Questions and Answers
What is the appropriate monitoring for a patient receiving TPN who is scheduled to be NPO?
Which statement about sedation protocols for intubated patients is correct?
Which of the following measures is recommended to prevent alarm fatigue in a clinical setting?
What is the correct recommendation for administering intravenous medications to prevent complications?
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What should be done if the residual check for a patient on tube feeding is less than 100?
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Which of the following is a potential risk associated with the use of succinylcholine during intubation?
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What is the primary purpose of analgesics in the intubated patient protocol?
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Which of the following interventions is vital in managing patients at risk for constipation?
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What is the primary goal of using sedatives in an intubated patient?
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What condition is succinylcholine associated with that requires caution?
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Which of the following is true regarding the administration of benzodiazepines?
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When assessing sedation levels using the RASS scale, what does a score of -5 indicate?
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What should be included in medication orders for sedatives during intubation?
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Study Notes
Introduction to Critical Care
- Ratios important for monitoring patient care: 1:1 (intensive), 1:2 (less intensive).
- Caregiver involvement enhances patient education and culturally competent care, impacting death, pain, and grief experiences.
Emergency Codes and Alarms
- Rapid response team (RRT) is activated for changes in patient status; code blue indicates no pulse.
- Never turn off alarms to prevent alarm fatigue; alarms should be patient-specific.
Fall Prevention
- All patients are at risk for falls; implementing bed alarms reduces incidents.
- Maintain bed at lowest level to enhance safety.
Nutrition Management
- NGT (nasogastric tube) or OGT (orogastric tube) utilized for feeding; TPN (total parenteral nutrition) is prescribed for NPO patients.
- Monitor gastric residuals: report if >100ml, acceptable if <100ml.
- Confirm tube placement via X-ray, pH testing, or auscultation.
Restraint Use
- Use soft/wrist restraints with assessments every 2 hours; ensure range of motion (ROM) exercises every 15 minutes.
- Document restraint usage with photographs and periodically re-evaluate necessity.
Intake and Output Monitoring
- Strict monitoring of I&O; foley catheters are not advised for incontinence to minimize CAUTI (catheter-associated urinary tract infection) risks.
- Conduct daily weights in the morning for accurate assessment.
Elimination Support
- Use rectal tubes cautiously; patients at risk for constipation may benefit from increased fluids and fiber.
- Colace prescribed as a stool softener.
Intravenous Lines
- Various IV access points include PICC lines (peripherally inserted central catheter), central lines with three lumens, and access through femoral, jugular, or subclavian paths.
- Be alert for pneumothorax complications from central line placements.
Cluster Care Practices
- Optimize patient sleep by adjusting the environment: dim lights at night and open curtains during the day.
Delirium and Sleep Issues
- Factors contributing to delirium include insufficient sleep, immune suppression, and hypertension, often linked to obesity and elevated blood sugar.
Medication Management
- Sedatives (e.g. benzodiazepines, propofol) are utilized to calm patients and facilitate sleep, particularly for those on ventilators.
- Propofol has a short half-life and should be titrated with RASS score (-5 to 5) for sedation levels.
- Implement sedation holidays to assess patient response (once daily) and ensure correct medication order including max dose, parameters, starting dose, titrate amount, and time.
Intubation Protocol
- Essential medications during intubation include analgesics (pain relief), paralytics (muscle relaxation), and sedatives (inducing sleep).
- Use neuromuscular blockers cautiously; reversal agents include atropine or neostigmine, keeping in mind that succinylcholine poses a risk for malignant hyperthermia (MH), treated with dantrolene.
- Airway management is critical; supplemental oxygen alone does not constitute airway protection.
Opioid Management
- Opioids like fentanyl and MSO4 (morphine sulfate) may reduce CNS activity, leading to decreased blood pressure and respiratory rate; Naloxone (Narcan) available for reversal.
Antibiotic and Antimicrobial Treatment
- Obtain cultures before administering antibiotics like vancomycin to assess infection; red man syndrome risk observed with rapid infusion.
- Administer corticosteroids to decrease immune response, monitoring peak (20-40) and trough (5-15) levels. Be aware of nephrotoxicity and increased blood sugar; taper dosage appropriately.
Gastrointestinal Medications
- Anti-ulcer agents include H2 blockers (-tidine) to reduce acid and PPIs (-prazole) to prevent secretion.
- Sucralfate creates a protective coating for the GI tract during treatment.
Medications Overview
- Medications such as sedatives are used to calm patients and promote sleep, especially in critical care settings.
- It's important to prevent patients from fighting against mechanical ventilation support.
Sedatives and Their Use
- Benzodiazepines (Benzos): Effective for decreasing anxiety.
- Propofol: Only administered if the patient is intubated; has a short half-life and requires titration based on the Richmond Agitation-Sedation Scale (RASS), aiming for scores between -5 (unarousable) and 5 (alert).
- Use a "train of 4" to assess neuromuscular function; a response of 2/4 indicates more alertness.
Titration and Orders
- Sedation orders should include maximum dose, parameters for administration, starting dose, titrate amount, and titrate time.
- Conduct a "Sedation Holiday," stopping sedation at least once a day to assess patient status (every 1 hour).
Intubation Protocol
- For intubation, three types of medications must be included:
- Analgesic: Reduces pain.
- Paralytic: Induces paralysis (e.g., succinylcholine; it poses a risk for Malignant Hyperthermia (MH), treat MH with dantrolene).
- Sedative: Induces sleep or sedation to facilitate the process.
Reversal and Monitoring
- Reversal drugs like atropine and neostigmine may be used after paralysis. Note that neostigmine is not indicated if succinylcholine was used.
- Ensure the patient has an airway (oxygen alone does not qualify).
Opioids
- Common opioids include Fentanyl and Morphine Sulfate (MSO4).
- Narcan (Naloxone) is used as a reversal agent for opioid overdose.
- Monitor for central nervous system depression, which can lead to decreased blood pressure and respiratory rate; opioids may also induce sleep.
Antibiotics and Anti-ulcer Medications
- Vancomycin: Prior to administration, culture samples should be obtained to guide treatment. Administer slowly to prevent Red Man Syndrome.
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Anti-ulcer medications:
- H2-Receptor antagonists (e.g., -tidine): Decrease stomach acid production.
- Proton Pump Inhibitors (PPIs, e.g., -prazole): Prevent acid-related damage.
- Sucralfate: Provides a mucosal coating to protect from acidity.
Corticosteroids
- Corticosteroids reduce immune response and have specific pharmacokinetics (peak 20-40 minutes; trough 5-15 minutes).
- They pose risks including nephrotoxicity, elevated blood sugar levels, and increased risk of ulcers.
- A tapering regimen is necessary to prevent withdrawal and other complications.
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Description
This quiz covers essential topics related to critical care, including caregiver involvement, emergency response codes, and alarm management. It also addresses important aspects of patient nutrition and safety protocols in the ICU. Test your knowledge of these critical concepts to ensure competent and compassionate care.
