 1-4mmHg less than arterial PaCO2

76
Q

what is the advantage of capnography?

A

non-invasive

77
Q

what does capnography measure?

A

ETCO2

78
Q

what can affect capnography trace?

A 
system leaks
ETT kink
sensor obstruction
airway obstruction
apnoea
79
Q

what is normal PP oxygen?

A

80-100mmHg

80
Q

state mild and severe values for hypoxaemia

A

mild- 70-80mmHg

severe- less than 60mmHg

81
Q

what does PP oxygen show?

A

ability to oxygenate blood

82
Q

what does PP CO2 show?

A

ability to ventilate and perform gas exchange in alveoli

83
Q

state normal PP CO2

A

35-45mmHg

84
Q

what is hypocapnia PP CO2?

A

less than 35mmHg

85
Q

what is hypercapnia PP CO2?

A

over 45mmHg

86
Q

what are considerations when giving oxygen therapy?

A

minimise stress
minimal restraint
be prepared for decompensation and intubation

87
Q

what are examples of non-invasive oxygen provision?

A

flow by
oxygen cage
nasal prongs

88
Q

what are examples of invasive oxygen provision?

A

nasal catheters
trans-tracheal
endotracheal
ventilation

89
Q

state how mentation is classed as

A 
normal
obtunded
stuporous
comatose
hyper-excitable
90
Q

define hyper-excitable

A

excessive reaction to stimuli

91
Q

what can cause reduced mentation?

A

shock
hypoperfusion
hypoxaemia
primary neurological disease

92
Q

list cranial nerve function assessment

A

PLR
pupil size and symmetry
oculocephalic reflexes
menace reflex

93
Q

what should be seen in PLR?

A

both pupils responding bilaterally, rapidly and consensually

94
Q

what are examples of abnormal pupil size and symmetry?

A

anisocoria
miosis
mydriasis

95
Q

define anisocoria

A

different sized pupils

96
Q

define miosis

A

constricted pupils

97
Q

define mydriasis

A

dilated pupils

98
Q

what is meant by oculocephalic reflex?

A

tracking response of eyes when head moved side to side

99
Q

what should be seen in menace reflex?

A

reflex blinking in response to rapid approach to an object

100
Q

what is nystagmus?

A

eyes make repetitive, uncontrolled movements

can be horizontal, vertical or rotational

101
Q

define strabismus

A

one or both eyes deviated from normal position

102
Q

what are signs of increased ICP?

A

absent PLR

pupil changes

103
Q

describe the modified GCS

A

3 sections scored out of 6 then totalled

lower the score the worse prognosis

104
Q

what are the 3 sections in modified GCS?

A

motor activity- gait, ambulation
brainstem reflexes- PLR, oculocephalic reflex, pupil size
level of consciousness- response to stimuli

105
Q

when should you alert clinician regarding modified GCS?

A

if deteriorate 2 or more since last check

106
Q

what is meant by the cushings reflex?

A

hypertension and bradycardia as a result of increased ICP

107
Q

what patients are at risk of ICP?

A

head trauma
seizures
meningoencephalitis

108
Q

how should you manage patients with high ICP?

A

raise head and thorax 15-30 degrees
sternal recumbency to aid ventilation
oxygen
avoid increasing ICP

109
Q

how can you avoid increasing ICP?

A

no jugular samples

avoid stimulations to sneeze, gag, vomit

110
Q

what should you do if patient seizes?

A

note length and type

111
Q

how should you manage seizure patients?

A 
cool if hyperthermic
have seizure plan on door of kennel
keep meds accessible
keep in padded kennel
give oxygen before and after seizure
elevate head and thorax when safe
112
Q

what needs to be closely observed in patients with lesions to cervical region?

A

respiratory function

113
Q

how should you manage spinal trauma patients?

A

transport on spinal board
minimise movement
keep flat

114
Q

what are nursing considerations for patients with decreased conciousness?

A

monitor gag reflex, regurgitation
may need to intubate
physiotherapy
hygiene

115
Q

list features of critical care wards triage station

A 
ECG
portable monitoring equipment
exam table
BP machine
oxygen
portable ultrasound
consumables
116
Q

list features of high dependency area

A 
oxygen
monitoring equipment
observation charts
heat sources
pumps for meds
moveable trolley for access to patient
ventilator
anaesthetic machine
patient easily accessible
117
Q

what are features of emergency crash station?

A 
easily accessible
wheels to allow moving
crash table always clear
stocked and checked regularly and after use
clearly labelled draws of contents
118
Q

list some equipment found on crash trolleys

A 
ETT and equipment for intubation
suction
IV consumables
pre-drawn saline for flush
chest drain equipment
IO equipment
ECG
ambu bag
defibrillator
essential drugs
capnography
119
Q

what are some essential drugs used in crashes?

A

adrenaline
atropine
reversal agents
dosage charts

120
Q

what are some features to make feline friendly areas?

A

glass doors to see through but reduce noise
windows blocked at bottom to prevent seeing dogs
away from dogs
in quiet area
separate oxygen cages

121
Q

what are features of nursing station in critical care ward?

A

able to see whole room
patient records easily accessible
easy computer access
list of important contact numbers

122
Q

what is the reason for having a lab in critical care ward?

A

quick diagnosis

use out of hours

123
Q

what tends to be found in labs in critical care wards?

A 
blood gas/electrolyte machine
centrifuge
haematology
biochemistry
coagulation times
microscope
SNAP tests
124
Q

what is measured in minimum database?

A

PCV
TS
blood gas analysis- ventilation, acid base, electrolytes, lactate, oxygenation
blood glucose

125
Q

what tests are in extended database?

