Critical Care Flashcards
(55 cards)
1
Q
Stridor
A
- indicates respiratory distress
- immediately reported to the health care provider
- high-pitched and coarse
- heard over the trachea
2
Q
Slightly pink sputum is _______ after removal of an endotracheal tube
A
normal
3
Q
Complication associated with DKA treatment with regular insulin
A
- hypokalemia and hypoglycemia
- stop insulin for low potassium
4
Q
Assist-control (AC)
A
- senses for a spontaneous breath
- delivers fixed preset tidal volume at set intervals
- most common mode
- full airway protection
5
Q
PEEP
A
- pressure added at exhalation (spontaneous)
- increases thoracic pressure
- decreases cerebral perfusion
- will INCREASE ICP
- decreases cerebral perfusion
- 15 is highest setting
- will increase ICP
- keeps small airways open
- mitigate atelectasis
- risk for hypotension
- can cause ulcer
- decrease CO and preload
- monitor for decreased MAP
6
Q
Indicators of pain
A
- Resistance with passive movements, muscle tension, and restlessness
- ventilator asynchrony
- tachypnea
- pupil dilation
7
Q
DIC
A
- caused by eclampsia, gram-negative sepsis, and cancer
- abnormal clotting
- depletes clotting factors and platelets
- extensive bleeding
- emergency
8
Q
DIC results in
A
- pain
- ischemia
- stroke like symptoms
- dyspnea
- tachycardia
- reduced kidney function
- bowel necrosis
9
Q
DIC treatment
A
- packed red blood cells and fresh frozen plasma transfusions (clotting factors)
- Heparin may be prescribed
10
Q
Hallmarks of DIC
A
- thrombocytopenia
- coagulopathy
- increased prothrombin time
- increased partial thromboplastin time
- decreased fibrinogen
- hemolysis
11
Q
Central/PICC line care
A
- aspirate each lumen for blood return
- then pulsatile flush with 10 mL saline
- change dressing every 7 days unless soiled
- aseptic technique
- nurse and pt wear mask during change
- clean with chlorhexidine daily
- do not lift objects greater than 5 pounds
- cover in shower
high risk for infection!
12
Q
Critical care increased risk of infection
A
- central lines
- non-tunneled catheters
- used for short-term access
- good for 5-7 days
13
Q
Tracheostomy equipment
A
- inner cannula
- obturator
- suction equipment
- ensure placement = withdraw 1-2 cm before applying suction
- catheter size = 12-14 Fr
- 80-120 mmHg (adult —> older than 2)
- 80-100 mmHg (infant)
- 10-15 seconds
- oxygen source
14
Q
Hemolytic reaction
A
- back pain
- instable vital signs
- apprehension/restless
- hemoglobinuria
- hemoglobin in urine
- causes red/brown urine color
- stop blood transfusion
- leave VAD to flush with saline
15
Q
Infiltration
A
- catheter outside vein
- nonvesicant*
- swelling
- coolness*
- discomfort
- treatment
- discontinue vascular access
- elevate extremity
- monitor hemoglobin+hematocrit
- alternate hot and cold
- start new VAD on other side
16
Q
Extravasation
A
- infiltration but with vesicant
- stop and elevate
- use phentolamine or topical nitroglycerin
17
Q
ICU oral hygiene
A
- decreases risk of aspiration + ventilator pneumonia
- promotes well-being
- decreases cavities
18
Q
Hypothermia
A
- mild
- 32-35 C
- slurred speech
- moderate
- 28-32 C
- severe
- less than 28 C
19
Q
Angiography
A
- bed rest to allow affected extremity to remain straight
- requires contrast media
- increase fluids
- assess kidney function via lab testing
20
Q
Non-fatal drowning
A
- causes pulmonary edema
- water washes out alveolar surfactant
- hypoxia
- hypercarbia (increased carbon dioxide)
- acidosis
- vent/perfuse mismatch
21
Q
Compensatory stage of shock
A
- AKA nonprogressive
- first stage
- hypotension
- decreased bloow to lungs
- cold/clammy skin
22
Q
Progressive stage of shock
A
- second stage
- anasarca
- generalized edema
- decreased LOC
- decreased urine
- weak pulses
- hypotension
- tachycardia
23
Q
Irreversible stage of shock
A
- final stage
- decreased perfusion due to decreased cardiac output
- hypotension
- hypoxemia
- cyanotic skin
- bradycardia*
- unresponsive
24
Q
External Ventricular Drain
A
- maintain same level as clients head (tragus)
- elevate HOB to 30 degrees
- clamp before repositioning client
- flush only when needed
25
Facial trauma
- nasal fracture
- can cause brain trauma
- monitor for increased intracranial pressure!!
- vomiting!!
