PreLabs Flashcards

1
Q

What basic examinations and physical examinations are done as part of a neurological assessment

A

Assessment of Level of Consciousness (LOC) Glasgow Coma Scale (GCS) Motor examination Posturing (decorticate or decerebrate) Reflex testing (including brain stem reflexes in stuporous or comatose patients) Pupils/ pupillary reflex C-Spine precautions Sedation Assessment Delirium (CAM-ICU)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How is a critically ill patient’s level of consciousness best evaluated

A

The Glasgow Coma Scale (GCS) is a standardized method of evaluating a patient’s LOC. This method ranks patient response in three categories to create a score than ranges from 3 (lowest LOC) to 15 (fully awake). These categories are eyes open, best verbal response, and best motor response.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How is the Glasgow Coma Scale level modified when the patient is intubated

A

If the patient is intubated, a “T” is placed after the score

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Your patient has a cervical spine fracture at C4 with spinal cord involvement. How will this impact their respiratory system

A

A patient with a C-Spine injury may be unable to protect their airway. Due to limited mobility, this type of injury may result in difficulty stabilizing and securing the airway for spontaneous breathing. Further, if there is damage to the central or peripheral nervous systems, the patient’s drive and/or ability to breathe spontaneously may be affected and interventions may be needed in order to ensure proper ventilation occurs.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How can motor strength be assessed in an unconscious patient

A

An unconscious patient is assessed by applying a noxious stimuli and assessing the response.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What brainstem reflexes do RTs typically assess? Which cranial nerves are responsible for these

A

RTs are focused on the reflexes that affect gagging and coughing during suctioning because these reflexes protect the airway. The glossopharyngeal cranial nerve (9th) and the Vagus cranial nerve (10th) are responsible for these reflexes, respectively.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Your patient does not respond to your voice but withdraws to physical stimulation. What level of sedation is this according to the Richmond Agitation Sedation Scale (RASS)

A

According to RASS, a patient not responding to voice but withdraws to physical stimulation is under a deep sedation rated as a -4 on the Scale.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

. Your patient is moving about spontaneously with non-purposeful movements. The ventilator is frequently alarming because of patient-ventilator dysynchony. What level of sedation is this according to the Richmond Agitation Sedation Scale (RASS)

A

According to RASS, a patient that is moving with non-purposeful movements and fighting with the ventilator is considered agitated and rated as a +2 on the Scale.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Define delirium

A

Delirium is defined as a sign of acute brain dysfunction resulting in a disturbance of consciousness with reduced ability to sustain or shift attention. Delirium develops over a short period of time and tends to fluctuate over the course of the day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What does delirium in the ICU patient indicate

A

If delirium is present in an ICU patient, it is a sign that there is an underlying medical problem that needs addressing immediately. Delirium can be monitored in the ICU by using the Confusion Assessment Method for the ICU (CAM-ICU) assessment or the Intensive Care Delirium Screening Checklist (ICDSC) assessment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

List the non-pharmacologic interventions that can be used to manage delirium.

A

The nonpharmacological that can be used to manage delirium includes frequent reorientation of the patient, cognitively stimulating activities, sleep protocols, early mobility and ROM exercises, timely removal of catheters, use of aids (eyeglasses, hearing aids, etc), early correction of dehydration, and the minimization of unnecessary noise.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Summarize the ABCDE protocol

A

The ABDCE protocol is designed to standardize care processes and improve collaboration among members of the healthcare team. By using this protocol we can break the cycle of oversedation and prolonged ventilation. ABC is in regards to awakening and breathing coordination. D is in regards for delirium management and interventions. E is in regards to early exercise and mobility.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Describe why spontaneous awakening trials are coordinated with respiratory care

A

To make sure that is there is any problems in breathing when doing a spontaneous awakening trial it can be managed and taken care of with the respiratory care team.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Your patient’s intracranial pressure (ICP) is 20 mmHg and the mean arterial pressure (MAP) is 95 mmHg. Calculate the cerebral perfusion pressure and describe the impact on cerebral perfusion

A

CPP= MAP-ICP CPP= 95-20 CPP= 75 The capillary bed is compressed and microcirculation will be compromised.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Describe the purpose of jugular venous oxygen saturation monitoring.

A

Jugular venous oxygen saturation monitoring (SjvO2) assesses global cerebral oxygenation in patients with traumatic brain injuries by inserting a catheter into the internal jugular vein and directing it upwards to where the tip of catheter rests in the jugular venous bulb located at the base of the brain.

After insertion, blood samples can be taken to measure the partial pressure of oxygen or saturation of the jugular veins.

Typically, a normal SjvO2 is from 50-75% and can be taken continuously.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Describe the purpose of Licox monitoring.

Compare this to SjvO2 monitoring

A

The purpose of Licox Monitoring is to assess the level of brain tissue oxygenation by connecting to a catheter inserted in the brain. Licox monitoring is typically done in patients with a traumatic or neurological brain injury.

