Critical Care
Define a critically ill patient + name 5 critical-care locations.
High risk for actual/potential life-threatening problems. Locations include ICU, trauma, cardiac care, cardiac cath lab, transplant units, RRT, telemetry, ER, recovery room
Define ED triage + explain the main principle.
Quickly sorts patients and assigns resources to the right place/time. Life threats are treated first
What does ABCDE stand for?
Airway + cervical spine, Breathing/ventilation, Circulation/hemorrhage control, Disability/neuro, Exposure/environmental control.
What is the purpose of the secondary survey and an artificial airway?
Secondary survey identifies all injuries after primary survey/lifesaving interventions. Artificial airway bypasses the upper airway/larynx by placing a tube into the trachea.
Name the 4 environmental emergencies + most common animal bites.
Heat exhaustion, heat stroke, hypothermia, animal bites. Dogs/cats are most common.
Name the major critical-care problems and 1 intervention for each.
Explain ESI 1–5 + illness severity + resource utilization.
For A–C, give major assessments and interventions
A: Airway patency, suction/jaw thrust, remove obstruction, stabilize C-spine.
B: Rate/depth, chest movement, lung sounds, O₂; BVM with 100% O₂ if inadequate. Prepare for needle thoracostomy/chest tube if absent breath sounds.
C: Pulse, skin, cap refill, BP; CPR if no pulse; 2 large-bore IVs if hypotensive, fluids/blood, control bleeding.
Explain H + I.
Mechanism + who/what/where/when/how; allergies, meds, past history/surgery, last meal, preceding events/environment. Head-to-toe: head/neck/face, chest, abdomen/flanks, pelvis/perineum, extremities.
I: Logroll to inspect posterior; 3–4 people, one supporting head; inspect wounds/deformities and palpate spine.
Compare heat exhaustion vs heat stroke.
Exhaustion: prolonged heat → dehydration, diaphoresis, tachycardia, hypotension, nausea/confusion. Temp can reach 105.8°F.
Stroke: >105.8°F, altered mentation, absent sweating, hot/dry skin, possible collapse/hallucinations. Cool aggressively to 102°F and monitor for rhabdomyolysis, myoglobinuria, DIC.
ICU patient is intubated, sedated, anxious, in pain, confused, and unable to sleep/communicate. Identify problems + interventions.
Pain → assess/treat. Anxiety → explain/reassure through appropriate communication. Communication impairment → alternate communication. Sensory/delirium → treat underlying cause/limit noise. Sleep → reduce noise/light, cluster care, orientation tools.
Patient has a life-threatening problem but no diagnosis yet. What comes first?
Recognize and intervene in the life-threatening problem before establishing the medical diagnosis.
A trauma patient has shallow respirations, unequal chest movement, a weak carotid pulse, and altered LOC. What should the nurse assess/intervene on first, and why?
Airway (A) first. Maintain the airway while protecting the cervical spine, then assess breathing, circulation, and disability in order. The primary survey prioritizes life threats first.
Give the intubation sequence.
Consent/teaching → equipment ready (BVM/O₂, suction, IV) → sniffing position → preoxygenate 100% O₂ → ventilate between attempts if needed → inflate cuff → confirm placement → secure tube → document position → monitor SpO₂/ABGs.
Explain moderate vs severe hypothermia.
Moderate: 89.6–93.2°F: rigidity, lethargy, confusion, bradycardia/bradypnea, metabolic/respiratory acidosis, hypovolemia.
Severe: <86°F: may appear dead, bradycardia, asystole/VF, absent reflexes, fixed/dilated pupils. Rewarm to at least 86°F/30°C before pronouncing dead. Treat ABCs, rewarm, correct dehydration/acidosis, treat dysrhythmias.
How do anxiety, pain, sensory overload/delirium, and sleep disruption affect ICU patients?
Anxiety causes fear/uncertainty; pain can be moderate-severe and comes from invasive procedures/tubes/immobility; delirium can involve confusion, memory problems and restlessness; sleep is disrupted by noise, lights and interruptions. Use orientation, reduce noise/light, cluster care, comfort measures, and appropriate communication.
Explain START triage and the four colors.
START uses RPM = Respirations, Perfusion, Mental status and can be completed in ~15 seconds.
Trauma patient has an obstructed airway, poor respirations, weak pulse, altered LOC, exposed body, and anxious family. Walk through A→G.
A: Open/protect airway + C-spine.
B: Assess ventilation → O₂/BVM if inadequate.
C: Pulse/BP/bleeding → CPR if pulseless; IVs/fluids/control bleeding as needed.
D: GCS + pupils.
E: Expose but prevent heat loss/protect privacy.
F: Monitoring + family support.
G: Labs/EKG/NG tube/oxygenation/pain/comfort as indicated.
What ongoing monitoring occurs after the secondary survey?
Airway patency/effectiveness is always highest priority. Monitor RR/rhythm, O₂ saturation, ABGs if ordered, LOC, VS, pulses, urine output, and skin perfusion. Patient may go to CT/OR, ICU/telemetry/general bed, or another facility.
Deep cat bite to hand: explain treatment and complications.
Copious irrigation, debridement, tetanus prophylaxis, analgesics. Consider prophylactic antibiotics because it is a hand bite/puncture. Cat bites are deep and have high infection risk, including septic arthritis, osteomyelitis, and tenosynovitis.
Explain teaching strategies, family roles, and how to decrease family vulnerability.
Identify what patient/family knows and concerns; decrease stress/promote comfort; repeat information calmly because anxiety, pain, fatigue, and medications affect comprehension. Family provides support/information, may have POA, and can assist with care. Introduce the healthcare team, provide crisis intervention/education, allow visitation, offer presence during procedures, build trust, and answer questions.
Explain the nurse's role across disaster preparedness, mitigation, response, and recovery.
Preparedness: disaster plans, warning systems, drills, resources, rescue-team training, shelter education, public education.
Mitigation: identify hazards and reduce/minimize their effects.
Response: triage, treat injuries/other conditions, supervise shelter.
Recovery: follow-up physical/psychological care, recovery assistance, cleanup, risk assessment, infectious-disease monitoring, prevention of future disasters.
Give the complete ABCDEFG sequence with the key priority for each.
A: Airway + C-spine
B: Breathing/ventilation
C: Circulation + hemorrhage control
D: Disability/neuro/GCS
E: Exposure + environmental control
F: Facilitate monitoring + family presence
G: Get resuscitation adjuncts
The goal is to identify and treat life threats first.
Explain primary survey → secondary survey → ongoing assessment.
Primary survey first to identify/lifesave: ABCDEFG. After life-saving interventions, perform H = history/head-to-toe and I = posterior inspection. Then document findings and continue monitoring, with airway always the highest priority.
Complete bite question: dog vs cat vs human + treatment + rabies.