Critical Care- ICU Flashcards
(160 cards)
1
Q
5 important aspects to start with in ICU
A
- Assess situation
- Communicate with RN, respiratory therapist, intensive study, residents
- If you don’t know, ask
- Find all lines and tubes, know what they do and what their complications are
- Understand readings on the monitors
2
Q
2 types of vascular catheters
A
Arterial, Venous
3
Q
What 5 arteries are vascular catheters involved in?
A
Femoral Radial Axillary Brachial Dorsalis Pedis
4
Q
Arterial vascular catheter used for _____________
A
continuous monitoring of BP
5
Q
Arterial vascular catheter has access for
A
Blood gasses
6
Q
3 complications of arterial vascular catheters
A
Bleeding
Infection
Lack of blood flow to tissue supplied by artery
7
Q
Venous vascular catheters are involved in these 3 veins
A
Femoral
Jugular
Subclavian
8
Q
Venous vascular catheter is a ______ (more commonly seen in hospitalized patients)
A
Peripheral IV
9
Q
5 complications of venous vascular catheter
A
Hematoma Phlebitis Cellulitis Emboli Infiltration
10
Q
A-line stands for ______
A
Intra-arterial line
11
Q
Where is an A-line inserted
A
radial or brachial artery
12
Q
A-line measures _______
A
ABGs
Arterial BP
13
Q
What is the minimal MAP for early mobility/organ function?
A
65 mmHg
14
Q
What needs to be level for accurate reading of A-line?
A
Transducer
15
Q
If transducer is too high, BP reads ______
A
Low
16
Q
If transducer is too low , BP reads ______
A
High
17
Q
What determines the appropriate transducer level?
A
Level with right atrium
18
Q
Who re-levels the transducer?
A
RN
19
Q
What is a peripheral IV used for?
A
Blood draws
Administration of meds, fluids, blood
20
Q
Where is a peripheral IV usually inserted?
A
Hand, forearm, can be in foot
21
Q
Can a peripheral IV become infiltrated?
A
yes
22
Q
How often should a peripheral IV be changed?
A
every 3-5 days
23
Q
If IV is in the foot, need to check with nurse before ________ (because likely that all other veins are not intact)
A
Ambulating
24
Q
What is another name for a pulmonary artery catheter?
A
Swan-Ganz catheter
25
Where is a Swan-Ganz/pulmonary artery catheter inserted?
subclavian or internal jugular to pulmonary artery
26
What does a Swan-Ganz/pulmonary artery catheter evaluate?
- Cardiac function
| - Effects of medications
27
What distinguishes pulmonary artery catheter/Swan-Ganz?
Blue tube with saran Wrap coming out
28
Who typically has a pulmonary artery/Swan-Ganz catheter?
- Open heart surgery
| - CHF
29
What 3 things does a pulmonary artery/Swan-Ganz catheter measure?
- pulmonary artery pressure
- pulmonary artery wedge pressure (left atrial pressure)
- cardiac output
30
What is another name for a peripherally inserted central catheter?
PICC Line
31
Where is a picc line located?
cephalic vein to right atrium or superior vena cava
32
How is picc line placement confirmed?
Chest x-Ray
33
What patients would receive a picc line?
Long term antibiotics, TPN (total parental nutrition), chemo
34
How long can a picc line stay in place?
Can last for weeks
35
What should you avoid with a pt with a picc line?
Do not take BP in that extremity
36
What is an IABP?
Intra-aortic balloon pump
37
Where is IABP located?
Catheter tip inserted into femoral artery to aortic arch
38
How would you treat pt with IABP?
- Usually don't see pt with IABP
- Can do passive ROM on extremities where catheter is not
- Typically, pt is too unstable
39
What is the purpose of an IABP?
- Increase myocardial oxygen supply
| - Increase cardiac output
40
What is indicated for IABP pt?
Bed rest
41
Patient with IABP is in in cardiogenic shock, weaning from ______
Cardiopulmonary bypass
42
Where is a central venous line inserted?
subclavian, internal jugular, femoral vein
43
Where does the central venous line end?
Inferior vena cava, superior vena cava, right atrium
44
_____ transducer is similar to that of A-line transducer
Central Venous Line
45
Central venous line can have multiple lumens (triple lumen) - TLC
Explain this feature
1 large catheter is inserted
| 3 lines branch off that can feed multiple medications through
46
What is a central venous line used for?
