Critical Care > Exam 1 > Flashcards

Exam 1 Flashcards

(45 cards)

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1
Q

What do you do for a patient with compromised respiratory issues who can’t ambulate to break up secretions?

A

Turn every 2 hours.

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2
Q

What is the biggest thing you look for in a patient who overdosed?

A

Hypoventilation (Decreased Respirations)

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3
Q

What are your ABG results from hypoventilation secondary to overdose?

A

Respiratory Acidosis.

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4
Q

What is the result of fluid in the alveoli?

A

Decreased oxygenation to the body.

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5
Q

What is the ABG result of hyperventilation?

A

Respiratory Alkalosis.

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6
Q

What class of medications would you use to treat asthma and what routes? (4)

A
  1. Oxygen via face mask or NC
  2. Rapid acting beta2-agonists via nebulizer
  3. Inhaled anticholinergics
  4. Systemic corticosteroids orally or IV
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7
Q

Discharged teaching for an immunocompromised patient to prevent infection.

A

Get Vaccinations: Hepatitis A, MMR, Influenza, Pneumococcus and Herpes

Do not take live live attenuated influenza vaccine that comes in a nasal spray

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8
Q

Discharge instructions for an asthma patient:

A
  1. Review medication regimen
  2. When to return to physician
  3. Identify and stay away from triggers
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9
Q

What are some assessments that help confirm a COPD patient is becoming compromised after surgery?

A
  1. Listen to lungs
  2. ABGs
  3. Vitals
  4. Encourage coughing to bring up secretions and note color and consistently
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10
Q

What is the most common cause for a pulmonary embolism?

A

A clot broken off from another place in the body. i.e. (DVT, fat from long bone fracture, septic vegetation, or iatrogenic catheter fragment)

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11
Q

Prevention of PE and DVT: (3)

A
  1. Compression stockings
  2. Low molecular weight Heparin
  3. Mobilization regimen
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12
Q

What medications do you give for somebody with a PE and what are there actions?

A
  1. Unfractionated heparin/low molecular weight heparin or fondaparinux.
    - Prevents further clots from forming.
  2. t-PA (alteplase)- Clot buster
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13
Q

What are the alternatives for patients who cannot take anti-coagulants?

A
  1. Catheter embolectomy or local intraembolic thrombolytic

2. Vena cava filters to stop clots from lower extremities.

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14
Q

What are the diagnostic tests used to diagnosis ARDS?

A
  1. ABG
  2. PaO2/FiO2 ratio alterations less than 200.
    75/.35 = 214 (mild) 60/.6= 100 (moderate) 40/.8= 50 (severe)
  3. Capillary wedge pressure less than 18
  4. Chest x-ray
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15
Q

What is the rule of nines?

A

Adults > 9 yrs : head and arms 9% each. Chest, Back, and each leg 18 % each. Groin. 1%

Children 1-8 yrs: Head, chest, and back 18% each. Each arm 9%. Each leg 14%.

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16
Q

What are some nursing implication to prevent ventilator-associated pneumonia (VAP)? (5)

A
  1. Elevate head of bed 30-45 degrees
  2. Sedation interruptions and readiness to wean off vent
  3. DVT and ulcer prophylaxis
  4. Oral care with chlorhexidine
  5. Only change circuit when necessary and only use sterile water
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17
Q

What can cause a VAP?

A
  1. Dental plaque and oral bacteria
  2. Contaminated water/solutions and cross colonization (hands, gloves)

This leads to pooling of secretions above ET tube. Which causes aspiration of these secretions which ends in pneumonia.

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18
Q

Nursing interventions for a patient with cystic fibrosis?

A
  1. Antibiotic therapy.
  2. Airway clearance via mucolytic agents, recombinant human DNase, chest physiotherapy, and bronchodilators.
  3. And nutritional support via enteral nutrition with pancreatic enzymes.
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19
Q

What type of trauma puts you most at risk for infection and organ damage?

