Critical Care Nursing Flashcards

What is the nursing management for a patient with acute respiratory distress syndrome (ARDS)?

Answer: Low tidal volume ventilation (6 mL/kg), prone positioning, PEEP optimization, and conservative fluid management

ARDS management: lung-protective ventilation (low tidal volume 6 mL/kg ideal body weight), appropriate PEEP to maintain oxygenation, prone positioning (12-16 hours/day improves oxygenation), conservative fluid management, sedation management, and monitoring for barotrauma.

What does the nurse assess using the Richmond Agitation-Sedation Scale (RASS)?

Answer: Level of sedation or agitation in critically ill patients, ranging from -5 (unarousable) to +4 (combative)

RASS rates sedation/agitation: +4 combative, +3 very agitated, +2 agitated, +1 restless, 0 alert and calm, -1 drowsy, -2 light sedation, -3 moderate sedation, -4 deep sedation, -5 unarousable. Target is typically 0 to -2 in ICU patients, adjusted to clinical needs.

What is the priority nursing action during a cardiac arrest when the rhythm shows ventricular fibrillation?

Answer: Initiate CPR and prepare for immediate defibrillation

Ventricular fibrillation (VF) is a shockable rhythm. Priority: immediate high-quality CPR, defibrillate as soon as possible (120-200J biphasic), resume CPR immediately after shock for 2 minutes, administer epinephrine after 2nd shock, and amiodarone after 3rd shock per ACLS protocol.

What is the nurse's role in end-of-life care in the Saudi ICU?

Answer: Provide comfort measures, manage symptoms, support family communication, respect cultural/religious practices, and coordinate with the palliative care team

ICU end-of-life nursing: provide dignified comfort care, manage pain and symptoms, support family (facilitate visits, communication with physicians), respect Islamic end-of-life practices (facing Qibla, Quran recitation), ensure Do Not Resuscitate orders are clear, and coordinate with palliative care and chaplaincy services.

What nursing considerations apply when caring for a patient on continuous renal replacement therapy (CRRT)?

Answer: Monitor hemodynamic stability, manage anticoagulation of the circuit, assess fluid balance hourly, monitor electrolytes, and troubleshoot alarms

CRRT nursing care: continuous hemodynamic monitoring (hypotension risk), circuit anticoagulation management (citrate or heparin), hourly fluid balance assessment, frequent electrolyte monitoring (especially calcium with citrate), catheter site assessment, temperature monitoring (heat loss), and filter/circuit lifespan tracking.

What is the significance of elevated lactate levels in a critically ill patient?

Answer: Elevated lactate (>2 mmol/L) indicates tissue hypoperfusion and is a marker of shock severity and mortality risk

Elevated lactate indicates anaerobic metabolism due to tissue hypoperfusion (inadequate oxygen delivery). Lactate >2 mmol/L is concerning; >4 mmol/L indicates severe shock with high mortality risk. Serial lactate monitoring guides resuscitation adequacy — lactate clearance of >10% per hour is the goal.