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Flashcards in ICU Deck (337)
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1
Q

what is critical care nursing?

A

field of nursing which focuses on the care of critically ill or unstable patients

2
Q

what patients often need critical care?

A

those with life threatening or potentially life threatening problems

3
Q

why is intense and often constant monitoring of the critical patient needed?

A

their condition can change on a moment to moment / hour to hour basis

4
Q

what is a vital skill of a critical care nurse?

A

able to respond rapidly to an emergency or crisis situation

5
Q

what patients need critical care nursing?

A
cardiovascularly unstable
respiratory distress
neurological disease
multiple trauma
systemic disease
extensive wounds or burns
electrolyte imbalances
patients with sepsis or systemic inflammatory response syndrome
neonates / adolecents
6
Q

what is triage?

A

assessment of patient to see if they are stable or unstable and decide order of treatment

7
Q

when is triage especially useful?

A

when multiple patients arrive in a short time frame

8
Q

what is the main question that needs to be answered during veterinary triage?

A

can the patient be left with the owner or do they need immediate veterinary intervention

9
Q

what is involved in triage?

A

quick physical assessment of the 3 major body systems

10
Q

what are the 3 major body systems assessed in triage?

A

CVS
respiratory
neuro

11
Q

how long should the triage primary survey take?

A

no longer than 2 minutes

12
Q

what happens if the patient fails any of the 3 major body system assessments in triage?

A

they have failed triage, are not stable and require immediate intervention

13
Q

where is triage usually undertaken?

A

reception area / car park with the owner present

14
Q

what should you do when arriving to a patient for triage?

A

Introduce yourself to client: Your name, your role and a brief summary of what
you are intending to do next

15
Q

what question must you ask before approaching a patient to be triaged?

A

Ask the client if the patient is friendly – your safety is still paramount in these situations

16
Q

when can a triaged patient stay with their owner?

A

if stable and passed triage and owner is happy to be left with them

17
Q

what should happen if a patient is unstable / has not passed triage?

A

Immediately take patient from the owner for emergency treatment

18
Q

what questions should be asked during triage assessment?

A

Is the patient tachycardic/bradycardic?
What is the pulse quality like?
Is the patient tachypnoeic/dyspnoeic?
Does the patient have respiratory distress or visible effort when breathing?
Is there excessive bleeding?
Is the patient severely painful?
Is the patient bright & alert or dull/obtunded/collapsed?
Is the patient ambulatory?
Is the patient displaying seizure activity?
What is the colour of the patient’s mucous membranes and is this abnormal e.g. white, red, grey or brown?
What is the patient’s capillary refill time and is this within normal range?

19
Q

what must be communicated to the owner during triage?

A

Explain to the owner what you have found and why you are concerned
Ask their permission to take the patient for further assessment and/or treatment
Explain someone will be back shortly to give them an update and collect a full history
Remember – this can be a very distressing situation for the client!

20
Q

how may communication with client differ in a real emergency?

A

very quick explanation and then take patient!

21
Q

what should you do if you triage a patient and you are unsure of their triage status?

A

take the patient to ask for a second opinion, it is better to be overcautious, than potentially leave an unstable patient without treatment!

22
Q

in the critical patient what should monitoring be tailored to?

A

the individual

23
Q

what is useful for monitoring the critical patient?

A

monitoring equipments

24
Q

what is even more key than monitoring equipment when monitoring the critical patient?

A

good regular physical assessment and eye for observation

25
Q

why should you never 100% rely on monitoring equipment?

A

equipment can fail

26
Q

what must be recognised during monitoring?

A

trends - deterioration or improvement

27
Q

what critical patients are likely to need constant monitoring?

A

critical patients and those likely to deteriorate

28
Q

what critical patients are likely to need monitoring every 15-30 mins?

A

GA recovery, starting blood transfusion

29
Q

what critical patients are likely to need monitoring every 1-2 hours?

A

hypoglycaemic patients, monitoring RR, needing medication

30
Q

what critical patients are likely to need monitoring every 4-6 hours?

A

stable patients but clinical status may deteriorate e.g. coagulopathies, cardiac disease

31
Q

what are the 3 body systems that need to be monitored and assessed frequently?

A

cardiovascular
respiratory
neurological

32
Q

how can the CVS be monitored?

A
PR and quality
HR
BP
MM
CRT
ECG
auscultation
33
Q

what are the best pulses to assess PR and quality in dogs?

A

femoral

dorsal pedal

34
Q

what are the best pulses to assess PR and quality in cats?

A

femoral

dorsal pedal often hard to feel

35
Q

when assessing PR and quality what are you looking for?

A

PR within normal limits
ascertain pulse quality
are there pulse defecits

36
Q

how can you assess for pulse deficits?

A

auscultate and feel pulse at the same time

37
Q

what is a regular pulse with no deficits?

A

PR matches HR - one pulse for every heart beat

38
Q

what do pulse deficits indicate?

A

arrhythmia

39
Q

what should you do if there is an irregular pulse?

A

attach ECG
auscultate
paper ECG trace

40
Q

what are the 3 main types of abnormal pulse quality?

A

weak / thready
bounding (strong and longer duration)
snappy (strong and shorter duration)

41
Q

what do weak/thready pulses indicate?

