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PHTH 564 - ICU > Intro to Critical Care > Flashcards

Intro to Critical Care Flashcards

(94 cards)

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1
Q

Most commonly used outcome measure for consciousness in ICU?

A

RASS (Richmond Agitation Sedation Scale)

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2
Q

Most commonly used outcome measure for pain in ICU?

A

Behavioural Pain Scale (BPS)

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3
Q

2 most common pt populations in the ICU?

A
  1. Resp failure requiring mechanical ventilation

2. CV instability requiring invasive hemodynamic monitoring

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4
Q

______ _____ _____ = inserted into peripheral vein; enables administration of fluids and medications; is gravity driven or on pump

A

peripheral intravenous line

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5
Q

_____ ___
= to give meds that will erode peripheral veins and require mixing with larger blood volumes quickly such as chemo or antibiotics

A

PICC line

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6
Q

What does PICC stand for?

A

peripherally inserted central catheter

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7
Q

Normal ICP ?

A

5-10 mmHg

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8
Q

Increased ICP > __ mmHg for over 5 mins = brain damage

A

20

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9
Q

With ___ and ____, always check physicians orders regarding target values and activity orders (ability to change pt position or do chest PT)

A

EVD; ICP

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10
Q

Always check the EVD stopcock has been closed before any position change (T/F)

A

TRUE

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11
Q

Increased BP will increase ICP (T/F)

A

TRUE

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12
Q

__-__ % of pts have some cognitive deficit at discharge from ICU

A

70-80

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13
Q

Many pt’s D/C from ICU suffer from apraxia (T/F)

A

TRUE

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14
Q

Inspection on a ventilated pt should include position/stability of _____ and _____ setting

A

airway; ventilator

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15
Q

Normal end total CO2 ?

A

35-45mmHg

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16
Q

What is the P/F ratio?

A

The ratio of arterial O2 partial pressure to fractional inspired O2

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17
Q

What is the normal P/F ratio

A

> 380

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18
Q

Purpose of arterial line?

A

Constantly monitors arterial BP; access for direct blood sampling for painless and frequent analysis of ABG’s

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19
Q

The pt (can/cannot) mobile with an arterial line

A

CAN

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20
Q

For the arterial line to give accurate readings the transducer needs to be at the level of?

A

Superior vena cava (4th intercostal space)

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21
Q

When pt has an arterial line, what should you avoid?

A

Excessive wrist movement or hip flexion >90

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22
Q

MAP = ?

A

SBP + (2xDBP)/3

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23
Q

Normal MAP?

