ICU Equipment

Question 1

What equipment might be seen in an ICU?

Answer 1

• pulse ox
• capnography
• doppler and oscillometric non-invasive blood pressure
• invasive blood pressure, arterial catheters via trasnducers onto monitor
• central venous pressure via central line, haemodynamic presure
• multiparameters
• glucometer
• lactate monitor
• microscope
• biochemistry and haematology machine
• centrifuge
• syringe drivers and infusion pumps

Question 2

Why might you use a lactate monitor?

Answer 2

if you do not own a blood gas analysis machine

Question 3

What parameters will you find on a blood gas reading?

Answer 3

• pH
• PaO2/PvO2
• PaCO2/PvCO2
• BE
• HCO3
• anion gap

Question 4

What is Pao2/PvO2 measuring?

Answer 4

partial pressure of oxygen dissolved in plasma

Question 5

What is PaCO2/PvCO2 measuring?

Answer 5

partial pressures of carbon dioxdie dissolved in plasam

Question 6

What is BE on a blood gas analysis?

Answer 6

base excess or deficit, H ions needed to return the pH back to normal

Question 7

What is HCO3 measuring?

Answer 7

bicarbonate (buffer)

Question 8

What is anion gap measuring?

Answer 8

unmeasured anions in the blood e.g ketones, uric acid, ethylene glycol

Question 9

What is the normal range for pH?

Answer 9

7.35-7.45

Question 10

What is the normal range for PaO2?

Answer 10

80-100mmHg

Question 11

What is the normal range for PaCO2?

Answer 11

35-45mmHg

Question 12

What is the normal range for HCO3?

Answer 12

21-24

Question 13

What is the normal range for BE (base excess)?

Answer 13

+2 or -2mEq

Question 14

What is the normal range for anion gap for dogs and cats?

Answer 14

dogs = 12-24mEq/L
cats = 13-27mEq/L

Question 15

What can an increase in lactate cause?

Answer 15

emtabolic acidosis

Question 16

What pH will you get with metabolic acidosis?

Answer 16

<7.35

Question 17

What pH will you get with metabolic alkalosis?

Answer 17

> 7.45

Question 18

What is it called when metabolic aklkalosis causes a pH of >7.45?

Answer 18

alkalaemia

Question 19

What is it called when metabolic acidosis causes a pH of <7.35?

Answer 19

acidaemia

Question 20

What compensatory factors occur with metabolic acidosis?

Answer 20

pH within normal limits but HCO3 is very low and PaCO2 is also low

Question 21

What compensatory factors occur with metabolic alkalosis?

Answer 21

pH within normal limits but HCO3 very high and PaCO2 also high

Question 22

What happens if the PaCO2 is >45mmHg?

Answer 22

respiratory acidosis

Question 23

What happens if PaCO2 is <35mmHg?

Answer 23

respiratory alkalosis

Question 24

What happens if the body is in respiratory alkalosis?

Answer 24

hypoventilation to retiain CO2 to bring pH down

Question 25

What happens if the body is in respiratory acidosis?

Answer 25

body with hyperventilate to get rid of CO2

Question 26

If a patient has a blood gas of
pH - 7.063
PaCO2 - 106.7mmHg
HCO3 - 28.4
BE - 4.2
what causes this?

Answer 26

Aacidaemia and primary resporatory acidosis with partial metabolic acidosis

Question 27

If a patient has a blood gas
of
pH- 7.202
PaCO2 - 19.8mmHg
HCO3 - 7.4mEq/L
BE - 18.5
what causes this?

Answer 27

acidaemia, respiratory alkalosis, metabolic acidosis with compensatory respiratory alkalosis

Question 28

If a patient has this blood gas analysis
pH - 7.49
PaCO2 - 47mmHG
HCO3 - 34.8mEq/L
BE- 10.2
what causes this?

Answer 28

alkalemia, respiratory acidosis, metabolic alkalosis and compensatory respiratory acidosis

Question 29

What conditions can cause metabolic acidosis?

Answer 29

diarrhoea, diabetic ketoacidosis, renal failure, addisons disease, lactic acidosis (sepsis)

Question 30

What conditions can cause metabolic alkalosis?

Answer 30

vomiting (loss of H ions),hypoalbuminaemia (weak acid), upper GI obstruction (vomiting)

Question 31

What is the rule of 20?

Answer 31

lists the critical parameters to be checked in critical patients

Question 32

What is included in the rule of 20?

Answer 32

• fluid balancce
• oncotic pull/albumin
• glucose
• electrolytes and acid base
• oxygenation and ventilation
• levels of consciousbess/mentation
• blood pressure
• heart rate, rhythm and contractibility
• temperature
• coagulation
• RBC and Hb
• renal function
• immune status
• GI motility
• drug doses/drug metabolism
• nutrition
• pain control
• patient mobilisation/care
• wound care
• TLC

Question 33

How wouldyou nurse a ventilation patient?

Answer 33

-eye care - dry eye
- mouth care - ulcers, lack of moisture
- airway
- humidification
- physio and positioning
- lines, drains,tubes
- urination/defaecation
- drugs
- treatment of underlying conditions
- record keeping
- acid base, blood gases and electrolytes

Question 34

How would you monitor a patient with head and neck trauma who is un-responsive?

Answer 34

• fluid balance
• glucose and electrolyte monotoring
• ventilation/oxygenation
• mentation/coma score
  NIBP monitor for cushings reflex
• HR and ECG monitor bradycardia
• parenteral nutrition
• coagulation checks
• mannitol/hypertonic saline
• u-catheter
  RBC

Question 35

What causes a cushings reflex?

Answer 35

raised intracranial pressure

Question 36

What nursing care would you provide for a head and neck trauma patient?

Answer 36

turning every 4 hours, eye care, oral care, wound management, TLC

Question 37

What is the rule of 20 for a BOAS patient presenting as cyanotic/dyspnoeic and anxious?

Answer 37

• fluid balance - high flow oxygen therpay
• glucose and electrolytes
• temperature
• venilation/oxygenation - PaO2/PaCO2
• BP
• HR and ECG
• drugs
• nutrition - parenteral