Critical Care

Question 1

Stridor

Answer 1

• indicates respiratory distress
• immediately reported to the health care provider
• high-pitched and coarse
• heard over the trachea

Question 2

Slightly pink sputum is _______ after removal of an endotracheal tube

Answer 2

normal

Question 3

Complication associated with DKA treatment with regular insulin

Answer 3

• hypokalemia and hypoglycemia
• stop insulin for low potassium

Question 4

Assist-control (AC)

Answer 4

• senses the ability for a spontaneous breath
• When taking a spontaneous breath, it delivers the tidal volume preset on the ventilator

Question 5

PEEP

Answer 5

• pressure added at exhalation
• keeps small airways open
• mitigate atelectasis
• risk for hypotension
• can cause ulcer
• decrease CO and preload

Question 6

Indicators of pain

Answer 6

• Resistance with passive movements, muscle tension, and restlessness
• ventilator asynchrony
• tachypnea
• pupil dilation

Question 7

DIC

Answer 7

• caused by eclampsia, gram-negative sepsis, and cancer
• abnormal clotting
• depletes clotting factors and platelets
• extensive bleeding
• emergency

Question 8

DIC results in

Answer 8

• pain
• ischemia
• stroke like symptoms
• dyspnea
• tachycardia
• reduced kidney function
• bowel necrosis

Question 9

DIC treatment

Answer 9

• packed red blood cells and fresh frozen plasma transfusions
• Heparin may be prescribed

Question 10

Hallmarks of DIC

Answer 10

• thrombocytopenia
• coagulopathy
  
  • increased prothrombin time
  • increased partial thromboplastin time
  • decreased fibrinogen
• hemolysis

Question 11

Central/PICC line care

Answer 11

• aspirate each lumen for blood return
  
  • then flush
• 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!

Question 12

Critical care increased risk of infection

Answer 12

• central lines
• non-tunneled catheters
  
  • used for short-term access
  • good for 5-7 days

Question 13

Tracheostomy equipment

Answer 13

• 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

Question 14

Hemolytic reaction

Answer 14

• 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

Question 15

Infiltration

Answer 15

• 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

Question 16

Extravasation

Answer 16

• infiltration but with vesicant
• stop and elevate
• use phentolamine or topical nitroglycerin

Question 17

ICU oral hygiene

Answer 17

• decreases risk of aspiration + ventilator pneumonia
• promotes well-being
• decreases cavities

Question 18

Hypothermia

Answer 18

• mild
  
  • 32-35 C
  • slurred speech
• moderate
  
  • 28-32 C
• severe
  
  • less than 28 C

Question 19

Angiography

Answer 19

• bed rest to allow affected extremity to remain straight
• requires contrast media
  
  • increase fluids
  • assess kidney function via lab testing

Question 20

Non-fatal drowning

Answer 20

• causes pulmonary edema
• water washes out alveolar surfactant
• hypoxia
• hypercarbia (increased carbon dioxide)
• acidosis
• vent/perfuse mismatch

Question 21

Compensatory stage of shock

Answer 21

• AKA nonprogressive
• first stage
• hypotension
• decreased bloow to lungs
• cold/clammy skin

Question 22

Progressive stage of shock

Answer 22

• second stage
• anasarca
  
  • generalized edema
• decreased LOC
• decreased urine
• weak pulses
• hypotension
• tachycardia

Question 23

Irreversible stage of shock

Answer 23

• final stage
• decreased perfusion due to decreased cardiac output
• hypotension
• hypoxemia
• cyanotic skin
• bradycardia*
• unresponsive

Question 24

External Ventricular Drain

Answer 24

• maintain same level as clients head (tragus)
• elevate HOB to 30 degrees
• clamp before repositioning client
• flush only when needed

Question 25

Facial trauma

Answer 25

• nasal fracture
• can cause brain trauma
• monitor for increased intracranial pressure!!
  
  • vomiting!!
  • restlessness
  • altered LOC
  • headache
• elevate HOB 30-45 degrees
• neutral head position

Question 26

Chest trauma

Answer 26

• shallow respirations is an expected finding

Question 27

Bronchoscopy

Answer 27

• 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

Question 28

Anthrax

Answer 28

• caused by bacteria (give antibiotic)
• risk for hypoxia
  
  • continuous pulse oximetry is essential
• x-ray for abnormalities in lungs

Question 29

Tracheostomy care

Answer 29

• shower shield
• do not remove old ties before applying new ties
• do not wash inner cannula with water
  
  • instead use 1/2 strength hydrogen peroxide
  • and saline
• only suction when needed