Review Flashcards
Insulin drip
atlanta multiplier method
starting rate units/hour = (BG - 60) x .02
blood sugar 226
(226-60) x .02 = 3.32 …. 3 units/hour
correction bolus forumula
glucose correction factor
Ideal blood glucose
100
example:
250-100
————–
30
= 5.0u
fasting glucose is 326
ideal is 100
correction factor of 30
30 = 7.53 or 8 units
Notes
Will be given glucose correction factor
Ideal is always 100
Round up if the decimal is 5 or greater
hypoglycemia
glucose is 40
how much d50 iv push should mrs. jones receive
D50 formula
= (100-bg) x 0.4 ml IV
(100-40) x 0.4 ml IV
24ml/IV
40 glucose is considered
a severe hypoglycemia
ABG Analysis
ph 7.35, pao2 60, paco2 50, hco3 30
compensated respiratory acidosis
ph 7.50, pao2 75, paco2 40, hco3 32
uncompensated metabolic alkalosis
ph 7.6, pa02 80, paco2 30, hco3 24
uncompensated respiratory alkalosis
ph 7.3 pa02 75, paco2 32, hco3 19
partially compensated metabolic acidosis
ph 7.45, pa02 75, paco2 28, hco3 20
fully compensated respiratory acidosis
Two challenge rule
f you call the provider and you don’t get a reasonable solution, restate what you think is approrpriate, restate why you think it’s appropriate, and if you still don’t get what you need, contact another provider
Compassion fatigue
Intrusive Thoughts Blending of Roles Lowered Tolerance Dread Depression Self-destructive Actions Hyper-vigilance Decreased Functioning Loss of Hope
Best level for hospital and NICU
Level 1 hospital: good. Teaching hospital with multiple care pathways and can handle multiple patients.
NICU: level 3 is the best
Open vs. Closed unit
Open:
- multiple staff is coming and going, physicians, ancilary staff, nurses, all managing a patient
- most typically used
Closed:
certain staff including an intensivist who managed your patient. Great, unless the intensivist missing something, or something special happens that’s not in the intensivists realm of specialty.
VAP bundle includes?
prevent ventilator associated pneumonia
- head of bed elevated 30
- oral care every 2 hours
- turn Q2
- sedation vacation every 24 hours
- peptic ulcer prphylaxis within the first 24 hours of mechanical ventilation
- DVT thrombosis w/i 24 hours on vent (DVT precautions)
Biggest problems for critical care patients
- they are vulnerable
- communication issues
- technology
- complex, multiple-step process
Safe Medical Device Act
- Require that hospitals report serious or potentially serious device-related injuries to the U.S. Food and Drug Administration (FDA).
- All implantable devices must be documented and tracked with the FDA
Weaning of morphine per london health center guidelines
Morphine: If dose is less than 4mg per hour , then decrease by half every six hours. If dose is more than 4mg an hour, decrease by 25% every 6 hours until less than 4
Most beneficial in reducing pain in patients
Touch and family
To provide adequate pain control, first rule out?