A

70-110mmHg

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24
Q

MAP > __ is necessary to perfuse coronary arteries, brain and kidneys

A

60

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25
Normal HR for adults?
60-110
26
4 arrhythmias to watch for?
PVC's, AFib, ventricular fibrillation, ventricular tachycardia
27
Tachycardia = HR > ____
110
28
Bradycardia = HR < ___
60
29
5 signs of ventricular fibrillation?
1. unresponsive 2. ineffective pulse 3. no spontaneous respiration 4. cyanosis 5. duskiness, mottled skin
30
Where can a central venous line be inserted?
through subclavian or internal jugular vein into superior vena cava or through femora vein into common iliac vein
31
____ _____ _____ = provides info about cardiac function and adequacy of circulating vascular volumes
central venous pressure
32
Normal central venous pressure values?
2-7 if self ventilating; 6-12 on a ventilator
33
Why is central venous pressure higher if you are on a ventilator?
PEEP affects pressure in thorax
34
Low CVP = __ HR and __ BP
increased; decreased
35
High CVP = __BP and __HR; or __ HR and ___ BP
increased; decreased; decreased x2
36
CVP helps us asses if fluid is ____ secretions or ______ _____
lung; pulmonary edema
37
3 purposes of pulmonary arterial line?
1. allow sampling of mixed venous blood to calculate a-VO2 difference 2. monitor PAP, PCWP and RAP 3. allows a measurement of CO
38
We may mobilize someone on a pulmonary arterial line very cautiously (T/F)
FALSE
39
5 s/s of cardiac pain?
1. pressure, fulness, burning or tightness in chest 2. SOB 3. cold sweats 4. crushing / searing pain in back / UE / face 5. nausea / vomiting
40
Pacemakers can be internal or external (T/F)
TRUE
41
3 guidelines post internal heart device implantation for first 4-6 weeks?
1. < 90 degrees shoulder flexion or abduction of arm on the same side as the heart device 2. do not do any activities where you are repeatedly pushing and pulling, swinging 3. do not lift anything more than 5 kg or 10 lbs
42
What does a high WBC count indicate?
infection
43
Does high INR and PTT indicate increased risk of clotting?
no
44
Normal Hb levels?
135 -170 g/L
45
Normal platelet levels?
150-400
46
INR normal values?
.9-1.3
47
PTT normal values?
24-40s
48
Low INR / PTT levels - increased risk for ______
clots
49
High INR/PTT levels = risk for _______ and ______
brusing / bleeding
50
_______ is a substance released into the blood when heart muscle is damaged
troponins
51
Troponins < ____micrograms / L indicates cardiac muscle injury y
0.05
52
Troponins rises over __-__ hours, peaks at __-__ hours, declines over ___ days
4-8;10-24;10
53
Normal albumin levels?
3.5-6g/dL
54
______ is a blood protein that fights infection and helps wound healing, as well as preventing swelling and plays a part in maintenance of plasma volume
albumin
55
Decrease in _____ leads to body wide interstitial edema
albumin
56
3 effects of low K+?
1. depressed cardiac activity 2. arrhythmias 3. muscle weakness and fatigue
57
_____ regulated blood volume, osmotic equilibrium and pH
sodium
58
3 effects of high K+?
1. cardiac arrhythmias/arrest 2. diarrhea 3. vomiting
59
3 effects of low Na+?
1. decreased blood volume / BP 2. pulmonary and pleural effusion 3. excessive sweating
60
5 effects of high Na+?
1. thirst 2. muscle spasms + weakness 3. lethargy / coma 4. thickening of secretions 5. tachycardia
61
One of the most important functions of ______ is muscle relaxation
magnesium
62
3 effects of increased Mg+?
1. low BP/HR (muscles are too relaxed) 2. abnormal heart rhythms and asystole 3. impaired breathing and respirations
63
5 effects of decreased Mg+?
1. abnormal heart rhythms and tachycardia 2. muscle cramps 3. hyperactive reflexes 4. tremors 5. overall weakness
64
______ is present in every cell type and causes neuronal stabilization and controls excitation
Ca++
65
MSK effect of high Ca++?
usually Ca++ is leached from your bones; weakens them and causes bone pain and muscle weakness
66
3 CNS effects of high Ca++?
1. confusion 2. lethargy 3. fatigue
67
High _____ can cause thirst and frequent urination because your kidneys have to work harder to filter it
Ca++
68
4 GI effects of high Ca++?
1. stomach upset 2. nausea 3. vomiting 4. constipation
69
High Ca++ = ____ in neuromuscular excitability
decrease
70
Low Ca++ = ______ in neuromuscular excitability
increase
71
Effect of low Ca++ in CNS?
paraesthesia / seizures
72
Effect of low Ca++ in CVS?
arrhythmias/arrest
73
Effect of low Ca++ in MSK?
muscle spasms and twitching
74
Effect of low Ca++ in resp system?
Stridor, bronchospasm
75
Effect of low Ca++ in GI system?
Diarrhea due to smooth muscle relaxation
76
Increase in _______ indicates renal failure or hypovolemia
urea
77
Decrease in _______ indicates malnutrition, liver failure or over hydration
urea
78
______ levels are an indicator of kidney function
creatine
79
Increase in creatine indicates what two things?
1. renal failure | 2. muscle injury
80
Decrease in creatine indicates what 2 things ?
1. malnutrition | 2. chronic loss of muscle bulk
81
______ failure has effects on the resp system and MSK function
Renal
82
Fluid overload can lead to pulmonary ______ and peripheral ______
edema; swelling
83
Acute renal failure = acidosis, which effects ________ contractility
diaphragm
84
Chronic RF pt's common display muscle _______ and ______
weakness; myopathy
85
Normal urine output?
1 mL/kg/hr
86
Less than ___ mL/kg/hr of urine out put = renal failure
1/2
87
5 precautions post dialysis?
1. low BP 2. nausea 3. cramps 4. headaches 5. fatigue
88
4 precautions with PEG/G - TUBE/NG tube?
1. ensure feeds are off 20 minutes before hands on or chest treatment 2. everytime feeds are off we effect the pt's nutrition and blood sugar levels 3. modify hand placement for assisted cough maneuver 4. dont pull, kink of put too much pressure on tube
89
4 concerns with PEG/G - TUBE/NG tube?
1. aspiration 2. infection/septicemia 3. tube dislodgement 4. bowel perforation
90
______ ______ ______ = infusion of nutritional substances directly into bloodstream, usually through peripheral or central line
total parenteral nutrition (TPN)
91
Why use TPN?
provides alternate form of nutrition when GI tract is not functioning
92
ROM/Strength/Balance outcome measure for ICU pts?
chelsea critical care physical ax
93
Pt's with rectal tube will not be able to sit longer than ____ minutes
30
94
Acronym for cause of muscle weakness in ICU?
``` M - meds U - undx neuromuscular disease S - SCI C - critical illness polyneuropathy L - loss of muscle bulk, immobility E - electrolyte imbalanced S - systemic illness/ sepsis ```

PHTH 564 - ICU (15 decks)

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