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PHTH 564 > ICU Assessment > Flashcards

ICU Assessment Flashcards

1
Q

Name 4 critical care areas

A
  • Intensive care units
  • step down/high acuity/intermediate unit
  • Operating rooms
  • Recovery rooms
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2
Q

Critical care areas have the highest _____

A

staff to patient ratio

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3
Q

What are the two more typical patient populations found in the critical care units

A
  • Respiratory failure requiring mechanical ventilation

- Cardiovascular instability requiring invasive hemodynamic monitoring

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4
Q

3 sources of information for ICU patients

A

Charts
Monitors
Nurses

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5
Q

4 questions you consider when first assessing a patient

A
  • What brought them in
  • Do they have any mobility orders or ROM restrictions?
  • What is their current status
  • What is the plan for today for them? (i.e. tests, ventilator weaning, OR, dressing changes, etc.)
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6
Q

What is a peripheral intravenous line? where is it inserted? how does it work?

A
  • Inserted into a peripheral vein
  • Enables administration of fluids and meds
  • is gravity driven or on a pump
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7
Q

What is a PICC line? Purpose? Where does it insert?

A
  • Peripherally inserted central catheter
  • To give medications that will corrode peripheral veins and require mixing with larger blood volumes quickly such as chemotherapy or antibiotics
  • Can also use to take blood samples
  • Inserted in peripheral vein but travels all the way into superior vena cava so that it can mix with more blood
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8
Q

Why do you need to assess Level of consciousness

A

Need to know how much can this patient participate in treatment vs how much will be passive

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9
Q

What are 2 commonly used sedation scales

A
  • Richmond agitation sedation scale (RASS)

- Glasgow coma scale

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10
Q

Scoring on the RASS

A

Grading -5 to +4.
0 is normal (alert and calm)
+4 is combative violent danger - calling security and police
-5 is unarousable, no response to voice of physical stim

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11
Q

What is a useful tool for assessing pain in ICU patients

A

Behavioural pain scale S

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12
Q

Scoring of the behavioural pain scale?

A

3-12

12 = most pain

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13
Q

What is normal ICP?

A

5-10mmHg

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14
Q

What ICP will lead to brain damage

A

> 20mmHg for over 5 minutes

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15
Q

What is the purpose of an extraventricular drain?

A

To monitor and drain ICP as needed

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16
Q

What are important considerations when working with a patient with a extraventricular drain

A
  • Always check physicians orders regarding target ICP and ability to change patients position or do chest physiotherapy
  • Activity Will be pretty limited especially if stopcock is open, if we change position and in turn change how gravity is working with these drains we can get into trouble
  • always make sure stopcock is closed before any position changes
  • Increased BP will increase ICP - be careful what you do
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17
Q

What are 3 things you need to know when assessing spinal stability

A
  • ASIA
  • If injury is stable or not, especially if it is getting worse
  • Orders around collar and braces
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18
Q

What is very important to screen for when assessment cognition and behaviour? Why?

A

Delirium

The earlier we can catch it the better, has effect of morbidity and mortality

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19
Q

70-80% of patients have some _____ at discharge from ICU

A

Cognitive deficit

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20
Q

What are some examples of cognitive deficit faced by people upon discharge from ICU

A
  • Attention, concentration & memory
  • Depression
  • High level functioning
  • ordering
  • Impaired judgement
  • Decreased awareness
  • Apraxia
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21
Q

How do you assess Patients emotional and behavioural changes

A

Ask friend or family is they are different from before the event

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22
Q

What is different in an IPPA of a ventilated patient

A
  • Inspection: Should include the position/stability or airway and ventilator settings
  • Palpation - Passive ventilation will follow path of least resistance and preferentially ventilate upper areas
  • Auscultation - On a ventilator all breath sounds will be significantly louder
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23
Q

Why do you inspect and palpate the chest and abdomen

A

Because these will both affect diaphragm function, ability to cough and clear, ability to get air in.

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24
Q

How are secretion measurements done in ICU

A

Amount: 1,2,3 (small, med, large)
Description: Mucoid (M), Mucopurulent (MP), purulent (P), Bloody (B)

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25
Q

What are

  • Mucoid (M)
  • Mucopurulent (MP)
  • purulent (P)
  • Bloody (B)
A
  • Mucoid: clear salivary
  • Mucopurulent: Clear mixed with gross green stuff
  • purulent: gross green stuff
  • Bloody - blood
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26
Q

How is CO2 monitored in ICU

A

End tidal COW using monitoring device in vent tubing - dont need to draw blood for ABGs

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27
Q

What is normal CO2

A

Same as PaCO2 in ABGs: 35-45 mmHG

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28
Q

What happens to the CO2 monitor when you mobilize a patient

A

Can disconnect it

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29
Q

What does increasing PaCO2 when doing activity indicate

A

yOu are working them too hard

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30
Q

What is the P/F ratio

A

FiO2 ratio - The ratio of arterial oxygen partial pressure to fractional inspire oxygen = PaO2/FiO2

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31
Q

What is normal P/F ratio

A

> 380
Because PaO2 80/0.21
Room air oxygen is 21%

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32
Q

What is an arterial line? It’s purpose? Where is it inserted?

