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ICU Flashcards

1
Q

nurse to pt ratio ICU

A

2:1

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2
Q

SDU nurse to pt rati

A

o

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3
Q

3:1 medsurg nurse to patient ratio

A

5:1

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4
Q

indicators for the ICU

A

resp insufficiency
cardio insufficiency
depressed consciousness or coma

(breathing, heart, brain or threat of these things )

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5
Q

Note format in the ICU differs from regular SOAP notes how

A
  1. ID
  2. problem
  3. background information
  4. current problems
  5. physical findings (I and O)
  6. evaluation of patient by system
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6
Q

systems for evaluation daily in the ICU`

8

A 
respiratory
cardiovascular
neurological
GI and nutrition
Hematology
Renal
Electrolytes
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7
Q

respiratory in the ICU

what do we need to learn with regards to the language

A

mechanical ventulation
ballon inflates acting like a cork and also for positive pressure ventilation

having this tube protects the airway

when pts are on ventilators you know that, at least with regards to respiration, you are probably okay

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8
Q

3 main types of ventilation modes

A

refers to the frequency of breaths provided

Assisted-control (AC)

intermitten mandatory ventilation (IMV/SIMV)

spontaneous (spontaneous)

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9
Q

assisted control is used for

A

pts that are unable to take deep breaths on their own

coma
extreme sedation

fixed rate

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10
Q

can pts initiate breaths on AC

A

Yes

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11
Q

what to pts need for AC

A

need to be sedated in order to tolerate

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12
Q

IMV/SIMV

A

intermitten mandatory ventilation

periodic breaths at a set rate
pt can initiate breaths above that set rate

this is usually much more comfortable for people

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13
Q

pressure support ventilation is used when

A

pt initiates every breath

but are supported by positive pressure

least invasive and most comfort

used for weaning mechanical ventialtion

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14
Q

how to talk about mechnaical respiration

A

mode (RR)
TV

FiO2
PEEP

PSV

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15
Q

SIMV 12 (14) 400 50% PEEP=5 PSV=8

A

12 set breaths pts taking 14

Tidal volume is 400

Fio2 OF 50% Required for saturaton

the positive end expiratory pressure

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16
Q

tidal volume normally

A

6ml/kg

480ml

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17
Q

what are we worried about what higher tidal volume

A

associated with barotrauma

with critically ill you usually want low volume ventilation

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18
Q

fraction of oxygen saturation

A

usually expressed as a percentage

start with 100% when beginning and titrate down

when you are round and presenting and the person requires an fIo2 OF 50% THIS IS A SIGNAL THAT THIS PERSON IS REALLY SICK

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19
Q

PEEP

A

positive end expiratory pressure-COPD

keeps the alveoli open and is useful in people with “stiff lungs”

need a higher amount

5cm H20 is helpful in promoting oxygen and reducing barotrauma

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20
Q

pressure support (PSV)- is used to

A

overcomes resistance of the tube
used in iMV and spontaneous ventilation

positive pressure applied with patient-initiated breaths

or else it feels like sucking through a straw

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21
Q

when do you do a tracheostomy

A

allows you to take the breathing tube out and place a whole for positive pressure ventilation without going through the mouth

prevents errosin of the trachea and bacteria infiltration.