A 
biochemistry
haematology
urinalysis
coagulation profile
blood typing and cross matching
SNAP tests
126
Q

what needs to be considered when choosing kennel for patient?

A

size
walk in
top or bottom
oxygen kennel

127
Q

when are patients placed in incubators?

A

neonates

if cant maintain temperature

128
Q

where do critical patients tend to be kept in the ward?

A

in cot or trolley

129
Q

what are some considerations of patient accommodation in critical care ward?

A 
access to nursing and observation
access to oxygen
temperament
visibility
barrier nursing
recumbency
places to hide for cats
130
Q

list considerations for patient environment in critical care wards

A 
calm and quiet
dim light
reduced traffic for infection and noise control
signs on doors
cats separate
clean and tidy
easy access to consumables
access to monitoring equipment
131
Q

what tends to be found on hospital sheets?

A 
patient and owner details
date
problem list
notify if list
tubes, drains, IV lines
IVFT and meds information
clinical notes
weight- admit and daily
food intake
clinician notes
temperament
resus status
132
Q

what measures are in place for infection control?

A 
hand hygiene
wiping equipment before and after use
gloves
prevent HAI
barrier nursing
133
Q

what patients should be barrier nursed?

A

wounds
potential infectious disease
compromised immune system

134
Q

what measures are in place to maintain patient hygiene in hospital?

A 
eye lube
oral hygiene
monitor excretions
prevent and treat urine scalding
monitor bladder for expression and catheterisation
keep on vet bed
clean and dry patient if soiled
tail bandages
135
Q

how do you manage hypothermia?

A 
incubator
bubble wrap
heat mats
blankets
vet bed
warm IVFT
136
Q

when do and dont you actively cool hyperthermic patients?

A

if over 40 degrees unless pyrexic as helps fight infection

137
Q

when do you stop actively cooling hyperthermic patients?

A

at 39.6 degrees as continue to cool and risk hypothermia

138
Q

how can you cool hyperthermic patients?

A

air con
ice under bedding
cooling mats
tepid bath

139
Q

what consideration is needed for hyperthermic patients?

A

oxygen needed as higher consumption

140
Q

how are lines, tubes and drains managed?

A 
checked 2x daily
remove as soon as no longer needed
treat aseptically
label and colour code 
monitor production from drains
141
Q

what are the aims of physiotherapy?

A 
decrease complications
improve circulation
allow muscle and tendon relaxation
aid pain management
reduce inflammation
promote recovery
142
Q

when is physiotherapy indicated?

A 
pressure sores
muscle contraction
pulmonary secretions build up
muscular weakness
atrophy
joint stiffness
limb swelling
pain
boredom
143
Q

when is physiotherapy contraindicated?

A 
unstable patients
unstable fractures
spinal injury
head trauma
blood disorders
very stressed 
very painful
144
Q

what is the importance of providing nutrition to patients in hospital?

A

enterocytes in GIT need constant direct supply of nutrients
after 3 days of none cells start to die creating weakness in GIT barrier so increased permeability which can lead to bacteria and endotoxins entering systemic circulation

145
Q

why is it important to try to get early enteral nutrition in critical patients once stable?

A

may have been anorexic before hospital

146
Q

what needs to be considered when introducing food to patients in hospital?

A

refeeding syndrome

147
Q

list examples of enteral feeding tubes

A 
NO
NG
oesophagostomy
percutaneous endoscopic gastrotomy
jejunostomy
148
Q

why do PEG tubes need to be left for minimum 10 days after placement?

A

allow adhesions to form to reduce risk of peritonitis

149
Q

how are patients fed through J tube?

A

CRI of jejunal diet only

150
Q

what is meant by parenteral nutrition?

A

nutrients given directly into patients blood as CRI avoiding GIT

151
Q

what is the negatives of parenteral nutrition?

A

less balanced

more expensiv

152
Q

when is parenteral nutrition used?

A

non-functioning GIT
unconscious
severe neuro deficits

153
Q

how is TPN given?

A

via central line or peripheral central catheter

154
Q

what is PPN?

A

40-70% nutrient given parenterally

155
Q

what are considerations for parenteral nutrition?

A

strict aseptic technique as sepsis risk
TPN can cause thromboembolisms
new bag and giving set every 24 hours

156
Q

how can stress be minimised in hospitalised patients?

A 
TLC
bonding
sedation to allow rest
steady for nervous patients 
reassurance
air diffusers
hiding spots
157
Q

how is hypovolaemia managed?

A

observe compensation mechanisms
fluid bolus of 5-20ml/kg over 10-20 minutes
reassess after each bolus

158
Q

how is hydration monitored in hospitalised patients?

A

assess hydration daily
update fluid plan regularly
plan for ongoing losses and maintenance

159
Q

what is normal UOP?

A

1-2ml/kg/hr

160
Q

how is UOP monitored?

A 
monitor ins and outs
assess tissue perfusion
closed system IDUC
weigh bedding
weigh patients for rapid changes
161
Q

how are IDUC managed?

A

aseptic handling
clean 2x daily
lower than patient but not on floor
prevent patient interference

162
Q

how can you provide TLC to hospitalised patients?

A 
bond with patient
quiet time
grooming
affection
toys
time out of kennel
hand feeding
owner visits
163
Q

why are nursing care plans used for critical patients?

A

standardise care so all needs covered and problems highlighted

164
Q

what are the stages of nursing care plans?

A

assessment
planning
implementation
evaluation

Clinical Nursing May Exam (22 decks)

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