Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Winter 2018-Patient Assessment > Quiz One > Flashcards

Quiz One Flashcards

1
Q

Be able to give 5 examples of causes of delirium.

A

D-Drugs (Continuous drips, Na+, Ca+, BUN/Cr, NH3+) E-Environmental factors (hearing aids, eyes glasses, sleep/wake cycle) L-Labs (Na, K, Ca, BUN/Cr, NH3+) I-Infection R-Respiratory Status (ABGs, PaO2, PaCO2) I-Immobility O-Organ Failure U-Unrecognizable Dementia S-Shock (Sepsis, cardiogenic, steroid)

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

What are the different features that are associated with the definition of delirium

A

1)Acute Changes or fluctuating Mental status 2) Inattention 3) Altered LOC or Disorganized Thinking

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

ABCDE Protocol

A

Awakening and Breathing Coordination Delirium Management Exercise and Mobility It is important to know so that the RN and Rt can coordination the SAT and SBT trial to be done together Rt can help with the non pharm intervention in delirium management RT may help with airways in early exercise

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

What is you ICP normals

A

10-15 mmHg

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

How to calculate MAP

A

(Systolic + [Diastolic *2]) /3

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

Ideal CPP

A

>60-70 But may depend on dr. Orders

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

Jugular Venous Saturation

A

Measures SjvO2 (could also give PO2) Gives a global approximation Can be used both as a spot check and continuous monitor

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

Cerebral Oximetry

A

SO2 of the underlying tissue Can be continuous or used for spot checks

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

Licox

A

PO2 of underlying tissue Is a continuous measurement

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

What type of ICP monitor allows for concurrent EVD

A

Fluid filled system where catheter is inserted into the ventricle of the brain

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

What is the relationship between SjvO2, Cerebral Metabolic Rate, and Cerebral Oxygen Therapy Delivery

A

SjvO2=(Cerebral Oxygen Delivery)/(Cerebral Metabolic Rate)

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

GCS-Motor Response

A

6-Obey Command

5-Localizes to pain

4- Withdrawl frm pain

3- Adbnormal flexion

2-Abnormal extension

1-No movement

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

GCS-Verbal Response

A

Oriented (5) Confused (4) Inappropriate Words (3) Inappropriate sounds (2) No Response (1)

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

GCS-Eye Opening Response

A

Spontaneously(4) To Speech (3) To Pain (2) None (1)

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

Glossopharyngeal Nerve

A

Cranial Nerve IX Gagging and swallowing (Sensory) and taste Assessed through oral care

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

Vagus Nerves

A

Cranial Nerve X Gagging and swallowing speech and cough Assessed through suctioning

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

RASS -3

A

Patient has any movement in response to voice but no eye contact

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

RASS -4

A

Patient has any movement to physical stimulation

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

RASS -5

A

Patient has no response to any stimulation

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

RASS

A
  1. Observe the Patient-The patient is alert, restless, or agitated (Score 0 to +4) 2.If Not Alert, State Patient Name and Ask to Open Eyes and Look at Speaker-Patient awake with sustained eye opening and eye contact (Score -1) Patient awakened with eye opening and eye contact, but it is not sustained (Score -2) Patient has any movement in response to voice but no eye contact (Score -3) 3.There is no response to verbal stimulation, physically stimulate by shaking shoulder and/or rubbing sternum •Patient has any movement to physical stimulation (Score -4) •Patient has no response to any stimulation (Score -5)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Sedative

A

any drug that reduces CNS arousal Sleep is not the same as sedative Benzodiazepines Nonbenzodiazepines Barbituates

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

Hypnotic

A

any drug that induces sleep

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

Anxiolytic

A

any drug that reduces symptoms of anxiety

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

Analgesia

A

any drug that reduces the sensation of pain General anesthesia has four characteristics: unconsciousness, analgesia, muscle relaxation, and depression of reflexes.

