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PHTH 564 - ICU > Intro to Critical Care > Flashcards

Intro to Critical Care Flashcards

1
Q

Most commonly used outcome measure for consciousness in ICU?

A

RASS (Richmond Agitation Sedation Scale)

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2
Q

Most commonly used outcome measure for pain in ICU?

A

Behavioural Pain Scale (BPS)

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3
Q

2 most common pt populations in the ICU?

A
  1. Resp failure requiring mechanical ventilation

2. CV instability requiring invasive hemodynamic monitoring

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4
Q

______ _____ _____ = inserted into peripheral vein; enables administration of fluids and medications; is gravity driven or on pump

A

peripheral intravenous line

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5
Q

_____ ___
= to give meds that will erode peripheral veins and require mixing with larger blood volumes quickly such as chemo or antibiotics

A

PICC line

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6
Q

What does PICC stand for?

A

peripherally inserted central catheter

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7
Q

Normal ICP ?

A

5-10 mmHg

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8
Q

Increased ICP > __ mmHg for over 5 mins = brain damage

A

20

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9
Q

With ___ and ____, always check physicians orders regarding target values and activity orders (ability to change pt position or do chest PT)

A

EVD; ICP

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10
Q

Always check the EVD stopcock has been closed before any position change (T/F)

A

TRUE

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11
Q

Increased BP will increase ICP (T/F)

A

TRUE

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12
Q

__-__ % of pts have some cognitive deficit at discharge from ICU

A

70-80

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13
Q

Many pt’s D/C from ICU suffer from apraxia (T/F)

A

TRUE

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14
Q

Inspection on a ventilated pt should include position/stability of _____ and _____ setting

A

airway; ventilator

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15
Q

Normal end total CO2 ?

A

35-45mmHg

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16
Q

What is the P/F ratio?

A

The ratio of arterial O2 partial pressure to fractional inspired O2

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17
Q

What is the normal P/F ratio

A

> 380

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18
Q

Purpose of arterial line?

A

Constantly monitors arterial BP; access for direct blood sampling for painless and frequent analysis of ABG’s

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19
Q

The pt (can/cannot) mobile with an arterial line

A

CAN

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20
Q

For the arterial line to give accurate readings the transducer needs to be at the level of?

A

Superior vena cava (4th intercostal space)

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21
Q

When pt has an arterial line, what should you avoid?

A

Excessive wrist movement or hip flexion >90

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22
Q

MAP = ?

A

SBP + (2xDBP)/3

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23
Q

Normal MAP?

A

70-110mmHg

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24
Q

MAP > __ is necessary to perfuse coronary arteries, brain and kidneys

A

60

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25
Q

Normal HR for adults?

A

60-110

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26
Q

4 arrhythmias to watch for?

A

PVC’s, AFib, ventricular fibrillation, ventricular tachycardia

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27
Q

Tachycardia = HR > ____

A

110

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28
Q

Bradycardia = HR < ___

A

60

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29
Q

5 signs of ventricular fibrillation?

A
  1. unresponsive
  2. ineffective pulse
  3. no spontaneous respiration
  4. cyanosis
  5. duskiness, mottled skin
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30
Q

Where can a central venous line be inserted?

A

through subclavian or internal jugular vein into superior vena cava or through femora vein into common iliac vein

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31
Q

____ _____ _____ = provides info about cardiac function and adequacy of circulating vascular volumes

A

central venous pressure

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32
Q

Normal central venous pressure values?

A

2-7 if self ventilating; 6-12 on a ventilator

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33
Q

Why is central venous pressure higher if you are on a ventilator?

A

PEEP affects pressure in thorax

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34
Q

Low CVP = __ HR and __ BP

A

increased; decreased

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35
Q

High CVP = __BP and __HR; or __ HR and ___ BP

A

increased; decreased; decreased x2

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36
Q

CVP helps us asses if fluid is ____ secretions or ______ _____

A

lung; pulmonary edema

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37
Q

3 purposes of pulmonary arterial line?

A
  1. allow sampling of mixed venous blood to calculate a-VO2 difference
  2. monitor PAP, PCWP and RAP
  3. allows a measurement of CO
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38
Q

We may mobilize someone on a pulmonary arterial line very cautiously (T/F)

A

FALSE

39
Q

5 s/s of cardiac pain?

A
  1. pressure, fulness, burning or tightness in chest
  2. SOB
  3. cold sweats
  4. crushing / searing pain in back / UE / face
  5. nausea / vomiting
40
Q

Pacemakers can be internal or external (T/F)

A

TRUE

41
Q

3 guidelines post internal heart device implantation for first 4-6 weeks?

A
  1. < 90 degrees shoulder flexion or abduction of arm on the same side as the heart device
  2. do not do any activities where you are repeatedly pushing and pulling, swinging
  3. do not lift anything more than 5 kg or 10 lbs
42
Q

What does a high WBC count indicate?

A

infection

43
Q

Does high INR and PTT indicate increased risk of clotting?

A

no

44
Q

Normal Hb levels?

A

135 -170 g/L

45
Q

Normal platelet levels?

A

150-400

46
Q

INR normal values?

A

.9-1.3

47
Q

PTT normal values?

