Critical care

Card Set Information

Author:
Lunnasea
ID:
255834
Filename:
Critical care
Updated:
2014-01-15 19:23:21
Tags:
Pt care ICU
Folders:
Patient care in the ICU
Description:
test 1
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  1. Morphine
    • Pain control Opiate
    • onset 5 mins
    • duration 4-5 hrs
    • 2-4 mg IV q 4hrs
    • Most common used
  2. Hydromorphone (Dilaudid)
    • Pain control Opiate-
    • Onset 15 mins
    • duration 4-5 hrs
    • 0.2-1mg IV q 2-3 hrs
    • Synthetic version of Morphine and at least 7 times as potent.
  3. Fentanyl
    • synthetic opiate analgesic
    • very potent
    • -typical dose 50mcg-100mcg
    • Onset 1-2min
    • Short acting
    • -IV duration .5 to 1 hour
    • Useful for procedures and surgery
  4. Titration
    • Adjustment of a drug fro an individual level to provide the greatest comfort to the patient with minimal side effects.
    • Often an independent nursing judgement.
  5. Narcan
    • Opiate reversal agent
    • 0.1-0.2mgIV at two to three minute intervals
    • caution: Narcan reverser all opiate effects including pain relief.
  6. Sedation
    • Midazolam (Versed)- a bensodiazepine
    • Rapid onset-short duration 4 hours
    • dosage can be weight based
    • Reversed with Romazicon(Flumazenil 0.2mg every minute-maximum 4 dosages
    • Treatment is more for agitation than pain
  7. Lorazepam/Ativan
    • Benzpdiazepine
    • Slow onset 10-20 mins
    • Long duration 12hrs
    • Reversal agent romazicon/Flumazenil
    • .2mg IV max 1mg
    • Side effect : seizures
  8. Propofol (Diprivan)
    • Rapid onset-2mins
    • Very short acting duration of 2-5 minutes
    • As soon as the drug is stopped, the pt starts to wake up.
    • White colored drug-dissolved in lipid emulsion so can raise cholestorol
    • No reversal agent
    • Metabolized in liver-can discolor urine green
  9. Propofol Syndrome
    • Cardiac failure
    • Rhabdomolysis
    • metabolic acidosis
    • renal failure
  10. Sedation Assessment
    Richmond Agitation Sedation Score
    (RASS)
    • Uses 2 scores
    • -Target score-Physician designated
    • -Actual score-nurse assessed
    • Uses positive and negative numbers
    • Typical target score- 0 to -2
    • Which is light sedation, briefly awakes to voices
    • Actual score should match target score
  11. Neuromuscular Blockade
    • Creates a drug induced paralysis
    • Vecuronium-effective within 3 minutes -duration of 30-40 minutes
    • Pavulon onset 2-3 minutes - duration 45-60 minutes
    • Paralyzes Skeletal muscles only- not the brain
    • Don't forget sedation and analgesia
    • Side effects- tachycardia and hypertension
  12. Geriatric Critically ill Patient
    • Co morbidities
    • Polypharmacy
    • Decreased reserve
    • Reduced abilit for homeostasis
    • Impaired immune response
    • Decreased CNS reflexes, memory and BBB
  13. Delirium
    • Acute onset with difficulty with cognition, inattention, and confusion.
    • Common in the critically ill patient
    • Different than dementia - slow onset
    • High risk for the elderly
    • Will vary between lethargy/inattentiveness vs agitation, restlessness, combative
  14. Delirium Factors
    • Polypharmacy
    • Infection
    • Hyponatremia
    • Alcohol withdrawal
    • Hypoxia
    • Lack of sleep
    • Sensory overload
  15. Nutrition
    • Critically ill need increased calories for
    • healing and immune response
    • Strenghten muscles (protein)
    • Decrease length of stay
    • Glucose management in critical care
    • Metabolic demands are elevated in these pts.
  16. Non opioid Pain Therapy
    • acetaminophen
    • aspirin
    • NSAIDS
    • All have fewer side effects than opiods
    • May be used in combination with opiods
  17. Adjuvant Therapy
    • Drugs that assist in reducing certain types of pain
    • Used in addition to opioids
    • ex: corticosterioids for cancer patients for relief of pain.
    • Antideppressants and anticonvulsants for neuropanthic pain

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