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Critically Ill > ICU evaluation and preventative measures > Flashcards

ICU evaluation and preventative measures Flashcards

1
Q

What is the safest way medication can be administered?

A

oral/enteral route

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2
Q

What eternal access devices are used for short-term use?

A
  1. nasogastric tube
  2. orogastric tube
  3. nasoenteric tube
  4. oroenteric tube
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3
Q

What eternal access devices are used for long-term use?

A
  1. gastrostomy tube
  2. jejunostomy tube
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4
Q

What are the inclusion criteria for IV to PO switching?

A
  1. tolerate enteral nutrition
  2. tolerate scheduled oral meds
  3. s/s of infection improving
  4. functioning GI tract
  5. absorption and bioavailability of PO med comparable to IV
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5
Q

How can we tell an infection is improving when considering IV to PO?

A
  1. WBC decrease to normal
  2. improved chest x-ray
  3. temp <100 for 24-48h
  4. respitory rate <20 breaths/min
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6
Q

How can we tell if a patient has a functioning GI tract when converting from IV to PO?

A
  1. tolerating 1L/day of fluids
  2. tolerating 40mL/h of enteral nutrition
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7
Q

What are the exclusion criteria for IV to PO switching?

A
  1. unreliable response to oral meds (N/V)
  2. unable to swallow/unconscious
  3. NPO for procedure
  4. GI obstruction, malabsorption, GI bleed, paralytic ileus, severe diarrhea
  5. unresponsive to previous PO tx
  6. 3/4 mucositis
  7. The disease state does not support PO
  8. Pseudomonas infection/ IV abx <1day
  9. candida tx < 7days
  10. seizure/ aspiration risk
  11. refuses PO
  12. immunocompromised patients
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8
Q

How can we tell is someone has a disease that does not support PO?

A
  1. meningitis
  2. infective endocarditis
  3. infection of prosthetic device
  4. osteomyelitis
  5. sepsis
  6. severe cellulitis
  7. bronchiectasis
  8. pneumonia with AIDS
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9
Q

How can we tell if the patient is immunocompromised?

A
  1. febrile neutropenia
  2. cancer chemotherapy
  3. post-transplant
  4. functional asplenia
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10
Q

What is sequential therapy?

A

refers to the act of replacing a parenteral version with its oral counterpart of the same compound

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11
Q

What is switch therapy?

A

conversion of IV to PO equivalent within the same class

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12
Q

What is step-down therapy?

A

conversion from injection med to oral agent in another class or to a different med in the same class with a different dose, frequency, and spectrum of activity may not be the same

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13
Q

All ICU patients have Virchow’s triad, what are the 3 parts?

A
  1. stasis
  2. vascular injury
  3. hypercoagulable state
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14
Q

What are the major risk factors for VTE?

A
  1. cancer
  2. previous DVT
  3. obesity
  4. trauma
  5. surgery
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15
Q

When should LMWH or LDUH (low-dose unfractionated heparin) be started for DVT prophylaxis in critical care patients?

A

ASAP

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16
Q

What should be used for DVT prophylaxis in critical care patients at high risk for major bleeding?

A

mechanical thromboprophylaxis as monotherapy

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17
Q

When would a patient be considered high risk for major bleeding?

A

platelets <50,000

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18
Q

What are CIs for mechanical thromboprophylaxis?

A
  1. open wounds
  2. active DVT
19
Q

What is the dose of heparin (LDUH) for DVT prophylaxis?

A
  1. 5000 units SQ Q12H
    OR
  2. 5000 units SQ Q8H
20
Q

What is the renal dosing adjustment for LDUH?

A

No dosing adjustment required

21
Q

What is the dose of LMWH (Enoxeparin, LOVENOX) for DVT prophylaxis?

A
  1. 40mg SQ Q24H
    OR
  2. 30mg SQ Q12H
22
Q

What is the renal dosing adjustment for Enoxiparin?

A

CrCl <30: 30mg SQ Q24H

23
Q

What role does Fondaparinux (ARIXTRA) have in DVT prophylaxis?

A

can be used in patients with moderate, high, or very high risk of DVT if CrCl>30

24
Q

What role do DOACs have in DVT prophylaxis?

A

No role in ICU patients

25
Q

What is a serious immune-mediated adverse reaction with heparin products and what is the outcome?

A

Heparin-induced thrombocytopenia: presents as low platelets in the presence of UFH or LWMH and leads to thrombosis (stroke, MI, VTE)

26
Q

When should DVT prophylaxis be held?

A
  1. 48-72 hours after serious surgery
  2. 24 hours after minor surgery
27
Q

When should VTE prophylaxis be D/C?

A
  1. at discharge
  2. after discharge if at high risk of DVT
28
Q

What are major independent risk factors for stress ulcers?

A
  1. coagulopathy (platelets <50,000)
    and/or
  2. mechanical ventilation >48h
29
Q

What 2 drug classes are recommended for stress ulcer prophylaxis?

A
  1. H2RAs
  2. PPIs
30
Q

What are SEs with H2RAs?

A
  1. thrombocytopenia
  2. mental status changes/ CNS toxicity
  3. nosocomial pneumonia
  4. tachyphylaxis
31
Q

What is the dose of famotidine (PEPCID) for stress ulcer prophylaxis?

A

20mg Q12H

32
Q

What is the renal dose adjustment of famotidine (PEPCID) for stress ulcer prophylaxis?

A

CrCl<50: 20mg Q24H

33
Q

What are SEs with PPIs?

A
  1. GI disturbance
  2. nosicomial pneumonia
  3. c.diff super infection/ colitis
  4. long-term (fractures, electrolyte disturbances)
34
Q

What is the dose of Pantoprazole (PROTONIX) for stress ulcer prophylaxis?

A

40mg Q24H

35
Q

What is the dose of Esomeprazole (NEXIUM) for stress ulcer prophylaxis?

A

40mg Q24H

36
Q

What is the renal dosage adjustment for PPIs?

A

not required

37
Q

Which agents for stress ulcer prophylaxis can be administered IV or enteral?

A
  1. famotidine
  2. pantoprazole
  3. esomeprazole
38
Q

What is the target glucose range for ICU patients?

A

140-180 mg/dl

39
Q

What should be done if a patient becomes hypoglycemic BG</=70?

A
  1. stop insulin
  2. administer dextrose (25g IV or 50mL of 50% dextrose)
  3. re-evaluate insulin/ glucose control
40
Q

What are not routine methods of glucose control in ICU patients?

A
  1. oral/outpatient antidiabetic agents
  2. basal/bolus regimens
41
Q

What is the preferred method of glucose control in ICU patients?

A

range of short/rapid-acting insulin units given as SQ dose based on current reading

42
Q

When would insulin infusions be given in ICU?

A
  1. not responding to the correctional scale
  2. conditions affecting SQ absorption
  3. DKA
  4. HHS
43
Q

What are other risk factors for stress ulcers?

A
  1. sepsis/shock
  2. glucocorticoids
  3. NSAIDs
  4. hx of ulcers/bleeds within a year
  5. burns >20% BSA
  6. head/spinal trauma
  7. organ transplant
  8. AKI
  9. acute liver failure

Critically Ill (20 decks)

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