Blood transfusions
Meds
Chemo
47
What does a central venous line measure?
Central venous pressure (pressure in thoracic vena cava)
48
What are the 3 complications of a central venous line?
- Dysrhythmias
- Pseudoaneurysms
- Sepsis
49
Temporary dialysis catheter is aka
Trialysis
50
What is a Trialysis used for?
- Short term dialysis
| - CRRT (continual renal replacement therapy)
51
Describe the appearance of a Trialysis
Large bore with 2-3 lumens
52
Where does the trialysis insert
Direct access to vein:
- Femoral
- Jugular
- Subclavian
53
What is CRRT?
Continuous renal replacement therapy
54
Describe the process of CRRT
- Done through central catheter
| - slow, continuous mechanical means of removing fluid, electrolytes, solutes
55
What kind of patients use CRRT?
- used to stabilize and manage patients without adverse hypotensive effects
- Burn patients- less harsh
56
How long can CRRT be used for?
Can continue for weeks
57
How does the rate of infiltration compare to HD (hemodialysis)?
CRRT is much slower
58
For CRRT pt, PT is held until clarification from MD for _____ of non-involved limbs
ROM
59
Intraventricular catheter is aka
Ventriculostomy
60
Where is the ventriculostomy/intraventricular catheter inserted?
Threaded through burr hole into lateral ventricle (in head)
61
What does a ventriculostomy/intraventricular catheter measure?
Intracranial pressure or drains CSF
62
Has a ________ that needs to be level with position changes at the ______
Transducer, external auditory meatus
63
How inclined should the head of the bed be for a ventriculostomy/intraventricular catheter pt?
30 degrees
64
Increase in ________ can alter leveling system and amount of ________ drainage in a ventriculostomy pt
ICP, CSF
65
Take caution with __________ ROM for ventriculostomy pt
Cervical
66
Can the ventriculostomy be closed/disconnected?
Yes- RN may close drain prior to mobility (if pt is stable)--> must ask RN
67
Where is a hemovac inserted?
Into surgical site
68
What is a hemovac used for?
Drainage of edema, bleeding
69
What pt receives a hemovac?
- Joint replacements
- Spinal surgery
- TKR
- THR
70
When is a hemovac removed?
Approx 1-2 days post-op
71
What is an NGT
Nasogastric tube
72
Where is a NGT inserted?
Through nose into stomach
73
What is a NGT used for?
Tube feelings in incubated or comatose patients
74
What is NGT drainage used for?
- GI bleeds
| - post-op abdominal surgery
75
Pt with NGT has this precaution
NPO (nothing by mouth)
76
What is a PEG?
Per cutaneous endoscopic gastrostomy
77
Where is a PEG inserted?
Inserted into wall of stomach
78
When is a PEG used?
If feeding pt for long term
79
When pt is flat, tube feeds must be turned off to reduce __________
Risk of aspiration
80
What is the inclination angle of the head of bed for pt with PEG?
>30 degrees
| If not at 30, turn off tube feed
81
What is a JP drain?
Jackson-Pratt Drain
82
Where is a JP drain inserted/what does it look like?
Suction bulb inserted into surgical site
83
What is a JP drain used for?
Drainage of local edema, bleeding
84
What kind of pt may receive a JP drain?
- mastectomy
| - spinal surgery
85
What is a urinary catheter aka?
Foley catheter
86
Where is the Foley catheter inserted?
Directly into bladder
87
This type of Foley catheter for males can be easily dislodged
Texas (condom) catheter
88
Where does the Foley catheter need to remain? (What level)
Below the level of the bladder to prevent back flow
89
Where may a Foley catheter be located?
suprapubic region (surgically inserted into bladder just above pubic bone)
90
When is a chest tube used?
After surgical opening of
- pleural space
- pleural effusion
- pneumo- or hemothorax
91
Pt with open heart surgery, lobectomy, or pneumo- hemothorax may receive
chest tube
92
Where is a chest tube placed?
In mediastinum (s/p CABG) OR pleural cavity
93
Can pt be moved out of bed with chest tube?
Usually defer OOB until mediastinal CT is pulled
94
T/F
| Pleural CT is NOT contraindication for OOB
TRUE
95
T/F
| Pleural CT is NOT contraindication for shoulder ROM
TRUE
96
2 points regarding OOB/shoulder ROM that should be included for pleural CT
- pt may self limit (encourage pt to move shoulders)
| - encourage ROM and deep breathing
97
What level must the chest tube be kept at?
lower than chest to prevent back flow
98
What is the only restriction for mobilization for pt with chest tube?
