Critical Care

Question 1

after placement of ETT placement should be verified by

Answer 1

Chest x ray, assessing for equal breath sounds bilaterally

Question 2

intubate if GCS is less than

Answer 2

8

Question 3

tracheostomy tubes may be used for

Answer 3

tracheal obstruction, slow vent weaning, tracheal damage, neuromuscular damage

Question 4

tracheostomy nursing considerations

Answer 4

infection prevention, only suction to pre measured depth, must keep two back up trachs at bedside (one same size, one size smaller)

Question 5

Peak Inspiratory pressure (PIP)

Answer 5

the highest level of pressure in the lungs during inhalation

Question 6

Positive end expiratory pressure (PEEP)

Answer 6

amount of pressure in alveoli at the end of expiration

Question 7

Fraction of inspired oxygen (FiO2)

Answer 7

how much oxygen the client is getting

Question 8

tidal volume

Answer 8

amount of air inhaled during one respiratory cycle

Question 9

end-tidal carbon dioxide (ETCO2)

Answer 9

partial pressure of CO2 detected at the end of exhalation

Question 10

volume controlled ventilator mode

Answer 10

certain volume of air delivered to the client with each breath

Question 11

pressure controlled ventilator mode

Answer 11

lungs are inflated to a certain pressure

Question 12

CPAP

Answer 12

there is continuous positive airway pressure while the client control their respiratory rates and volumes

Question 13

BiPAP

Answer 13

there is positive airway pressure set at different pressures for inspiration and expiration

Question 14

high ventilator alarm

Answer 14

pressure in circuit is too high; coughing, gagging, bronchospasm, fighting ventilator, ETT occlusion, kink in tubing, increases secretion, thick secretions, water in ventilator circuit

Question 15

low ventilator alarms

Answer 15

pressure in circuit is too low; tubing is disconnected, loose connections, leak, extubation, cuffed ETT or trach is deflated, poorly fitting CPAP/BiPAP mask

Question 16

decorticate posturing

Answer 16

damage to midbrain, flexion, arms shaped like C’s moving towards spinal cord, rigid muscles, arms pulled in towards center, clenched fists

Question 17

decerebrate posturing

Answer 17

damage to deep brain structures (pons), extension, indicates worse, more extensive damage, arms and legs straight out, toes pointed downwards, neck and head arched back, rigid muscles

Question 18

monro-kellie hypothesis

Answer 18

skull is rigid contained filled with blood, brain, and CSF. If one of those increases, another must decrease

Question 19

S&S increased ICP

Answer 19

papilledema, pupil changes, impaired eye movement, headache, changes in LOC, seizures, impaired sensory and motor function, changes in speech, decerebrate, decorticate, flaccid, vomiting, increase SBP, decrease pulse, altered resp pattern

Question 20

S&S increased ICP infants

Answer 20

bulging fontanels, cranial suture separation, increase head circumference, high-pitched cry

Question 21

Vasoactive Infusions include

Answer 21

inotropes and vasopressors

Question 22

inotropes

Answer 22

act by increasing the force of myocardial contractility

Question 23

vasopressors

Answer 23

mimic sympathetic nervous system to cause vasoconstriction

Question 24

alpha 1 receptors

Answer 24

found in vascular smooth muscles, peripheral vasoconstriction, increased SVR

Question 25

beta 1 receptors

Answer 25

found in heart and intestinal smooth muscle, increase contractility, increase SV, HR, CO

Question 26

beta 2 receptors

Answer 26

found in lungs/bronchial vasculature, bronchodilation, coronary artery vasodilation

Question 27

epinephrine

Answer 27

given in shock, cardiac arrest, asystole

low dose: acts on beta 1 receptors to increase CO

high does: acts on alpha 1 receptors to increase systemic vascular resistance, increase BP

Question 28

norepinephrine

Answer 28

shock, hypotension
acts on alpha 1 receptors, causes peripheral vasoconstriction, increases BP, increases CO

Question 29

Phenylephrine

Answer 29

anesthesia induced hypotension, second line agent in some shock clients, only acts on alpha 1 receptors, causes only vasoconstriction (no inotropy), vasoconstriction -> increased BP

Question 30

dopamine

Answer 30

shock, hypotension, trauma
acts on dopamine receptors

low dose: use in kidney failure to increase renal blood flow (renal dopa), increase contractility -> increase CO

high dose: causes vasoconstriction, increases SVR, increases BP

Question 31

vasopressin

Answer 31

ADH, less diuresis = more volume in the vascular system, more volume = more pressure = raised BP, secondary line in vasodilatory shock, third line in septic shock

Question 32

Milrinone

Answer 32

cardiogenic shock, decreased CO, congenital/acquired heart defects, cause systemic and pulmonary vasodilation = decreased afterload, increase contractility