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

Anesthetics

A

any drug that reduces the ability to perceive sensations

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

Pharmacological Therapies

A

Many drugs can have multiple effects! Effect(s) often dose dependent Can get sedation effects at low dose and full anesthetic at high dose. Most available evidence regarding sedatives and analgesics in ICU patients indicates that it may be less important which drugs are delivered than their proper titration using goal-directed delivery (RASS Target) to optimize patient comfort while avoiding complications such as prolonged mechanical ventilation or reintubation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Benzodiazepines

A

Sedatives/Hypnotics/Anxiolytics Used for its effects of sedative (madadala), hypnotic (valum), anxiolytic Used to treat: anxiety, agitation, insomnia, seizures/ status epilepticus, muscle spasms, alcohol withdrawal (DTs) Can be short, intermediate or long-acting (longer-acting used for anxiety) Outside ICU used for anxiety and insomnia-Note: there are other benzo’s that are prescribed for assisting with sleep Some common benzo’s used for anxiety/hypnotic effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Benzodiazepines Cautions

A

Can cause loss of airway reflexes at high doses and decreased tidal volume at lower doses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Benzodiazepines Reversal Agent

A

flumazenil (Romazicon)

30
Q

Benzos for Sleep:

A

Flurazepam Triazolam (Halcion) Zopiclone(Imovane)

31
Q

Trade Name Midazolam

A

Versed It is a Benzodiazepines

32
Q

Trade Name Iorazepam

A

Ativan It is a Benzodiazepines

33
Q

Trade Name Diazepam

A

It is a Benzodiazepines Valium

34
Q

Trade Name Alprazolam

A

Xanax It is a Benzodiazepines

35
Q

Dexmedetomidine (Precedex)

A

Sedative, analgesic, sympatholytic, and anxiolytic properties

Will provide sedation with respiratory system depression

Benefits include less deliruim, shortened intubation time, and reduce ICU stay

Very Expensive!

36
Q

Barbituates

A

E.g. Thiopental (Sodium Pentothal), phenobarbital (Luminal) One of the oldest group of sedative drugs; use has largely been replaced by benzo’s Can be used as anesthetics (thiopental) or hypnotics

37
Q

Phenobarbital

A

Barbituates Phenobarbital used for seizure control Phenobarbital is a barbiturate and the most widely used anticonvulsant worldwide,[1] and the oldest still commonly used. It also has sedative and hypnotic properties, but as with other barbiturates, it has been superseded by the benzodiazepines for these indications.

38
Q

Anesthetics Stages

A

Stage 1: analgesia; patient retains consciousness without experiencing pain (“conscious sedation”) Stage 2: loss of consciousness Stage 3: respiratory depression; loss of reflexes (“surgical anesthesia”) Stage 4: complete loss of respiratory drive; may be loss of cardiovascular tone] All of the drugs discussed, in a dose-dependent fashion, can result in the different stages of anesthesia! (i.e. not just anesthetic drugs!)

39
Q

Diprivan (Propofol)

A

Propofol is often used for sedation for mechanically ventilated patients, for induction and maintenance of anesthesia and for conscious sedation. “milk of amnesia” Short-acting hypnotic agent Recovery is rapid and “clear” Does NOT have analgesic properties

40
Q

Diprivan (Propofol) Side Effects

A

Hypotension Respiratory depression Pain on injection

41
Q

Diprivan (Propofol) Uses

A

Induction and maintenance of general anesthesia

Sedation for mechanically ventilated patients

Procedural sedation

42
Q

Narcotics (Opioids)

A

Opioid – derivative of naturally occurring drug mixture opium, derived from the Poppy

43
Q

Narcotics (Opioids) Overdose

A

Pinpoint pupils, coma, and respiratory depression

44
Q

Narcotics (Opioids) Reversal Agent

A

Reversal agents are the narcotic antagonists naloxone (Narcan) or naltrexone (ReVia). Note: the reversal agent doesn’t last as long as the drug itself! Redosing may be needed!

45
Q

Common Narcotics

A

(Can be given via a bolus or infusion; Top 3 are most common in ICU) Morphine Fentanyl Codeine Meperidine (demerol) Oxycodone

46
Q

Morphine

A

Narcotic Can be aerosolized for palliative care Numerous brands

47
Q

Fentanyl

A

Narcotic Ex. Sublimaze, etc

48
Q

Oxycodone + acetaminophen

A

Percocet

49
Q

Narcotics (Opioids) Effects

A

Analgesia Sedation Decreases preload and afterload on the left ventricle Antitussive qualities (cough supression)

50
Q

Narcotics (Opioids) Side Effects:

A

Nausea and vomiting Constipation Tolerance/addiction Causes release of histamine Thus narcotic use in someone with hypersentive airways is discouraged! Bronchospasm, rashes, inflammation can result

51
Q

Non Steroidal Anti-Inflammatory Drugs (NSAIDs)

A

Acetaminophen (e.g. Tylenol/acetaminophen) Salicylates (Aspirin/acetylsalicylic acid) Ibuprofen (e.g. Advil/ibuprofen)

52
Q

Acetaminophen

A

Tylenol

Used in ICU for anti-pyretic effects

OD can cause hepatotoxicity

53
Q

Salicylates (Aspirin/acetylsalicylic acid)

A

(Aspirin/acetylsalicylic acid) Not used in ICU for it’s analgesia or anti-pyretic properties Given in acute coronary syndromes as it inhibits platelet aggregation Asthmatics can be sensitive to aspirin resulting in bronchospasm!