A

indicative of decreased systolic BP e.g. hypovolaemia/hypoperfusion

42
Q

what do bounding pulses indicate?

A

sepsis

43
Q

what do snappy pulses indicate?

A

anaemia

44
Q

what is the normal HR in small breed dogs?

A

100-140 bpm

45
Q

what is the normal HR in large breed dogs?

A

60-100 BPM

46
Q

what is classed as tachycardia in dogs?

A

> 140 bpm

47
Q

what is normal HR in cats?

A

140-180 bpm

48
Q

what is classed as tachycardia in cats?

A

> 180-200bpm

49
Q

what is classed as bradycardia in dogs?

A

<60 bpm

50
Q

what is classed as bradycardia in cats?

A

<120 bpm

51
Q

what may affect HR?

A

pain
stress
drugs
can increase or decrease HR

52
Q

what is normal blood pressure for dogs?

A

systolic: 110-160
diastolic: 55-110

53
Q

what is normal BP for cats?

A

systolic: 120-170
diastolic: 70-120

54
Q

what is normal MAP for dogs?

A

100 mmHg

55
Q

what is normal MAP for cats?

A

135 mmHg

56
Q

what is the acceptable range of MAP for cats and dogs?

A

60-120 mmHg

57
Q

what systolic BP is classed as hypotension?

A

<100 mmHg

58
Q

what MAP is classed as hypotesion?

A

<60 mmHg

59
Q

how can hypotension be treated?

A

fluid bolus

vasopressors

60
Q

what do vaspopressors do?

A

cause vasoconstriction

61
Q

what systolic BP is classed as hypertension?

A

> 170-200 mmHg

62
Q

what MAP is classed as hypertension?

A

> 120 mmHg

63
Q

how should hypertension be treated?

A

Antihypertensive drugs e.g. amlodipine

Investigate and treat underlying cause

64
Q

what are the non-invasive methods of BP reading?

A

doppler

oscillometric

65
Q

how does a doppler measure BP?

A

Uses sound waves to detect arterial blood flow as an audible signal

66
Q

how does oscillometric BP read BP?

A

Detects oscillations as blood flow returns to occluded artery

67
Q

where should blood pressure be read?

A

calm, quiet environment

where patient has adjusted to surroundings wherever possible

68
Q

what position should BP be read in?

A

lateral recumbancy

69
Q

what should the cuff be level with when measuring BP?

A

R atrium

70
Q

in what animals is it more crucial that the BP cuff is level with the R atrium?

A

large breed dogs

71
Q

how many BP readings should be taken?

A

3-5 and then use average

over a period of time

72
Q

what is the correct BP cuff size?

A

40% of leg circumferance

73
Q

what is the effect of a BP cuff that is too large?

A

falsely low readings

74
Q

what is the effect of a BP cuff that is too small?

A

falsely high readings

75
Q

what is the gold standard method for BP monitoring?

A

invasive - measured directly from the artery

76
Q

what is required for invasive BP monitoring?

A

arterial catheter placement
transducer
multiparameter monitor

77
Q

what BP measurements can be shown through invasive BP monitoring?

A

systolic
diastolic
mean

78
Q

is invasive BP measurement continuous?

A

yes - produces a wave-form

79
Q

describe normal MM

A

pale pink (presence of RBC’s in capillary beds of MM’s)

80
Q

what is suggested by red/ hyperaemic MM?

A

may suggest sepsis

81
Q

what is suggested by bright/cherry red MM?

A

carbon monoxide toxicity

82
Q

what is indicated by very pale / white MM?

A

anaemia or shock

83
Q

what do brown MM indicate?

A

indicative of paracetamol (acetaminophen) toxicity

84
Q

what is indicated by cyanotic MM?

A

hypoxia / hypoxaemia

85
Q

what do icteric / jaundiced MM indicate?

A

suggests liver disease or haemolysis

86
Q

what does petechiation on MM suggest?

A

coagulopathy

87
Q

when are tachy (dry) MM’s observed?

A

dehydrated patients

88
Q

define CRT

A

the amount of time it takes colour (i.e. blood) to return to the capillary bed of the membrane, after digital pressure has been applied

89
Q

what is CRT an indicator of?

A

peripheral perfusion

90
Q

what is normal CRT?

A

1-2 seconds

91
Q

what is indicated by prolonged CRT?

A

shock

hypoperfusion

92
Q

what is prolonged CRT due to?

A

vasoconstriction

93
Q

what is classed as a prolonged CRT?

A

> 2.5-3 seconds

94
Q

what is indicated by a rapid CRT (<1 second) and red/hyperaemic MM?

A

sepsis/SIRS

rapid CRT due to vasodilation

95
Q

what is indicated by a prolonged CRT and pale MM?

A

vasoconstriction (shock / hypoperfusion)

96
Q

what is indicated by a normal CRT and pale MM?

A

anaemia

97
Q

what is measured by an ECG?

A

the electrical activity of the heart

98
Q

what is the most accurate method to interpret ECG?

A

paper trace

99
Q

when is an ECG essential?

A

crash scenario

100
Q

when should all patients have constant ECG monitoring?