20
Q

In times of an emergency, how do you get IV access?

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A

IO is placed in sternum, legs, arms, or pelvis in emergency.

- 2 of the largest bore catheter peripheral lines are necessary

21
Q

signs and symptoms of compartment syndrome?

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A
  • throbbing pain
  • narcotics do not releive the pain
  • increased pain with passive stretching
  • area is firm
    LATE signs: paresthesia, pulselessness, paralysis
22
Q

proper responses for the trauma patient and family (select all that apply)

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A
  • consistent communication
  • patient’s and family’s perception
  • support systems and coping mechanism
  • early social worker involvement
  • family conferences in early emergent phase and critical care phase
  • consider family presence during procedures
23
Q

How does a patient with respiratory problems present?

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A

tachypnea, increased tidal volume
shallow resp
tachycardia, increased BP
accessory muscles and sternal retractions

24
Q

What conditions lead up to asthma?

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A

viral respiratory infections
rhinitis/sinusitis
GERD

25
What are the three hallmark signs of a PE?
dyspnea, hemoptysis, and chest pain with inspiration | - common sign is sudden onset of dyspnea and feeling of "impending doom"
26
When caring for an intoxicated patient, what is the best intervention to prevent harm to them self?
restraints or immobilizing devices (softs wrist restraints, soft mitts, elbow immobilizer, or vest) to not pull IV lines or lifesaving devices - must be repositioned - assessed points q hour
27
What physiology happens with a trauma patient?
hypovolemic shock-- hypotension and impaired cardiac output because of acute blood loss (external or internal)
28
What are you monitoring in a trauma patient?
vitals neuro ABC's
29
What are the values for ABG's?
pH 7.35-7.45 PaCo2 (resp) 45-35 HcO3 (metabolic) 22-26
30
What are the treatment options for DIC?
* *treat underlying cause** - stop abnormal coagulation and control bleeding by replacement of depleted blood and clotting components (FFP, platelets, PRBC) - medication can be used, based on patient’s condition
31
What are the lab values to look up for DIC?
decreased: platelet count, fibrinogen increased: FDP, D-Dimer prolonged: PT, activated PT, thrombin time
32
If the lab values are abnormal for DIC, what are the early s/s?
.
33
What are the risk factors for DIC? (3)
1. sepsis 2. multi-system trauma 3. burns
34
What type of care are you doing and avoiding for a DIC patient?
- pain relief - do NOT enhance vasoconstriction--kills tissue - frequent position changes with support and proper body alignment
35
Nursing dx for a DIC patient
- risk for fluid volume deficient - risk for impaired skin integrity - risk for imbalanced fluid volume - ineffective tissue perfusion - death anxiety
36
What are some goals from the nursing dx for a DIC patient?
- adequate oxygenation - adequate tissue perfusion - absence of bleeding - skin integrity - absence of pain and effectivecoping
37
What is an appropriate nursing dx for a patient with ARDS?
.
38
What are some early s/s for ARDS
restlessness**, disorientation, change in LOC; tachycardia, increased in temp; normal chest x-ray
39
What is EMTALA and their guidelines?
- Emergency Medical Treatment and Active Labor Act - Requires that anyone seeking emergency care be given a medical screening exam to rule out an emergent medical condition. The medical screening exam may not be delayed by discussion of finances. - has come within 250 yards of hospital
40
What is ESI?
- emergency severity index - national initiative to standardize triage systems using 5 levels - includes patient acuity and resources needed
41
What do the level for ESI mean and what are some examples of each level?
I- emergent (cardiac arrest, O2 sat )
42
What are the 4 criteria/questions to determine ESI?
- are they dying? - should they wait? - how many resources will they need? - vitals
43
What tests would the triage RN order?
EKG...
44
What are some required triage questions?
safe at home | SI/HI
45
What are some major questions to ask for a MVA patient?
- type of vehicle - speed - patient’s location - restraint? airbag? - point of impact - ejection - ambulatory at scene - outcome of other passengers
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