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22
Q

cardiovascular support

what does the heart need in the ICU

A

a functioning pump

sufficient fluid volume

regulated resistance of the cardiovascular system

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23
Q

when you have pump dysfunction

A

cardiogenic shock

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24
Q

when you have volume depletion

A

hypovolemic shock

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25
when you have resistance dysfunction
septic or neruogenic anaphylactic shock
26
how do you find out what type of shock the patient might be in
hR, rhythm, BP, CP hx of trauma or illness EKG echocardiogram
27
three things we need in managing cariogenic shock
cardiac output cvp svr
28
cariogenic shock
pump problem with reduced co increased systemic vascular resistance due to hypovolemia increased central venous pressure
29
what do you do for cariogenic shock
need to start a inotropic agent (increased stroke volume leads to increased cardiac output) dobutamine is one such drug will relax the SVR and decrease it due to baroreceptor response does not increase arterial bp so they made need drugs for this as well
30
hypovolemic shock picture what does venous pressure look like
decreased CO decreased central venous pressure increase systemic vascular resistance
31
what do you do for the hypovolemic pt when will loss lead to shock
need fluids can lose up to 15% of blood volume and compensate after 30% will go into shock
32
what is the amount of total body fluid of a 80 kg man of a 60 kg woman what is blood volume
80kg man 48 60kg women 3.6 L blood volume 5. 3L 3. 6L
33
volume replacement looks like
calculate fluid loss giving 4 times the loss in IV crystallous percent blood loss times total blood x4 35% x 5.3=1.9 so replace 7.5-8L
34
target CVP is between
5-10 mm Hg
35
what does fluid overload look like
12-15 mm Hg
36
septic or neurogenic shock picture
unable to maintain resistance increased co Decreased systemic vascular resistance
37
how does dopamine help with neurogenic shock at a low dose
low dose (1-5mcg) increases blood flow to renal, mesenteric, and cerebral regions, by increasing SVR in other regions.
38
pressures put pts at risks for
ischemic necorosis
39
hypertensive emergency tx
give anti-hypertensices drips of nitroprusside, nicardipine, celvidipine, esmolol use CCB now (pines) the goal is to get them back on oral medications
40
Swan Ganz cathter
No longer used first reason to have person in the ICU invasive monitor that could detect wedge pressure in the heart but doesn't really seem to make a difference in outcome
41
neurological problem what exam are we using to evaluate decline how often do they need to be checked
With neuro issue in ICU, need q1hr neuro checks (can only be done in the ICU with pt:RN ratio 2:1) glasgow coma score pupils reflexes need to document what is normal for this patient
42
CPP what is the equation and how do you monitor
Cerebral perfusion pressure (CPP) so, for critical head injuries, have to monitor/control both intracranial pressure & BP) MAP-ICP
43
CPP goal
cerebral profusion goal is around 60 mmHg
44
gold standard for invasive intracranial pressure monitoring
Ventriculostomy
45
Licox monitor
inserted like a camino bolt measures O2 content of blood considered more useful than camino because it measures direct oxygenation rather than perfusion pressure (which correlates with oxygenation)
46
goal CPP is often around
60 mm HG
47
Goal ICP should be
generally less than 22 mm Hg
48
to maintain CPP we can ...
lower ICP (preferable) or raise MAP (last resort)if
49
if a person is borderline with CPP
if the ICP is within normal limits you know the brain probably has good circulation (unless hypotensive)
50
a weak point in the cerebral artery often asymptotic usually devastating
50% never make it into the hospital Subarchanoid hemorrhage
51
management of subarachnoid hemorrhage
critical BP control, neuro checks, seizure and vasospasm prophylaxis need to be on seizure medication because of lowered threshold need to repair the aneurysm
52
repair of the aneurysm
endovascular coiling catheter is inserted in the groin, snaked up the artery into the brain and placed into the aneurysm filled with a thread and keeps from rupturing (does not occur at highland)
53
what is the F/U care for repair of a aneurysm
very high risk of vasospasm need to stay in the ciu HHH tx hypervolemic hypertensive hemodilution pump them up so there is no chance of vasopsasm (will be experienced as stroke)
54
nutrition in the ICU short term
most ICU ptaients are too obtuned to eat and are NPO use thick NG tube not dobhoff usually because they can inserted into a lung if not done right
55
g-tube
long term solution goes to the stomach many times you need a PEG which is like a G tube
