Table 3.
Cognition of adult critical care nurses regarding IAP (n = 1068)
| No. | Category | Question | Frequency | Percentage |
|---|---|---|---|---|
| 1 | Description | Which is the correct description of Intra-abdominal pressure? | ||
| Intra-abdominal pressure is a stable pressure state in the closed abdominal cavity.* | 896 | 83.9% | ||
| Intra-abdominal pressure is produced by the hydrostatic pressure of the abdominal viscera. | 93 | 8.7% | ||
| Intra-abdominal pressure decreased during inspiration and increased during expiration. | 29 | 2.7% | ||
| Intra-abdominal pressure is determined by abdominal wall compliance. | 50 | 4.7% | ||
| 2 | Description | Which is correct about the normal intra-abdominal pressure in critically ill patients? | ||
| 0–5 mmHg | 208 | 19.5% | ||
| 5–7 mmHg* | 502 | 47% | ||
| 8–10 mmHg | 269 | 25.2% | ||
| 11–13 mmHg | 89 | 8.3% | ||
| 3 | Description | Intra-abdominal hypertension refers to | ||
| Persistent or repeated pathological elevation of intra-abdominal pressure ≥ 10 mmHg. | 216 | 20.2% | ||
| Persistent or repeated pathological elevation of intra-abdominal pressure ≥ 11 mmHg. | 122 | 11.4% | ||
| Persistent or repeated pathological elevation of intra-abdominal pressure ≥ 12 mmHg.* | 598 | 56% | ||
| Persistent or repeated pathological elevation of intra-abdominal pressure ≥ 13 mmHg. | 132 | 12.4% | ||
| 4 | Description | How many grades of intra-abdominal hypertension can be divided? | ||
| 3 grades | 268 | 25.1% | ||
| 4 grades* | 688 | 64.4% | ||
| 5 grades | 79 | 7.4% | ||
| 6 grades | 33 | 3.1% | ||
| 5 | Description | Abdominal compartment syndrome (ACS) refers to the continuous increase of intra-abdominal pressure exceeding ____ mmHg (with or without peritoneal perfusion pressure < 60 mmHg), combined with new organ dysfunction or organ failure. | ||
| 15 mmHg | 143 | 13.4% | ||
| 20 mmHg* | 648 | 60.7% | ||
| 25 mmHg | 187 | 17.5% | ||
| 30 mmHg | 90 | 8.4% | ||
| 6 | Consequences | What are the mechanisms of organ dysfunction caused by intra-abdominal pressure? (multiple choice item) | ||
| The increased intra-abdominal pressure is directly transmitted to other chambers of the body.* | 353 | 33.1% | ||
| The increased intra-abdominal pressure is indirectly transmitted to other chambers of the body. | 587 | 55% | ||
| Increased intra-abdominal pressure affects systemic haemodynamics.* | 323 | 30.2% | ||
| Increased intra-abdominal pressure affects local haemodynamics. | 797 | 74.6% | ||
| 7 | Consequences | Increased intra-abdominal pressure will not lead to the following situations? | ||
| Increased myocardial compliance, increased cardiac output, and elevated blood pressure.* | 528 | 49.4% | ||
| Lung compliance decreased, pulmonary oedema, atelectasis, and hypoxemia. | 194 | 18.2% | ||
| Intracranial venous outflow obstruction, intracranial hypertension, and decreased cerebral perfusion. | 229 | 21.4% | ||
| Reduced renal blood flow, oliguria, anuria, and renal failure. | 117 | 11% | ||
| 8 | Factors related to IAH | What is the pathogenesis of the effect of elevated intra-abdominal pressure on the body? | ||
| Related to the oedema of damaged organs and the increase of extracellular fluid caused by direct compression, ischaemia-reperfusion injury, release of vasoactive substances, and increase of vascular.* | 630 | 59% | ||
| Related to the oedema of damaged organs and the increase of intracellular fluid caused by direct compression, ischaemia- reperfusion injury, release of vasoactive substances, increase of vascular. | 289 | 27.1% | ||
| Related to the increase of abdominal wall tension caused by the increase in abdominal contents. | 131 | 12.3% | ||
| Related to the decrease in abdominal wall tension and the increase in abdominal contents. | 18 | 1.7% | ||
| 9 | Factors related to IAH | What are the following factors that do not lead to increased intra-abdominal pressure? | ||
| Increased content of the abdominal cavity | 112 | 10.5% | ||
| Accumulation of abdominal contents | 98 | 9.2% | ||
| Increased abdominal wall compliance* | 546 | 51.1% | ||
| Capillary leakage and fluid resuscitation | 312 | 29.2% | ||
| 10 | Conditions for IAP monitoring | Which of the following situations does not require routine monitoring of intra-abdominal pressure? | ||