- restlessness
- altered LOC
- headache
- elevate HOB 30-45 degrees
- neutral head position
26
Chest trauma
- shallow respirations is an expected finding
27
Bronchoscopy
- expected
- sore throat
- green sputum
- coughing when sipping water (indicates return of gag relflex)
- adverse
- short of breath
- indicates respiratory distress
- pneuomothorax
- decreased breath sounds on affected side
- tachypnea
- tachycardia
28
Pneumonectomy
- surgical removal of entire lung
- post care
- early ambulation
- coughing, deep breathing is GOOD
- only supine or operative side
- pulmonary function normal after 1 week
-
29
Anthrax
- caused by bacteria (give antibiotic)
- risk for hypoxia
- continuous pulse oximetry is essential
- x-ray for abnormalities in lungs
30
Tracheostomy care
- shower shield
- do not remove old ties before applying new ties
- do not deflate cuff first 24 hours
- do not inflate before suctioning
- do not wash inner cannula with water
- instead use 1/2 strength hydrogen peroxide
- and saline
- only suction when needed
31
Post femoral angioplasty care
- neurovascular
- assess extremities' distal pulse/temperature
- report signs of decreased sensation and paresthesia
- can be arterial occlussion
- give antiplatelets to prevent occlusion
32
Kock pouch care
- client will have wound drain, medena catheter in stoma, and urinary cathether
- monitor urine output
- check for ostomy pouch leaks
- note size/shape/color or stoma
33
Ostomy care
- use mild soap, not moisturizing
- regular gloves, not sterile
- don’t use alcohol
- empty when 1/3 - 1/2 full
- cut pouch 1/16 - 1/8 inch around stoma
34
Healthy stoma
- protudes 2.5 cm with open lumen on top
- pink/red
- moist
35
Stoma ischemia
- dry
- dusky
- red/purple
36
Retracted stoma
- concave
- bowl shaped
37
Stoma stenosis
- narrow
- flattened
- constricted
38
Hemodialysis complication
- hypotension
- too much fluid being removed
- dizziness
- fall risk
39
Peritoneal dialysis
- constipation is common
- causes outflow failure
- drainage volume is less than inflow volume
- reposition and encourage bowel movement
- give laxative or enema
40
Vaginal coposcopy
- intercourse not adviced first 48 hours
- first intercourse will be painful
41
Lung lobe removal care
- closed chest drainage system
- incensitive spirometer during recovery
42
Blood compatibility
- O+
- can give to any other +
- can receive only O +/-
- O- (universal receiver)
- give to everyone
- receive only O-
- A/B+ (universal donor)
- give to matching +
- receive matching + or -
- A/B/O-
- give to matching + or -
- receive from matching -
43
Positive blood and giving
- Postive only wants to GIVE rides to other positives
- (A+) is morning class, can give rides to other positive morning classes (A+) or (AB+) because they have morning class
- (B+) is evening class, can give rides to other positive evening class (B+) or (AB+) because they also have evening class
- (AB+) is A Big girl, can only fit Another Big positve girl (AB+)
- (O+) is a skinny girl. Can fit all other positives in her car
44
Negative blood and giving
- negative GIVES rides to anyone (+/-)
- (A-) is morning class, can give rides to other morning classes (A+/-, AB+/-)
- (B-) is evening class, can give rides to other evening classes (B+/-, AB +/-)
- (AB-) A Big girl can only fit Another Big girl (AB+/-)
- (O-) skiiny girl who gives rides to everyone
45
Positive blood and receiving
- If youre recieving a ride, you dont have a choice who is in the car
- (A+) is morning class, can receive a ride from other morning classes (A), but no choice who's in the car (A+/-, O+/-)
- (B+) is evening class, can receive ride from other evening classes (B), but no choice who's in the car (B+/-, O+/-)
- (AB+) is A Big girl, doesnt matter who offers ride, youll accept anyone (universal receiver)
- (O+) is skinny girl, wants to ride with other skinny girls (O+/-)
46
Negative blood and receiving
- when negative and receiving a ride, you want another negative person
- (A-) is morning class, will take rides with other morning class (A-), or skinny girl (O-), as long as theyre also negative
- (B-) is evening class, will take rides with other evening class (B-), or skinny girl (O-), as long as theyre also negative
- (AB-), A Big girl whose negative, will accept ride from anyone if theyre also negative (AB-,A-,B-,O-)
- (O-) negative skinny girl will only take ride from another negative skinny girl (O-)
47
Blood types rules
- giving
- positives only give rides to other positives
- AB+ can fit only one more AB+
- negatives dont care if you're positive or negative
- AB- gives rides to other AB, dont care if youre positive or negative
- receiving
- positives willing to receive rides from anyone
- AB+ will receive ride from everyone (universal donor)
- negatives receivce ride from only other negatives
- AB- will receive ride from anyone, as long as theyre negative
48
Femoral vein catheter care
- central line
- do not sit more than 45 degrees
- no soap to clean
- clean every 7 days unless soiled
- chlorhexidine to clean
49
Chest physiotherapy (CPT)
- loosen secretions
- give bronchodilator 15-30 min BEFORE
- perform at least 30 min before meals
- dont do with rib fracture, increaed ICP, or on anticoagulants
50
Homan's sign
- detects DVT
- low reliability
- positive result is pain foot dorsiflexion
51
Ventriculoperitoneal (VP) shunt
- drains cerebrospinal fluid
- used in hydrocephalus
- monitor for abdominal distention or discomfort
52
Prevent febrile reaction with blood transfusion
- use leukocyte reduced blood
53
Rewarm slowly
- to prevent cardiac arrhythmia's
- A.fib
- V.fib
54
Sengstaken-Blakemore tube
- used in tamponade therapy
- gastro/esophageal bleeding
- gastric balloon used
- KEEP SCISSORS AT BEDSIDE IF BALLOON SHIFTS
- used to rapidly deflate balloon
55
Mechanical ventilation care
- supine
- elevate HOB to MORE than 30 degrees
- High-Fowlers
