Term
|
Definition
| a condition in which tissue perfusion is inadequate to deliver oxygen and nutrients to support vital organs and cellular function |
|
|
Term
| What is tissue perfusion? |
|
Definition
| Tissue perfusion is a function of cardiac output (CO) and systemic vascular resistance (SVR) |
|
|
Term
| What do cells revert to in all types of shock? |
|
Definition
| cells must revert to anaerobic metabolism |
|
|
Term
| What happens to the vital signs in COMPENSATED pre-shock? |
|
Definition
BP = near normal
HR > 100
RR > 20 breaths/min
Skin = cold and clammy
Urinary Output = Mildly decreased
Mentation = Confused
Acid-base balance = Respiratory Alkalosis |
|
|
Term
| What is the role of the nurse during pre shock? |
|
Definition
| The role of the nurse at this stage is to monitor the patient’s hemodynamic status, administer medications and fluids, and assess level of consciousness, vital signs, urinary output, skin, and laboratory values |
|
|
Term
| What happens during UNCOMPENSATED shock? |
|
Definition
| The patient loses the ability to compensate for the insult, infection, or injury |
|
|
Term
| What systems are affected first during UNCOMPENSATED shock? |
|
Definition
Heart and kidneys.
Body is unable to meet the increased O2 demands produces ischemia and myocardial depression which makes the heart stop beating/slow down.
Hypotension makes perfusion to the kidneys impossible and the urine output drops to less than 30 mL/hr |
|
|
Term
| What does shock damage to the kidneys and heart cause? |
|
Definition
-inflammatory response from the body
-coagulation cascade
-acidosis because kidneys aren't making hco3 |
|
|
Term
| How do the kidneys compensate for shock? |
|
Definition
-Release ADH to retain water
-Aldosterone release to increase renal absorption of sodium & water
-Angiotensin II is released to promote vasoconstriction |
|
|
Term
| What controls the release of aldosterone? |
|
Definition
|
|
Term
| What controls the release of renin? |
|
Definition
| decrease renal perfusion, renin releases angiotension I, then angiotension II to increase circulation volume |
|
|
Term
| What is important to note about geriatric people? |
|
Definition
Decreased renal ability to respond to changes
All compensatory mechanisms are decreased |
|
|
Term
| What shock is most common in geriatric patients? |
|
Definition
|
|
Term
| What is the medical/nursing management of shock? |
|
Definition
Continuous EKG and pulse ox monitoring
Frequent vital signs
Strict I&O
ABGs, electrolyte monitoring |
|
|
Term
| What are the goals of medical/nursing management of shock? |
|
Definition
Optimizing the intravascular volume
Supporting the pumping action of the heart
Improving the competence of the vascular system
Supporting the respiratory system
Continuous assessment and reassessment
Involving the patient and family in care |
|
|
Term
| How do you calculate MAP? |
|
Definition
MAP = 2x DBP+SBP/3
Diastolic cycle is one half the systolic |
|
|
Term
Which of the following assessment findings is congruent with the onset of the uncompensated stage of shock?
Bradycardia
Decreased urine output
Systemic edema
Nausea and vomiting |
|
Definition
B. Decreased urine output
Rationale: The systemic impact of hypotension, and thus hypoperfusion, on the kidneys results in decreased urine output. At this stage, the heart is normally attempting to increase CO by increasing HR. Edema and nausea are not typically manifestations of this stage of shock. |
|
|
Term
| What happens to the vitals in end stage organ damage? |
|
Definition
BP remains low despite interventions
Renal and liver failure occur
Anaerobic metabolism contributes to worsening lactic acidosis, and respiratory system failure prevents adequate oxygenation |
|
|
Term
| What do renal and liver failure lead to? |
|
Definition
| overwhelming metabolic acidosis and rising lactic acidosis levels. Respiratory system can’t ventilate and provide adequate oxygen despite ventilator support |
|
|
Term
| Is end stage organ damage reversible? |
|
Definition
|
|
Term
| What is the glycemic control index for critically ill patients? |
|
Definition
|
|
Term
| What happens to the vitals during shock? |
|
Definition
BP - Systolic <80-90 mmHg
RR - rapid, shallow respirations; crackles
HR - 100-150 bpm
Skin - mottled, petechiae
Output - severely decreased
Mentation - lethargic
Acid-base - Metabolic Acidosis |
|
|
Term
| What happens to the vitals during end-organ dysfunction? |
|
Definition
BP - Requires mechanical or pharmalogic support
HR - erratic or asystole
RR - requires ventilation
Skin - Jaundice
Output - Anuric, requires dialysis
Mentation - Unresponsive
Acid-Base - Profound Acidosis |
|
|
Term
|
Definition
-FLUIDS
-MEDICATIONS
-NUTRITION
-RESPIRATORY |
|
|
Term
| What kind of fluids are used in shock? |
|
Definition
| Crystalloids, colloids, and blood components |
|
|
Term
| Why are vasoactive medicines used during shock? |
|
Definition
| Used to increase myocardial contractility, regulate HR, reduce myocardial resistance, and initiate vasoconstriction |
|
|
Term
| What is important to note about vasoactive medications? |
|
Definition
-Monitor vital signs for the first 15 mins
-Central line
-Must use IV pump
-ART Line
- |
|
|
Term
| What nutrition for shock patients is important to note? |
|
Definition
| Compensates for increased metabolic rate and caloric requirements |
|
|
Term
| What is the stress ulcer prophylaxis? |
|
Definition
| antacids, H2 blockers, or PPI |
|
|
Term
| What is hypovolemic shock? |
|
Definition
| The most common type of shock that is characterized by a decreased intravascular volume. Reduction of fluid from 15-25%. |
|
|
Term
| What are the goals of treatment of hypovolemic shock? |
|
Definition
| restore intravascular volume, reverse the events leading to inadequate tissue perfusion, and correct the cause of the fluid loss |
|
|
Term
| What is the chain of hypovolemic shock? |
|
Definition
| Decreased blood volume -> decreased venous return -> decreased stroke volume -> decreased CO -> decreased perfusion |
|
|
Term
| What are the nursing priorities of hypovolemic shock? |
|
Definition
| close monitoring and administration of necessary fluids and medications |
|
|
Term
| Why do blood products need to be filtered when infusing? |
|
Definition
| PRBCs contain cellular debris and require filtration |
|
|
Term
| What type of blood do we give for someone who has a history of a transfusion reaction? |
|
Definition
| Leukocytes washed blood for patients who have had non-hemolytic reactions |
|
|
Term
| When do we give platelets? |
|
Definition
| Platelets are given to treat bleeding caused by decreased circulating platelets or functionally abnormal platelets |
|
|
Term
|
Definition
| FFP to replace a specific coagulation factor or a deficiency of the factor, to reverse warfarin |
|
|
Term
| What type of IVF should we give to replace volume in hypovolemic shock? |
|
Definition
Isotonic fluid-NS, LR
Hypertonic fluids pulls fluids out of cells into vessels |
|
|
Term
| What patient position is ideal for hypovolemic shock? |
|
Definition
|
|
Term
| What are the s/s of hypovolemic shock? |
|
Definition
-Decreased BP
-High HR/Pulse
-Decreased Output
-Dry mucus membranes |
|
|
Term
| What is cardiogenic shock? |
|
Definition
| occurs when the heart’s ability to contract and to pump blood is impaired and the supply of oxygen is inadequate for the heart and tissues |
|
|
Term
| What is the most common cause of cardiogeic shock? |
|
Definition
|
|
Term
| What are the other causes of cardiogenic shock? |
|
Definition
Severe hypoxemia
Acidosis
Cardiomyopathy
Arrhythmias |
|
|
Term
| What is the chain of cardiogenic shock? |
|
Definition
| decreased cardiac contractility -> decreased SV/CO -> decreased tissue perfusion, pulmonary congestion, and decreased coronary artery perfusion |
|
|
Term
| What are the s/s of cardiogenic shock? |
|
Definition
-Output decreased
-Skin is cold/clammy
-Mental status changes
-BP drops
-Anxiety is obvious
-Capillary refill is delayed |
|
|
Term
| What do you monitor is heart failure causes cardiogenic shock? |
|
Definition
| JVD, rales, shortness of breath, and S3 gallop |
|
|
Term
| What are the goals of treatment for cardiogenic shock? |
|
Definition
| Goals are to limit myocardial damage and to improve the cardiac function |
|
|
Term
| What labs are viewed with cardiogenic shock? |
|
Definition
| Labs BNP-ventricular dysfunction, Cardiac enzymes CK-MB every 6-8 hrs x 3, peak 12-24 hrs; Troponin more specific may rise from admit in 3 hrs. 12 lead EKG, echocardiogram. |
|
|
Term
| What is the pharmalogic therapy used to cardiogenic shock? |
|
Definition
-Oxygen
-Analgesia
-Antiplatelets
-Beta blockers
-Vasoactive medications
-Diuretics
-Antiarrythmics |
|
|
Term
| What does morphine do for chest pain? |
|
Definition
| Dilates the blood vessels, reduces the workload of the heart by both decreases the preload and after load. |
|
|
Term
| What is important to note about vasocative medication drips? |
|
Definition
Used to improve contractility, optimize preload and aferload, decrease o2 demand of heart, and stabilize the heart rate and rhythm.
Dobutamine, dopamine, and nitroglycerine |
|
|
Term
|
Definition
| Inotropic, increases strength of contraction, improve SV and therefore CO |
|
|
Term
|
Definition
Sympathomimetic, used to improve tissue perfusion
Increases myocardial oxygen demond |
|
|
Term
|
Definition
Venous vasodilator, reduces preload
Higher doses = arterial vasodilation, decrease afterload |
|
|
Term
| What is distributive shock? |
|
Definition
Occurs when the body’s ability to adjust vascular tone is impaired, and thus blood volume is abnormally displaced in the vasculature
Blood pools in the peripheral blood vessels which causes relative hypotension. Which leads to inadequate tissue perfusion |
|
|
Term
| What are the 3 categories of distributive shock? |
|
Definition
Septic shock
Neurogenic shock
Anaphylactic shock |
|
|
Term
|
Definition
| Sepsis is a Medical Emergency that is caused by an overwhelming immune response of the body to infection. |
|
|
Term
| What does a septic reaction cause? |
|
Definition
| trigger wide-spread profound inflammation which leads to blood clotting and leaky vessels. |
|
|
Term
| What are the 4 stages of Sepsis? |
|
Definition
SIRS : defined by 2 or more of the following criteria
SEPSIS : SIRS plus present or suspected infection
SEVERE SEPSIS : Sepsis plus one other criteria
SEPTIC SHOCK : Severe Sepsis that fails to respond to fluid resuscitation –(40ml/kg) |
|
|
Term
|
Definition
2 or more of:
Heart rate > 90 beats per minute
Temperature < 96.8ºF (36º C) or
> 1oo.4º F (38.3º C)
Respiratory rate > 20 breaths per minute
White blood cell count > 12,000/mm3 or
< 4000 mm
OR normal WBC with 10 or more bands |
|
|
Term
| What are the symptoms of sepsis? |
|
Definition
Altered mental status
Hyperglycemia (>140mg/dl with no hx diabetes)
Mottled skin, delayed capillary refill
Tachypnea
Lactate > 1 |
|
|
Term
| What are the symptoms of severe sepsis? |
|
Definition
Acute oliguria for two hours (<0.5 ml/kg per hour) despite fluid resuscitation
Organ dysfunction (serum lactate > 4)
Hypo-perfusion (MAP < 65 mmHg, acute oliguria, increase in creatinine)
Platelets count < 100,000
Hypotension SBP < 90mm/hg or > 40mm drop below baseline BP |
|
|
Term
| What does lactate measure? |
|
Definition
hypoperfusion and hypoxia
Byproduct of anaerobic metabolism |
|
|
Term
|
Definition
severe sepsis that fails to respond to fluid resuscitation –(40ml/kg)
Acute Lung Injury with PaO2/FiO2 ratio<250 in absence of pneumonia or <200 in presence of pneumonia
New elevation bilirubin >2.0, Creatinine > 2.0
New Platelet Count <100,000
Unexplained PT (INR)> 1.5 |
|
|
Term
| What labs could possibly be indicative of sepsis? |
|
Definition
WBC’s >12,000 or < 4000 OR WBC count normal with >10% bands
Lactic acid > 4.0mMol/L
Platelets < 100,000
INR > 1.5 , PTT > 60 secs.
Procalcitonin > 0.075ng/ml
Creatinine > 2mg/dl
Bilirubin > 4mg/dl
Glucose ≥ 180mg/dl in non-diabetic |
|
|
Term
| What is the treatment of sepsis? |
|
Definition
-FLUID AND ANTIBIOTICS
Assess for adequacy/patency of airway, apply oxygen if needed
IV Access – 2 peripheral IV’s (20 or 18g.) at minimum OR intraosseous (IO) access
IV Fluids – Initial fluid resuscitation should be with crystalloid IVF (NS, LR, etc). Begin with 500ml over 20-30 minutes.
VASOPRESSORS – Norepinephrine, Epinephrine, Vasopressin
LABS – Blood Cultures x 2 PRIOR to antibiotics within 1 hour of sepsis diagnosis, Lactate level
BROAD – SPECTRUM Antibiotics |
|
|
Term
Which of the following actions should a nurse perform in order to reduce the acutely ill patient’s risks of developing septic shock?
Provide prophylactic antibiotics whenever possible
Limit the number of caregivers who participate in a patient’s care
Avoid the use of hypertonic IV solutions
Maintain asepsis when performing invasive procedures |
|
Definition
D. Maintain asepsis when performing invasive procedures
Rationale: Nurses caring for patients in any setting must keep in mind the risks of sepsis and the high mortality rate associated with sepsis. All invasive procedures must be carried out with aseptic technique after careful hand hygiene. Hypertonic solutions do not pose a risk of sepsis. Prophylactic antibiotics are not indicated for most patients, and it is unnecessary to limit the number of caregivers. |
|
|
Term
| What is neurogenic shock? |
|
Definition
Vasodilation occurs as a result of a loss of balance between parasympathetic and sympathetic stimulation
Due to spinal cord injury, spinal anesthesia or nervous system damage. |
|
|
Term
| What does nursing care emphasize with neurogenic shock? |
|
Definition
| the consequences of spinal cord injury (if present), in addition to responsibilities related to shock |
|
|
Term
| What are the symptoms of neurogenic shock? |
|
Definition
Hypotension (due to massive vasodilation)
Bradycardia (due to overwhelming parasympathetic stimulation
Poikilothermia (unable to regulate temperature)
Warm, dry extremities |
|
|
Term
| What is the pharmalogic support for neurogenic shock? |
|
Definition
| Phenylephrine (neosynephrine) for BP |
|
|
Term
| How else is neurogenic shock treated? |
|
Definition
Airway support
Fluids as needed |
|
|
Term
| What is anaphylactic shock? |
|
Definition
| Caused when the patient develops a systemic antigen– antibody reaction to foods, bee stings, or medications |
|
|
Term
| What are the drugs for anaphylaxis? |
|
Definition
| epinephrine, antihistamines, and bronchodilators are necessary after eliminating the causative factor |
|
|
Term
| What is obstructive shock? |
|
Definition
Caused by a physical obstruction to blood flow, either in the heart or major blood vessels
Common causes include cardiac tamponade, tension pneumothorax, and pulmonary embolism (PE) |
|
|
Term
| What does treatment focus on for obstructive? |
|
Definition
| Relieving the obstruction |
|
|
Term
| What are the s/s of cardiac tamponade? |
|
Definition
Narrowing pulse pressure
Chest pain
Distant/muffled heart sounds
Jugular vein distention
Hypotension
Tachycardia |
|
|
Term
| How is cardiac tamponade treated? |
|
Definition
|
|
Term
| What are the s/s of a tension pneumothorax? |
|
Definition
Jugular vein distention
Crepitus
Dyspnea
Chest pain
Tachycardia
Tachypnea
Tracheal shift |
|
|
Term
| How is a tension pneumothorax treated? |
|
Definition
Chest tube
Needle decompression |
|
|
Term
| What are the s/s of a PE? |
|
Definition
Pleuritic chest pain
SOB
Tachypnea
Hypoxia
Anxiety |
|
|
Term
|
Definition
Thrombolytic drug
Surgical embolectomy
Prevent clot expansion |
|
|
Term
|
Definition
Multiple Organ Dysfunction Syndrome (MODS)
Altered organ function in acutely ill patients that requires medical intervention to support continued organ function |
|
|
Term
|
Definition
| severe organ dysfunction of at least two organ systems lasting at least 24 to 48 hours in the setting of sepsis, trauma, burns, or severe inflammatory conditions |
|
|
Term
| What is treatment of MODS aimed at? |
|
Definition
| aimed at controlling the initiating event, promoting adequate organ perfusion, and providing nutritional support |
|
|
Term
| What is the most common manifestation of MODS? |
|
Definition
| acute renal failure and acute respiratory distress syndrome (ARDS) |
|
|
Term
| What are the early warning signs of MODS? |
|
Definition
| early change in mentation and gradual risk in temperature in elderly |
|
|
Term
Is the following statement true or false?
Vigilant monitoring in a high-acuity care setting allows the care team to accurately predict patients who are likely to develop MODS. |
|
Definition
False
Rationale: It is not possible to predict which patients will develop MODS, partly because much of the organ damage occurs at the cellular level and therefore cannot be directly observed or measured |
|
|
Term
| What happens in abdominal compartment syndrome? |
|
Definition
| fluid leaks into the intra-abdominal cavity, increasing pressure that is displaced onto surrounding vessels and organs. Venous return, preload, and c.o. are compromised. The pressure elevates the diaphragm, making it difficult to breathe effectively. Results in decreased output/ absent bowel sounds/ intolerance of tube feeding |
|
|
Term
| What do CVP lines measure? |
|
Definition
| The amount of fluid returning to the heart at the level of the right atrium |
|
|
Term
| What do PAC lines measure? |
|
Definition
| Blood volume status, blood flow, and tissue oxygenation |
|
|
Term
| What causes respiratory failure? |
|
Definition
-Anemia
-Hemorrhage
-Intracardiac shunts
-ARDS
-Airway obstruction
-Weakness of breathing
-Muscular weakness
-Lung disease
-Chest wall abnormalities |
|
|
Term
| When is intubation and mechanical ventilation needed? |
|
Definition
| -Protection of the airway during neurological stuff, acute intoxication, during sedation for testing
-Airway clearance for those unable to manage it
- |
|
|
Term
|
Definition
| Used to keep alveoli open during exhalation and to allow more time for gas exchange and to decrease functional residual capacity |
|
|
Term
| What is usually the first sign of shock? |
|
Definition
|
|
Term
| What can also cause acidosis? |
|
Definition
| Release of cellular mediators |
|
|
Term
| Why are beta blockers a problem in geriatric shock? |
|
Definition
| Masks the s/s of tachycardia |
|
|
Term
| Do elder people have a greater risk for septic shock? |
|
Definition
| No, same as everyone else |
|
|
Term
| What do you give for fluid replacement in hypovolemic shock? |
|
Definition
-Crystalloids
-Colloids
-Blood Components |
|
|
Term
|
Definition
| -Everything is third spacing and you want to get the fluids back into the vessels and out of it. |
|
|
Term
| What population is more likely to expiernece cardiogenic shock? |
|
Definition
|
|
Term
| What causes symptoms in Sepsis? |
|
Definition
Symptoms are not caused by the germ (microorganism) itself,
but by the body’s response to fight the germ !!! |
|
|
Term
| What does lactate measure? |
|
Definition
|
|
Term
| What is a critical lactate? |
|
Definition
|
|
Term
| Neurogenic causes what in HR? |
|
Definition
Bradycardia - PARASYMPATHETIC
Hypotension |
|
|
Term
| What level of injury is associated with neurogenic? |
|
Definition
|
|
Term
| Is there a lot of skin care associated with neurogenic shock? |
|
Definition
|
|
Term
| What do we give for anaphylaxis? |
|
Definition
-Pepcid
-Albuterol
-Epinephrine
-Benadryl
-Steroids |
|
|
Term
| Where does the trachea go in a tension pneumothorax? |
|
Definition
|
|
Term
| How many systems are affected in mods? |
|
Definition
|
|
Term
| What is usually affected in MODS? |
|
Definition
|
|
Term
| What are the Neurological Issues in Critical Care? |
|
Definition
risk for altered LOC, regardless of diagnosis
Delirium
Pain
Anxiety
Dependency and
withdrawal
Depression
Communication |
|
|
Term
| What is the minimum level of access for the ICU patient? What's it used for? |
|
Definition
Peripheral IV access
Emergency access
Fluids, medications |
|
|
Term
| What are the preferred method of vascular access? What are they used for? |
|
Definition
Central IV
Vasoactive and vasopressor medications
Total parenteral nutrition |
|
|
Term
| What do PA and Arterial lines measure? |
|
Definition
| monitor perfusion and cardiac status |
|
|
Term
|
Definition
Normal 2-8 mmHg
Fluid replacement goal is 8-12 |
|
|
Term
|
Definition
| Central Line-Associated Blood Stream Infections |
|
|
Term
| What do you do if there is CLABSI? |
|
Definition
Use subclavian site unless medically contraindicated
If jugular vein is chosen, use the right side to reduce the risk of noninfectious complications |
|
|
Term
|
Definition
A peripheral IV in the arterial system used for frequent blood pressure monitoring
Continuous BP monitoring
Titration of vasoactive medications |
|
|
Term
|
Definition
Pulmonary artery catheter (PAC): Facilitates the evaluation of:
blood volume
blood flow
tissue oxygenation
PA cath measures blood volume, how the heart is pumping and how the vasculature responds and tissue oxygenation or perfusion |
|
|
Term
Which of the following aspects of an acutely ill patient’s care would necessitate the insertion of a central venous catheter?
The patient has recently been transferred to the ICU from a medical unit.
The patient is expected to require IV antibiotics.
The patient will likely need to receive parenteral nutrition.
The patient’s family has not agreed on his “code status.” |
|
Definition
C. The patient will likely need to receive parenteral nutrition.
Rationale: Parenteral nutrition usually necessitates the insertion of a central line. Uncertainty about code status, the use of IV antibiotics, and recent admission do not necessarily require that the patient have a central line inserted. |
|
|
Term
| What are the vasoactive medicines? |
|
Definition
Amiodarone
Dopamine
Dobutamine
Epinephrine
Norepinephrine
Nitroglycerine
Nitroprusside |
|
|
Term
| What are the Devices to Assist With Cardiac Function? |
|
Definition
Pacemakers
External
Transvenous
Permanent/internal
Intra-aortic balloon pump (IABP)
Ventricular assist device (VAD) |
|
|
Term
|
Definition
| Continuous positive airway pressure (CPAP): Delivers air under pressure to keep the airway and alveoli open |
|
|
Term
|
Definition
| Bi-level positive airway pressure (BiPAP): Pressure varies between inhalation and exhalation |
|
|
Term
| What does the use of positive pressure ventilation increase? |
|
Definition
| intrathoracic pressure and causes a decrease in preload |
|
|
Term
| What is the difference between CPAP and BiPAP? |
|
Definition
CPAP delivers a constant pressure to keep airway and alveoli open
Sleep apnea
Exacerbation of asthma and COPD
BiPAP has the ability to provide two levels of pressure
Inspiratory pressure
Exhalation pressure |
|
|
Term
| What is Volume-cycled ventilators? |
|
Definition
The most commonly used ventilators:
Volume of air delivered with each inspiration is preset |
|
|
Term
| What is Pressure-cycled ventilators? |
|
Definition
Deliver a flow of air (inspiration) until it reaches a preset pressure
Settings include:
Rate
Fraction of inspired air (FIO2)
Tidal volume
Positive end expiratory pressure (PEEP) |
|
|
Term
To evaluate the both oxygenation and ventilation in a patient with acute respiratory failure, the nurse uses which of the following?
ABGs
Hemodynamic monitoring
CXR
Pulse oximetry |
|
Definition
ABG
Rationale: ABG analysis is useful because it provides information about both oxygenation and ventilation and assists with determining possible etiologies and appropriate treatment. The other tests may also provide useful information about patient status but will not indicate whether the patient has hypoxemia, hypercapnia, or both. |
|
|
Term
| What is the Nursing Management of the Ventilated Patient? |
|
Definition
Frequent, comprehensive assessment of the patient
Assessment of the ventilator equipment
Promoting effective airway clearance
Promoting mobility
Promoting coping
Promoting communication
Participating in weaning the patient from the ventilator
Ventilator associated pneumonia (VAP) prevention |
|
|
Term
| What are the nursing interventions for the ventilated patient? |
|
Definition
Elevation of the head of the bed 30-45 degress
Maintaining cuff pressure in the endotracheal tube between 20-25 mmHg
Providing oral care with chlorhexidine and water-soluble mouth moisturizer
Secretion removal with specially designed endotracheal tubes with subglottic secretion removal
Sedation reduction, daily cessation followed by
Assessment of weaning readiness with brief weaning trials
Stress ulcer disease prophylaxis
Deep vein thrombosis prophylaxis |
|
|
Term
| What are the Potential Complications of Ventilation? |
|
Definition
Ventilator-associated pneumonia (VAP)
Increased intracranial pressure
Altered mental status
Decreased cardiac output
Hypervolemia
Venous thromboembolism
Barotrauma
Pneumothorax
Gastrointestinal bleeding |
|
|
Term
Is the following statement true or false?
The tidal volume that is set for a patient who is ventilated determines the quantity of air that the patient will receive during each cycle of the ventilator. |
|
Definition
True
Rationale: The tidal volume (Tv) is the amount of air given in each breath. This is usually between 5 and 7 mL of air per kilogram of body weight. |
|
|
Term
|
Definition
|
|
Term
|
Definition
Due to lung inflammation which results in lung injury-Acute Lung Injury (ALI)
Causes:
Sepsis, trauma, pancreatitis, blood transfusion, shock |
|
|
Term
| What happens during ARDS? |
|
Definition
Increase in alveolar capillary permeability, causes damage to alveolar wall
Diffuse “white out” on chest xray due to fluid in alveolar spaces |
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Term
| How do we prevent CLABSI? |
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Definition
-Hand hygiene
-Chlorehexidine for skin prep
-Use full-barrier precautions during central line insertion
-Avoid using the femoral vein for catheters in adults
-Remove unnecessary catheters |
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Term
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Definition
| Used to decrease the HR in vtach/afib |
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Term
| What happens with inflammation in ARDS? |
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Definition
| Inflammation causes vasodilation, capillary permeability and clotting. Edema includes inflammatory debris, dead cells, protein. Clotting – micro-clotting causes decrease in perfusion. ARDS occurs in phases over a period of time |
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Term
| What are the long term effects of ARDS? |
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Definition
| lung destruction, hyaline membrane = scar tissue in lung |
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Term
In order to reduce a patient’s risk of developing ventilator-associated pneumonia (VAP), the nurse should:
Administer bronchodilators as ordered
Perform frequent, thorough mouth care
Reposition the patient every 2 hours
Turn off the ventilator for at least 4 hours in each 24-hour period |
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Definition
B. Perform frequent, thorough mouth care
Rationale: To prevent VAP, mouth care should be given at least every 4 hours in order to maintain mucosal integrity and prevent pooling of secretions. Frequent mobility is important but does not necessarily prevent VAP. Bronchodilators do not significantly reduce the patient’s risk of this complication, and the ventilator is never turned off in order to prevent VAP. |
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Term
While caring for a patient who has been admitted with a pulmonary embolism, the nurse notes a change in the patient's arterial oxyhemoglobin saturation (SpO2) from 94% to 88%. The nurse will
a. assist the patient to cough and deep-breathe.
b. help the patient to sit in a more upright position.
c. suction the patient's oropharynx.
d. increase the oxygen flow rate. |
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Definition
d. increase the oxygen flow rate.
Rationale: Increasing oxygen flow rate will usually improve oxygen saturation in patients with ventilation-perfusion mismatch, as occurs with pulmonary embolism. Because the problem is with perfusion, actions that improve ventilation, such as deep-breathing and coughing, sitting upright, and suctioning, are not likely to improve oxygenation. |
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Definition
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Definition
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Term
| Why do people get tube feedings? |
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Definition
Nutritional support
Aspiration risk |
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Term
Is the following statement true or false?
Hypovolemia is the most common cause of nosocomial urinary tract infections. |
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Definition
False
Rationale: Prolonged use of indwelling urinary catheters is implicated in most cases of nosocomial UTIs. |
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Term
| What are the musculoskeletal issues of ICU? |
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Definition
| ICU-acquired weakness- The inability of a patient to move against resistance: |
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Term
| What can cause ice-acquired weakness? |
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Definition
Contractures
Nitrogen wasting: Related to a protein deficit
Bone demineralization
Patient’s risk of falls must also be addressed |
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Term
| What are the Psychosocial Issues of ICU? |
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Definition
Entry into an ICU is stressful for patients and their friends and families
Fear, anxiety, and grieving must be addressed
Sleep disturbances exacerbate patients’ psychosocial issues
End-of-life issues must be addressed in a direct and empathic manner |
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Term
A patient with hypercapnic respiratory failure has a respiratory rate of 8 and an SpO2 of 89%. The patient is increasingly lethargic. Which collaborative intervention will the nurse anticipate?
a. Administration of 100% oxygen by non-rebreather mask
b. Endotracheal intubation and positive pressure ventilation
c. Insertion of a mini-tracheostomy with frequent suctioning
d. Initiation of bilevel positive pressure ventilation (BiPAP) |
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Definition
b. Endotracheal intubation and positive pressure ventilation
Rationale: The patient's lethargy, low respiratory rate, and SpO2 indicate the need for mechanical ventilation with ventilator-controlled respiratory rate. Administration of high flow oxygen will not be helpful because the patient's respiratory rate is so low. Insertion of a mini-tracheostomy will facilitate removal of secretions, but it will not improve the patient's respiratory rate or oxygenation. BiPAP requires that the patient initiate an adequate respiratory rate to allow adequate gas exchange. |
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Term
All the following medications are ordered for a mechanically ventilated patient with acute respiratory distress syndrome (ARDS) and acute renal failure. Which medication should the nurse discuss with the health care provider before administration?
a. IV ranitidine (Zantac) 50 mg IV
b. sucralfate (Carafate) 1 g per nasogastric tube
c. IV gentamicin (Garamycin) 60 mg
d. IV methylprednisolone (Solu-Medrol) 40 mg |
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Definition
c. IV gentamicin (Garamycin) 60 mg
Rationale: Gentamicin, which is one of the aminoglycoside antibiotics, is potentially nephrotoxic, and the nurse should clarify the drug and dosage with the health care provider before administration. The other medications are appropriate for the patient with ARDS. |
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Term
Which of these nursing actions included in the care of a mechanically ventilated patient with acute respiratory distress syndrome (ARDS) is most appropriate for the RN to delegate to an experienced LPN/LVN working in the intensive care unit?
a. Placing the patient in the prone position
b. Assessment of patient breath sounds
c. Administration of enteral tube feedings
d. Obtaining the pulmonary artery pressures |
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Definition
c. Administration of enteral tube feedings
Rationale: Administration of tube feedings is included in LPN/LVN education and scope of practice and can be safely delegated to an LPN/LVN who is experienced in caring for critically ill patients. Placing a patient who is on a ventilator in the prone position requires multiple staff and should be supervised by an RN. Assessment of breath sounds and obtaining pulmonary artery pressures require advanced assessment skills and should be done by the RN caring for a critically ill patient. |
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Term
| What is dobutamine's main effect? |
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Definition
| Increasing contractility of the heart and increasing blood pressure for CHF and low cardiac output |
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Term
| What is dopamine's main effect? |
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Definition
| Increased HR and BP in bradycardia and hypotension |
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Term
| What is Nitroglycerin's vs. Nitroprusside main effect? |
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Definition
| Nitrog and Nitrop both vasodilator but nitrog also vasodilates coronary arteries and nitrop is strictly systemic |
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Term
| What is Norepinephrine and Vasopressin's main effect? |
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Definition
| Both increased blood pressure in cardiac arrest, hypotension, DI, GI bleed and septic shock |
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