56
hematology concerns in ICU when would you consider a transfusion for a pt in the ICU
many pts are ANEMIC can be consuming RBC may be malnourished if HMG falls below 8 can consider a transfusion can wait till it falls to round 6 need to follow coags (INR) and correct as needed
57
electrolyte concerns in the ICU
need to follow I and Os very closely insensate fluid loss is also of concerned
58
healthy people lose how much water
400 mo H20 from longs and 400mL from the skin in the ICU you need to follow I and O over multiple days
59
renal concerns
need to follow urine output BUN and Cr these numbers hould not be climbing
60
three kinds of renal problems and the most common
person in shock will have pre renal intrinsic damage can occur through durg intake and IV contrast post obstruction from stones and BPH is uncommon in the ICU but is not unheard of
61
hypophosphatemia could effect breathing in what ways
makes it harder to wean off ventilator because of the decreased smooth muscle strength effects the diaphragm
62
infectious disease concrens in the ICU
we are worried mostly about all the tubes need to track temp and WBC every day if they are being treated from infection need to documetn
63
If pt has a new fever or ↑WBC GET A
panculture blood sputum urine
64
why are we worried about pneumonia in the icu
Because of the ventilator | need a CXR
65
prophylaxis for ICU pt
GI/nutrition | hematology-
66
what is the reason we really need to worry about prophylactic GI nutrition
feed as soon as possible need protein to heal and decreased risk of ulcers need PPI stool softener (these pts are constipated--> leads to BO and electrolyte abnormalities) suppository
67
hematology prophylaxis
out them on prophylactic heparin or LMWH when pt is hemodynamically stable
68
which meningitis vaccine do we give
ACYW teenagers 11-18 yo (1st dose 11 and second does 16 years old) anyone younger can get the vaccine if worried about exposure and you would need it for prophylaxis
69
Men B vaccine
against serogroup B meningitides is given to young children in England given the low incidence here is is not routine given to kids going off to collage or kdis going over seen where there are high rates of meningitis
70
what oxygen saturation is toxic
>60% for 48 hours can be toxic
71
at an intermediate dose how dose dopamine work
) stimulates beta receptors in heart, increased cardiac output
72
At a high dose how does dopamine work
(>10mcg) stimulates alpha receptors in systemic and pulm circulation, increasing SVR while preserving CO, thus helping to correct hypotension
73
complications with dopamine
 Complications: tachycardia at intermediate doses, ischemic limb necrosis (consider alpha blocker)
74
goal ICP
generally <22 mm HG
75
goal MAP
>8- mm Hg
76
two ways to maintain CPP
o To maintain CPP, can lower ICP (preferable) or raise MAP (less preferable)
77
screwed into skull to rest just under dura, provides real time ICP data
o Camino Bolt
78
measures O2 content of blood, more useful than Camino since it measures direct
o Licox monitor
79
if a pts with aneurysm ahs a vasospasim requires
Vasospasm requires emergent transluminal balloon angioplasty will be experienced as a stroke
80
BIG THREE kill your pt quickly
respiratory insufficiency, CV insufficiency and neuro injury know all their stats form before
81
small stuff that can kill your pt slowly
``` GI/nutrition hematology electrolytes renal, infectious dz ```
82
Minimum UOP should be
Minimum UOP should be ≥20ml/hr and BUN/Cr should not be climbing
83
Pre-renal:
↓blood flow to kidney (hypovolemia, renal artery obstruction
84
Intrinsic: renal causes
: damage to kidney (drugs, ischemia, infection) CT
85
Post-renal:
obstruction of urinary tract (stones, catheter, BPH)
86
electrolyte imbalance that makes it difficult to wean someone off the ventilator
Hypophosphatemia d/t decrease in smooth muscle strength including the diaphragm
87
Hypomagnesemia what is normal and what kind of problems does it cause
normal range is 1.7-2.3, and low levels <0.7 can cause fatal arrhythmias
88
Most ICU pts need to be on these meds
stool softeners PPI- prevent ulcers Heparin or LMWH
89
PROPHYLAXIS for DVT
: DVT and PE, every pt should be wearing sequential compression devices on their legs Every patient should get prophylactic heparin or LMWH when hemodynamically stable.
90
when would you want to start prophylactic heparin in a pt with a brain bleed
 Brain bleed generally wait until 72 hours later but it depends on the brain bleed and how bad it was
91
overall impressions of the pt in the ICU
``` Respiratory Cardiovascular Neuro GI/Nutrition Heme FEN/Renal ID Prophylaxis ``` and monitor medication sedation (propofol or versed) and integumentation

Surgery (18 decks)

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