Critical Care Nursing Flashcards

What are some skills required in critical care nursing?

Advanced interpretation of clinical assessments, rapid analysis and intervention with strong decision-making skills, ethical advocacy for patients and families, technical proficiency, collaboration and coordination, and the use of evidence based practice.

Define Coronary Care Units.

Specialised intensive care unit dedicated to caring for patients with cardiac diseases and complications that require continuous monitoring and specialised interventions. Conditions include acute MIs, unstable angina, ACS, severe arrhythmias, post surgery recovery, and cardiogenic shock.

Define paediatric critical care.

It focuses on the specialised needs of infants, children, and adolescents with life threatening conditions, recognising their distinct physiological differences. There are age-specific assessments, weight-based dosing, family-centred care, and developmental considerations.

What are some respiratory considerations in paediatric patients?

Smaller airways, higher rates of oxygen consumption, compliant chest wall.

What are some cardiovascular considerations in paediatric patients?

Higher baseline heart rate, rate-dependent cardiac output, limited stroke volume.

What are some metabolic/fluid considerations in paediatric patients?

Higher metabolic rates, greater surface area/weight ratio, limited glycogen stores.

What are some developmental and age-specific needs for infants?

They aren’t as good at thermoregulation, they have higher body water percentages, higher baseline HRs, greater chance for rapid deterioration.

What are some developmental and age-specific needs for toddlers and children?

They require age-appropriate explanations for procedures, therapeutic play to manage anxiety, age-specific assessment tools, parental involvement to reduce stress.

What are some developmental and age-specific needs for adolescents?

They have an increased need for physical privacy and emotional space, they need to be included in decision-making, respect their independence, support social connections, address body image concerns and fear of implications.

What are some considerations with obstetric emergencies?

Consider dual patient assessments (maternal-foetal) and continuous foetal monitoring. Pregnant women have a higher O2 consumption (20-40%), lower functional residual capacity, high diaphragm positioning, higher RR, increased blood volume (40-50%), higher cardiac output, anaemia, supine hypotensive syndrome, high thromboembolism risk, increased GFR, urinary stasis, delayed gastric emptying, and displaced abdominal organs.

What are the 3 most common life-threatening obstetric emergencies?

1. Obstetric Haemorrhage

2. Eclampsia

3. Amniotic fluid embolism

Define an obstetric haemorrhage.

Excessive bleeding in pregnancy, childbirth, or the postpartum phase which is measured as more than 500mL with vaginal births or more than 1000mL with caesarean births.

Define eclampsia.

Seizures that occur in pre-eclamptic patients, typically after 20 weeks gestation.

Define an amniotic fluid embolism.

A rare but severe complication that occurs when amniotic fluid enters the maternal circulation which presents as sudden cardiovascular collapse, hypoxia, and seizures.

What are the 3 most common urgent obstetric emergencies?

1. Ectopic pregnancies

2. Pre-term labour

3. Pre-eclampsia

Define an ectopic pregnancy.

A pregnancy implanted outside the uterine cavity, most likely in the fallopian tubes.

Define pre-term labour.

Labour that occurs before 37 weeks of gestation evidenced by regular contractions and cervical changes.

Define pre-eclampsia.

A hypertensive disorder specific to pregnancy, occurring after 20 weeks gestation. Hypertension can accompany proteinuria, headaches, and visual changes.

What are 2 time critical obstetric emergencies?

1. Trauma

2. Maternal sepsis

Describe trauma related to obstetric emergencies.

Physical injuries obtained during pregnancy which requires dual assessment of both the mother and foetus.

Define maternal sepsis.

Life threatening organ dysfunction due to infection during pregnancy or the postpartum phase.

What are some considerations for geriatric emergencies?

Consider poly-pharmacy, adverse drug events, atypical symptom presentations, and increased vulnerability. Age-related physiological changes include lower vital capacity, lower cough reflex, higher closing volume causing oxygenation challenges, lower cardiac reserve, arterial compliance, and baroreceptor sensitivity affecting vital sign interpretation.

What are some assessment tools used with geriatric patients?

Tools that assess functional status, cognitive ability, social supports, general routine screening, environmental modifications, risk assessment, early mobilisation, post-fall evaluations, dose adjustments, discharge planning, carer education, follow-up planning, community service referrals.

What are some common geriatric ED presentations?

Falls and traumatic events, delirium, sepsis, acute cardiac events, medication non-compliance, urinary tract infections.

Describe falls and traumatic presentations in geriatric populations.

Mechanical incidents causing injury, likely related to gait, balance, vision, and environmental factors.

Describe delirium.

