failure to rescue and code management

what is the earliest warning sign og physiological instability

change in mental status

what does the neurological bell curve focus on

decreased LOC

what does the respiratory bell curve focus on

respiratory rate

what does the cardiac bell curve focus on

worsening EKG strip

what happens to LOC as the patient progresses along the neurological bell curve

restless to combative to unresponsive

what happens to the RR as the patient progresses along to respiratory bell curve

respirations increase until it leads to apnea

what components make up the MEWS score

RR, HR, BP, temp, urinary output

when using the mews score what trend is a warning score

a high or increasing score

what is the role of the rapid response team

brings critical care to the patients bedside

when should you call the rapid response team

physiologic or lab value changes, “gut feeling”, high MEWS score

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

which patients are the most vulnerable to failure to rescue

trauma and surgical

what potential complications can place the patient at risk for failure to rescue

cardiopulmonary arrest, pneumonia, upper GI bleed, VTE, sepsis

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

when do S/S of impending arrest begin

up tp 72 hours before

which is more important during CPR compressions or breaths

compressions

what is the goal of CPR

preserve brain function

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

what style of communication should be used during codes

closed feedback

after a patient is shocked what is the immediate next step

resume CPR, don’t do a pulse check first

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

nursing care post-code

O2, correct hypotension, EEG if patient is comatose

what is a reperfusion injury

as oxygen is introduced back into brain cells they begin to die as they carried back inflammatory agents

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)

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)

what are the outcomes of induced hypothermia post-code

better neurologic function and decreased mortality

how should a patient in induced hypothermia be rewarmed

0\.5 degrees per hour

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

what does the nursing care look like for a patient in induced hypothermia

analgesics, sedation (reduced shivering), paralytics (alleviate muscle movement), keep MAP > 70

why is meperidine (demerol) given to induced hypothermia patients

decreases shivering threshold

why are sedatives such as propanol and fentanyl given to induced hypothermia patients

decreases shivering but no the threshold

what are the goals for cardiac rehabilitation

reduce risk for future MI and rehospitilization, lessen chest pain and need for meds, control risk factors

what are the components of cardiac rehabilitation

exercise, healthy diet, reduce stress, stop smoking, meds