A

all cardiac patients

those likely to have arrhythmias (e.g. GDV and sepsis)

101
Q

what is enabled by an ECG trace?

A

distance monitoring

102
Q

how can the heart be assessed?

A

auscultation and listen for abnormalities

103
Q

what should you be listening for or heart auscultation?

A
any abnormalities (e.g. murmurs, gallop rhythm)
pulse deficits
104
Q

what areas of the respiratory system can be monitored?

A
RR
resp effort
lung auscultation
pulse ox
capnography
ABG
O2 therapy
105
Q

what is normal RR in dogs?

A

10-30 brpm

106
Q

what is normal RR in cats?

A

20-30 brpm

107
Q

what is bradypnoea?

A

<15 brpm

108
Q

what are the causes of bradypnoea?

A

srugs
hypocapnia
CNS disease (affected resp centre)
hypothermia

109
Q

what breaths per min is classed as tachypnoea?

A

45-50 brpm

110
Q

what are the causes of tachypnoea?

A
hypoxia / hypoxaemia
hypercapnia
pain
hyperthermia
pyrexia
stress
compensation for metabolic acidosis
111
Q

what is apnoea?

A

Absence of any ventilatory effort (patient has stopped breathing)

112
Q

what are the causes of apnoea?

A

Respiratory or cardiac arrest
Drug overdose
Neurological complications e.g. increased ICP

113
Q

what is normal respiratory effort?

A

Gentle chest movements, minimal abdominal movement

114
Q

what is dyspnoea?

A

difficulty/laboured breathing

115
Q

what indicates dyspnoea?

A
Increased chest and abdominal muscle movement
Postural changes (orthopnoea) e.g. extension of head and neck, abduction of elbows, nostril flaring on inspiration
Open-mouth breathing
116
Q

what are the causes of dyspnoea?

A

Upper airway obstruction and flail chest
Pleural space disease e.g. pleural effusion, pneumothorax and diaphragmatic rupture
Pulmonary parenchymal disease e.g. pulmonary contusions, pulmonary oedema and pneumonia
Upper airway disease e.g. BOAS, laryngeal paralysis

117
Q

what may be seen with upper airway obstruction and flail chest?

A

paradoxical breathing pattern (‘see-saw’ effect of thorax

and abdomen)

118
Q

how is decreased respiratory effort shown?

A

Reduced chest and abdominal muscle movement

119
Q

what can cause decreased respiratory effort?

A

Head and spinal trauma/injury
Tetanus
End stage respiratory fatigue/failure - if tachypnoeic for a long time

120
Q

what should be done when assessing the respiratory system first?

A

listen to patient’s breathing from a distance and observe the breathing pattern

121
Q

what should you observe about breathing sounds?

A

Is there noise on inspiration, expiration or both?
Stridor (dry noise, e.g. laryngeal paralysis)
Stertor (wet noise/snore e.g. BOAS)

122
Q

how should you auscultate the thorax to listen for lung sounds?

A

Divide hemi-thorax (left and right lungs) into dorsal, middle and ventral
lung fields
Auscultate each lung field cranial to caudal
Compare adjacent lung fields and left/right lungs

123
Q

what causes decreased/absent lung sounds dorsally?

A

pneumothorax

124
Q

what causes decreased/absent lung sounds ventrally?

A

pleural effusion

125
Q

what is decreased/absent lung sounds accompanied by?

A

rapid, shallow breathing pattern (due to limited space for lungs to expand adequately)

126
Q

what sounds may be heard if there is diaphragmatic rupture?

A

Borborygmi (gut sounds)

127
Q

what are crackles/wheezes on lung auscultation indicative of?

A

bronchopulmonary disease e.g. pulmonary oedema, pulmonary contusions, damage/disease of lung parenchyma e.g. pneumonia

128
Q

what is measured by pulse ox?

A

Measures oxygenation of blood (% of oxygen bound to haemoglobin in arterial blood)

129
Q

what is assessed by pulse ox?

A

Assesses patient’s oxygenation levels

130
Q

what is the benefit of pulse ox?

A

Non-invasive and provides continuous information

131
Q

what is the disadvantage of pulse ox?

A

Does not measure tissue perfusion or ventilation

132
Q

what is normal SpO2?

A

> 95%

133
Q

where can the pulse ox reader be placed?

A

Tongue, lip, ear, inguinal fold, prepuce or vulva
Pigmentation can affect reading so avoid these areas
Rectal probes also available

134
Q

what is measured by capnography?

A

measures amount of CO2 present in expired gas

135
Q

what is normal EtCO2?

A

35-45 mmHg

136
Q

what EtCO2 indicates hypercapnia?

A

> 50 mmHg

137
Q

what EtCO2 indicates hypocapnia?

A

<30 mmHg

138
Q

why is EtCO2 an indirect measurement of ventilation?

A

EtCO2 value is approx 1-4 mmHg less than PaCO2

139
Q

what may affect measurement of capnography / capnography trace?

A
System leaks
Endotracheal tube (ET tube) kink
Sensor obstruction
Airway obstructions e.g. mucous secretions, regurgitation  Apnoea – aids early detection of cardiac arrest
140
Q

what does the partial pressure of oxygen measure?