→ hypoxia → hypoglycemia → withdrawal → sleep deprivation → immobility → fear
Three purposes of sedation
Amnesia: to forget what’s going on
Agitation:
Anxiety: go to sedation as last resort
Neonatal: Mother-Driven Interventions for pain
breastfeeding
skin-to-skin care
maternal voice, maternal heartbeat with NNS
olfactory, aromatherapy recognition
Neonatal: Sensorial Interventions for pain
containment & swaddling
facilitated tucking
vestibular stimulation (rocking)
orotactal stimulation: non-nutritive sucking (NNS) sweet solutions
Combining interventions offers additional benefits
Delirium classifications
- Hyperactive (agitated): Most common. sudden change, hallucinated, hyperactive
- Hypoactive (quiet) – often misdiagnosed as depression, become nonresponsive and sluggish
- Mixed: Second most common, bipolar-ish
Treat Cause of Delirium Acronym
THINK
- Toxic situations and medication: CHF, shock, dehydration, organ failure. Benzodiazepines, anticholinergics, and steroids
- Hypoxemia
- Infection/sepsis, inflammation, immobilization
- Nonpharmacological interventions: sleep, reorientation/reassurance, familiar people/objects
- K+ (potassium) or other electrolyte imbalance
Delirium
- Common in critically ill patients (esp. on ventilator)
- Caused by neurotransmitter imbalance in brain
Predisposing factors
- Patient (age, substance use, sensory impairment)
- Illness (infection, electrolyte imbalance, low HCT)
- Iatrogenic (polypharmacy, sleep disruption, immobility)
-causes hospitals not to get reimbursed
Sedation med used for long term, or low level sedation
Lorazepam (Ativan): benzodiazepine
* intravenous onset: 15 to 30 minutes, duration ~8 hours * intermittent or continuous - can only be mixed with d5w - can cause renal tubular necrosis
When you want a sedation medication that acts rapidly and ends rapidly?
Propofol (Diprivan): short-acting general anesthetic agent
* onset: 40 seconds, duration 3 to 5 minutes * sedation is necessary with rapid awakening * bolus, then continuous - usually on ventilated patients - containers it's in can only be used for 12 hours - (lipid) generally used through central line or used large bore peripherally because it's very irritating - if drip is stopped, expect them to wake up in 8
Ventilation vs. Respiration
Ventilation is the rate at which gases enter or leave the lungs whereas respiration is the transport of oxygen from the outside air to the cells within tissues, and the transport of carbon dioxide in the opposite direction
the volume of air breathed in or out of the lungs during normal respiration
0.5
tidal volume
The Ventilation-Perfusion (V/Q) ratio (normal?)
The V/Q ratio is the ratio between the amount of air getting to the alveoli (the alveolar ventilation, V, in ml/min) and the amount of blood being sent to the lungs (the cardiac output or Q - also in ml/min).
V/Q = (4 l/min)/(5 l/min)
V/Q = 0.8
Shunt Unit
Inadequate ventilation to an alveolus
Example: Pneumonia
Dead Space Unit
Alveolar cluster where perfusion fails
Example: Pulmonary embolism
Normal ABG’s
PaO2: 80-100 SaO2: 93-99 pH: 7.35-7.45 PaCO2: 35-45 HCO3: 22-26
Type? Impaired Gas Exchange -Pneumonia -Pulmonary edema -ARDS -Atelectasis Nursing Interventions?
Type I- Hypoxemi Nursing Interventions: -Cough and deep breathe -HOB elevated -administering of meds such as diuretics -Add some ventilator peep -incentive spirometry -Get up to allow lung expantion
Ineffective Breathing Pattern -COPD -Neurological Respiratory Failure -Muscular Failure Type? Nursing Interventions?
Type II- Hypercapneic Nursing interventions: -Bipap -ventilate them and change inspiratory expiratory ratio to allow more time to breathe in (add paralytics) -mechanical ventilation -change position Q2 -HOB elevated
Difference between CPAP and BIPAP
CPAP
- Continuous Positive Airway Pressure
- for patients who need continuous low pressure to keep lungs open
BIPAP
- Bilevel Positive Airway Pressure
- can assist with low level pressure at inspiration and expiration to help lungs stay open
Volume Control
controlling the volume on the ventilator
pressure control
delivers volume until a certain pressure is acheived
synchronized intermitted mandatory ventilation
on the breaths that the ventilator is going to deliver, it will deliver the settings. Won’t assist on their own breaths
What is ECMO and how does it work?
- extracorporeal life support
- De-saturated blood is drained via a venous cannula, CO2 is removed, O2 added through an “extracorporal” device (often misnamed an oxygenator), and the blood is then returned to systemic circulation via another vein (VV ECMO) or artery (VA ECMO)