On the other hand, SjvO2 monitoring is only done on TBI patients and measures cerebral oxygenation in areas around the brain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

When is Train of Four monitoring used and why

A

Train of Four monitoring is a peripheral nerve stimulator that measures the effects neuromuscular blockade agents (NMBA) have on musculoskeletal activity. Usually, electrodes are placed over the ulnar artery at the wrist or the elbow and clinicians measure the number of twitches in response to a stimulus. The number of twitches is indicative of the percentage of blockade effect the NMBA has

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Describe purpose of therapeutic hyperventilation. Is this a routine therapy

A

The purpose of therapeutic hyperventilation is to increase minute ventilation in hopes of decreasing PaCO2. Subsequently, cerebral arteries vasoconstrict and reduce cerebral perfusion. Ultimately, decreasing intracranial pressure. This is not a routine therapy because if we decrease cerebral perfusion too frequently, then oxygen delivery to the brain decreases and may cause an anoxic brain injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

our patient is being sedated with midazolam and morphine and is receiving tubocurarine. The TOF is at 1⁄4 twitches. What do you expect when assessing their gag and cough response? Explain why

A

Since the patient displays only 1⁄4 twitches in response to the stimuli, 90% blockage is occuring due to the effects of tubocurarine. Tubocurarine is a NMBA, which means it will relax the skeletal muscle. When assessing their gag and cough response, we would not expect it to occur that much because of the lack of response seen during TOF monitoring. Also, since tubocurarine paralyzes the skeletal muscle, the gagging and coughing response will not occur as frequently as well

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Describe purpose of therapeutic hypothermia. Is this a routine therapy

A

The purpose of therapeutic hypothermia is to lower body temperature of patients who have recently experienced cardiac arrest, a stroke, or a traumatic brain/spine injury. Essentially, reducing body temperature will reduce blood flow and consequently, reduce the risk of ischemic injury. This is not a routine therapy as there are complications, like arrhythmias, coagulation issues, risks of infection and a risk of electrolyte imbalance. Also, rewarming should be done slowly and steadily as it may cause harmful spikes in intracranial pressure. Most deaths that occur from therapeutic hypothermia are due to the rewarming process done inadequately.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Sedation level in the ICU is a delicate balance. Discuss the negative impact of too little and too much sedation

A

Too Little: -Feel pain and have anxiety -Increased stress levels -Patient-ventilator synchrony -Adverse neurocognitive sequelae (PTSD or depression) Too Much: -Failure to initiate spontaneous breathing, thus longer duration of mechanical Ventilation -Longer duration of stay in ICU -Increases risk for delirium -Impede assessment of neuro function -Many agent-specific risks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Propofol

A

Trade Name: Diprivan

Effects/Uses: General Anesthesia

Cautions: No analgesic effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Lorazepam

A

Trade Name: Ativan

Effects/Uses: Treat anxiety, sleep issues, alcohol withdrawal, active seizures, and nausea

Side Effects: Weakness, sleepiness low BP, decreased effort to breath

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Diazepam

A

Trade Name: Valium

Effects/Uses: Calming, benzodiazepines withdrawal, alcohol withdrawal,

Side Effects: Sleepiness, coordination issues, suicide, decreased breathing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Midazolam

A

Trade Name: Versed

Effects/Uses: Induction agent

Cautions: Should not be used in emergencies due to its slow onset, stops memory formation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Demedetomidine

A

Trade Name: Precedex

Effects/Uses:Anxiety reducing, sedative, pain med.

Used as a sedative without respiratory depression

27
Q

Phenobarbital

A

Trade Name: Barbituates Effects/Uses: Seizure controller

28
Q

Pethidine

A

Trade Name: Demerol

Effects/Uses: Anaglesic for moderate to severe pain. Rapid onset

Cautions:Effect only last 1-2 hours

Reversal Agent: Naloxone

29
Q

Fentanyl

A

Trade Name: Actiq, Duragesice, Fentora Effects/Uses: Pain Med, used in combination with anaesthia. Rapid onset but effect only last 1-2 hours Reversal Agent: Naloxone

30
Q

Haloperidol

A

Trade Name: Haldol Effects/Uses:Anti-psychotic, delirium management (only after her medicine/therapies have been tried)

31
Q

Succinycholine

A

Trade Name: Anectine

Effects/Uses:Depolarizing Paralytic

Reversal Agent: No reversal agent

32
Q

Atracurium

A

Trade Name: Tracrium Effects/Uses: Non-depolarizing Paralytic Reversal Agent: Neostigmine

33
Q

Pancuronium

A

Trade Name: Pavulon Effects/Uses: Non-depolarizing Paralytic Reversal Agent: Neostigmine

34
Q

Rocuronium

A

Trade Name: Zemuron Effects/Uses: Non-depolarizing Paralytic Reversal Agent: Neostigmine

35
Q

CO

A

Cardiac output is the volume of blood pumped by the heart per minute. Normal value: 4-8 L/min. Directly Measured

36
Q

SV

A

Stroke volume is the volume of blood ejected from the left ventricle per every contraction. Calculated

37
Q

Assuming CO remains the same, as SVR is increased, BP ____________ (increases, decreases or remains the same).

