Med Con III > ICU > Flashcards

ICU Flashcards

(47 cards)

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1
Q

What is included in the first step: review medical history?

A

-past medical and surgical history
-medication that may impact mental status, wakefulness, ability to follow commands
-medication that my impact HR and blood pressure
-previous level of functional independence and activity tolerance

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2
Q

what is included in the mental status/congitive decision point?

A
  1. is the patient awake and alert
  2. can the patient follow simple commands
  3. is the metal status stable? rule out delirium
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3
Q

Explain the RASS scale

A

0 is the goal pt is alert and calm if not need to increase or decrease sedation medication
+4 combative- overly combative or violent
-4 no response to voice but any movement to physical stimulation
-5 unarousable no response to voice or physical stimulation

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4
Q

What is AAO x4

A

pt knows
what their name is
where they are
what the date is
what the cause or circumstance of their hospitalization

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5
Q

what are dejonghes 5 orders? to follow commands

A
  1. open your eyes
  2. look at me
  3. open your mouth and stick out your tongue
  4. nod your head
  5. raise your eyebrow when i have counted up to 5

pt must follow greater than 3 out of 5 of the commands

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6
Q

a disturbance of consciousness that is accompanied by a change in cognition that cannot be better accounted for by a pre-existing dementia

A

delirium

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7
Q

explain signs of hyperactive delirium

A

-increases motor activity
-loss of control of activity
-restlessness
-wandering

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8
Q

explain signs of hypoactive delirium

A

-decreased activity
-decreased action speed
-decreased speed of speech
-decreased amount of speech
-reduced awareness of surroundings
-withdrawl

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9
Q

can delirium and type of delirium fluctuate throughout the day?

A

yes it can

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10
Q

is delirium= brain dysfunction

A

yes

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11
Q

with delirium there is an increased risk of 6 month mortality
increased risk of depression and PTSD

A

true

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12
Q

explain the 4 steps of CAM-ICU

A
  1. acute changes or fluctuating mental state in the last 24 hours
  2. inattention- squeeze hand with each letter A
  3. current RASS level
  4. disorganized thinking
    -will a stone float on water
    -are there fish in the sea
    -does one pound equal 2 pounds
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13
Q

what is normal MAP

A

70-110mmhg

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14
Q

when should we be concerned about MAP

A

below 60 mmhg for prolonged periods of time, tissue will not get enough blood flow and organ ischemia may occur

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15
Q

equation for MAP

A

DBP+1/3 (SBP-DBP)

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16
Q

what are the main concerns if the patient has Afib

A
  1. Clotting
  2. lower BP

is pt on an anti-coagulant

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17
Q

what value do you need to look for in:
Heparin
Coumadin/warfarin

A

Heparin- PTT
Coumadin/warfarin- INR

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18
Q

what are the main complications with cardiac monitoring equipment? and when could it happen?

A
  1. infection
  2. thrombosis
    -putting the catheter in and taking it out
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19
Q

what is an indwelling catheter the provides measurement of systolic, diastolic and mean arterial pressure continuously?

Study These Flashcards
A

Arterial catheter
-allows access for arterial blood gas sampling

20
Q

What are the main pre-cautions when working with a patient who has an arterial line?

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A
  1. high pressure system- if it pulls out—> hemorrhage/bleeding
  2. transducer height- the transducer is specifically calibrated for a certain height
21
Q

If a pt has an arterial line their BP is 120/80 when lying and you dont change the transducer height and when they are sitting BP is still 120/80? is that okay?

Study These Flashcards
A

no pt is most likely hypotensive because the transducer if below the patient will measure a higher reading

22
Q

if a transducer is too low it will display a _____ BP
if a transducer is too high it will display a _____ BP

Study These Flashcards
A

too low it will display a high BP
too high it will display a low BP

23
Q

what are central venous catheters used for?

Study These Flashcards
A
  1. monitoring pressure and heart function
  2. venous access for hemodialysis, nutrition and or medication administration
24
Q

how would central venous pressure (CVP) change with dehydration?

25
how would central venous pressure change with volume overload (hypervolemia)
increased/greater CVP
26
if someone has a Central venous catheter what do you need to ask yourself?
why do they have it is it due to hemodynamic instability do i need to be seeing this patient right now
27
what are the most common complications of a Central venous catheter?
pneumothorax or dysrhythmias
28
what is a concerning pulse ox reading?
below 89%
29
what is a concerning RR
24-35
30
what is a concerning PaO2 level?
below 50% tissue begins to die
31
when is mechanical ventilation used?
when there is inadequate gas exchange type 1: paO2 low hypoxemic respiratory failure Type 2: paCO2 increase with decreased pH
32
how does a negative pressure ventilation work (iron lung)?
creates a negative pressure in the environment around the patients chest thus pt has to suck air into lungs
33
how does a positive pressure ventilation work?
application of super-atmospheric pressure to the upper airway to assist inspiration this forces air into the lungs
34
why might a mechanical ventilator alarm for higher pressure needed
mucus plug, bronchospasm (cough), condensation
35
why might a mechanical ventilator alarm for lower pressure?
machine is disconnected, tube leak, trach leak
36
why might a pt RR be high on a mechanical vent
pain, agitation, exercise
37
why might a pt RR be low on a mechanical vent
fatigue, medication
38
what lab values would you be concerned about: Patient with MI? Pt with HF? pt with respiratory failure? pt with COPD? pt with renal disease? pt with diabetes?
MI: troponin HF: BNP respiratory failure/COPF: PH, PaO2 Renal disease: creatinine diabetes: Hb-A1c- long term blood glucose- current
39
cut off for hemoglobin
> 7 with out cardiovascular disease and no signs of bleeding
40
cut off for hematocrit
>25%
41
cut off for platelets
>20,000 cells/mm3
42
white blood cells cut off
<5,000 cells/mm3 consider limiting patient to infection risk >10,000 consider active infection
43
ranges for potassium
3.5-5.3 meq/L
44
ranges for sodium
135-148 mEq/ L
45
ranges for calcium
8.5-10.5 mg/dl
46
ranges for magnesium
1.8-2.7 mg/dl
47
glucose range
>60 mg/dl but <300 mg/dl
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