icu skills quiz

What is normal SV?

60-100 mL/beat

What is normal CO?

4-8 L/min

What is normal SVV?

< 13%

What to do if SVV is > 13?

fluid response

What is normal SVR?

800-1200

What is normal CI?

2.2 to 4.1 L/min/m²

What are some inotropes used to ↑ CO?

Dobutamine

Dopamine

Epinephrine

Milrinone (Primacor)

What do we do if SVR is high?

Give vasodilators

What are some vasodilators used in ↑ SVR?

Nicardipine (Cardene)

Clevidipine (Cleviprex)

What are some vasopressors used in ↓ SVR?

Levo

Epi

Neo

Dopamine

What is a sedation vacation and how is it performed?

cut the sedation off once per shift, monitor the pt and if they respond to commands, start the sedation back at half the previous rate and titrate up

Your IV of dobutamine infiltrates. What do you do?

Stop the infusion and try to aspirate the medicine in the IV out of it. Get the extravasation form from policy stat. Call pharmacy and see if there is an antidote. If there is, administer 5 different shots of the antidote in a circular pattern around the infiltrated IV and into the IV. Assess the skin and document it in the chart.

What are the correct steps in titrating vasoactives?

Assess the pt and their vital signs and titrate according to them and the protocol for the drug. Make rate changes in the computer and monitor pt closely after changes.

Why give Dopamine vs. Levo

Dopamine has A + B properties

Levo is more A

If symptomatic bradycardia from levo switch to dopamine

Why would you give cardene?

↓ BP

3 SIRS criteria

↑ HR

↑ RR or WOB

↑ Temp

↑ WBC

Sources of infection

pneumonia

uti

wound

cellulitis

meningitis

Two ways to identify septic shock?

lactate above 4

SPB < 90 or MAP < 65

Labs for sepsis

lactate

CBC w diff

blood cultures

U/A

Your patient accidentally pulls out their EVD/ventriculostomy. How do you respond?

Cover it with an occlusive dressing, notify MD, frequent neuro checks

Where do you zero the ventriculostomy/EVD drain to?

tragus of the ear/insertion site

What is the correct procedure when the lab calls results?

Repeat it back to them and write the levels down. notify MD within 30 min.

Where do you chart your pre procedure time out in one chart

lines and devices

Resources available to learn more about drugs, IV compatibility, and disease processes

lexicomp

trissler IV comparability

nursing resource center

As an ICU nurse how should you proceed if you are concerned about a patients rhythm

call and get and EKG

assess patient and for symptoms that would indicate the rhythm is real

notify MD

What do you need to check if you get capture during pacing

check a pulse

What would Diltiazem (cardizem) be prescribed for?

arrhthmyias

increase HR

Why would someone get dopamine

they have decrease HR and BP

describe the effect of dopamine

increases heart rate (focused on CO)

low doses (< 3mcg) causes vasodilation

higher doses (>3mcg) causes vasoconstriction

indication for amiodarone

irregular heart rhythm (a fib, a flutter, sinus arrhythmias)

SE and complications of amiodarone

elevated liver enzymes

arrhythmias

hypotension

prolonged QT interval

name 2 vasodilators

name 2 vasoconstrictors

nitroglycerine and nitroprusside

levo and epi

List 3 causes of dampened invasive pressure waveforms

kink

air bubbles

blood clots

change pressure bag

Describe care of a radial a line

zero once per shift

change tubing every 96 hours or 48 if vamp

check settings and waveforms

Medications used to treat seizures

ativan

valium

depakote

keppra

phenytoin

gabapentin

What info is included on a focus note for a code stroke

last known well time

neurological symptoms

NIHSS stroke scale

BG levels and vitals

onset of symptoms

4 things to get when setting up a central line

sterile caps

central line kit

sterile gown

sterile gloves

mask

how often do you chart vitals when giving a bolus during sepsis

q 15 min during bolus and for one hour after

what is the correct procedure if the blood sugar machine reads high

send the blood to the lab for BG

what is symptomatic bradycardia

HR < 60

fatigue, dizziness, nausea, sob, decrease LOC

3 ways to treat symptomatic bradycardia

atropine

epinephrine

pacing

look at possible cause

when cardioverting a patient name the steps and items to have in the room.

