Kirby’s Rule Of 20

Question 1

Define obtunded.

Answer 1

Slow or inappropriate response to sensory stimuli.

Question 2

Define stuporous.

Answer 2

Unconscious but rousable to noxious stimuli.

Question 3

Define delirium.

Answer 3

Reduced state of consciousness with profound disorientation.

Question 4

Define comatose.

Answer 4

Unconscious and unresponsive.

Question 5

What are the six perfusion parameters used to determine cardiac performance?

Answer 5

Mentation, heart rate, pulse rate, mucus membrane color, capillary refill time, and extremity temperature.

Question 6

What is the difference between systolic and diastolic pressure?

Answer 6

Systolic is the pressure during contraction of the heart muscle and diastolic signifies the pressure when the heart muscle is between beats

Question 7

What are the three general causes of hypotension?

Answer 7

Reduction in preload, reduction in cardiac function, and reduction in systemic vascular resistance.

Question 8

What are the two phases of coagulation?

Answer 8

Primary and secondary.

Question 9

Where does primary hemostasis occur?

Answer 9

At the site of tissue injury, when von Willebrand factor binds to collagen and platelets to form platelet aggregation and clots.

Question 10

When does secondary hemostasis occur?

Answer 10

Secondary hemostasis follows primary and involves coagulation factors interacting through a mutual sequential activation of the intrinsic and extrinsic pathways.

Question 11

What percentage of cardiac output is dedicated to helping kidneys maintain arterial blood pressure?

Answer 11

20 to 25%.

Question 12

Define pre-renal azotemia.

Answer 12

Pre-renal is caused by non-renal physiological or hemodynamic factors in which renal perfusion is compromised affecting blood flow and causing ischemic injury.

Question 13

Define intrinsic renal azotemia.

Answer 13

Intrinsic renal refers to direct damage to the renal parenchyma.

Question 14

Define post-renal azotemia.

Answer 14

Post renal refers to an obstruction or impediment in the outflow of urine that prevents urine from being eliminated from the body.

Question 15

What is an important but often discounted aspect of critical care that is also necessary for recovery from all disease processes?

Answer 15

Nutrition.

Question 16

What is the body’s primary energy source that is utilized by every cell?

Answer 16

Glucose.

Question 17

Where would you measure for a nasal esophageal tube?

Answer 17

From the tip of the nose to the seventh or eighth intercostal space. The xiphoid process is also another landmark.

Question 18

Where would you measure for a nasogastric tube?

Answer 18

From the tip of the nose to the last rib.

Question 19

Where would you insert your needle when performing thoracocentesis?

Answer 19

Between the seventh and ninth intercostal space.

Question 20

Define an antigen.

Answer 20

An antigen is any foreign substance that when introduced to the body stimulates an immune response.

Question 21

Define an antibody.

Answer 21

An antibody is a protein used by the immune system To neutralize an antigen.

Question 22

What are the four phases of the healing process?

Answer 22

Inflammation debridement, proliferation and maturation.

Question 23

What are the four factors of drug movement?

Answer 23

Absorption, distribution, metabolism, and excretion.

Question 24

Define pharmacokinetics.

Answer 24

The pharmacology that is concerned with how drugs move within the body.

Question 25

Define pharmacodynamics.

Answer 25

The pharmacology that is concerned with the drugs physiological effect on the body.

Question 26

What are the five rights of drug administration?

Answer 26

The right drug, the right patient, the right dose, the right route, and the right time.

Question 27

What, if left unidentified or untreated, leads to greater morbidity, mortality, and patient suffering?

Answer 27

Pain.

Question 28

What are the six events that make up the pathophysiology of pain?

Answer 28

Nociception, transduction, transmission, modulation, projection, and perception.

Question 29

What does nociception refer to?

Answer 29

The perception of noxious stimuli at the site of tissue injury.

Question 30

In reference to pain, what does transduction refer to?

Answer 30

Transduction is the noxious stimuli being converted to an electrical impulse.

Question 31

In reference to pain, what does transmission refer to?

Answer 31

Transmission refers to the electrical impulse being propagated from the site of tissue injury to the spinal cord.

Question 32

In reference to pain, what does modulation refer to?

Answer 32

Modulation refers to the electrical signal being amplified or suppressed by interneurons.

Question 33

In reference to pain, what does projection refer to?

Answer 33

Projection refers to the electrical signal traveling to the brain.

Question 34

In reference to pain, what does perception refer to?

Answer 34

Perception refers to the integration and processing of nociceptive information to recognize the stimulus as painful.

Question 35

Name at least four physiological consequences of pain.

Answer 35

Increased myocardial oxygen demand, decreased tidal volume, peripheral vasoconstriction, decreased tissue oxygen delivery, increased temperature, increased metabolic rate, stress hormone release, decreased gastrointestinal blood flow, increased blood viscosity, and immunosuppression.

Question 36

Define multimodal analgesia.

Answer 36

Multimodal analgesia refers to the practice of using multiple drugs, each with a different mechanism of action, that are complementary or synergistic.

Question 37

Define the discipline of critical thinking.

Answer 37

The process of conceptualizing, analyzing, synthesizing, and applying critical care concepts.