A

Indwelling catheter

  • Constantly monitors arterial BP (SBP, DBP, MAP) on bedside monitor
  • Access for direct blood sampling for painless and frequent analysis of ABGs
  • inserted radially and femorally in adults, can also be inserted in axillary and pedal arteries
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33
Q

Can a patient mobilize with an arterial line?

A

Yes

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34
Q

When mobilizing with an arterial line what comes with you and what stays at bedside

A
  • Arterial line itselt
  • transducer
  • pressure bag

Left at bedside: monitor

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35
Q

Arterial line PT Considerations?

A
  • Measure is not always accurate
  • For line to give accurate readings the transducer needs to be at the level of the superior vena cave (4th intercostal space)
  • Interference will occur from changes in joint position and resulting compression of line
  • Avoid excessive wrist motion or hip flexion
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36
Q

How can you tell if the arterial line is working

A
  • A clear waveform on the bedside monitor

- Can also check with a cuff pressure measurement

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37
Q

What is considered normal adult BP

A

100-140/50-90

38
Q

What BP would you not mobilize a Pt

A

Higher than 200/100

lower than 90/60

39
Q

Is a raise in blood pressure or a drop in blood pressure more of a concern

A

Drop - O2 will not be reaching vital organs

There is no evidence showing that when patients get hypertensive they are at increased risk of cardiac arrest

40
Q

A sudden drop or rise in BP of ____ is cause for concern

A

> 20mmHg

41
Q

What is Mean arterial Pressure, include equation

A

Average of SBP and DBP

MAP = SBP +(2*DBP)/3

42
Q

What is normal MAP

A

70-110 mmHg

43
Q

A MAP >60 is necessary to perfuse coronary arteries, brain, kidneys

A

60mmHg

44
Q

Normal HR

A

60-110

45
Q

What may cause an increase in HR

A
  • Stress
  • Fever
  • pain
46
Q

What will cause a decrease in HR

A

sleep or vagal stimulation

47
Q

Why do we care about heart arythmias?

A

Lets us know how heart is functioning - if it is not pumping effectively we are not getting oxygen to the tissues that require it. On extreme end you can end up in cardiac arrest if you are not getting blood to the coronary arterie

48
Q

What are 4 arythmias to watch

A
  1. Pre-ventricular contractions
  2. A-fib
  3. Ventricular-Fib
  4. Ventricular tachycardia
49
Q

How do pre-ventricular contractions appear on an ECG

A

Dropping beats

50
Q

How does A-Fib appear on an ECG

A

many fibrillations between QRSs

51
Q

What is tachycardia? What do you need to consider?

A

> 110 BPM - need to consider Pts max HR based on age and see if they will have a limited cardiovascular reserve

52
Q

What is bradycardia

A

<60 BPM

Can they increase the HR enough to pump better and faster if they need to

53
Q

S&S of ventricular fibrillation

A
  • Unresponsive
  • ineffective pulse
  • No spontaneous respirations
  • Cyanosis
  • Duskiness, mottled skin
    Don’t nee d to look at ECG monitor to realize this is going on
54
Q

What occurs at heart during ventricular fibrillations

A

Heart is only quivering due to the rapid multiple electrical discharges in the myocardium

55
Q

What is a central venous line?
Where is it inserted?
Purpose?

A
  • A pressurized bag and transducer are connected to the indwelling catheter allowing for measurement of central venous pressure.
  • Inserted through the subclavian or internal jugular vein int the superior vena cava or through the femoral vein into the common iliac vein
  • has multiple lumens to permit the administration of meds that will corrode peripheral veins and require mixing with larger blood volumes, nutrition, and conduct volume and hemodynamic monitoring (central venous pressure)
56
Q

Considerations for central venous lines

A

Transducer must be level with right atrium to get accurate reading

57
Q

What does central venous pressure tell you

A

Provides info about cardiac function (right heart function - how well heart is pushing blood out) and the adequacy of circulating vascular volume

58
Q

Normal central venous pressure value

A

2-7 if self ventilating

6-12 mmHg on a ventilator as PEEP affects pressure in thorax

59
Q

What can cause a low CVP?

A
  • Increased HR and decrease BP = decreaded volume in circulation
  • Sepsis or shock
  • Hemorrhage
  • Peripheral vasodilation/venous pooling
  • Decreased venous return - often positional
60
Q

What can cause a high CVP

A
  • Increased BP and decrease HR = increase pressure in vasculature
  • Ex: Hypervelemia, PE, inotropes
    OR
  • Decreased HR and decreased BP = poor myocardial function, decreased cardiac output
61
Q

Why do we care about CVP?

A
  • Helps us to assess if fluid in lungs is secretions of pulmonary edema
  • Helps us make decisions about how cardiovascularly stable a patient is, how much we can do with them
62
Q

What is a pulmonary arterial line? Where does it enter? What is its course?

