ABCDEF Bundle

what defines critical care nursing

care of patients with life threatening or highly complex conditions

what does critical care nursing involve

intensive patient care, multidisciplinary team, advanced technology, medical devices, pharmacological interventions, increased care complexity, wide range of conditions, and multifaceted treatment plans

Intensive patient care involves:

continuous observation, frequent assessment, immediate interventions when needed, and advanced life support measures

What is the first (highest) thing on the EBP pyramid

Meta analyses

what is meta analyses

combines results from multiple studies, including RCTs, provides a comprehensive view of evidence, and a highly reliable level of evidence

what is the second thing on the EBP pyramid

RCTs

what is a randomized control trial (RCT)

subjects are randombly assigned to : treatment and control group, and its more reliable because randomization helps reduce bias

what is the third thing on the EBP pyramid

observational studies

what are observational studies

researchers observe subjects over time, do not manipulate variables, its more scientific than anecdotal evidence, and can still have bias and confounding factors

what is the 4th (lowest) thing on the EBP pyramid

anecdotal evidence

what is anecdotal evidence

based on personal experience, observations, opinions, LOWEST level of evidence, lacks scientific rigor, and more vulnerable to bias

what happens as you move higher on the EBP pyramid

bias is better controlled, scientific rigor increases, more trustworthy conclusions, stronger peer-reviewed research. just MORE VALID!

benefits of EBP

improves patient outcomes, improves patient safety, helps healthcare professionals make decisions using best available evidence, standardizes care

barriers to EBP

resistance from staff, lack of resources

What is the ABCDEF bundle

evidence based guideline to provide holistic patient centered care in ICU

Why is the ABCDEF bundle important

focuses on whole patient, reduces stupid interventions, emphasizes long term outcome, integrates pain management, delirium prevention, early mobility, fam involvement

what does A stand for

Assess, prevent, manage pain

what does B stand for

Both spontaneous awakening trials (SAT) and spontaneous breathing trials (SBT)

what does C stand for

Choice of analgesia and sedation

what does D stand for

Delirium: Assess, prevent, manage

what does E stand for

Early mobility and exercise

what does F stand for

Family engagement and Empowerment

How will you assess pain if the patient CAN communicate

use visual/numerical pain scales to have pt report pain intensity

How will you assess pain if the patient CANT communicate

Use behavioral/observational indicators

what are some examples pain scales you can use if the patient cannot communicate

FLACC (Face Legs Aactivity Cry Consolability), CPOT (Critical Care Pain Observation Tool)

How is the CPOT scored

4 behavioral categories scored from 0-2, yielding a total score between 0 and 8

what are 2 pharmacological pain interventions

analgesics and opioids

what are 2 non-pharmacological pain interventions

physical therapy and mindfullness techniques

Do you need to reassess the patient after giving pain meds

Yes

What is a SAT (Spontaneous Awakening Trial)

Wake tf up. DECREASE SEDATION so the patient can be more ALERT. This can help support the patient's recovery and help to better assess their condition

What is a SBT (Spontaneous Breathing Trial)

Breathe bitch. Evaluate the patient's ability to breathe on their own with less ventilator support

Why would we use SAT and SBT

minimize unnecessary sedation, promote recovery, and assess readiness to breathe independently to transition away from vent

guidelines of SAT and SBT

use evidence based protocols to perform trials safely

What members of the healthcare team will you be working closely with for ventilator management

Respiratory Therapists

What things need to be considered when choosing a medication for patient sedation

pt specific needs, age, weight, kidney function, liver function, medical conditions

short acting meds

work fast, wear off fast, good for temporary/acute needs or procedures

long acting meds cons

resp depression, GI effects (constipation), addiction potential

long acting meds pros

last longer, sustained effects, used when long lasting pain/sedation is needed

what are the sedation assessment tools

RASS and Ramsay Scale

Is family allowed to provide information about patient preferences, values, usual behaviors etc

YES!

Delirium

An acute change in mental/cognitive status

cognitive changes

confusion, memory problems, disorientation, difficulty maintaining attention, difficulty thinking clearly

emotional changes

anxiety, depression, irritability, mood changes

KEY CHARACTERISTIC: Fluctuation Course

Symptoms can come and go, change in intensity, change over hours or days

Medical risk factors of delirium

severe infection, underlying conditions, dementia

medication risk factors for delirium

some meds can trigger or worsen delirium

environmental risk factors for delirium

lack of natural light, sleep disturbances, isolation

how to prevent delirium

early detection via regular screening, non pharmalogical interventions like reorienting the patient, promoting sleep, cognitive activities, reduce environmental contributors

how to manage delirium

meds, behavioral interventions (reassurance, simplify tasks, familiar environment), family to provide comfort and help with orientation

what is the assessment tool you use for delirium

CAM-ICU (Confusion assessment method)

physical benefits to early mobility

preserves muscle strength, reduce risk of DVT, improve physical function

psychological benefits of early mobility

increase mood, decrease anxiety and depression, and improve cognitive function

length of stay benefits of early mobility

can shorten ICU and/or hospital stay and can reduce healthcare costs

what safety measures are important before mobilizing the patient

make sure there is adequate staffing, have necessary equipment is available, monitor patient, make sure mobility is appropriate for patient condition

should you individualize mobility based on things like age, disabilities, etc

yes

can patients be mobilized while having lines/tubes/ventilators

yes it just requires planning and coordination. educate family and caregivers. begin mobilty as soon as medically possible

what are patient outcomes to family involvement

shorter ICU stay, better mental health, greater satisfaction

how to empower family members

ask for their opinion, listen to what they know about the patient, respect their insights

what are some barriers to family engagement

restricted visitation hours, lack of understanding, mistrust

what do nurses need to do so they can interact with families more efficiently and empathetically

reflect on their own attitudes, beliefs, biases, and assumptions