what is the earliest warning sign og physiological instability
change in mental status
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2
what does the neurological bell curve focus on
decreased LOC
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3
what does the respiratory bell curve focus on
respiratory rate
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4
what does the cardiac bell curve focus on
worsening EKG strip
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5
what happens to LOC as the patient progresses along the neurological bell curve
restless to combative to unresponsive
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6
what happens to the RR as the patient progresses along to respiratory bell curve
respirations increase until it leads to apnea
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7
what components make up the MEWS score
RR, HR, BP, temp, urinary output
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8
when using the mews score what trend is a warning score
a high or increasing score
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9
what is the role of the rapid response team
brings critical care to the patients bedside
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10
when should you call the rapid response team
physiologic or lab value changes, “gut feeling”, high MEWS score
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11
what steps can be taken to prevent failure to rescue
high RN-to-patient ratios, more BSN, recognize S/S, prepare emergency supplies, collaboration and autonomy,, high-tech, RRT
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12
which patients are the most vulnerable to failure to rescue
trauma and surgical
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13
what potential complications can place the patient at risk for failure to rescue
cardiopulmonary arrest, pneumonia, upper GI bleed, VTE, sepsis
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14
define failure to rescue
inability to save a patients life by timely diagnosis and treatment when a complication occurs, or the inability to save a hospitalized patients life when they experience a complication
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15
when do S/S of impending arrest begin
up tp 72 hours before
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16
which is more important during CPR compressions or breaths
compressions
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17
what is the goal of CPR
preserve brain function
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18
how should pulse checks during CPR be managed
complete full 2 minute cycles with minimal interruptions and pulse checks, use ETCO2 and monitor ROSC over BP and pulse checks
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19
what style of communication should be used during codes
closed feedback
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20
after a patient is shocked what is the immediate next step
resume CPR, don’t do a pulse check first
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21
what factors can influence the decision to terminate a code
no consistent perfusion for more than 30 min, initial rhythm of systole, length of time between cardiac arrest and start of CPR
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22
nursing care post-code
O2, correct hypotension, EEG if patient is comatose
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23
what is a reperfusion injury
as oxygen is introduced back into brain cells they begin to die as they carried back inflammatory agents
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24
how does the cold hypothermic setting benefit the brain
brain cells lasted longer since the cerebral metabolism was decreased (lower O2 demands), decreased excitatory neurotransmitters, decreased permeability (less cerebral edema)
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25
how cold should a patient in induced hypothermia be kept at and for how long
32-34 degrees for 12-24 hours (cool as quickly as possible after ROSC)
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26
what are the outcomes of induced hypothermia post-code
better neurologic function and decreased mortality
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27
how should a patient in induced hypothermia be rewarmed
0\.5 degrees per hour
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28
what are the side effects/complications of induced hypothermia
decreased electrolytes and insulin sensitivity, hypovolemia (cooling causes increased UO), risk for infection and bleeding, bradycardia
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29
what does the nursing care look like for a patient in induced hypothermia
Studied by 10 people
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