A

Balloon tipped catheter used on very sick patients
- Enters subclavia, internal jugular, femoral or brachial veins then threaded via the vena cava into right atrium, into the pulmonary artery, and possibly a pulmonary capillary where it sits and monitors

63
Q

What is the purpose of a pulmonary arterial line

A
  • Allow sampling of mixed venous blod to calculate a-v O2 difference
  • Monitor pulmonary arterial pressure, pulmonary capillary wedge pressure, and right atrial pressure
  • Allows a measurement of cardiac output
64
Q

Pulmonary arterial line concerns

A
  • Very easily dislodged from correct position, usually only insitu with very cardiovascularly unstable patients and has ability to cause serious damage so usually no physiotherapy intervention when it is in place
65
Q

What do you do if a line is pulled ou

A

Notify others
Elevate + put pressure on it
Wait for someone to reinsert

66
Q

What are some ICU conditions that can cause chest pain/discomfort?

A
  • Infection
  • PE
  • Rib fracture
  • Trauma
  • Pneumothorax
67
Q

Cardiac pain S&S

A
  • Pressure, fullness, burning, or tightness in chest
  • Crushing or searing pain that radiates to their back, neck, jaw, shoulders, and one or both arms
  • Pain that comes on suddenly, lasts more than a few minutes, gets worse with activity, goes away and comes back, or vairies in intensity
  • SOB
  • Cold sweats
  • Dizziness or weakness
  • Nausea or vomiting
68
Q

2 types of pacemakers

A

Internal and external

69
Q

What are internal pacemakers

A

They implant a small electronic device that is usually placed in the chest (just below the collarbone) to help regulate slow electrical problems with the heart - used for long term use

70
Q

What is an external pacemaker? What are special considerations for it

A

External wires come out of thebody and are attached to an external unit. Used for temporary packing.

Patients are often on bed rest - Because if wires are pulled out they may not be able to maintain rhythm i.e. they could go into cardiac arrest

71
Q

What are the precautions following the insertion of an internal pace maker

A

For first 4-6 weeks

  • <90 degrees of shoulder flexion or abduction of arm on the same side as heart device
  • Do no do any activities where you are repeatedly pushing and pulling, swinging
  • Do not lift anything more than 5kilograms or 10lbs
72
Q

What is an IABP

A

Intra Aortic Balloon Pump
- Pup that goes into aorta - balloon inflates when heart is in diastole and it will push some fluid back up into heart and into coronary arteries - used to get more coronary blood flow. If they have one in not a patients you will be seeing as a PT.

73
Q

Name 6 electrolytes

A
  • K
  • Na
  • Magnesium
  • Ca
  • Creatinine
  • Urea
74
Q

What does albumin do?

A
  • Fights infection
  • Helps wound healing
  • helps body maintain plasma volume
75
Q

What is the white cell count used for

A

to detect presence of infection or leukemia

76
Q

High levels of WBC =

Low levels of WBC =

A
  • Indicated infection

- Increased risk of bruising, using appropriate infection control standards, fatigue during ax/rx

77
Q

Low Hb =

High Hb =

A

Low = Fatigue, dizziness, headache, lack of concentration, collapse. Can lead to cardiac damage

High = increased risk of clotting

78
Q

What do platelets do

A

Allow blood clots to occur

79
Q

Decreased platelets =

Increased platelets =

A

Dec: Thrombocytopenia, causing bruising, increased risk of bleeds
Inc: Clotting risk (DVT, PE_

80
Q

Platelet levels ;
<100 =
<50 =
<20 =

A 
<100 = Care with Rx 
<50 = Question if we should Rx 
<20 = risk of spontaneous bleeding
81
Q

What does INR Stand for ? what is it?

A

International normalized ratio - A ratio of clotting time of blood compared to normal

82
Q

What does PTT stand for? What is it?

A

Partial thromboplastin time

Time taken for blood to clot

83
Q

Normal INR

Therapeutic range of INR if on anticoagulants?

A

0.9-1.3

2-3

84
Q

PTT normal

A

24-40 seconds

85
Q

Low INR/PTT levels =

High INR/PTT levels =

A

Low: There is increase risk of clots. Watch out for DVTs/PEs maybe on bedrest

High = At risk of bruising and bleeding. this may require more stringent safety measures when you are treating

86
Q

What is troponin

A

A substance released into the blood when heart muscle is damaged

87
Q

What troponin levels indicate cardiac muscle injury

A

<0.05 ug/L

88
Q

Following heart muscle damage Troponin rises for ____, peaks at ___, declines over _____

A

4-8 hours
10-24 hours
10 days

89
Q

What is albumin

A

A blood protein that fights infection and helps wound healing. It also prevents swelling as it plays a part in maintenance of plasma volume

90
Q

What are normal albumin volumes

A

3.5-6 g/dL

91
Q

What causes a decreased in Albumin? What does this decrease lead to?

A

Caused by malnutrition, sepsis and liver failure

Leads to body wide interstitial edema

PHTH 564 (5 decks)

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