Critical Care Nursing Flashcards

What are some skills required in critical care nursing?

Advanced interpretation of clinical assessments, rapid analysis and intervention with strong decision-making skills, ethical advocacy for patients and families, technical proficiency, collaboration and coordination, and the use of evidence based practice.

Define Coronary Care Units.

Specialised intensive care unit dedicated to caring for patients with cardiac diseases and complications that require continuous monitoring and specialised interventions. Conditions include acute MIs, unstable angina, ACS, severe arrhythmias, post surgery recovery, and cardiogenic shock.

Define paediatric critical care.

It focuses on the specialised needs of infants, children, and adolescents with life threatening conditions, recognising their distinct physiological differences. There are age-specific assessments, weight-based dosing, family-centred care, and developmental considerations.

What are some respiratory considerations in paediatric patients?

Smaller airways, higher rates of oxygen consumption, compliant chest wall.

What are some cardiovascular considerations in paediatric patients?

Higher baseline heart rate, rate-dependent cardiac output, limited stroke volume.

What are some metabolic/fluid considerations in paediatric patients?

Higher metabolic rates, greater surface area/weight ratio, limited glycogen stores.

What are some developmental and age-specific needs for infants?

They aren’t as good at thermoregulation, they have higher body water percentages, higher baseline HRs, greater chance for rapid deterioration.

What are some developmental and age-specific needs for toddlers and children?

They require age-appropriate explanations for procedures, therapeutic play to manage anxiety, age-specific assessment tools, parental involvement to reduce stress.

What are some developmental and age-specific needs for adolescents?

They have an increased need for physical privacy and emotional space, they need to be included in decision-making, respect their independence, support social connections, address body image concerns and fear of implications.

What are some considerations with obstetric emergencies?

Consider dual patient assessments (maternal-foetal) and continuous foetal monitoring. Pregnant women have a higher O2 consumption (20-40%), lower functional residual capacity, high diaphragm positioning, higher RR, increased blood volume (40-50%), higher cardiac output, anaemia, supine hypotensive syndrome, high thromboembolism risk, increased GFR, urinary stasis, delayed gastric emptying, and displaced abdominal organs.

What are the 3 most common life-threatening obstetric emergencies?

1. Obstetric Haemorrhage

2. Eclampsia

3. Amniotic fluid embolism

Define an obstetric haemorrhage.

Excessive bleeding in pregnancy, childbirth, or the postpartum phase which is measured as more than 500mL with vaginal births or more than 1000mL with caesarean births.

Define eclampsia.

Seizures that occur in pre-eclamptic patients, typically after 20 weeks gestation.

Define an amniotic fluid embolism.

A rare but severe complication that occurs when amniotic fluid enters the maternal circulation which presents as sudden cardiovascular collapse, hypoxia, and seizures.

What are the 3 most common urgent obstetric emergencies?

1. Ectopic pregnancies

2. Pre-term labour

3. Pre-eclampsia

Define an ectopic pregnancy.

A pregnancy implanted outside the uterine cavity, most likely in the fallopian tubes.

Define pre-term labour.

Labour that occurs before 37 weeks of gestation evidenced by regular contractions and cervical changes.

Define pre-eclampsia.

A hypertensive disorder specific to pregnancy, occurring after 20 weeks gestation. Hypertension can accompany proteinuria, headaches, and visual changes.

What are 2 time critical obstetric emergencies?

1. Trauma

2. Maternal sepsis

Describe trauma related to obstetric emergencies.

Physical injuries obtained during pregnancy which requires dual assessment of both the mother and foetus.

Define maternal sepsis.

Life threatening organ dysfunction due to infection during pregnancy or the postpartum phase.

What are some considerations for geriatric emergencies?

Consider poly-pharmacy, adverse drug events, atypical symptom presentations, and increased vulnerability. Age-related physiological changes include lower vital capacity, lower cough reflex, higher closing volume causing oxygenation challenges, lower cardiac reserve, arterial compliance, and baroreceptor sensitivity affecting vital sign interpretation.

What are some assessment tools used with geriatric patients?

Tools that assess functional status, cognitive ability, social supports, general routine screening, environmental modifications, risk assessment, early mobilisation, post-fall evaluations, dose adjustments, discharge planning, carer education, follow-up planning, community service referrals.

What are some common geriatric ED presentations?

Falls and traumatic events, delirium, sepsis, acute cardiac events, medication non-compliance, urinary tract infections.

Describe falls and traumatic presentations in geriatric populations.

Mechanical incidents causing injury, likely related to gait, balance, vision, and environmental factors.

Describe delirium.

