Critical Care PDF

Critical Care Pulmonary Capillary Wedge Pressure (PCWP) Normal: 8-13 mm Hg Measures left atrial pressure Cardiac Arrhythmias Treatments Uncontrolled atrial fibrillation → synchronized cardioversion Ventricular dysrhythmias → Lidocaine Ventricular fibrillation or unstable ventricular...

Critical Care Pulmonary Capillary Wedge Pressure (PCWP) Normal: 8-13 mm Hg Measures left atrial pressure Cardiac Arrhythmias Treatments Uncontrolled atrial fibrillation → synchronized cardioversion Ventricular dysrhythmias → Lidocaine Ventricular fibrillation or unstable ventricular tachy Defibrillate Sinus bradycardia → Atropine Implantable Cardioverter Defibrillator (ICD) Given with life-threatening dysrhythmias Pacemaker capabilities Pt teaching: refrain from lifting affected arm above shoulder until physician says OK. Firing can be painful. Ventilator Alarms High Alarm - obstruction due to increased secretions, Ventilator Alarms - HOLD tubing kink, or if they pt coughs or gags on tubing H High alarm Low Alarm - disconnection or leak; pt stops breathing O Obstruction NI: assess what alarm went off and provide intervention L Low Alarm as needed; assess oxygen level; call RT and/or MD if D Disconnection assistance is needed Positive End-Expiratory Pressure (PEEP) Used during mechanical ventilation to maintain airway pressure above atmospheric pressure Improves oxygenation while decreasing FiO2 to a less toxic level Tracheostomy Trach care: clean inner cannula, suction, and place new dressing Always have suction equipment at bedside Blood Transfusion 1. Find pt’s blood type and crossmatch with another RN a. Need at least 2 pt identifiers b. Blood must be administered within 20 minutes 2. Obtain baseline vital signs, educate pt on s/sx of transfusion reaction 3. Prepare Y tubing with NS; clamp NS 4. Spike blood bag and leave blood clamp open 5. Infuse slowly for first 15 minutes and stay with pt to assess for reactions (nausea, vomiting, chills, hypotension, fever, back pain, dyspnea) 6. Take vital signs after 15 minutes AND when infusion is done 7. Deliver blood over 2-4 hours 8. After infusion is complete, open NS clamp to flush blood from tubing Reaction Suspected Immediately STOP transfusion Disconnect tubing and assess s/sx of reaction STAY with the pt. NEVER leave pt alone until MD comes or symptoms resolve. Notify MD and blood bank Document event  Critical Care Shock Shock Widespread reduction of tissue perfusion that can lead to organ damage (d/t lack of oxygen and nutrients) Early s/sx: restlessness and agitation (d/t cerebral hypoxia) S/sx: hypotension, tachycardia, weak peripheral pulses Shock can lead to multiple organ dysfunction syndrome (MODS), systemic inflammatory response syndrome (SIRS), respiratory distress, pleural effusion, death NI: Oxygen/ventilation, IV fluid resuscitation (restore tissue perfusion), assess vital signs, cardiac meds (varies based on type of shock) Disseminated Intravascular Coagulation Coagulation disorder that causes thrombosis and hemorrhage Labs: prolonged PT & PTT, decreased fibrinogen and platelet count S/sx: petechia, hemoptysis, oozing from IV sites & gums, GI bleeding, hypotension, tachycardia NI: assess for s/sx of bleeding, monitor PT/INR levels, IV heparin during first phase to inhibit coagulation, provide emotional support Multi-Organ Dysfunction Syndrome (MODS) Inadequate tissue perfusion and increased oxygen demands  Critical Care ABG pH Low High Acidosis Alkalosis High Low Low High PaCO2 HCO3 PaCO2 HCO3 Respiratory Metabolic Respiratory Metabolic Acidosis Acidosis Alkalosis Alkalosis