Critical Care Final Exam Study Guide

How is a fever defined, and what should it prompt in evaluation and what should you take into consideration?

A fever is typically defined as a temperature >38°C. It should prompt a careful assessment rather than unnecessary lab or imaging tests. Consider non-infectious causes like environmental factors, postop inflammation, transfusions, or drug-induced fever.

What populations are at higher risk for antibiotic resistance?

Those in long-term care/SNF, with prior resistance history, on dialysis, routinely using broad-spectrum antibiotics, with multiple comorbidities, or immunocompromised are at higher risk.

What lab values are used in evaluating infection?

WBC with left shift,
Elevated procalcitonin (for antibiotic de-escalation),
CRP (general inflammatory marker, and
ESR (also an inflammatory marker but slower than CRP)
Keep in mind, WBC can elevate from steroids, surgery, or trauma—not just infection.

What are key considerations when drawing blood cultures?

Draw from two separate sites,
use a new line/stick (unless testing for line infection),
and ensure proper volume.

What is a consideration for rapidly decompensating individuals?

In rapidly deteriorating patients, do not delay antibiotics.

How can nurses reduce CAUTI risk?

Minimize catheter use
change long-term catheters before collecting samples,
follow strict sterile technique
consider external devices like PureWick.

What is an important consideration of antifungals and what is the most common organism in the critically ill?

Fungal infections are hard to detect. Candida albicans is common.

What are treatment options for fungal infections?

Treatments include
Amphotericin B,
Caspofungin,
Fluconazole, and
Voriconazole.

What is C. difficile (CDIFF) and what usually causes it?

C. diff occurs from antibiotic disruption of gut flora. Common drugs causing it: clindamycin, penicillin, cephalosporins, quinolones.

How is C dif treated and what is the nursing care for it?

Treat with oral vancomycin or fidaxomicin.

Nursing care: fluids, strict isolation, soap and water handwashing, perianal skin care, slow diet reintroduction, correct electrolytes.

Why is necrotizing fasciitis considered an emergency and what are the treatments and imaging for it?

It's a rapidly fatal, polymicrobial infection “flesh eating disease” common in diabetics/immunocompromised patients. Requires broad antibiotics for treatment, cultures, surgical consult for management, and CT showing “gas-forming organisms”.

What are signs of HIV progressing to AIDS?

1) CD4 <200,
2) development of opportunistic infection,
3) opportunistic cancer, or
4) wasting syndrome (≥10% unintentional weight loss).

What are key principles of antibiotic stewardship?

De-escalate early, stop empiric therapy within 24–48 hours, avoid prolonged use without need, consult ID specialists early.

What are key PPE precautions?

Standard: Hand hygiene, gloves as needed.

Airborne: N95, negative-pressure room (e.g., TB, chickenpox).

Droplet: Surgical mask, eye protection, gown/gloves (e.g., COVID, flu).

Contact: Gloves, gown (e.g., MRSA, VRE, C. diff—no alcohol rubs).

What does a DNR order mean for patient care?

Patient still receives treatment for their condition, but no CPR or intubation if arrest occurs. Options like DNI may also be included.

What’s the difference between aggressive and comfort care?

Aggressive: Curative, full code, frequent monitoring.

Comfort: Focused on comfort only, stop non-comfort meds/feeds, use IV analgesics and sedatives, infrequent vitals, minimal interventions.

What is the role of inpatient hospice?

The patient is admitted aka “discharged” to hospice service, still in hospital but receives additional hospice support. Hospice manages comfort meds, provides bereavement services, helps with funeral arrangements. Paid by insurance or Medicare.

What is terminal extubation, and how is it managed?

Removal of an endotracheal tube after comfort care orders. Requires sedation/analgesia beforehand. Add scopolamine or 3% saline nebulizers for secretions. Goal: breathing comfortably until death.

How does brain death differ from cardiac death?

cardiac = heart stops.

•Absence of heart sounds

•Lethal rhythm on the monitor

•No respirations

Declared by a physician, NP, PA, or nurse

Brain death = irreversible loss of brain function;

Brain death testing includes pupil, corneal, oculocephalic aka “doll’s eye” test, oculovestibular “keeping gaze fixed on a target”, gag, pain, and apnea tests.

3 criteria for brain death: Determination of irreversible coma, Absence of brainstem reflexes and pain response, Apnea

DECLARED BY NEUROLOGIST

What is the oculovestibular test, and what does it show?

Cold water is instilled in the ear. Brainstem function = eyes deviate toward water. In coma, no nystagmus. No movement = brainstem dysfunction.

Eye will drift slowly to where the cold water was and then will rapidly shift to the opposite direction (nystagmus)

Don’t test if TM is ruptured.

How is the apnea test done for brain death?

-After 30 min of 100% O2, ventilator is stopped and

-ABG is pulled to make sure that meet requirements for test.

-O2 given at 6–8 L/min via ETT.

-after 10-12 minuted mechanically ventilate if no spontaneous breaths are present

If no spontaneous breathing and CO₂ > 60 mmHg or ≥20 mmHg rise, brain death is supported!!

What are accepted ancillary tests for brain death?

Cerebral scintigraphy (nuclear scan to see cerebral flow), cerebral angiography (contrast X-ray to see cerebral flow), EEG.

What are key transplant eligibility and disqualification criteria?

Disqualify as donor: Advanced age, active cancer/infection, poor match (too many antibodies), family refusal.

Disqualify as recipient: Advanced age, severe comorbidities (AIDS, organ failure), substance use, socioeconomic barriers