explain procedure to pt

notify MD and get crash cart in room

hook up cardioverter to patient

follow MD orders during procedure

have ambu, O2, and suction available

5 things to monitor when caring for a DKA pt

AGAP

BG

CO2

ABGs

neuro checks

potassium

when should you consider a potassium jump for your patient (not DKA)

< 3.9

when do you add potassium to the IV fluids for a patient in DKA

3.3-5

what are some S&S of DKA

increase hunger

increase thirst

increase urination

kussmal respirations

fruity breath

increase RR

altered LOC

metabolic acidosis

Name 6 things and ICU nurse does for routine skin care

apply mepelex

applies heel protectors

apply barrier cream

turn q 2 hour

makes sure pt is not sitting on any lines or devices

assess patient braden every shift

wash hands and wears gloves

incontinent care

as an ICU nurse, what would you do if your pt has a seizure

give valium

ensure pt is not at a risk for self harm

make sure O2 and oxygen set up

document length and type of seizure

let provider know

turn on side if episode of emesis occurrs

what is the rate of compressions/ventilation during CPR

30:2

how often do you give breaths to an intubated pt during a code

12 min

ever 6 sec

what is the rate of compressions during a code

100-120

what are the goals of care when caring for a pt that is experiencing a STEMI

early reperfusion

relief of chest pain

ST back to baseline

what is the RASS we titrate to during sedation

-2 or -1

normal CVP

2-6

state 3 reasons why your patient would receive beta blockers

high HR

high BP

post MI

if the SVR is low how could we raise it

vasopressors

the physician gives you an order to add vasopressin. How is it mixed and what is the rate of ml/hr?

0.04 u/min or 12 ml/hr

20 units mixed with 100 ml NS

what is included in a neurovascular check

GCS

pupils

neurovascular

neuromuscular

behavior

name 5 things you would grab for an EVD insertion and where you would find the items?

cranial access kit

sterile gauze/tegaderm

EVD drain

stapler

betadine

5E

how is cardene mixed and how do we titrate it? when would you consider PRN meds?

25 mg with 250ml

2.5mg/hr every 15 min

give prns to titrate off cardene

your pt received TNK, you take the patient for their CT scan of the brain exactly 24 hours s/p TNK. It is negative for hemorrhage. What orders will you call the physician for?

aspirin therapy

You are taking care of a patient after an acute MI. What medication will you verify is on their MARS?

beta blocker

aspirin

plavix

statins

how often do you chart a NIH for an acute stroke?

every shift for 72 hours

what is a risk predictor for skin breakdown

braden assessment

where can I find out if my IVs are compatible with each other?

lexicomp -> trisslers IV compatability

how do I order another iV bag and why is it important to avoid interruption in IV vasoactive therapy

right click on the med in the MAR and med request it

so their pressure stays optimal

5 Hs of cardiac arrest

hydrogen ions

hypothermia

hypovolemia

hypokalemia

hypoxia

5 Ts of cardiac arrest

cardiac tamponade

tension pneumothrax

pulmonary thombus

cardiac thrombus

toxins

can cause muscle jerking

common induction agent for intubation

etomidate

rapid onset (paralytic)

4-6min duration of action

succinylcholine

common drugs for sedation

etomidate

ketamine

propofol

precedex

neuromuscular blocking agents

Succinylcholine

vecuroniuim

rocuronium

cisatracurium (nimbex)

can cause hypotension and bradycardia but does not decrease respiratory drive

precedex

long onset

not used for rapid sequence intubation

nimbex

causes paralysis but does not provide sedation

neuromuscular blocking agents

contraindicated in myasthenia gravis

vecuronium

can cause tachycardia and hypertension

ketamine

onset is dose dependent

duration of action is 30-90 min

rocuronium

decreases LOC but not all pain

sedation goals are set to scale

sedative hypnotics

can cause hypotension, bradycardia, and resp depression

bottle and tubing changed every 12 hours

propofol

usage of train of fours

used to show the voltage number a patient requires for their neuromuscular blocking agent

why would someone get dobutamine

they have decreased cardiac output

why would someone get midazolam (versed)

seizures

pain control

why would someone need milrinone (primacor)

they have decreased cardiac output

increased BP

why would someone get nitroglycerin

they have increase BP

chest pain

why would someone get phenylephrine (neo-synephrine)

they have increased bP

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