A

___increases___

38
Q
  1. Assuming SVR remains the same, as CO is decreased, BP ______ (increases, decreases or remains the same).
A

decreases__

39
Q
  1. Describe how systemic vasodilation affects BP.
A

Systemic vasodilation will relax the blood vessels and reduce systemic vascular resistance. The reduction in resistance will will also lead to a decrease in blood pressure.

40
Q

Cerebral Oximetry

A

SaO2 of the underlying tissue

Can be both a continuous monitor as well as a spot check

41
Q
A

Idioventricular Rhythm

42
Q
A

3rd Degree HB

43
Q

Severe Mitral Valve Stenosis

A

HR Increased

SVR Decreased

BP Decreased

CO Increased

CVP Decreased

PAP Decreased

PAWP Decreased

44
Q

When is defibrillation indicated

A

Pulseless VT and Vfib

45
Q

When is trancutaneous pacing indicated

A

unstable bradyarrhythmia

46
Q

When is synchronized Shock indicated

A

Unstable Tachyarrhythmia

47
Q

In Pressure Control Why Can you not determine airway resistance

A

because flow will vary in this mode

48
Q

What happens to CVP in PPV and spontaneous breathing

A

CVP will increase with PPV and decreased with spontaneous breathing

49
Q

PPV and V/Q Mismatching

A

Will increase (worsening)

50
Q

PPV and Pulmonary Vascular Resistance

A

Will decrease due to improved ABG

Will increase due to compression of alveolar capillary via overdistension of alveoli

51
Q

PPV and Venous Return and CO

A

decreased venous return

Decreased CO

52
Q

PPV and Renal System

A

Decrease urine output

Increased ADH and ANP release

activation of renin antiotension

53
Q

Differentiate between barotrauma and volutrauma.

A

Barotrauma causes rupture of the A/C membrane and results in air leaking into places it shouldn’t be (pneumothorax, pneumomediastinum, PIE)

Volutrauma causes stretch injury to the A/C membrane and results in leaky A/C membranes and release of inflammatory mediators.

54
Q

Differentiate between atelectatrauma and shear stress.

A

Arelectatrauma is the injury resulting from repetitive derecruitment/recruitment of alveoli—typically occurs in the dependent areas. Shear stress the is the strain injury on the alveolar wall between the expanded unit and derecruited unit; causes capillary injury.

55
Q

Describe what is meant by “open lung ventilation”.

A

Using appropriate PEEPS to maintain recruitment of lung units throughout exhalation (i.e. avoiding derecruitment).

56
Q

Describe how V/Q matching are impacted with positive pressure ventilation.

A

Both increased deadspace (in gravity independent areas) and increased shunt (in gravity dependent areas).

57
Q

A high PEEP would be most likely to cause hemodynamic compromise in which of the following patients? (Rank from most likely to cause compromise (1) to least likely to cause compromise (4).

COPD patient

ARDS patient

Normal lungs

Patient with significantly increased intraabdominal pressure

A

__2__ COPD patient

__4__ ARDS patient

__3__ Normal lungs

__1__ Patient with significantly increased intraabdominal pressure

58
Q

Your patient is being ventilated in CMV-VC with RR 15 and VT 500. As deadspace increases, you would expect to happen to the following

VD/VT

PECO2

VA

PaCO2

A

VD/VT Increase

PECO2 Decrease

VA Decrease

PaCO2 Increase

59
Q

Hemodynamic profile in regards to CO, Hr, and SVR

A

Heart rate will always be opposite of CO an

SVR and HR will always go in the same direction except in septic shock

60
Q

Hemodynamic Profile of Obstructive Shock

A

CVP Increase

PAP Can be normal, increased, or decreased

PAWP Can be normal, increased, or decreased

BP Decrease

CO Decrease

HR Increase

SVR Increase

61
Q

Hemodynamic Profile of Neurogenic Shock

A

CVP Decrease

PAP Decrease

PAWP Decrease

BP Decrease

CO Decrease

HR Decrease

SVR Decrease

62
Q

Hemodynamic Profile of Septic Shock

A

CVP Decrease

PAP Decrease

PAWP Decrease

BP Decrease

CO Increase

HR Increase

SVR Decrease

63
Q

Hemodynamic Profile of Cardiogenic Shock

A

CVP Increase

PAP Increase

PAWP Increase

BP Decrease

CO Decrease

HR Increase

SVR Increase

64
Q

Hemodynamic Profile of Hypovolemia Shock

A

CVP Decrease

PAP Decrease

PAWP Decrease

BP Decrease

CO Decrease

HR Increase

SVR Increase