ICU Nursing Flashcards
(116 cards)
1
Q
which patients require critical care nursing?
A
CVS instability
respiratory/neurological distress
multiple trauma (RTA)
systemic disease
extensive wounds/burns
electrolyte imbalances
sepsis/systemic inflammatory response syndrome
2
Q
what is the aim of triage?
A
quickly assess each patient to establish whether stable or unstable and decide order of treatment
3
Q
how do we triage?
A
quick physical assessment of the 3 major body systems - cardiovascular, respiratory and neurological
4
Q
how do patients fail a triage?
A
failing any of the 3 MBS assessments mean they have failed the triage and require immediate intervention
5
Q
what is involved in the quick initial triage assessment?
A
check whether tachy/bradycardic, pulse quality
any tachypnoea/dyspnoea, increased respiratory effort
excessive bleeding
severely painful
mentation
ambulatory or not
any seizure activity
mm colour and CRT
6
Q
which patients require constant monitoring?
A
critical patients and those likely to deteriorate
7
Q
which patients require monitoring every 15-30 mins?
A
GA recovery, those starting a blood transfusion
8
Q
which patients require monitoring every 1-2 hours?
A
hypoglycaemic patients
monitoring RR
those needing medication
9
Q
which patients require monitoring every 4-6 hours?
A
stable patients but clinical status may deteriorate e.g. coagulopathies, cardiac disease
10
Q
how can we measure the cardiovascular system function?
A
pulse rate, heart rate and quality blood pressure mm colour and CRT time ECG heart auscultation
11
Q
what does it indicate if there are pulse deficits?
A
indicative of arrhythmias - confirm with ECG
12
Q
what do weak/thready pulses indicate?
A
decreased systolic BP e.g. hypovolaemia/hypoperfusion
13
Q
what do bounding pulses indicate?
A
sepsis
14
Q
what do snappy pulses indicate?
A
indicative of anaemia
15
Q
what is the normal heart rate for large breed dogs?
A
60-100 bpm
16
Q
what is the normal heart rate for small breed dogs?
A
100-140 bpm
17
Q
what is the normal heart rate for cats?
A
140-180bpm
18
Q
what heart rate is considered tachycardic?
A
> 140bpm dogs
>180-200bpm cats
19
Q
what heart rate is considered bradycardic?
A
<60bpm dogs
<120bpm cats
20
Q
what is normal MAP?
A
dogs 100mmHg
cats 135 mmHg
21
Q
what is normal systolic bp?
A
dogs 110-160mmHg
cats 120-170mmHg
22
Q
what blood pressure values are considered hypotensive?
A
<100mmHg systolic
<60mmHg MAP
23
Q
what blood pressure values are considered hypertensive?
A
> 170-200mmHg systolic
>120mmHg MAP
24
Q
what are the 3 methods of measuring blood pressure?
A
doppler
oscillometric
invasive BP
25
how should we take BP readings?
calm quiet environment, allow patient to adjust
lateral recumbency
3-5 readings and average
26
how large should a BP cuff be?
40% circumference of the leg
27
what do red/hyperaemic mms indicate?
sepis
28
what do bright red/cherry red mms indicate?
carbon monoxide toxicity
29
what do very pale/white mms indicate?
anaemia or shock
30
what do brown mms indicate?
paracetamol toxicity
31
what does petechiation on mms indicate?
coagulopathy
32
what does crt indicate?
peripheral perfusion
33
what is normal CRT?
1-2 secs
34
what does prolonged CRT indicate?
>2.5-3 secs
| indicates shock/hypoperfusion
35
what does rapid CRT plus red/hyperaemic mms indicate?
<1 sec
sepsis/SIRS
rapid CRT due to vasodilation
36
what does pale mms and prolonged CRT indicate?
vasoconstriction (shock/hypoperfusion)
37
what does pale mms and normal CRT indicate?
anaemia
38
which conditions are likely to result in arrhythmias?
GDV and sepsis
39
how do we assess function of the respiratory system?
```
RR and effort
lung auscultation
pulse oximetry
capnography
arterial blood gases
oxygen therapy and considerations
```
40
what is the normal RR range in dogs and cats?
dogs 18-36 brpm (breed size dependent)
| 20-30 brpm
41
what is considered bardypnoea?
<15 brpm
42
what are some possible causes of bradypnoea?
drugs
hypocapnia
CNS disease (respiratory centre affected)
hypothermia
43
what is considered tachypnoea?
>45-50 brpm
44
what are some of the causes of tachypnoea?
```
hypoxia/hypoxaemia
hypercapnia
pain
hyperthermia
pyrexia
stress
compensation for metabolic acidosis
```
45
what are some possible causes of apnoea?
respiratory or cardiac arrest
drug overdose
neurological complications
46
what are some of the causes of dyspnoea?
upper airway obstruction, flail chest
pleural space disease
pulmonary parenchymal disease
upper airway disease (BOAS, laryngeal paralysis)
47
what are the indications a patient is dyspnoeic?