| When patients have abdominal pathological symptoms. | 111 | 10.4% | ||
| When patients have hypoperfusion or excessive fluid. | 247 | 23.1% | ||
| During enteral nutrition in patients with severe acute pancreatitis. | 192 | 18% | ||
| When patients have trauma leading to exposure of abdominal organs.* | 518 | 48.5% | ||
| 11 | Conditions for IAP monitoring | Which of the following situations is prohibited from monitoring intra-abdominal pressure by bladder measurement? | ||
| Abdominal surgery | 92 | 8.6% | ||
| Intraperitoneal Haemorrhage | 259 | 24.3% | ||
| Intestinal obstruction | 108 | 8.6% | ||
| Trendelenburg position ( lies supine, feet raised higher than their head)* | 609 | 57% | ||
| 12 | Conditions for IAP monitoring | How often do you routinely measure IAP when the patient’s IAP ≥ 12 mmHg? | ||
| Every 1 h | 116 | 10.9% | ||
| Every 2 ~ 3 h | 209 | 19.6% | ||
| Every 4 ~ 6 h* | 621 | 58.1% | ||
| Every 6 ~ 8 h | 122 | 11.4% | ||
| 13 | Technique of accurate IAH monitoring | What factors will affect the measurement of intra-abdominal pressure? (multiple choice item) | ||
| Patients body position* | 81 | 7.6% | ||
| Breath holding* | 141 | 13.2% | ||
| Infusion volume in bladder* | 103 | 9.6% | ||
| Zero reference level* | 203 | 19% | ||
| Mechanical ventilation* | 180 | 16.9% | ||
| Tension of abdominal muscle* | 155 | 14.5% | ||
| Patients wear a chest and abdomen belt* | 225 | 21.1% | ||
| Dysphoria* | 172 | 16.1% | ||
| 14 | Technique of accurate IAH monitoring | Which of the following operations increase the patient’s risk of urinary or intra-abdominal infection? | ||
| Strictly follow the aseptic principle. | 133 | 12.5% | ||
| Strictly disinfect each connection port of the pipeline. | 46 | 4.3% | ||
| Repeatedly opened the connection and injected with normal saline.* | 861 | 80.6% | ||
| Perineal care and catheterisation care | 28 | 2.6% | ||
| 15 | Technique of accurate IAH monitoring | What kind of situation does the patient have that should try to avoid the head of the bed elevation? | ||
| Grade Ⅰ IAH | 98 | 9.2% | ||
| Grade Ⅱ IAH | 231 | 21.6% | ||
| Grade Ⅲ IAH | 233 | 21.8% | ||
| Grade Ⅳ IAH* | 506 | 47.4% | ||
| 16 | Nursing care for patients with IAH | Do you think which method can accurately reflect the capacity status of the patient relatively when IAH happens? | ||
| Central venous pressure measured by the traditional (intermittent) technique | 217 | 20.3% | ||
| Pulmonary artery wedge pressure is measured by the traditional (intermittent) technique | 82 | 7.7% | ||
| Arterial blood pressure measured by pressure transducers | 182 | 17% | ||
| Thermodilution or left ventricular end-diastolic volume assessed by ultrasonography* | 587 | 55% | ||
| 17 | Nursing care for patients with IAH | Do you think which is the correct setting of ventilator parameters in patients with intra-abdominal hypertension? | ||
| The plateau pressure is < 30 cmH2O (1 cmH2O = 0.098 kPa). | 299 | 28% | ||
| The plateau pressure should be measured by oesophageal pressure or calculated by formula.* | 462 | 43.3% | ||
| PEEP was set at 70% of the intra-abdominal pressure. | 170 | 15.9% | ||
| PEEP was set at 30% of the intra-abdominal pressure. | 137 | 12.8% | ||
| 18 | Nursing care for patients with IAH | When the patient’s intra-abdominal pressure increased to_____, you will suggest to the doctor to implement measures to reduce intra-abdominal hypertension. | ||
| 7 mmHg | 45 | 4.2% | ||
| 12 mmHg | 369 | 34.6% | ||
| 16 mmHg* | 385 | 36% | ||
| 20 mmHg | 203 | 19% | ||
| 25 mmHg | 66 | 6.2% | ||
| 19 | Nursing care for patients with IAH | If intra-abdominal pressure continues to rise, which of the following measures can be taken? (multiple choice item) | ||
| Patients who received enteral nutrition should have received a reduction or suspension of enteral nutrition.* | 116 | 10.9% | ||
| Muscle relaxants* | 387 | 36.2% | ||
| A large amount of rehydration | 811 | 75.9% | ||
| Abdominal ultrasound examination* | 179 | 16.8% | ||
| Trendelenburg position | 565 | 52.9% | ||
| Haemodialysis/ultrafiltration* | 333 | 31.2% | ||
| Open abdomen* | 484 | 45.3% | ||
* The correct answer
IAP: Intra-abdominal Pressure