54
Q

Ibuprofen (e.g. Advil/ibuprofen)

A

(e.g. Advil/ibuprofen) Has analgesic, anti-inflammatory and antipyretic effects Not typically used in ICU environment

55
Q

Anti-Psychotics

A

Eg. Haldol (haloperidol) Typically used to control active psychotic symptoms in someone with psychotic disorders (e.g. schizophrenia disorders) Used in delirium management after other management is tried

56
Q

Paralytics (Neuromuscular Blocking Agents – NMBAs)

A

= Paralytics or skeletal muscle relaxants All patients require proper eye care as no more blinking; light taping of eyes Paralyze only!! (i.e. lack amnesic, sedative and analgesic properties!) MUST sedate patient and use analgesics as necessary! Two types: 1) Non-depolarizing 2) Depolarizing

57
Q

Non-depolarizing NMBAs

A

Tubocurarine, atracurium (Tracrium), pancuronium (Pavulon), rocuronium (Zemuron) etc. Mechanism of action: Competitively blocking the binding of acetylcholine to its receptors preventing Acetylcholine from depolarizing the muscle fiber causing vagolytic effedct The increased MAP can incresae ICP! Slow onset of action, longer duration These tend to be used to maintain paralysis in ICU

58
Q

Non-depolarizing NMBAs Side effects

A

Cardiovascular effects (tachycardia, vasoconstriction and hypertension). Pavulon the worst. Have a tendency to release histamine Need to provide ventilation!

59
Q

Non-depolarizing NMBAs Reversal Agent

A

Neostigmine-Neostigmine is a cholinesterase inhibitor (cholinesterase is the enzyme that breaks down AcH)

60
Q

Depolarizing NMBAs

A

Rapid onset; short duration Used for short procedures (e.g. intubation) Succinylcholine (Anectine) There are NO reversal agents!! Sensitivity to Succinycholine –metabolized by plasma cholinesterase. Pts with abnormal or deficient pseudocholinesterase do not meatbolize effective and have a prolonged recovery requiring mechanical ventialitn

61
Q

Depolarizing NMBAs Mechanism of Action

A

Act by depolarizing the muscle fiber and prolonging the depolarized state; results in fasiculations (uncoordinated skeletal muscle contractions) First depolarize the muscle fiber and then prolong the depolarized state to prevent repolarization

62
Q

Depolarizing NMBAs Side Effects

A

Tachycardia, hypertension Histamine release (and thus brochospasm; hypotension) Hyperkalemia Increased ICP Malignant hyperthermia (rarely) Sensitivity to Succinycholine Side effect Muscle pain and soreness

63
Q

Depolarizing NMBAs When are they Used

A

For intubation Reduce ICP in intubated patients with uncontrollable ICP To achieve patient-ventilator synchrony To reduce oxygen consumption To stop status epilepticus or shivering (therapeutic hypothermia) In surgery, or to facilitate procedures or diagnostic studies To paralyze selected patients who must remain immobile (e.g. trauma patients).

64
Q

A decreased PaCO2 level has what impact on cerebral blood flow

A

Decreased CO2 will result in vasoconstriction and decrease cerebral blood flow

65
Q

Over Sedation

A

Prolonged mechanical ventilation, ICU stay-Trach, VAP

Additional Testing

Added Cost

Inability to Communicate

Cannot evaulate Delirium

66
Q

Delirium Definition

A

An acute brain dsyfunction (not chronic, like dementia) that involves altered LOC and inattention or disorganized thinking

Tends to flucuate throughout the day

67
Q

Why is it important to evaulate delirium

A

It it is a sign that there is an underlying medical problem

Will help us to improve sedation level

Will improve overall care

68
Q

CNS and PNS

A

CNS-Brain and Spinal Cord

PNS-12 pairs of cranial nerves and 31 spinal nerves

69
Q

What part of the brain controls respirtion

A

Medulla (dorsal and ventral groups, primary control)

Pons (apneustics and pneumotaxics center that fire tunes the main controls)

There are also central and peripheral chemorecptors

70
Q

Where does the phrenic nerve arise from

A

C3-C5

Winter 2018-Patient Assessment (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions