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MED SURGIC nu2530 CRITICAL CARE EXAM 1, 2, 3.
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MED SURGIC nu2530 CRITICAL CARE EXAM 1, 2, 3.
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CRITICAL CARE EXAM 1, 2, 3.CRITICAL CARE EXAM 1
REVIEW
1. End of life care – Critically ill and ethical issues- Respect DNR
a. Living wills
b. Health care surrogate
c. Communication
2. Advanced directives
3. Communication
4. Environmental factors
a. Noise reduction - reduce the alarms.
5. Therapeutic response to family - keep informed, know who is in charged w/family
6. Communication in critically ill - inform them on what is going on
7. What to watch for in critical pt with opiates - antidote is narcan - watch
respirations, hypotension, apnea, bradycardia, restlessness and nausea
8. Ventilator weaning process - spontaneous breathing trial (pg215 table 9.5) before
extubating Assess pt discomfort - signs and symptoms pg 214
a. What would be the appropriate method to wean someone?
i. Not going to have someone on PEEP or high oxygen
ii. spontaneous breathing trial (pg215 table 9.5) before extubating
9. Handoff report to other nurses - SBAR - situations, background, assessment
and recommendations
10. Which pt would you select for priority intervention - ABC's and Maslow’s
11. Paradoxical means not equal or opposite of chest rise – can see this in COPD pts.
12. Cagnography & hypercapnia both relates to CO2 - end of ETT to check for placement,
not the best option, checks for high or low co2 after exhaling
13. Angiogram and pt is agitated you need to sedate, if invasive you need a consent
1. Any kind of scan (CT Scan, angiogram) and patient is anxious: patient needs
to remain sedated
, CRITICAL CARE EXAM 1, 2, 3.
14. Risk factors for ARDS - trauma, sepsis, gastric aspiration content, pneumonia,
15. ARDS and chest x-rays - bilateral infiltrates (white-out) , it is positive for ARDS, "ground
glass appearance"
a. Bilateral infiltration
b. White out on xray
c. “Ground glass”
16. Ards - they will be on antibiotics and steroids (increases sugar and oral thrush), look for
hyperglycemia or infections.
1. Someone with ARDS will be on (hypovolemia=fluids/sepsis=antibiotics)
a. Antibiotics
b. Steroids (hyperglycemia)
c. Thrush (candidiasis)
They will be on antibiotics and steroids (increases sugar and oral thrush), look for hyperglycemia
or infections.
17. Trying to decrease Vap (pg422,box 14-4 & 14-5)- elevated head greater then 45,
hand hygiene, …….
1. Oral care for decreased chances of VAP (Ventilatory acquired pneumonia)
Trying to decrease Vap (pg422,box 14-4 & 14-5)- elevated head greater then 45, hand hygiene
18. Lab values - understand factors of O2 stats - know what it is and what it means pg 404 -
depends on pt and condition. O2 stats is the measurement of oxygen on the hemoglobin.
1. Understand the factors of O2 Saturation; 92% is normal for a COPD patient, but
not normal for a healthy adult
19. Rank in order of priority - optimizing oxygen delivery to patient - pain is low, then is
not priority. if pain in high then it is a priority
20. Copd -(barrel chest, purse lip breathing, large ap diameter, tripod position)
greatest risk for developing respiratory failure, why? Increase ap diameter is bigger risk,
1. COPD patients have Barrel chest, AP diameter
, CRITICAL CARE EXAM 1, 2, 3.
Think about what would be the biggest risk factor that this patient would go into respiratory
failure
Copd -(barrel chest, purse lip breathing, large ap diameter, tripod position)
greatest risk for developing respiratory failure, why? Increase ap diameter is bigger risk,
21. Ace inhibitors - end in pril - causes cough
Beta - lol - don’t give to asthma pt
22. Best method of communication to pt with other language - get translator
23. Ards - barotrauma (high pressure in lungs) and PiP(also known as plateau pressure) - keep
pip under 40 & 30(plat)
24. Tidal volume is regulated by two pressure in a ventilator - pip and plateau pressure. If
they are high and then tidal volume will be high and will have barotrauma.
1. ARDS/barotrauma/PEEP(PIP)---Plateau pressure definition
25. Most important to report to dr with pt that has VAP - pg420. - fever, WBC count and
purulent sections
1. What is most important to report to the HCP?
a. About a patient who has VAP
26. Albuterol - SABA for asthma - increases bp, tachycardia, jitteriness
1. Albuterol is used for asthma
a. Side effects are tachycardia and increased BP
27. Healthcare team involved with pt in ventilator - needs range of motion so should have PT
28. Vena Cava filters - invasive so you have to have consent
29. Factors for dvt and pe - immobilization, birth control, sedentary life, advanced age, altered
coagulating of blood.
1. You have a HC team when someone is intubated and the patient is immobile,
important part of the team is physical therapy
1. risk factors DVT and PE
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