```
increased chest and abdominal muscle movement
postural changes (orthopnoea)
open-mouth breathing
```
48
why might a patient display reduced respiratory effort?
head and spinal trauma/ijury
tetanus
end stage respiratory failure/fatigue
49
what does decreased dorsal lung sounds indicate?
pneumothorax (air in pleural space)
50
what does decreased ventral lung sounds indicate?
pleural effusion (fluid in pleural space)
51
what does borborygmi sounds in the lung field indicate?
diaphragmatic rupture
52
what do crackles/wheezes on lung auscultation indicate?
bronchopulmonary disease e.g. pulmonary oedema, pulmonary contusions, damage/disease of lung parenchyma
53
where can you place a pulse oximeter?
```
tongue
lip
ear
inguinal fold
prepuce
vulva
```
54
what is a normal ETCO2 value?
35-45 mmHg
55
which factors can affect the capnography measurement/trace?
```
system leaks
ET tube kink
sensor obstruction
airway obstructions
apnoea (aids early detection of cardiac arrest)
```
56
what is PaO2?
amount of O2 dissolved in arterial blood
57
what is PaCO2?
amount of CO2 dissolved in arterial blood
58
what is normal PaO2 range?
80-100 mmHg
59
what is normal PaCO2 range?
35-45 mmHg
60
where do we obtain an arterial blood sample from?
dorsal pedal artery
61
what non-invasive methods of oxygen provision are available?
flow-by oxygen e.g. mask, tubing held near patients mouth/nose
oxygen cage
nasal prongs
62
what invasive methods of oxygen delivery are available?
nasal catheters
trans-tracheal
endotracheal (intubation)
(IPPV or mechanical)
63
how do we assess neurological system function?
mentation
cranial nerve function
modified glasgow coma score (MGCS)
increased intracranial pressure
seizures
64
what does obtunded mean?
reduced alertness/consciousness, easily roused with non-noxious stimuli
65
what does stuporous mean?
unconscious, only rousable with noxious stimuli
66
what does comatose mean?
unconscious, no response to any stimuli, including noxious stimuli
67
what are some potential causes of reduced mentation?
shock/hypoperfusion
hypoxaemia e.g. severe anaemia
primary neurological disease
68
how can we assess cranial nerve function?
```
pupillary light reflex
pupil size and symmetry
oculocephalic reflexes
menace relfex
nystagmus
strabismus
```
69
what is miosis?
constricted pupils
70
what is mydriasis?
dilated pupils
71
what is nystagmus?
eyes making repetitive, uncontrolled movements - may be horizontal/vertical/rotational
72
what is strabismus?
one or both eyes deviated from normal position
73
what can absent PLRs or changes in pupil size indicate?
raised ICP - trauma or intra-cranial lesions (tumour, inflammation)
74
what are the 3 sections of the modified glasgow coma score?
motor activity
brainstem reflexes
level of consciousness
75
what is cushing's reflex?
marked hypertension and bradycardia
76
what does cushings reflex indicate?
raised ICP - emergency
77
what can be given to try and lower ICP?
mannitol
| hypertonic saline
78
which patients are most at risk of raised ICP?
head trauma
seizures
meningoencephalitis patients
79
how can we help manage raised ICP?
elevate head and thorax up by 15-30°
sternal recumbency to aid respiratory ventilation, provide O2
no jugular sample
avoid stimulation to sneeze/gag/vomit
80
how can we manage seizure patients?
may require active cooling
provide flow-by oxygen during/after seizures
elevate head and thorax once safe to do so
make sure in padded kennel with seizure medications readily available
81
what other considerations are there for patients with lesions of cervical region?
closely monitor respiratory function
82
what other considerations are there for spinal trauma patients?
spinal board for transport and movement for potentially unstable spines
keep flat, minimise movement
83
what other considerations are there for patients with decreased consciousness?
monitor gag reflex, regurgitation
may require airway protection
physiotherapy
hygiene e.g. eye and oral care
84
what are the areas of a critical care ward?
```
triage station
high dependency (critical) patient area
emergency crash station
feline-friendly area
nursing station
laboratory area
```
85
what should there be in the triage area?
oxygen supply
portable ultrasound machine (free fluid checks)
consumables
examination table
portable monitoring equipment
telemetry for ECG
blood pressure machine
good space to move
86
what equipment should there be in the high dependency area?
```
oxygen supply
monitoring equipment
chart for observation and recording
pumps and syringe drivers
heat source for patient
moveable trolley
ventilator/anaesthetic machine
easy access/space for constant patient monitoring
```
87
what are the features of a feline friendly ward?
glass doors - easy to see through but provides noise reduction
glass cover - cats cannot see dogs walking past
oxygen and electricity wall access
separate oxygen cages
88
what are the important features of a critical care nursing station?
list of important contact numbers
computer access for charging/px records/emergency details
able to observe whole room
patient records to hand
89
which equipment might feature in the laboratory area?
