Critical Care Exam 1

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Questions and Answers

What is the hallmark sign of Cushing's Syndrome?

Hyperglycemia (correct)

Hypokalemia

Slow wound healing

Weight gain

Which diagnostic test helps determine if Cushing's Syndrome is due to a pituitary or adrenal cause?

24 hour urine cortisol test

Midnight salivary cortisol level

Plasma ACTH levels (correct)

Low Dose dexamethasone suppression test

What is a common psychological symptom associated with Cushing's Syndrome?

Increased libido

Cognitive clarity

Emotional lability (correct)

Improved sleep quality

What treatment option is appropriate for an ACTH-secreting pituitary adenoma in Cushing's Syndrome?

Surgical removal of the adenoma Signup and view all the answers

Which of the following symptoms is NOT typically associated with Cushing's Syndrome?

Excessive hair loss Signup and view all the answers

What is the normal range for Central Venous Pressure (CVP)?

2-6 mmHg Signup and view all the answers

Which catheter is specifically used for administering Total Parenteral Nutrition (TPN)?

Central Venous Catheter (CVC) Signup and view all the answers

What is a potential disadvantage of using a Central Venous Catheter (CVC)?

Risk of central line-associated bloodstream infection (CLABSI) Signup and view all the answers

What does the PA diastolic pressure (PAD) measure in relation to fluid volume status?

Sensitive indicator with normal range of 5-16 mmHg Signup and view all the answers

Where is the most typical site for placing a Central Venous Catheter (CVC)?

Internal Jugular vein Signup and view all the answers

What distinguishes an ICU from a PCU?

ICU has a 1:2 patient ratio while PCU has a 3:1 ratio. Signup and view all the answers

What is the purpose of triage in emergency care?

To assess and sort patients based on acuity and life-threatening conditions. Signup and view all the answers

In the Emergency Severity Index (ESI), what does level 1 indicate?

Patients in imminent danger or dying, needing immediate assessment. Signup and view all the answers

What is included in a primary survey for trauma patients?

Addressing life-threatening findings before moving on. Signup and view all the answers

Which statement is true regarding patients in levels 3, 4, and 5 of the ESI?

Level 3 patients are stable but may need extensive diagnostics. Signup and view all the answers

What does 'acuity' refer to in the context of critical care?

The degree of medical intervention required by a patient. Signup and view all the answers

What would be the likely response for a patient classified under ESI level 2?

They should be seen promptly as their vital signs are threatened. Signup and view all the answers

What is typically involved in the detailed assessment performed by emergency nursing after triage?

A systematic head-to-toe evaluation. Signup and view all the answers

What is the purpose of performing a dynamic response test on A-line tubing?

To confirm that the A-line is optimally dampened and accurately measures blood pressure. Signup and view all the answers

What might indicate a need for immediate intervention when monitoring A-line and EKG readings?

Both the A-line and EKG flatline simultaneously. Signup and view all the answers

Which of the following is NOT a risk associated with A-lines?

Pulmonary embolism Signup and view all the answers

What does the term phlebostatic axis refer to?

The anatomical location used for placing the transducer to ensure accurate readings. Signup and view all the answers

Which of the following is a component of the '5 P's' used for neurovascular checks?

Pallor Signup and view all the answers

What life-long treatment is necessary after adrenal gland surgery?

Hormone replacement therapy Signup and view all the answers

In the Oliguric Phase of AKI, what is a common daily urine output range?

Less than 400 mL Signup and view all the answers

Which classification system is used to assess the severity of AKI?

RIFLE classification Signup and view all the answers

What dietary restriction is typically necessary for a patient with kidney disease?

Phosphorus restriction Signup and view all the answers

Which symptom might indicate an imbalance of potassium in AKI patients?

Dysrhythmias Signup and view all the answers

What is the expected urine output in the Diuretic Phase of AKI?

1-3 L Signup and view all the answers

In the context of CKD, when might patients first begin to show symptoms?

When 50% of nephrons are damaged Signup and view all the answers

Which diagnostic test is contraindicated in patients with renal impairment?

MRI with contrast Signup and view all the answers

Study Notes

Critical Care Overview

ICU (Intensive Care Unit) cares for critically ill patients, with staffing ratios of 2:1, while PCU (Progressive Care Unit) handles less acute cases at 3:1.
Triage categorizes patients based on acuity, ranging from life-threatening (Level 1) to stable conditions (Level 5) using the Emergency Severity Index (ESI).

Triage Levels

Level 1: Most critical, life-threatening conditions, unstable vital signs (e.g., unresponsive trauma).
Level 2: High-risk patients requiring immediate attention (e.g., strokes, myocardial infarction).
Levels 3, 4, 5: Less critical stability; apt for diagnostic tests or simple examinations.

Patient Assessment

Conduct systematic head-to-toe assessments following triage.
Use primary and secondary surveys for trauma patients, focused assessment for non-trauma.
Life-threatening findings during assessment should be addressed immediately.

Hemodynamic Monitoring

Phlebostatic axis is at the 4th intercostal space for accurate transducer referencing.
Zero balancing ensures the pressure system reads accurately, requiring flatlining during the setup.

Dynamic Response Test

Observed via a square wave on monitoring equipment during a fast flush of arterial lines.
Ensures that arterial lines are optimally dampened for accurate blood pressure readings.

Alarm Systems and Risks

Set parameters for high-low pressure alarms (e.g., alarms for pressures below 90 mmHg).
Risks associated with arterial lines include hemorrhage, infection, thrombus formation, neurovascular impairment, and potential loss of limb.

Central Venous Pressure Monitoring (CVP)

Normal CVP range is 2-6 mmHg; reflects right ventricle preload and fluid volume.
Central Catheter types include CVCs, Swan Ganz Catheters, PICC lines, and midline catheters.
CVC indications: needed for vesicants, continuous or rapid medication administration, and monitoring CVP.

Pulmonary Artery Catheter (Swan Ganz)

Measures pulmonary arterial pressures (normal ranges: PAD 5-16 mmHg; systolic 15-28 mmHg; PAWP 16 mmHg).
Valuable for assessing heart function and fluid volume status in conditions like heart failure or shock.

Endocrine System Overview

Cushing's Syndrome linked to excess corticosteroids, manifesting as weight gain, purple stretch marks, and hyperglycemia.

Cushing's Syndrome Diagnosis and Treatment

Diagnosed with elevated cortisol levels and may require surgical intervention to address tumors or adenomas.
Nursing considerations include monitoring vital signs, managing stress, and lifelong medication adjustment post-surgery.

Renal Health: AKI vs. CKD

CKD may be asymptomatic until 50% nephron damage occurs, while AKI develops quickly due to prerenal, intrarenal, or postrenal issues.

Acute Kidney Injury (AKI) Phases

Oliguric Phase: Output < 400 mL/day; may last up to 2 weeks.
Diuretic Phase: Urine output increases significantly; risk of dehydration and electrolyte imbalances.
Recovery Phase: May take up to 12 months for stabilization.

AKI Diagnosis and Treatment

Diagnosed via renal scans, ultrasounds, or biopsies; contraindications include MRI with contrast.
Treatment may require hemodialysis for critical electrolyte imbalances or elevated BUN.

Nutritional Considerations for Renal Patients

Renal diets restrict phosphorus and protein while ensuring caloric intake is met with healthy fats.
TPN or enteral feeding may be necessary for patients with poor appetite.

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Description

This quiz covers essential topics in critical care including emergency care, hemodynamic monitoring, endocrine and renal functions, organ transplants, and immunological health. Test your knowledge on complex systemic failures and their management in critical care contexts.