An acute confusional state representing cerebral dysfunction, typically having a rapid onset and fluctuating course.

Describe sepsis.

A life threatening organ dysfunction caused by a dys-regulated host response to infection, often with an atypical presentation in older adults.

Describe acute cardiac events in geriatric populations.

Sudden cardiac conditions including myocardial infarctions, heart failure exacerbation, and arrhythmias, resulting in ED presentations in older adults.

Describe medication related issues in geriatric populations.

Adverse drug events can occur from polypharmacy, altered pharmacokinetics or pharmacodynamics, inappropriate prescribing.

Describe urinary tract infections in geriatric populations.

Infections of the urinary system, often with atypical presentation, complicated by functional or anatomical abnormalities.

Describe the features of HIRAID documentation.

It improves quick documentation and reduces deterioration by covering the patient’s history, infection risk, primary and secondary surveys, nurse-initiated interventions, nurse-initiated pathology/imaging, and re-assessment times.

Describe the role of the clinical initiatives nurse.

They are the first point of contact for patients in waiting rooms. They initiate early interventions/assessments, monitoring patients for deterioration, communicating wait times, and providing timely pain relief/comfort measures.

Describe the role of ED nurse practitioners.

They autonomously manage patients, prescribe medications, order diagnostics, and refer to specialists. They also discharge patients and perform procedures like suturing and casting. They have a Masters in Nurse Practitioner and advanced clinical experience (5+ years).

Describe the role of clinical nurse specialists.

They provide expertise in specific areas like trauma, paediatrics, mental health, or cardiac care.

Describe the role of the resuscitation nurse.

They manage critically ill patients, leading/participating in resuscitation efforts, managing advanced airways, vascular access, and emergency medications. They undertake resus study days, courses on the emergency management of severe trauma, and postgraduate emergency nursing qualifications.

Describe the role of the triage nurse.

They apply the Australasian Triage Scale to rapidly prioritise patients based on clinical urgency. They also perform initial interventions for time-critical conditions, conducting rapid primary surveys and comprehensively documenting with the HIRAID framework.

Describe the 4 hour model of care.

1. Initial assessment and management (10-15 mins)

2. Targeted tests and continued management (15-60 mins)

3. Advanced diagnostics and treatment evaluation (60-180 mins)

4. Multidisciplinary collaboration, disposition planning (180-240 mins)

Explain the frequency of vital signs for different types of patients.

Critical patients have continuous monitoring or 5 minutely monitoring. Moderate risk patients have 15 minutely obs for an hour, then half hourly if stable. Stable patients have hourly monitoring until discharge.

Define the Australasian Triage Scale.

A 2-5 minute thorough assessment based on clinical urgency, not diagnosis. Patients are re-triaged when their condition changes. It also considers resource allocation, staff skill mix, safety monitoring, and various patient-specific factors. There are 5 categories ranging from immediately life threatening to less urgent patient presentations.

Describe a Category 1 triage.

An immediately life threatening condition, like cardiac or respiratory arrests, immediate airway risks or extreme distress, a RR under 10, severe shock, BP under 80mmHg, GCS under 9, ongoing/prolonged seizures, IV overdoses, or unresponsive patients. They are immediately seen by doctors.

Describe a Category 2 triage.

An imminently life threatening condition, like moderate/severe respiratory distress, blood loss (circulatory compromise), HR under 50 or over 150, chest pain of a cardiac nature, very severe pain, time-critical treatment needed, BGL under 3mmol/L, acute stroke/altered consciousness. They are seen within 10 minutes.

Describe a Category 3 triage.

A potentially life threatening condition, like severe HTN, moderate blood loss, moderate SOB, seizure (now alert), moderately severe pain, persistent vomiting and dehydration, head injury with a short LOC (now alert), or suspected sepsis. They are seen within 30 minutes.

Describe a Category 4 triage.

A potentially serious condition, like a mild haemorrhage, foreign body, minor head injury with no LOC, moderate pain with risk factors, vomiting and diarrhoea without dehydration, minor limb trauma, eye inflammation, and non-specific abdominal pain. They are seen within 60 minutes.

Describe a Category 5 triage.

A less urgent condition, like minimal pain with no risk factors, low-risk history (now asymptomatic), minor symptoms of an existing illness, minor wounds, a review of results, medical certificates, and scheduled re-visits. They are seen within 120 minutes.

Explain the general triage process.

When a patient presents, the triage nurse does an initial ABCDE and visual assessment of their appearance and distress. They take a focused history of the complaint, onset, duration, medical history, and medications. They do vitals and a focused physical assessment based on the chief complaint, evaluating risks for deterioration. Then they assign a triage category.