A

24-40s

48
Q

Low INR / PTT levels - increased risk for ______

A

clots

49
Q

High INR/PTT levels = risk for _______ and ______

A

brusing / bleeding

50
Q

_______ is a substance released into the blood when heart muscle is damaged

A

troponins

51
Q

Troponins < ____micrograms / L indicates cardiac muscle injury y

A

0.05

52
Q

Troponins rises over __-__ hours, peaks at __-__ hours, declines over ___ days

A

4-8;10-24;10

53
Q

Normal albumin levels?

A

3.5-6g/dL

54
Q

______ is a blood protein that fights infection and helps wound healing, as well as preventing swelling and plays a part in maintenance of plasma volume

A

albumin

55
Q

Decrease in _____ leads to body wide interstitial edema

A

albumin

56
Q

3 effects of low K+?

A
  1. depressed cardiac activity
  2. arrhythmias
  3. muscle weakness and fatigue
57
Q

_____ regulated blood volume, osmotic equilibrium and pH

A

sodium

58
Q

3 effects of high K+?

A
  1. cardiac arrhythmias/arrest
  2. diarrhea
  3. vomiting
59
Q

3 effects of low Na+?

A
  1. decreased blood volume / BP
  2. pulmonary and pleural effusion
  3. excessive sweating
60
Q

5 effects of high Na+?

A
  1. thirst
  2. muscle spasms + weakness
  3. lethargy / coma
  4. thickening of secretions
  5. tachycardia
61
Q

One of the most important functions of ______ is muscle relaxation

A

magnesium

62
Q

3 effects of increased Mg+?

A
  1. low BP/HR (muscles are too relaxed)
  2. abnormal heart rhythms and asystole
  3. impaired breathing and respirations
63
Q

5 effects of decreased Mg+?

A
  1. abnormal heart rhythms and tachycardia
  2. muscle cramps
  3. hyperactive reflexes
  4. tremors
  5. overall weakness
64
Q

______ is present in every cell type and causes neuronal stabilization and controls excitation

A

Ca++

65
Q

MSK effect of high Ca++?

A

usually Ca++ is leached from your bones; weakens them and causes bone pain and muscle weakness

66
Q

3 CNS effects of high Ca++?

A
  1. confusion
  2. lethargy
  3. fatigue
67
Q

High _____ can cause thirst and frequent urination because your kidneys have to work harder to filter it

A

Ca++

68
Q

4 GI effects of high Ca++?

A
  1. stomach upset
  2. nausea
  3. vomiting
  4. constipation
69
Q

High Ca++ = ____ in neuromuscular excitability

A

decrease

70
Q

Low Ca++ = ______ in neuromuscular excitability

A

increase

71
Q

Effect of low Ca++ in CNS?

A

paraesthesia / seizures

72
Q

Effect of low Ca++ in CVS?

A

arrhythmias/arrest

73
Q

Effect of low Ca++ in MSK?

A

muscle spasms and twitching

74
Q

Effect of low Ca++ in resp system?

A

Stridor, bronchospasm

75
Q

Effect of low Ca++ in GI system?

A

Diarrhea due to smooth muscle relaxation

76
Q

Increase in _______ indicates renal failure or hypovolemia

A

urea

77
Q

Decrease in _______ indicates malnutrition, liver failure or over hydration

A

urea

78
Q

______ levels are an indicator of kidney function

A

creatine

79
Q

Increase in creatine indicates what two things?

A
  1. renal failure

2. muscle injury

80
Q

Decrease in creatine indicates what 2 things ?

A
  1. malnutrition

2. chronic loss of muscle bulk

81
Q

______ failure has effects on the resp system and MSK function

A

Renal

82
Q

Fluid overload can lead to pulmonary ______ and peripheral ______

A

edema; swelling

83
Q

Acute renal failure = acidosis, which effects ________ contractility

A

diaphragm

84
Q

Chronic RF pt’s common display muscle _______ and ______

A

weakness; myopathy

85
Q

Normal urine output?

A

1 mL/kg/hr

86
Q

Less than ___ mL/kg/hr of urine out put = renal failure

A

1/2

87
Q

5 precautions post dialysis?

A
  1. low BP
  2. nausea
  3. cramps
  4. headaches
  5. fatigue
88
Q

4 precautions with PEG/G - TUBE/NG tube?

A
  1. ensure feeds are off 20 minutes before hands on or chest treatment
  2. everytime feeds are off we effect the pt’s nutrition and blood sugar levels
  3. modify hand placement for assisted cough maneuver
  4. dont pull, kink of put too much pressure on tube
89
Q

4 concerns with PEG/G - TUBE/NG tube?

A
  1. aspiration
  2. infection/septicemia
  3. tube dislodgement
  4. bowel perforation
90
Q

______ ______ ______ = infusion of nutritional substances directly into bloodstream, usually through peripheral or central line

A

total parenteral nutrition (TPN)

91
Q

Why use TPN?

A

provides alternate form of nutrition when GI tract is not functioning

92
Q

ROM/Strength/Balance outcome measure for ICU pts?

A

chelsea critical care physical ax

93
Q

Pt’s with rectal tube will not be able to sit longer than ____ minutes

A

30

94
Q

Acronym for cause of muscle weakness in ICU?

A 
M - meds 
U - undx neuromuscular disease 
S - SCI
C - critical illness polyneuropathy
L - loss of muscle bulk, immobility 
E - electrolyte imbalanced 
S - systemic illness/ sepsis

PHTH 564 - ICU (15 decks)

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