Talking in "code"
Standards of Care
Sepsis
Matters of the Heart
PICU Potpourri
100
What are your options for calling a code blue?
Push the code blue button in the pt room or call 5555 and tell the operator "pediatric/adult code blue, PICU room ????"
100
How often are vital signs taken on a PICU status patient (5)?
Every 2 hours
100
What is the definition of septic shock?
Infection with hypothermia or hyperthermia, tachycardia, and altered mental status
100
How is cardiac output calculated?
Cardiac output = stroke volume x heart rate
100
What is the "code" dose of epinephrine?
0.01 mg/kg or 0.1 ml/kg
200
A code red is called in the OR. What is your responsibility?
Make sure all doors are shurt and that people do not attempt to use the elevators. If necessary, RACE. Rescue, alarm, confine, extinguish/evacuate.
200
Your patient is a PICU status patient (acuity 5), but is on a dopamine gtt. How often are you expected to do vital signs?
A patient on a pressor gtt should have vital signs completed every hour.
200
When does sepsis become septic shock?
-Decreased peripheral pulses -Cap refill of >3 seconds or flash cap refill -Mottled or cool extremities -Decreased urine output (<1ml/kg/hr)
200
Your patient had a tetrology of Fallot repair today. Your patient now has a heart rate of 200 bpm and appears to be in JET (junctional ectopic tachycardia). Your pt is not tolerating this rhythm and has poor cardiac output. What are your options to convert the pt back to a NSR?
Cool pt to 35 degrees c, sedation, inotropic support, overdrive pacing (when able to capture the rate), paralysis, and medications like amiodarone or procainamide.
200
You have a new-onset DKA. You have just started an insulin gtt at 0.1 units/kg/hr. How quickly should the patient's blood glucose be allowed to drop?
Typically 50-100 dL/hr
300
A family member of a patient in the PICU is in the waiting room and is upset and pulls a weapon out and begins threatening people. What is your responsibilty as a nurse in the PICU?
Call 5555 and notify PBX of the code silver and location of the person with the weapon. Evacuate the area specified and any area near by if able to do so safely. Seek cover for yourself and anyone around you behind locked doors. Stay alert, and be prepared to give more information as needed.
300
You have a patient who has been in the PICU for three months. You notice that the code sheet is the original code sheet from admission. How often are our code sheets updated for long-term patients?
Code sheets should be updated on the 1st day of every month for long-term patients.
300
What are some complications of septic shock?
ARDS, DIC, acute renal failure, and MODS (multiple-organ dysfunction syndrome)
300
Tetrology of Fallot is a series of what heart defects?
A VSD, right ventricular outflow tract obstruction, aortic override, and pulmonary stenosis.
300
What drugs would you expect to give for rapid sequence intubation? What doses would you expect to give?
Fentanyl - 1mcg/kg Versed - 0.1 mg/kg or ketamine 0.5-2 mg/kg Vecuronium - 0.1 mg/kg or rocuronium 1 mg/kg
400
PSLMC Administrators have decided to activate the emergency preparedness/disaster plan due to a tornado in the area. Where is the "command center" set up?
The command center is located in the administration offices.
400
The MD ordered lasix for your 5 kg patient. The order reads: Lasix 5 mg IV q 8 hours What is missing from this order?
The order should have the dose expressed in total mg AND mg/kg/dose for patients under 40 kg. The order should read: Lasix 5 mg (1mg/kg/dose) IV q 8 hours.
400
What patients are most at risk for sepsis?
Neonates, children younger than 3 years, failure to thrive, immunosuppresive therapy, primary immunodeficiency, AIDs, noncompliance with vaccination schedules and congenital heart disease.
400
What are the stages of a hypoplastic left heart repair and when are they typically completed?
First stage palliative = Norwood/BT Shunt Second stage palliative = Glenn usually 3 to 6 mos after Norwood Third stage palliative = Fontan (preferred age is less than 4 years)
400
Your patient is on CRRT. They are currently in CVVHDF mode. What does this mean?
Continuous veno-venous hemodiafiltration. Is most common because both small and medium sized molecules are cleared and both dialysate and replacement fluids are required.
500
What is a "code ACE"?
Code ACE is Access Control Emergency and is called to alert you that part of the facility has been locked down. Lock your unit exits per policy and level of access.
500
What is the minimum rate for fluids running through invasive monitoring lines?
The minimum rate will be 1.5 ml/hr unless otherwise ordered.
500
What is SIRS (systemic inflammatory response syndrome)?
An activation and release of various mediators and cytokines which is the body's systemic inflammatory/immune and hormonal response to severe injury or illness (e.g. infection, hemorrhage, trauma, pancreatitis, and burns)
500
Your patient had a TAPVR repair today. What are some possible post-operative complications?
Pulmonary hypertensive crisis, sick sinus syndrome and other atrial dysrhythmias, restenosis of the anastomosis, and inability to relieve the stenosis fully.
500
You are admitting a 16 year old girl who admits to taking a whole bottle of tylenol. Knowing what you do about tylenol ingestions, you know the physician will order mucomyst. How will it be ordered?
A loading dose of 150 mg/kg infused over 15 minutes, then 50 mg/kg infused over 4 hours, and finally 100 mg/kg infused over 16 hours.
M
e
n
u