An acute confusional state representing cerebral dysfunction, typically having a rapid onset and fluctuating course.

Describe sepsis.

A life threatening organ dysfunction caused by a dys-regulated host response to infection, often with an atypical presentation in older adults.

Describe acute cardiac events in geriatric populations.

Sudden cardiac conditions including myocardial infarctions, heart failure exacerbation, and arrhythmias, resulting in ED presentations in older adults.

Describe medication related issues in geriatric populations.

Adverse drug events can occur from polypharmacy, altered pharmacokinetics or pharmacodynamics, inappropriate prescribing.

Describe urinary tract infections in geriatric populations.

Infections of the urinary system, often with atypical presentation, complicated by functional or anatomical abnormalities.

Describe the features of HIRAID documentation.

It improves quick documentation and reduces deterioration by covering the patient’s history, infection risk, primary and secondary surveys, nurse-initiated interventions, nurse-initiated pathology/imaging, and re-assessment times.

Describe the role of the clinical initiatives nurse.

They are the first point of contact for patients in waiting rooms. They initiate early interventions/assessments, monitoring patients for deterioration, communicating wait times, and providing timely pain relief/comfort measures.

Describe the role of ED nurse practitioners.

They autonomously manage patients, prescribe medications, order diagnostics, and refer to specialists. They also discharge patients and perform procedures like suturing and casting. They have a Masters in Nurse Practitioner and advanced clinical experience (5+ years).

Describe the role of clinical nurse specialists.

They provide expertise in specific areas like trauma, paediatrics, mental health, or cardiac care.

Describe the role of the resuscitation nurse.

They manage critically ill patients, leading/participating in resuscitation efforts, managing advanced airways, vascular access, and emergency medications. They undertake resus study days, courses on the emergency management of severe trauma, and postgraduate emergency nursing qualifications.

Describe the role of the triage nurse.

They apply the Australasian Triage Scale to rapidly prioritise patients based on clinical urgency. They also perform initial interventions for time-critical conditions, conducting rapid primary surveys and comprehensively documenting with the HIRAID framework.

Describe the 4 hour model of care.

1. Initial assessment and management (10-15 mins)

2. Targeted tests and continued management (15-60 mins)

3. Advanced diagnostics and treatment evaluation (60-180 mins)

4. Multidisciplinary collaboration, disposition planning (180-240 mins)

Explain the frequency of vital signs for different types of patients.

Critical patients have continuous monitoring or 5 minutely monitoring. Moderate risk patients have 15 minutely obs for an hour, then half hourly if stable. Stable patients have hourly monitoring until discharge.

Define the Australasian Triage Scale.

A 2-5 minute thorough assessment based on clinical urgency, not diagnosis. Patients are re-triaged when their condition changes. It also considers resource allocation, staff skill mix, safety monitoring, and various patient-specific factors. There are 5 categories ranging from immediately life threatening to less urgent patient presentations.

Describe a Category 1 triage.

An immediately life threatening condition, like cardiac or respiratory arrests, immediate airway risks or extreme distress, a RR under 10, severe shock, BP under 80mmHg, GCS under 9, ongoing/prolonged seizures, IV overdoses, or unresponsive patients. They are immediately seen by doctors.

Describe a Category 2 triage.

An imminently life threatening condition, like moderate/severe respiratory distress, blood loss (circulatory compromise), HR under 50 or over 150, chest pain of a cardiac nature, very severe pain, time-critical treatment needed, BGL under 3mmol/L, acute stroke/altered consciousness. They are seen within 10 minutes.

Describe a Category 3 triage.

A potentially life threatening condition, like severe HTN, moderate blood loss, moderate SOB, seizure (now alert), moderately severe pain, persistent vomiting and dehydration, head injury with a short LOC (now alert), or suspected sepsis. They are seen within 30 minutes.

Describe a Category 4 triage.

A potentially serious condition, like a mild haemorrhage, foreign body, minor head injury with no LOC, moderate pain with risk factors, vomiting and diarrhoea without dehydration, minor limb trauma, eye inflammation, and non-specific abdominal pain. They are seen within 60 minutes.

Describe a Category 5 triage.

A less urgent condition, like minimal pain with no risk factors, low-risk history (now asymptomatic), minor symptoms of an existing illness, minor wounds, a review of results, medical certificates, and scheduled re-visits. They are seen within 120 minutes.

Explain the general triage process.

When a patient presents, the triage nurse does an initial ABCDE and visual assessment of their appearance and distress. They take a focused history of the complaint, onset, duration, medical history, and medications. They do vitals and a focused physical assessment based on the chief complaint, evaluating risks for deterioration. Then they assign a triage category.