A

amount of O2 dissolved in arterial blood

141
Q

what does the partial pressure of CO2 measure?

A

amount of CO2 dissolved in arterial blood

142
Q

what is measured by PaO2?

A

the patient’s ability to oxygenate their blood

143
Q

what is the normal range of PaO2?

A

80-100 mmHg

144
Q

what is indicated by PaO2 of 70-80 mmHg?

A

mildly hypoxaemic, may require oxygen supplementation

145
Q

what is indicated by PaO2 of <60 mmHg?

A

considered severely hypoxaemic, oxygen therapy required

146
Q

what is measured by PaCO2?

A

the patient’s ability to ventilate and perform gas exchange in the alveoli

147
Q

what is the normal range of PaCO2?

A

35-45 mmHg

148
Q

what does PaCO2 of <35mmHg indicate?

A

hyperventilation (hypocapnia)

149
Q

what does PaCO2 of >45mmHg indicate?

A

hypoventilation (hypercapnia)

150
Q

where may ABG samples be gained from?

A

dorsal pedal artery

151
Q

what are the main considerations when giving oxygen therapy?

A

Important to minimise patient stress
Hands off approach
Minimal handling/restraint
Patient is very fragile – can decompensate rapidly
Provide oxygen in method least stressful to patient
Allow 15-30 minutes of oxygen/in oxygen cage before further examination (unless obviously obstructed)
Equipment prepared for emergency intubation

152
Q

how long should a patient receive oxygen therapy before they are examined further (unless obvious obstruction)?

A

Allow 15-30 minutes of oxygen/in oxygen cage

153
Q

what are the non-invasive methods of oxygen provision?

A

Flow-by oxygen e.g. mask, tubing held near patient’s nose/mouth
Oxygen cage
Nasal prongs

154
Q

what are the invasive methods of oxygen provision?

A

Nasal catheters
Trans-tracheal
Endotracheal(intubation)
Ventilation either manual (IPPV) via personnel or mechanical via machine

155
Q

why are nasal catheters useful?

A

harder for patient to remove

156
Q

how can the neurological system of a patient be assessed?

A
mentation
cranial nerve function
MGCS
raised ICP
seizures
157
Q

what are the main levels of mentation?

A
normal
obtunded
stuperous
comatose
hyper-excitability
158
Q

describe normal mentation

A

Alert, responds appropriately to stimuli

159
Q

describe obtunded mentation

A

Reduced alertness/consciousness, easily roused with non-noxious stimuli

160
Q

describe stuperous mentation

A

Unconscious, only rousable with noxious stimuli

161
Q

describe comatose mentation

A

Unconscious, no response to any stimuli, including noxious stimuli

162
Q

describe hyper-excitability

A

excessive reaction to stimuli

163
Q

what are the potential causes of reduced mentation?

A

Shock/hypoperfusion
Hypoxaemia e.g. severe anaemia
Primary neurological disease

164
Q

what assessment can be used to check cranial nerve function?

A
pupillary light reflex
pupil size and symmetry
oculocephalic reflexes
menace reflexes
nystagmus
strabismus
165
Q

what is the PLR ?

A

Pupil response to light e.g. pen torch

166
Q

what is the correct PLR?

A

pupils should respond to light bilaterally,

rapidly and consensually

167
Q

what should pupils be like?

A

Pupils should be of an equal size & shape

168
Q

what is anisocria?

A

pupils are different sizes

169
Q

why is miosis?

A

constricted pupils

170
Q

what is mydriasis?

A

dilated pupils

171
Q

how is oculocephalic reflex checked?

A

response of eyes checked when head moved from side to side to check for physiological nystagmus

172
Q

what is the menace reflex?

A

Reflex blinking that occurs in response to the rapid approach of an object e.g. hand

173
Q

what is nystagmus?

A

Eyes make repetitive, uncontrolled movements without movement of the head (not physiological)
May be horizontal, vertical or rotational

174
Q

what is strabismus?

A

One or both eyes deviate from normal position

175
Q

what can indicated raised ICP?

A

Absent PLRs or changes in pupil size

176
Q

what can cause raised ICP?

A

trauma

intra-cranial lesions (e.g. tumor or inflammation)

177
Q

what are the 3 sections on the MGCS?

A

motor ability
brain stem reflexes
level of consciousness

178
Q

what is assessed in the motor activity area of MGCS?

A

gait and ambulation

179
Q

what is assessed in the brain stem reflexes area of MGCS?

A

PLRs
oculocephalic reflexes
pupil size

180
Q

what is assessed in the level of consciousness area of MGCS?

A

response to visual, auditory and noxious stimuli

181
Q

what is the total MGCS score out of?

A

18

182
Q

when should clinicians be notified about altered MGCS?

A

if score has deteriorated by 2 or more since last check as may indicate raised ICP

183
Q

what is the cushing’s reflex?

A

classic response to increased ICP with marked hypertension and reflex bradycardia

184
Q

what is required for a patient with the Cushing’s reflex?

A

emergency treatment

May require osmotic diuretics to reduce brain swelling/oedema e.g. Mannitol, hypertonic saline

185
Q

how should patients at risk of raised ICP be monitored?

