Critical Care and Oxygenation Review

Flashcards covering the fundamentals of critical care nursing, hemodynamic monitoring, ABG analysis, respiratory failure, mechanical ventilation, and pulmonary emergencies.

Critical Care Nursing

Nursing care for clients with life-threatening problems, often taking place in intensive care or progressive care units.

CCRN

Critical Care Registered Nurse certification that can be obtained by nurses working in critical care areas.

Progressive Care Units

Also known as "step down" units, these provide care for patients who require more monitoring than a general floor but are less critical than ICU patients.

VAP (Ventilator Associated Pneumonia) Prevention

Infection prevention bundle including hand hygiene, oral care, and suctioning oral/bronchial secretions PRN.

Alarm Fatigue

A phenomenon where registered nurses begin to ignore alarms if they go off too frequently; settings should be tailored to the client's condition.

ICU Delirium

Acute confusion or cognitive impairment occurring in critically ill patients, often managed by grouping care and dimming lights.

Mean Arterial Pressure (MAP)

The average pressure within the arterial system; high levels indicate heart muscle damage or stroke, while low levels ($< 65$) indicate decreased organ perfusion.

Pulse Pressure

The difference between systolic blood pressure ($SBP$) and diastolic blood pressure ($DBP$); high in exercise/atherosclerosis and low in HF/hypovolemia.

Central Venous Pressure (CVP)

The amount of blood returning to the heart; high levels indicate over-hydration and low levels indicate severe dehydration.

Cardiac Output

Calculated as $HR \times \text{Stroke Volume}$, where stroke volume is the blood ejected during ventricular contraction.

Systemic Vascular Resistance (SVR)

The resistance to blood flow by all systemic vasculature; low SVR occurs in septic shock and with vasodilators, while high SVR occurs in hypovolemia.

PA Catheter (Swan-Ganz)

A multi-lumen central hemodynamic monitoring line that enters through the superior vena cava into the pulmonary artery.

Pulmonary Artery Wedge Pressure (PAWP)

Pressure measured via the yellow lumen of a PA catheter when the balloon is wedged; it measures left ventricular filling and is sensitive to cardiac function.

Allen's Test

A physical assessment performed prior to arterial line placement to ensure adequate collateral circulation.

Phlebitic Axis

The level at which the PA catheter stopcock must be placed to ensure accurate invasive pressure readings.

Normal ABG pH

The standard range is $7.35$ to $7.45$; less than $7.35$ is acidosis, and greater than $7.45$ is alkalosis.

Normal ABG PaCO2

The standard range is $35$ to $45\text{ mmHg}$; levels above $45$ signify hypoventilation, while levels below $35$ signify hyperventilation.

Normal ABG HCO3 (Bicarbonate)

The standard range is $22$ to $26\text{ mEq/L}$; alterations from this range suggest a metabolic etiology.

Normal PaO2

The normal pressure of oxygen in arterial blood is $> 80\text{ mmHg}$; levels less than $60\text{ mmHg}$ indicate hypoxia.

ROME (ABG Interpretation)

Respiratory Opposite (pH and $CO_2$ move in opposite directions) and Metabolic Equal (pH and $HCO_3$ move in the same direction).

Ventilation Failure

A respiratory issue where $CO_2$ is not exhaled (hypoventilation) or exhaled too much (hyperventilation), characterized by $PaCO_2 > 45\text{ mmHg}$.

Oxygenation Failure

A respiratory issue where the patient is not getting enough $O_2$ (hypoxia), characterized by $PaO_2 < 60\text{ mmHg}$.

Acute Respiratory Distress Syndrome (ARDS)

An oxygenation issue characterized by fluid in the alveoli, "white lung" on CXR, and hypoxia that does not improve even with high $FIO_2$.

CPAP (Continuous Positive Airway Pressure)

Non-invasive ventilation that uses continuous pressure to keep the airway open; commonly used for sleep apnea.

BiPAP (Bilevel Positive Airway Pressure)

Non-invasive ventilation that provides both inspiratory and expiratory pressure; used for COPD or patients who are not ventilating well.

PEEP (Positive End Expiratory Pressure)

Pressure maintained in the lungs at the end of expiration to keep alveoli open; excessive PEEP can cause barotrauma and decreased cardiac output.

Assist-Control (AC) Ventilation

A mode of mechanical ventilation with a preset rate and tidal volume; if the client initiates a breath, the ventilator takes over.

SIMV (Synchronized Intermittent Mandatory Ventilation)

A mode where ventilator breaths are synchronized with the client's effort; often used as a weaning mode.

RASS (Richmond Agitation-Sedation Scale)

A scale used to assess sedation levels ranging from $+4$ (combative) to $-5$ (unarousable); $0$ is alert and calm.

Propofol

A general anesthetic sedative used only for intubated clients; it is contraindicated in patients with an allergy to eggs.

Vecuronium

A neuromuscular blocking agent that causes "medically induced paralysis"; it requires the concurrent use of sedatives and pain meds as the patient remains awake.

Pulmonary Embolism (PE)

A blockage of one or more arteries in the lungs, typically by a blood clot; risk factors include immobility, surgery, and A-Fib.

Heparin Protocol PTT

The goal range for therapeutic heparin infusion is usually a PTT of $55$ to $85$.

Tension Pneumothorax

A medical emergency caused by excessive pressure in the pleural space, characterized by tracheal deviation, JVD, and hypotension.

Tidaling

The normal movement of the water level with respiration in the water seal chamber of a chest tube drainage system.

Chest Tube Air Leak

Indicated by continuous bubbling in the water seal chamber; necessitates checking the tubing and tape for leaks.

Chest Tube Drainage Limit

The nurse should notify the provider if drainage exceeds $100\text{ mL/hr}$ or if it appears as bright red blood.