Special Considerations: the Intensive Care Unit (ICU)

Question 1

What are special considerations for acute care?

Answer 1

• Medical history
• Current illness (precautions and/ or contraindications)
• Medical stability
• Sedation/ level of alertness (ability to actively participate)
• Cognition
• Prior level of function (PLOF)
• Activity tolerance to perform mobility and activities of daily living (ADLs)
• Strength to perform mobility and participate in ADLs

Question 2

What should you use to find current information about the patient’s physiologic status?

Answer 2

Observe the equipment or devices that monitor the patient

Question 3

Make sure you observe the _____ and _____ of all equipment or devices as well as all tubes, monitor lead connections, intravenous connections and insertion sites.

Answer 3

type and location

Question 4

Maintain all tubes and leads free of ____ and ____.

Answer 4

Occlusion and tension

Question 5

Before starting treatment and during treatment make sure you are evaluating and determining the patients present _____ and _____ status

Answer 5

physical and mental

Question 6

Observe the patient and be monitoring device frequently to determine the response to _____ and identify significant changes in the patient condition or physiologic status.

Answer 6

treatment

Question 6

Who should you notify if there is a significant change in the patients condition or physiologic status?

Answer 6

Nursing and document and record your activities and observations

Question 7

Review the two charts in the ppt

Question 8

What are some commonly monitored physiological functions?

Answer 8

Cardiac and vital signs

Question 9

What helps monitor intracranial pressure (ICP)?

Answer 9

Intracranial pressure monitor

Question 9

What are additional monitoring systems weve been introduced to?

Answer 9

• Arterial pressure (A line)
• Central venous pressure (CVP)
• Indwelling right arterial catheter (Hickman catheter)
• Pulmonary artery catheter (PAC): aka a Swan-Ganz

Question 10

What are some precautions and considerations when working with someone with various lines (IV, arterial line, PICC line)?

Answer 10

• Shortest line is priority
• Do not pull anything out

Question 11

What does mechanical ventilation do?

Answer 11

• Sends a controlled flow of oxygen into a patients lungs
• Rate, pattern, and duration of gas exchange can all be adjusted

Question 12

What are the three types of mechanical ventilation?

Answer 12

• Assist-control
• Synchronized intermittent mandatory ventilation
• Pressure support ventilation

Question 13

What is the difference between noninvasive and invasive mechanical ventilation?

Answer 13

• Noninvasive: NC, face mask, and continuous positive airway pressure (CPAP)
• Invasive: endotracheal tube (ETT), nasotracheal, or tracheostomy

Question 14

Supplemental oxygen is indicated when…

Answer 14

Concentrations of inspired oxygen are insufficent for respiration and patients are at risk for hypoxia and hypoxemia (<90%)

Question 15

What are the modes of delivery of oxygen?

Answer 15

• Nasal cannula
• Face mask
• Nonrebreather
• Tracheostomy
• CPAP
• Bilevel positive airway pressure (BiPAP)

Question 16

What are some precautions and considerations when working with someone on a mechanical ventilation?

Answer 16

Don’t let it come unplugged?

Question 17

What are abdominal precautions (for things like post-surgical drain and wound vacuum systems)?

Question 18

What is an ostomy?

Answer 18

Opening in the abdomen to allow for elimination

Question 19

What are the 3 types of collecting devices for ostomys?

Answer 19

• Colostomy
• Ileostomy
• Urostomy

Question 20

What is the difference between a nephrostomy and urostomy?

Answer 20

• Nephrostomy is attached to the kidneys on the posterior side of the body
• Urostomy is at the stomach area by the ureters on the anterior side

Question 21

What are chest tubes used for?

Answer 21

Used to remove air, blood, or other undesirable matter from the patients chest or pleural cavity

Question 22

Where are chest tubes placed?

Answer 22

• Anterior or lateral chest wall to remove air
• Posterior and inferior chest wall to remove fluids and blood

Question 23

What are urinary catheters used for?

Answer 23

Used to alleviate urinary retention, rebuild bladder muscle tone, collect urine output and cultures, and manage bladder conditions

Question 24

What are the two types of urinary catheters for males?

Answer 24

• Indwelling (foley): catheter through the urethra
• Condom catheter

Question 25

What are the different types of feeding devices?

Answer 25

• Nasogastric tube (NG tube)
• Gastrostomy tube (G-tube)
• Total parenteral nutrition (TPN)

Question 26

Where is the intracranial pressure monitor placed?

Answer 26

Screwed into the skull between the arachnoid membrane and cerebral cortex to measure the ICP

Question 27

What is a normal ICP?

Answer 27

5-10-15 mm Hg

Question 28

What kind of medical intervention can be done for intracranial pressure?

Answer 28

• External ventricular drain (EVD): in the lateral ventricle to relieve ICP, hydrocephalus, or CSF after a hemorrhage
• Ventriculoperitoneal (VP) shunt

Question 29

What should you do with an EVD before patient mobility and participation?

Answer 29

Clamp the EVD

Question 30

What is a Swan-Ganz Catheter?

Answer 30

• Placed into the pulmonary artery for cardiac function monitoring
• Pulmonary artery pressure, right atrium pressure, pulmonary wedge pressure, etc

Question 31

Patient status can change _____ by _____.

Answer 31

Hour by hour