Length of tubing if connected to wall suction
99
What is a pt with a chest tube at risk for after CT is removed?
Risk of pneumothorax, await CXR
100
How many parts are there to the collection chamber for a chest tube?
3
101
What is the collection chamber of a chest tube for?
(R side) for drainage
102
What is the water seal chamber of a chest tube for?
(Middle) allows air out on exhalation, prevents air from entering pleural cavity on inhalation
103
What is located on left side of chest tube?
Suction control
104
Where is a tracheal tube located?
Oral or nasal
105
When is a tracheal tube indicated?
- upper airway obstruction
- inability to manage excessive excretions
- smoke inhalation (burn pts)
106
4 effects of tracheostomy
1. Long term airway management
2. Extended weaning time
3. Better oral hygiene
4. To entail for speech and PO
107
No restrictions for _________ ROM and ________ positioning
Cervical, prone
108
Alarms may go off when working with tracheal tube pt- look at the pt first and check for these 5 things
1. Secretions
2. Pt fighting vent
3. Kinked tube
4. Pt pops off vent
5. Elevated RR (coughing)
109
What tracheal tube ventilator mode is:
- Pt can initiate breath, vent provides preset tidal volume
- mandatory minimum set rate
Assist controlled (AC)
110
What tracheal tube ventilator mode is:
- full vent support
- delivery based on airway pressure
Pressure regulated volume control (PRVC)
111
What tracheal tube ventilator mode is:
- set rate synchronized with pt effort
- pt effort beyond set rate or unassisted
Synchronous intermittent mandatory ventilation (SIMV)
112
What tracheal tube ventilator mode is:
- no vent assist for breaths
- air continuously being pushed into airway to ease pressure
- used as weaning mode
Continuous positive airway pressure (CPAP)
113
ICU Monitor:
HR should be
80-100 bpm
| Green- top
114
ICU Monitor:
ABP should be
90-140/60-90 mmHg
red (2nd line)
115
ICU Monitor:
MAP should be
60-110 mmHg
red (parentheses next to ABP)
116
What is minimum MAP for good organ function?
65 mmHg
117
ICU Monitor:
SpO2 should be
95-100%
Blue (4th line)
118
ICU Monitor:
RR should be
12-18
White (2nd from bottom)
119
ICU Monitor:
PAP should be
20-30/5-15 mmHg
Yellow (3rd line)
120
_________ is often overshadowed by medical stabilization, as bedrest is common "treatment" for critical patients
Mobility
121
Early PT improves _______ outcomes and _______ length of stay
functional, decreases
122
5 effects of immobility on cardiovascular system
1. Decreased exercise tolerance
2. Decreased cardiac output due to reduced blood volume
3. Increased RHR
4. Slow recovery from activity
5. Orthostatic intolerance
123
What are 3 symptoms of orthostatic intolerance?
Lightheadedness, diaphoresis, nausea upon changing positions
124
3 effects of immobility on musculoskeletal system
1. Muscle atrophy due to decrease in number/magnitude of muscle contractions
2. Bone demineralization due to lack of weight bearing
3. Positioning important--> shortened positions enhance atrophy, lengthened and stretched positions alleviate loss of muscle fibers
125
4 effects of immobility on respiratory system
1. Decreased respiratory muscle strength
2. Decreased vital capacity due to supine positioning
3. Lung and chest wall stiffness
4. Increased risk of pneumonia
126
Encourage ________ and ________ breathing due to effects of immobility on respiratory system
Incentive spirometery, diaphragmatic
127
Be aware of abnormal sputum (orally or from trach)
Normal is ________, slightly sticky and viscous
Frothy sputum tinged with blood can indicate ________ (alert RN/MD immediately)
```
Normal = clear
Pink = pulmonary edema
```
128
Effect of immobility on thermoregulatory system-
Increased basal metabolic rate due to infection or _______ results in increased ____________
Fever, RHR
129
Effect of immobility on thermoregulatory system
Causes _______ core temperature with exercise
Increased
130
Effect of immobility on thermoregulatory system
Poor regulation of body heat results in increased complaints of _________
Fatigue
131
Effect of immobility on psychiatrics
Intellectual and perceptual deficits due to (4)
- alterations in sleep patterns
- presence of noxious stimuli (i.e. Catheters)
- noise
- loss in circadian light patterns
132
Effect of immobility on thermoregulatory system
Anxiety, agitation, delirium, and depression can affect ______ of pts in acute care
>50%
133
Effect of immobility on thermoregulatory system
- health issues after critical illness that may persist even after pt returns home
- can involve pt's body, thoughts, feelings or mind
- ICU acquired weakness or cognitive dysfunction
--> signs/symptoms of _________
Post-intensive care syndrome (PICS)
134
Effect of immobility on thermoregulatory system
What can help alleviate PICS?
