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Special Issues in Emergency Care and Resuscitation > Acute Care of the Chronically Ill > Flashcards

Acute Care of the Chronically Ill Flashcards

1
Q

introduction

A
  • many life sustaining therapies are handled by families and patients
  • mechanical ventilation IV medication
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2
Q

patients and caregivers are often experts in their condition or impairment

A
  • have an open mind and willingness to listen

- demonstrate confident in enlisting patient expertise

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3
Q

care of patients with terminal illness

A

-many terminally ill may forgo invasive and marginally effective medical treatment

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4
Q

terminal illness

A

-disease process expected to cause death (no cure) within about 6 months

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5
Q

palliative care

A
  • treatment of terminally ill without search for cure
  • cutting back on care
  • improving quality of life not treatment
  • deescalating care
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6
Q

may enter hospice programs near end of life

A
  • provide social and emotional support
  • treat discomfort
  • help patient/family cope with impending death
  • embracing death
  • palliative care on steroids
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7
Q

ventricular assist device

A

-supports heart conditions but does not cure

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8
Q

tracheostomy tubes

A
  • long term replacement for ET tubes, used for:
  • long term ventilatory support
  • frequently tracheal suctioning -> no humidity, no filtering
  • airway protection
  • stoma- the hole
  • takes out upper airway structures
  • may be bc ventilation at home
  • prone to lung infections and issues because there is no humidity or filtering from the mouth/nose
  • not necessarily on a ventilatory
  • unexpected loss of tube may or may not create an emergency
  • can be placed emergently by health care providers in cases of profound upper airway obstruction
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9
Q

tracheostomy structure

A
  • passes directly from opening in anterior neck into trachea
  • consists of:
  • outer cannula
  • inner cannula
  • obturator
  • separated so you can take one part out without taking out the whole thing
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10
Q

fenestrated tracheostomy

A
  • used for:
  • patients being evaluated for tube removal
  • patients requiring intermittent ventilator support
  • may be able to speak
  • breath around it
  • for patients who dont need complete support
  • patients who are wheening off of it
  • has holes
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11
Q

follow DOPE acronym for troubleshooting: tracheostomy

A
  • dislodged/displaced/disconnected
  • obstruction
  • pneumothorax
  • equipment- thing that is using the tracheostomy- ventilator, suctioning
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12
Q

long term ventilator

A
  • may be used for:
  • spinal cord injury
  • neuromuscular disease
  • lung injury
  • depression of inspiratory muscles
  • paralysis
  • guillian barre syndrome
  • positive pressure breathing
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13
Q

primary assessment of long term ventilators

A
  • includes determining if the ventilatory is working effectively
  • dont mess with ventilators that are working
  • if it does not appear to be working effectively:
  • work to adjust ventilator settings
  • disconnect the ventilatory completely
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14
Q

CPAP, BPAP, BiPAP

A
  • offer noninvasive option for oxygenation and ventilation support
  • patient causes the breath
  • ventilator causes the act of breathing-> CPAP, BPAP, BiPAP is supporting the breath
  • BiPAP- breathing in is one pressure, breathing out is a different pressure -> people find it more comfortable bc its more natural
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15
Q

diaphragm and phrenic nerve stimulators

A
  • allow some patients to breathe without ventilator assistance
  • if device fail, you can use conventional bag-mask technique
  • sleep apneic
  • will need external support
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16
Q

bilevel positive airway pressure

A

-BiPAP

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17
Q

left ventricular ejection fraction

A
  • if you don’t have heart failure -> 65-75% ejection fractoin
  • less than 20% is severe heart failure -> medication
  • less than 10% is critical heart failure
  • ventricular assist device for critical heart failure
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18
Q

ventricular assist device (VAD)

A
  • provide life saving bridge for patients with critical heart failure
  • used by patients who:
  • are awaiting heart transplant- VAD to bridge
  • need long term treatment when not candidates for heart transplantation
  • terminal VAD- cannot survive without the heart transplant but are not a candidate
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19
Q

complication for ventricular assist device

A
  • bleeding- must be on blood thinners for VAD
  • infection
  • device failure
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20
Q

few interventions available for EM

A
  • correcting problems with battery or power
  • supportive treatment
  • contacting care team - 24 hour service
21
Q

apnea monitors

A
  • used for:
  • infants with high risk of SIDS or apnea
  • premature infants*
  • diagnosis and evaluation of sleep apnea
  • monitors vary depending on purpose
22
Q

long term vascular access devices

A
  • someone requires regular vascular access
  • blood draws, IV access
  • chemotherapy
  • regular need for antibiotics
  • for administering
  • placed for a number of reasons
  • many are maintained with heparin (prevents blood clotting)
  • contaminated catheters can cause serious infections
  • sterile technique must be used -> devices are under the skin and will require reimplantation via surgery if it is infection
23
Q

common long term vascular access devices

A
  • peripherally inserted central catheter (PICC) - peripheral inserted in the vein but the end of it is at the center -> 6 months or less
  • midline catheter- higher up , indwelling at home catheter, for patients that may need central lines
  • double or triple lumen central catheter
  • hickman, broviac, and groshong, catheters
  • implanted ports
  • dialysis catheter
24
Q