A

Assess MGCS, HR, BP, RR q1 – 6hrs, depending on patient stability

186
Q

what patients are at risk of raised ICP?

A

head trauma, seizures e.g. status epilepticus and meningoencephalitis patients

187
Q

what position should patients at risk of raised ICP be placed in?

A

elevate head and thorax upwards by 30-40 degrees

sternal recumbancy to aid respiratory ventilation

188
Q

why is elevation head and thorax upwards by 30-40 degrees in patients at risk of raised ICP helpful?

A

decreases pressure on brain due to increased venous drainage

189
Q

how can you avoid inadvertently increasing ICP in at risk patients?

A

No jugular samples
Avoid stimulation to sneeze e.g. intranasal catheters or nasal prongs
Avoid stimulation to gag/vomit e.g. intubating a light patient, morphine

190
Q

what elevated parameter may seizing patients develop?

A

hyperthermia - may need active cooling

191
Q

what should be in and around the kennel of a patient who may potentially seizure?

A

Seizure plan on kennel door
Seizure medications easily accessible
Padded kennel

192
Q

what should be provided to all patients during / after seizures?

A

flow by oxygen

193
Q

when should the thorax and head of seizing patients be elevated?

A

once safe to do so

194
Q

what personal safety concerns are there with a seizing patient?

A

take care not to get bitten during seizure

195
Q

what should be noted about a seizure when it occurs?

A

Length of seizure (e.g. drug intervention after seizure is > 2 minutes long)
whether seizure is artial e.g. facial twitching, jaw chomping, fly catching etc or full e.g. tonic clonic seizure

196
Q

what should patients with lesions of cervical origin be monitored for?

A

Closely monitor respiratory function

197
Q

what are the main considerations when dealing with spinal trauma patients?

A

spinal board for transport and movement of potentially unstable spines
keep flat
minimise movement

198
Q

what are the main considerations when dealing with patients with decreased consciousness?

A

Monitor gag reflex, monitor for regurgitation, may require airway protection e.g. intubation
Physiotherapy and hygiene e.g. eye and oral care

199
Q

what are the main areas found in a critical care ward?

A
Triage station – secondary assessment/emergency treatment area 
High dependency (critical) patient area
Emergency crash station
Feline friendly area
Nursing station 
Laboratory area
200
Q

what is key about the triage area of ICU?

A

must be set and ready at all times

201
Q

why may an ultrasound machine be useful in triage?

A

free fluid checks of thorax or abdomen

202
Q

what level of nursing do patients receive in the high dependency area of ICU?

A

1:1 constant monitoring

203
Q

what is key about the high dependency area?

A

access to patient from all sides at all times

204
Q

what is key about the crash station?

A

designated table is kept clear at all times

205
Q

how often should stock in crash trolley be checked?

A

once a month but must be fully restocked and checked straight after each use

206
Q

what is contained within the crash trolley?

A

only necessary equipment / drugs

207
Q

what equipment is needed on the crash trolley?

A
Varity of ET tube sizes 
Laryngoscope
Tube tie/cuff inflator 
Intubeze for cats
Suction equipment
IV consumables
Pre-drawn saline for flush
Emergency chest drain equipment
Intraosseous needles and equipment
ECG pads
Ambu-bags for ventilation
Defibrillator and gel
Essential drugs: adrenaline, atropine, reversal agents
Easy to see drug dosage chart
208
Q

what are the drug doses given in on a crash trolley chart?

A

ml so can be dosed quickly

209
Q

what is different about the feline friendly ICU ward?

A

glass doors - easy to see into but reduce noise
cover on lower half of door to prevent cats seeing passing dogs
seperate oxygen cages

210
Q

what are the key features of the ICU nursing station?

A

able to observe entire room
computer access
list of contact numbers easy to access
patient records to hand

211
Q

where is the lab area situated in ICU?

A

within the emergency ward area

212
Q

what is the purpose of a lab area in ICU?

A

Quick diagnostics for emergency patients

Out of hour samples (lab closed)

213
Q

what is found in the lab area of ICU?

A
Blood gas/electrolyte machine
centrifuge
Diff-Quik stain
haematology machine
biochemistry machine
coagulation times
microscope
SNAP tests
214
Q

what are the tests involved in the minimum database?

A

Packed cell volume (PCV)
total solids (TS)
blood gas analysis (acid base, electrolytes, lactate, oxygenation and ventilation)
blood glucose

215
Q

what tests are involved in the extended database?

A

Biochemistry e.g. ALT, ALKP, BUN, CREA
Haematology e.g. complete blood cell count, blood smear
Urinalysis e.g. sediment analysis, dipstick and urine specific gravity (USG)
Coagulation profile e.g. APTT, PT
Blood typing
Blood cross matching
SNAP tests e.g. 4DX, Parvovirus, Angiostrongylus

216
Q

what is tested by ALT and ALKP?

A

liver function

217
Q

what is tested by BUN and CREA?

A

kidney functions

218
Q

what should patient accommodation be tailored to?

A

patients needs or requirements

219
Q

what are the main kennel types available in ICU?

A
Kennel size - small, medium and large 
Walk in kennels
Top or bottom kennels
Oxygen kennels
Incubator
Cot/trolley for critical patients
220
Q

what are the main considerations for where to house patients in ICU?