Early mobility
135
Effect of immobility on thermoregulatory system
What percentage of pts are affected by PICS post ICU?
30-80% (some never recover)
136
Effect of immobility-
Acquired neuromuscular disorders
Characterized by severe weakness with _________ that is common in critically ill pts
Respiratory failure
137
Effect of immobility-Acquired neuromuscular disorders
What does CIM stand for?
Critical illness myopathy
138
Effect of immobility-Acquired neuromuscular disorders
CIM is associated with: (4)
1. Neuromuscular blocking agents
2. IV corticosteroids
3. Hepatic failure
4. ARDS (acute respiratory distress syndrome)
139
Effect of immobility-Acquired neuromuscular disorders
CIM is associated with _____ and _____ muscle weakness, including _______ muscles
proximal and distal muscle weakness, respiratory muscles
140
Effect of immobility-Acquired neuromuscular disorders
In CIM, reflexes are _______ and sensation is _________ (spared/not-spared)
decreased, spared
141
Effect of immobility-Acquired neuromuscular disorders
With CIM, how is a myopathy diagnosed?
Muscle biopsy
142
Effect of immobility-Acquired neuromuscular disorders
CIP is associated with __________ neuropathy with inflammatory response from ___________ or _________ failure
axonal, sepsis or multi-organ
143
Effect of immobility-Acquired neuromuscular disorders
CIP is characterized by: (3)
1. Flaccid tetraplegia with lower limbs more affected than upper
2. Hyporeflexia
3. Sensory loss
144
Effect of immobility-Acquired neuromuscular disorders
CIP is a main contributor to _____
Persistent disability
145
2 types of acquired neuromuscular disorders as result of immobility are
Critical illness myopathy (CIM)
| Critical illness polyneuropathy (CIP)
146
Weakness acquired in ICU due to critical illness myopathy (CIM) and critical illness Polyneuropathy (CIP) is _______x more common than GBS or motor neuron disease
2-3x
147
Weaknesses acquired in ICU are detected incidentally because ________________ and exact onset is unclear
First PT contact once pt is more medically stable
148
CIP and CIM are encountered in _________% of ICU patients
30-60%
149
Is CIP or CIM more common?
CIP
150
CIM can occur as early as ________ days in presence of sepsis, but more often after more than __________ of mechanical ventilation
2-5 days, a week
151
Pts with CIP/CIM characterized by
- flaccid quadriparesis
- areflexic/hyporeflexic
- sparing of cranial nerves
152
Need to make sure pt is stable prior to mobilization or exercise- ask following 4 questions
1. Is HR, RR, BP acceptable range?
2. Is pt on vasopressin so due to severely low BP?
3. Is blood sugar level stable?
4. Have you assessed all lines and tubes?
153
Confusion, heart palpitations, anxiety, diaphoresis, hunger, nausea are symptoms of ______ and can lead to seizures or LOC if severe
Hypoglycemia
HA <70mg/dL
154
Important to maintain ____, _____, ______ in ICU patients
1. Aerobic work capacity
2. Strength
3. Endurance
155
_______ and ______ are important PT interventions for sedated or paralyzed pts
Positioning and ROM
156
Encourage ADLs to maintain _________ system and improve _________
Cardiovascular system, muscle strength
157
Exercise reduces risk of these in ICU (3) and alleviates symptoms of depression and improves quality of sleep
1. DVT
2. PE
3. Pneumonia
158
Active exercise reduces _____ when done in exercise specific manner
Atrophy
159
To improve Orthostatic intolerance, need to facilitate ______ and maximize __________
OOB, upright sitting time
160
T/F
Early activity is feasible and safe in respiratory failure patients
TRUE