```
blood gas/electrolyte machine
microscope
centrifuge
diff-quik stain
haematology machine
biochemistry machine
coagulation times
SNAP tests
```
90
what type of laboratory work might be carried out in critical care?
```
minimum database (PCV/TS, electrolytes, lactate, oxygenation/ventilation, glucose)
biochemistry and haematology
urinalysis
coagulation profiling
blood typing
blood cross-matching
SNAP tests
```
91
what information should be on the hospital sheet?
```
patient and owner details
date
problem list
tubes/drains/IV lines
IVFT and medications due
clinical notes
admin weight and daily weight record
daily record of RER and food intake
clinicians notes
clinician in charge and contact details
patient temperament
```
92
what categories of nursing considerations must be attended to in critical care?
```
infection control
hygiene
body temperature
lines/tubes/drains
physio
nutrition
pain and stress
fluid balance
TLC
```
93
what are the basic principles of infection control?
```
hand hygiene - wash before and after each patient
wipe equipment after use
appropriate use of gloves
prevent HAIs
PPE if barrier nursing
```
94
how can we keep the patient warm?
```
incubator
bubble wrap
heat mats (not directly under patient!)
hot hands
bair hugger
fleece blankets/vet beds
warmed IV fluids
```
95
how can we cool a hyperthermic patient?
```
fan/air conditioning
ice under bedding
cooling mats
cold damp bedding/towels
tepid water bath
frequently re-check temperature!
```
96
how often should we check lines/tubes/drains of critical cate patients?
minimum twice daily
| remove as soon as no longer required
97
what are the general aims of physiotherapy for critical care patients?
decrease chance of complications e.g. recumbent patients
improve circulation
allow muscle/tendon relaxation
aid pain management
reduce inflammation
promote recovery
98
what are the indications for physiotherapy?
```
pressure sores/decubitus ulcers
muscle contractions/spasm
buildup of pulmonary secretions
muscular weakness/atrophy
joint stiffness
limb swelling
pain
depression/boredom/stress
```
99
what are the contraindications for physiotherapy?
```
unstable critical patients
unstable limb/spinal fractures or spinal injuries
head trauma
blood disorders
very stressed/painful patients
```
100
what happens if there is no nutrients in the GI tract for >3 days?
cells will start to die - creates weakness in the GI tract barrier
101
what does weakness of the GI barrier lead to?
increased intestinal permeability - bacteria and endotoxins can cross barrier and enter systemic circulation (translocation)
impaired immune function of GIT
102
how do you avoid refeeding syndrome in anorexic patients?
1/3 RER on day 1, 2/3 RER on day 2 etc
103
what are the different types of enteral feeding tube?
NG/NO tube
oesophagostomy tube
percutaneous endoscopic gastrotomy (PEG) tube
jejunostomy tube
104
what are the considerations for patients with enteral feeding tubes?
check tube in correct location before every feed
check insertion site at least BID, clean site
sit in sternal/elevate thorax to prevent regurgitation and aspiration
J tube must have specific jejunal diet only
105
how long must PEG/J-tubes be left in? why?
minimum of 10-14 days
| allows adhesions to form to reduce risk of peritonitis upon removal
106
what is parenteral nutrition?
nutrients are provided directly into patients blood stream, avoiding GIT
107
what is total parenteral nutrition?
all nutrients parenterally
high osmolality
given via central line/peripherally inserted central catheter (PICC line)
108
what is partial parenteral nutrition?
40-70% of nutrients given parenterally
| may be given via central or peripheral route
109
what are the considerations for parenteral feeding?
strict aseptic technique - can cause sepsis
TPN NOT peripherally - can cause thrombophlebitis
new bag and giving set every 24 hours
110
what can we use to assess pain in cats?
feline glasgow pain score/colorado cat pain score
111
what can we use to assess pain in dogs?
canine glasgow composite pain scale
112
how can we minimise stress in critical care patients?
TLC - strengthen nurse/patient bond
sedative drugs to allow periods of rest
take your time/go slow with nervous patients
reassurance
feliway cat diffuser
hiding areas
113
how can we monitor urine output?
closed system IDUC
weight incontinence sheets/bedding/litter
weight at least once daily - fluid balance responsible for rapid changes in patients weight
114
what is a normal UOP?
1-2 ml/kg/hr
115
how can we provide TLC to critical care patients?
```
quiet time and lights out time
grooming/bathing/affection
toys (if appropriate)
time outside the kennel
hand-feeding
```
nursing care plans
owner visits
116
what is the purpose of a nursing care plan?
standardisation of nursing care -
ensures patients needs met and all areas of nursing are covered
highlights any problems/potential complications