A
Access for nursing care and observation 
Proximity of oxygen and electricity
Breed/temperament
Patient is easily visible
Do we need to barrier nurse?
Is the patient recumbent?
221
Q

what is needed within the kennel to ensure patient comfort?

A

Comfortable bedding
Inco pads under bedding
Positioning aids
Elevated water/feeding bowls e.g. Great Dane

222
Q

what comfortable bedding can be offered to ICU patients?

A

Vetbeds, duvets, orthomats, non-slip mats, blankets

Appropriate to breed/species/problem

223
Q

why should inco pads be placed between layers of bedding?

A

prevent urine scaulding

224
Q

what positioning aids may be used for ICU patients?

A

Pillows, foam wedges, sandbags, towels

225
Q

what specific things may be required for the kennels of cats in ICU?

A

hiding areas/bed boxes, consider type of cat litter (some from home)

226
Q

do all patients have to be housed in a kennel?

A

if especially stressed they can be left supervised outside of a kennel

227
Q

when are incubators usually used on ICU?

A

for neonates

228
Q

what should the environment of ICU be tailored to?

A

patients needs

229
Q

what are the main considerations regarding the ICU environment?

A

Calm, quiet +/- dim lighting
Reduced people traffic: infection and noise control
Warning signs on doors
Separate kennel area for cats
Keep clean and tidy
Consumables easily available and stocked up
Quick and easy access to monitoring equipment

230
Q

where should patients hospital sheet be kept?

A

on the fornt of the kennel

231
Q

what information should be placed on the ICU hospital sheet?

A
Patient details
Owner details
Date
Problem list and notify if list 
Tubes, drains and IV lines 
IVFT and medications due 
Clinical notes
Admit weight
Daily record of weight
Daily record of RER
Record of food intake
Clinician’s notes
Clinician in charge and contact details
Patient temperament
232
Q

what are the key nursing considerations for ICU patients?

A
infection control
hygiene
body temperature
lines, tubes and drains
physio
nutrition
pain and stress
fluid balance
TLC
233
Q

what are the key steps of infection control in ICU?

A

Hand hygiene – washing before and after each patient
Wiping equipment after each use
Appropriate use of gloves
Prevent hospital acquired infections (HAI’s)

234
Q

what is required for barrier nursing?

A

Personal protective equipment (PPE) e.g. gloves, apron, +/- mask/shoe covers

235
Q

which patients should be barrier nursed?

A

Any patient with wounds/potential infectious disease/compromised immune system

236
Q

what patients is provision of hygiene care essential for?

A

recumbent patietns

237
Q

what is involved in hygiene care of recumbent patients?

A

Providing frequent eye lubrication as required
Providing oral hygiene
Monitor urine or faecal continence and prevent urine/faecal scalding
Treatment of urine/faecal scalding

238
Q

what barrier products may be used in recumbent patients to prevent urine or faecal scalding?

A

Sudocrem, Vaseline, Cavilon spray .

239
Q

how is oral hygiene provided to recumbent patients?

A

Clean mouth with solution appropriate for use on MM’s

240
Q

how is urine/fecal scalding treated?

A

Flamazine, Isaderm cream

241
Q

what may need to have it’s size monitored in the recumbent patient?

A

bladder

242
Q

how can bladder size be monitored?

A

palpation or ultrasound measurement

243
Q

how can the bladder be emptied?

A

expression

catheterisation

244
Q

why are vet beds necessary in recumbent patients?

A

wick away urine from patient

245
Q

what should you do if the patient is soiled?

A

clean with animal friendly shampoo to reduce the risk of infection and scalding

246
Q

what may be placed to keep the patient a bit cleaner if faecal incontinence/diarrhoea present?

A

tail bandage

247
Q

how can hypothermia be treated?

A
Incubator
Bubble wrap
Heat mats (NOT directly
under patient!)
Hot hands
Bair hugger
Fleece blankets/vet beds
Warmed IV fluids
248
Q

when should patients be actively cooled?

A

> 40 degrees C unless pyrexic

249
Q

why should pyrexic patients not be cooled?

A

adaptive response to infection so should not be reversed

250
Q

what patients are at risk of hypeethermia?

A

BOAS
laryngeal paralysis
seizure

251
Q

how can hyperthermia be treated?

A
an/air conditioning
Ice under bedding
Cooling mats
Cold damp bedding/towels – NOT placed over the top of a patient
Tepid water bath NOT very cold water
oxygen flow-by
sedation in some cases
252
Q

how often should the temperature of the hyperthermic patient be checked?

A

q1 min

253
Q

when should active cooling end?

A

39 degrees C to prevent hypothermia

254
Q

when should lines, tubes and drains be checked?

A

minimum twice daily

255
Q

what is needed for lines, drains and tubes to ensure they are managed the same by all staff?

A

SOP

256
Q

when should lines, tubes and drains be removed?

A

as soon as no longer required

257
Q

how should lines, tubes and drains be handled?

A

aseptically to reduce infection risk

258
Q

what should be done with all lines, tubes and drains?

A

should be labelled clearly to prevent incorrect administration through them

259
Q

what should be recorded from drain output?