Describe some risk factors accompanying serious illnesses or injuries.

• Mechanism of injury (fall from 2m+, penetrating injury, ejection, explosion, death of same car occupant, MVA over 60kph)

• Co-morbidities (prematurity, respiratory/cardiovascular/renal disease, carcinoma, diabetes, substances, immunocompromised)

• Behaviour/history under 3mo (febrile, acute change in sleep/feeding, violence victim, sexual assault, neglect, seizures)

• Other (rash, actual/potential substance effects, chemical exposure, envenomation, immersion, unexplained alteration in temperature)

Define anaphylaxis and some risk factors.

A potentially life threatening severe allergic reaction that causes difficulty breathing, swelling, hoarse voice, wheeze, persistent dizziness, and floppiness in children. Risk factors include older age, cardiac or respiratory distress, delayed presentation or adrenaline administration, previous severe reaction history.

Describe the initial assessment and management of anaphylaxis.

Remove the allergen, lie them flat, give adrenaline IM 0.5mg, establish a patent airway, O2 support if indicated, IV access, establish continuous monitoring, and escalate for assistance.

Describe the stabilisation interventions for anaphylaxis.

Repeat IM adrenaline 0.5mg 5 minutely, anticipate the need for a fluid bolus (aim for 20mL/kg), pathology testing, consider nebulised adrenaline if ongoing dyspnoea, salbutamol for bronchospasm, if ongoing adrenaline requirement, consider an adrenaline infusion.

Describe the evaluation and monitoring requirements for anaphylaxis.

Monitor treatment response, anticipate a transfer or ward admission, confirm symptom resolution, educate the patient/family, confirm the supply of an EpiPen if they are being discharged.

Define asthma.

A chronic inflammatory disorder that causes airflow obstruction with recurrent wheezing, breathlessness, chest tightness, and coughing. Consider symptom severity (ability to speak in full sentences, SpO2, RR, HR, auscultation results).

Describe the initial assessment and management of asthma.

Determine the severity of the asthma attack, position them in High Fowlers, use supplemental O2, bronchodilators, consider nebulisers, IV access, repeat medication administration 20 minutely.

Describe the stabilisation interventions for asthma.

Continue using bronchodilators, second-line ipratropium and steroids if needed, IV magnesium sulfate, anticipate the need for NIV, update and escalate to senior nurses and clinicians.

Describe the evaluation and monitoring requirements for asthma.

Discharge them if they are comfortable, not needing a nebuliser, stable vitals, action plan in place, discharge meds, inhaler education, peak expiratory flow above 75% of their predicted level, consider specialist referrals, ensure adequate support systems are in place.

Describe the initial assessment and management of acute coronary syndromes.

Consider positioning, maintain airway, O2 support, ECG within 10 minutes, IV access, take cardiac biomarkers, aspirin 300mg, GTN 300 micrograms SL if BP is stable, analgesia, vital signs, focused cardiac assessment, PQRST, history of risk factors/medications, continuous cardiac monitoring.

Describe the stabilisation interventions for ACS.

Serial ECGs if symptoms persist/change, consider antiplatelets, anticoagulants, analgesia, beta blockers, cath lab or thrombolysis, repeat troponin, fluid management, 15 minutely vital signs, re-assess pain, arrhythmia monitoring, watch for heart failure, medication response, observe for complications.

Describe the evaluation and monitoring requirements for ACS.

Review troponins and ECG, echocardiogram if needed, determine disposition to either CCU, observation or discharge with follow up, specialist consults, medication reconciliation, education, arrange cardiac rehab referrals.

What are possible diagnoses of acute abdominal pain?

Can include appendicitis, AAA, cholecystitis, bowel obstructions, GI perforation, upper or lower GI bleeding, and acute pancreatitis.

Describe the initial assessment and management of acute abdominal pain.

Comfort positioning, maintain airway, O2 support, IV access, full blood count, UEC, analgesia before full assessment, urinalysis, consider pregnancy, BP in both arms, fluid resus if hypovolaemic, focused abdominal assessment, PQRST, last ins and outs, bowel/bladder function, guarding, distension, check for hernias, scrotal exam if applicable.

Describe the stabilisation interventions for acute abdominal pain.

Review initial results, multimodal analgesia, antiemetics, ultrasounds, CT, X-ray, pathology (lipase, LFTs), surgical consult, NBM status, 15-30 minutely vitals, fluid balance chart, re-assess pain, monitor for peritoneal signs, analgesia response, evolving signs like increased distension/guarding.

Describe the evaluation and monitoring requirements for acute abdominal pain.