CLABC

A

-hospital infection
-central line
Central line-associated bloodstream infection
-insurance doesnt pay for anything once you get one -> hospital is responsible

25
Q

medication infusion pumps

A
  • many IV medications are administered with infusion pumps

- specific intervals , reasons, timings

26
Q

problems with long term vascular access devices

A
  • devices have a limited life span

- mechanical failure or accidental removal may occur

27
Q

insulin pumps

A
  • electronic devices allowing diabetic patients to titrate exogenous insulin needs
  • potential to complicate emergency treatment of patients with insulin dependent diabetes who develop hypoglycemia
28
Q

tube feeding

A
  • allows nourishment and water to enter digestive system directly
  • tube types that go into the stomach:
  • nasogastric - sometimes can go home, move around
  • orogastric- hospital in patient is intubated
29
Q

other tube for feeing

A
  • nasoduodenal
  • Nasojejunal
  • gastrostomy
  • jejunostomy
  • percutaneous endoscopic gastrostomy (PEG)
  • percutaneous endoscopic jejunostomy (PEJ)
30
Q

colonstomy

A
  • surgery directing large intestine through a stoma

- colostomy bad collects stool and intestinal liquid for disposal

31
Q

urostomy/urinary diversion

A
  • urinary diversion is required for certain medical conditions such as:
  • bladder cancer
  • congenital anomalies
  • massive urinary tract obstructions (tumor)
  • dementia, stroke
32
Q

urinary catheterization

A
  • used when patients cannot urinate on their own
  • may remain in placed (indwelling catheters -> replaced sometimes)
  • may be used intermittently (straight catheter)
33
Q

dialysis

A
  • replacement for failed or failing kidneys
  • as kidney functions declines, substances accumulate in the body
  • if untreated, these substances may cause death
  • electrolytes build up- Cl
  • cardiac automaticity- mg, ca, k, Na
34
Q

two types of dialysis

A
  • hemodialysis- removes blood through a catheter or fistula

- peritoneal dialysis- solution is sent through a catheter to draw fluids from the body (can be done at home)

35
Q

graff

A

-surgical connecition blood circulation

36
Q

complications of dialysis include

A
  • massive fluid and electrolyte abnormalities
  • hypovolemia and fluid overload
  • infection
37
Q

complications of fistulas includes

A
  • life threatening hemorrhage (artery connecting to vein)
  • thrombosis
  • stenosis
38
Q

surgical drains and devices

A
  • a variety of drains and devices are used after surgery
  • prevent fluid from collecting at surgical site
  • outside of scope of practice to manipulate most of these devices and drains
  • can cause significant complications, including:
  • hemorrhage
  • infection
  • need for more surgery
39
Q

cerebrospinal fluid shunts

A
  • hydrocephalus: excess volume of cerebrospinal fluid (CSF) around brain
  • CSF shunt drains excess CSF
  • leads to:
  • headaches
  • visual disturbances
  • unsteady gait
  • nausea, vomiting
  • seizures
  • altered mental status
40
Q

ventricular peritoneal shunt

A
  • ventricle of brain to peritoneal cavity

- most common

41
Q

shunt consists of

A
  • inflow catheter
  • valve
  • outflow catheter
42
Q

cerebrospinal fluid shunts: increased ICP suggests

A
  • infection
  • shunt valve
  • malnutrition
  • catheter damage
  • altered mental status
43
Q

suspect shunt malfunction if

A
  • headache

- visual disturbances seizures

44
Q

paralysis, paraplegia, and quadriplegia

A
  • often accompanied by sensor deficits and loss of bowel or bladder control
  • caused by many medical conditions:
  • head trauma
  • cerebrovascular accident (CVA, stroke)
  • spinal cord injury
  • malignancy
  • other neuromuscular diseases
45
Q

paralysis

A

inability to move

  • may require:
  • urinary catheterization
  • total lifting assistance
46
Q

paraplegia

A

affects lower extremities

47
Q

quadriplegia

A

-affects upper and lower extremities

48
Q

complications of paralysis, paraplegia, and quadriplegia

A
  • respiratory muscle paralysis
  • pressure ulcers
  • autonomic dysreflexia
49
Q

external devices are often used to stabilize spinal structures

A
  • require additional consideration in patient movement
  • after spinal surgery
  • head mounts are usually screwed directly into skull- halo
  • urinary catheterization
  • autonomic

Special Issues in Emergency Care and Resuscitation (15 decks)

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