A

amount produced
type
colour

260
Q

what should be calculated from line, tube or drain fluid output?

A

ml/hr which will enable fluid calcs

261
Q

why must lines/tubes be clearly labelled?

A

to avoid mistakes with administration

262
Q

what are the general aims of physio?

A
Decrease chance of complications e.g. recumbent patients
Improve circulation
Allow muscle/tendon relaxation
Aid pain management
Reduce inflammation
Promote recovery
263
Q

what are the indications for physio?

A
Pressure sores/decubitus ulcers 
Muscle contraction/spasm
Build-up of pulmonary secretions 
Muscular weakness/atrophy
Joint stiffness
Limb swelling
Pain
Depression/boredom/stress
264
Q

what patients are contraindicated for physio?

A

Unstable critical patients
Unstable limb/spinal fractures or spinal injuries
Head trauma
Blood disorders e.g. thrombocytopenia (bleeding risk)
Very stressed or painful patients – patient must be appropriately analgised before attempting physiotherapy

265
Q

what are the main types of physio?

A
positioning
chest care
PROM
swelling management
pain relief
progressive exercise
266
Q

what action is involved in positioning physio?

A

Regular re-positioning: alternate R/L/Sternal q2-4hr
Limb elevation
Calm gentle handling

267
Q

what action is involved in chest care physio?

A

Gentle exercise
Positioning
Massage and coupage

268
Q

what action is involved in PROM physio?

A

Passive movements
Stretches
Active exercise

269
Q

what is involved in swelling management physio?

A

Effleurage
Elevation of limbs above heart level
Cryotherapy

270
Q

what is involved in pain relief physio?

A

Neutral positioning and regular repositioning
Passive movements
Gentle massage

271
Q

what is involved in progressive exercise physio?

A

Assisted or active standing and walking

272
Q

what is the benefit of positioning change physio?

A

improved respiratory function
Prevent pressure sores
Prevent lung atelectasis (especially if unable to move)

273
Q

what is the benefit of chest care physio?

A
Maintenance of bronchial hygiene 
Loosening secretions
Re-expansion of atelectatic lung 
Improved oxygenation
Reduced risk of aspiration
274
Q

what is the benefit of PROM physio?

A

Maintenance of joint and muscle range

Help with muscle atrophy

275
Q

what is the benefit of swelling management physio?

A

Quicker recovery time

Reduce limb oedema

276
Q

what is the benefit of pain relief physio?

A

Greater comfort
Quicker recovery
Easier mobilisation

277
Q

what is the benefit of progressive exercise physio?

A

Reduced loss of strength and range of motion
Loosening and elimination of secretions from airways
Re-expansion of atelectatic lung

278
Q

what is required by enterocytes in GI tract?

A

direct supply (oral ingestion) of nutrients

279
Q

what happens to enterocytes if there is not nutrients for >3 days?

A

cells begin to die

280
Q

how long without nutrition before enterocytes start to die?

A

> 3 days

281
Q

what is the issue created by dying enterocytes?

A

weakness in GI tract barrier

282
Q

what can a weakness in the GI tract barrier due to enterocyte death lead to?

A
Increased intestinal permeability
Bacteria and endotoxins can cross barrier and enter
systemic circulation (translocation)
Impaired immune functions of GIT (largest immune organ in body; contains approx. 50% lymphoid cells in body)
283
Q

what is translocation?

A

Bacteria and endotoxins can cross GI tract barrier and enter

systemic circulation leading to sepsis

284
Q

what is the nutrition aim for critical patients?

A

provide early entral nutrition as soon as possible

285
Q

when should nutrition of the critical patient begin?

A

as soon as possible once patient is adequately stabilised from acute conditions or surgery
Patient may have already been anorexic for many days prior to hospitalisation

286
Q

what should be calculated to aid nutrition?

A

resting energy requirement (RER) with a current weight

287
Q

how can critical patients be encouraged to eat?

A

Tempt with tasty foods/warming food, hand feeding
Appetite stimulants e.g. mirtazapine
Ensure water needs are met (50ml/kg/day) via oral or IVFT methods

288
Q

what should be done if the critical patient is unable to eat orally?

A

consider early placement of enteral feeding tube

289
Q

what can be caused by re-feeding syndrome?

A

severe electrolyte imbalance (hypokalaemia?)

290
Q

how can re-feeding syndrome be avoided?

A

slow reintroduction of food (e.g. 1/3 RER day 1, 2/3 day 2 etc)

291
Q

what are the main types of enteral feeding tubes?

A
Naso-gastric/naso-oesophageal (N-G/N-O) tube
Oesophagostomy (O) tube
Percutaneous endoscopic
gastrostomy (PEG) tube
Jejunostomy (J) tube
292
Q

what does enteral feeding tube placement depend on?

A

patients issues and co-morbidites

least invasive is first choice

293
Q

what must you do with an enteral feeding tube before each feed?

A

check tube is in correct location with sterile water

294
Q

how often should the insertion site of a feeding tube be checked and the site be cleaned?

A

BID

295
Q

what should the insertion site of the feeding tube be cleaned with?

A

dilute povidone iodine suitable for mucous membranes

296
Q

what should the feeding tube insertion site be monitored for?