Complete diagnostic workup, determine disposition as either a surgical admission, medical admission, observation, or discharge with follow-up, adjust analgesia, consider antibiotics, bowel prep, education, pre-op preparation if applicable.

Define sepsis.

A systemic infection manifesting as a temperature above 38.5 degrees or under 36 degrees, HR above 90bpm, hypotension under 90mmHg, RR over 20, SpO2 under 92%, altered mental status, confusion, or new delirium.

Describe the initial assessment and management of sepsis.

Consider positioning, O2 support, sepsis screening, IV access with 2 large bore cannulas, 2 sets of blood cultures, FBC, UEC, CRP, lactate, coags, urine, sputum, or wound swabs, urgent CXR, assess mental status, urine output, identify a source of infection, comprehensive history.

Describe the stabilisation interventions for sepsis.

Broad spectrum antibiotics within 60 minutes, initial fluid resus with 20 to 30mL/kg of crystalloids if hypotensive, re-assess after each 500mL, apply source control measures, vasopressors, ABG if respiratory distress, repeat lactate, continuous monitoring, monitor for fluid overload, fluid balance charting, assess mental status, check temperature, cooling measures.

Describe the evaluation and monitoring requirements for sepsis.

Review all results, refine antibiotic therapy, continue antibiotics if needed, check organ function, escalate to HDU or ICU if needed, corticosteroids for refractory shock, repeat lactate, fluid balance charting, document sepsis pathway and all interventions.

Describe the initial assessment and management of acute envenomation and toxins.

A-E assessment, contact Poisons Info Center, compression bandage the limb with immobilisation, IV access, FBC, UEC, CK, LFT, coags, activated charcoal if ingested, irrigation for ocular or dermal exposure, O2 support, vital signs, bite size exam, document baseline, assess for toxidrome patterns.

Describe the stabilisation interventions for acute envenomation and toxins.

1 vial of the right anti-venom for snake bites, 2 vials for funnel web spiders, IV paracetamol, naloxone if opioid based, remove compression bandage after anti-venom if applicable, serial bloods, fluid management, symptom-specific interventions, check response to treatment, anti-venom reactions, coagulopathy, neurotoxicity, myotoxicity symptoms, continuous monitoring.

Describe the evaluation and monitoring requirements for acute envenomation and toxins.

Re-assess pt’s status, consult toxicologist, repeat coags at 6 and 12 hours if it was a snake bite, discharge to ICU/HDU, ward admission, or follow up, psych assessment if intentional, education, assess organ function, document.

What is the MIST handover?

A rapid trauma handover focusing on critical details for immediate care, involving the mechanism of action, injuries, signs/symptoms, and treatment provided, followed by a standard ISBAR handover.

Describe the paramedic scope of practice and its impact.

Extended care paramedics can do advanced procedures like RSIs, thoracotomies, blood product administration. They coordinate retrieval efforts, make critical decisions in time-sensitive environments, and provide pre-arrival handovers to enable resource and specialist mobilisation in hospitals.

Explain how clinicians assess the airway in an A to E Assessment.

They assess patency and c-spine precautions, check for facial trauma, stridor, absent breath sounds, air movement. Threats include a full or partial obstruction, traumatic injuries, cancer-related growths. They measure SpO2, end tidal CO2, ABGs and supplemental oxygen delivery.

Explain how clinicians assess breathing in an A to E Assessment.

They evaluate the effectiveness of ventilation/oxygenation, look/listen/feel for rise and fall, RR, accessory muscle use, cyanosis, wheeze, crackles, chest expansion, tactile fremitus, tracheal position. Threats include a pneumothorax, partial obstruction, flail chest. Consider low/moderate flow of O2, non invasive ventilation, or intubation.

Explain how clinicians assess circulation in an A to E Assessment.

They controll haemorrhage and assess perfusion, look for external bleeding, skin colour, pallor, JVD, BP, murmurs, carotid bruits, pulse quality, rate, rhythm, central/peripheral changes, abdominal tenderness. Threats include haemorrhage, cardiac tamponade (fluid in pericardium), and cardiogenic or hypovolaemic shock. Measure BP, HR, lactate, Hb, urine output, control bleeding with direct pressure, establish IV access and start fluids/blood.

Explain how clinicians assess disability in an A to E Assessment.

They evaluate neurological status and pupils, look for unusual movements, unequal pupils, speech pattern, slurring, dysarthria, incoherent speech, GCS. Threats include TBIs, spinal cord injury, hypoglycaemia. Immobilise c-spine if needed, start glucose/dextrose administration, neuro referrals/consults.

Explain how clinicians assess exposure in an A to E Assessment.