A

redness, swelling or discharge

297
Q

how should patients be positioned for feeding through an enteral feeding tube?

A

sternal/elevate thorax to prevent regurgitation and aspiration

298
Q

how long must PEG or J-tubes be lift in situ for?

A

a minimum of 10-14 days after placement

299
Q

why must PEG/J-tubes be left in situ for a minimum of 10-14 days after placement?

A

to allow adhesions to form to reduce the risk of peritonitis upon removal

300
Q

what must be fed through a J-tube?

A

CRI of specific jejunal diet only

301
Q

what is parenteral nutrition?

A

Nutrients provided directly into patient’s blood stream, avoiding GIT

302
Q

how is parenteral nutrition delivered?

A

Delivered as a constant rate infusion (CRI)

303
Q

what are the downsides of parenteral nutrition?

A

Less balanced nutrition than enteral feeding

Much more expensive for client

304
Q

when is parenteral nutrition considered?

A

when enteral feeding is not an option

305
Q

when may enteral feeding not be an option?

A

Non-functioning GIT; severe neurological deficits; unconscious patients

306
Q

what are the 2 types of parenteral nutrition?

A

total parenteral nutrition (TPN)

partial parenteral nutrition (PPN)

307
Q

what happens during TPN?

A

all nutrients given parenterally

308
Q

how must TPN be given?

A

via central line/peripherally inserted central catheter (PICC line)

309
Q

why must TPN be given via central line/peripherally inserted central catheter (PICC line)?

A

high osmolality that can damage peripheral vessels

310
Q

what is involved in PPN?

A

40-70% of nutrients given parenterally

311
Q

how can PPN be given?

A

via central or peripheral route

312
Q

what are the main considerations when giving parenteral nutrition?

A

Strict aseptic technique - Can cause sepsis as breeding ground for bacteria
TPN NOT peripherally - Can cause thrombophlebitis
New bag and giving set every 24 hours

313
Q

how often must the parenteral feeding bag and giving set be changed?

A

New bag and giving set every 24 hours

314
Q

how can cat pain be assessed?

A

feline GPS

315
Q

how can dog pain be assessed?

A

canine GCPS

316
Q

when should patients pain be assessed?

A

repeated intervals throughout day

analgesia plan reviewed frequently

317
Q

how can stress in patients be minimised?

A

TLC, strengthen nursing/patient bond e.g. affection, grooming
Sedative drugs to allow periods of rest
Take your time/go slow with nervous patients
Reassurance
Feliway cat diffuser
Hiding areas: boxes/blankets over kennel door etc.

318
Q

what is hypovolaemia?

A

decreased intravascular blood volume

319
Q

how can patients compensate for hypovolaemia?

A

tachycardia and

peripheral vasoconstriction

320
Q

what fluid boluses can be given to address hypovolaemia?

A

5-20 ml/kg over 10 -20 min

321
Q

what should be done after fluid bolus is given?

A

patient is reassessed

322
Q

what is dehydration?

A

excessive loss of total body water

323
Q

how can dehydration be calculated?

A

Estimate degree (%) of dehydration e.g. skin tent, checking MM’s if
tacky
PCV/TS

324
Q

can patients be both dehydrated and hypovolaemic?

A

yes or one or the other in isolation

325
Q

when should patients hydration be assessed?

A

daily

326
Q

what should the fluid therapy plan account for?

A

Ongoing losses e.g. V+/D+
Drains e.g. abdominal/thoracic
maintenance

327
Q

what is the maintenance fluid rate for dogs and cats?

A

2 ml/kg/hr

328
Q

what is the type of fluid therapy decided on based on?

A

patients clinical condition

329
Q

when may whole blood or PRBCs be given?

A

if excessive blood loss during surgery, trauma, severe anaemia etc

330
Q

what is useful about monitoring patients urine output?

A

Assess/balance fluid going into patient with fluid coming out (in’s and out’s)
Assesses tissue perfusion

331
Q

how can urine output be monitored?

A

Closed system IDUC
Weigh incontinence sheets, bedding and litter
Weigh at least once daily: fluid balance responsible for rapid changes in patient’s weight

332
Q

what is normal urine output?

A

1-2 ml/kg/hr

333
Q

how should indwelling urinary catheters be cared for?

A

Aseptic handling, wear gloves
Clean twice daily
In plastic bag to keep clean
Ideally kept lower than patient to allow urine to drain via gravity
Do not disconnect closed system e.g. for walks
+/- collar to prevent patient interference

334
Q

what is involved in providing TLC to patients?

A
Develop a patient: nurse bond 
Lights out time
Quiet time
Grooming/bathing/affection 
Toys (if appropriate)
Time outside the kennel 
Hand feeding
Nursing care plans (NCP) 
Owner visits
335
Q

what are the 4 stages of a nursing care plan?

A

assessment
planning
implementation
evaluation

336
Q

when are nursing care plans produced?

A

Incorporated into daily routine

Completed for all critical patients

337
Q

what are the key benefits of a nursing care plan?

A

Standardisation of nursing care
ensures patient’s needs met and all areas of nursing are covered
Highlights any problems/potential complications

Decks in X Clinical Veterinary Nursing Theory Class (70):