Critical Care Test 1

When was the first ICU created

1970

What is the AACN

American Association of Critical Care Nurses

What is the SCCM

Society of Critical Care Medicine

Guidelines for clinical practice

guide clinical practice

establish goals for patient care

provide assessment of outcomes

Nursing process

assessment

diagnosis

outcome identification

planning

implementation

evaluation

evidence based practice

Used to build clinical care for patients based on research and other clinical studies

critical care nurse characteristics

technical competence

relationship building

ability to multitask

priority setting

SBAR

Situation

Background

Assessment

Recommendation

components of critical care experience

patient

family

environment

critical care environment

designed for efficient lifesaving interventions

sensory deprivation from lack of nonclinical interaction

sensory overload from noise, flow of caregivers, lights, etc

emotional and physical pain

modification of critical care environment

noise reduction: soothing music, private areas for family, etc.

adequate lighting: natural light and night and day synchronization

clustering care: to decrease the traffic in the room

components of the patient’s critical care experience

difficulty communicating

pain

fear

depression

lack of control

discomfort

thoughts of dying

loneliness

lack of family

quality of life after critical care

discharge from critical care unit can be ifficult

preparation of patients and family for transfer is important

PTSD can be developed

CRRT

Continuous Renal Replacement Therapy

Family needs

Receive assurance

Remaining near the patient

Receive information

Having support available

family interventions

communication

facilitate visitation

provide information

encourage family involvement in care

VALUE family communication Mnemonic

V- Value what the family tells you

A- Acknowledge family emotions

L- Listen to family members

U- Understand the patient as a person
E- Elicit questions from family members

Ethical principles

confidentiality

veracity

justice

fidelity

nonmaleficence

beneficence

autonomy

cofidenciality

the right of the patient to control the information relating to their own health

autonomy

respect for the individuals ability to make decisions about their own health

ethical dilemma warning signs

emotionally charged

significant change in patient’s condition

confusion about facts

hesitancy about the correct set of actions

deviation from customary practice

need for secrecy regarding proposed actions

advocacy

open communication of patient’s wishes and ethical concerns

true collaboration with healthcare team members

duty to treat

nurse are required to care for assigned patients

abandonment

seevering professional relationship when patient is in need of care

must ensure that patient care is arranged with another nurse, including breaks and lunch

moral conflict

a nurse is required to practice is a situation violates his or her moral o religious beliefs

life sustaining care considerations

constitutional rights

quality of life

impact of advanced technology

medical futility

ordinary versus extraordinary care

ordinary care

common, noninvasive, and tested treatment

nutrition, hydration, antibiotics

extraordinary care

complex, invasive, experimental treatments

ACLS, dialysis, unproved therapies

patient self determination act

patient’s right to initiate advance directive

patient’s right to consent or refuse treatment

where does pain come from in the ICU

Preexisting Conditions

Trauma

Invasive procedure

Airway management

Prolonged immobility

negative effects of pain and anxiety

tachycardia and hypertention

agitation

increases oxygen consumption

interference with healing

increased respiratory effort and hyperventilation

physiological response to pain and anxiety

tachycardia

tachypnea

increased glucose production

nausea/constipation

urinary retention

sleep disturbance

Guideline for pain, agitation, and delirium

promoting rest, comfort, and frequent reorientation are important nursing interventions to reduce pain and anxiety for critically ill patients

PADIS

Preventing and treating pain, agitation/sedation, deliruim, immobility,and sleep disruption

ABCDEF Bundle for PADIS prevention

A - assess, prevent, and manage pain

B- both spontaneous awakening trial and spontaneous breathing trial

C- choice of analgesia and sedation

D- delirium assessment and management

E- early mobility and exercise

F- family engagement and empowerment

The A in the ABCDEF Bundle

assess, prevent, and manage pain

The B in the ABCDEF Bundle

both spontaneous awakening trial and spontaneous breathing trial

The C in the ABCDEF Bundle

choice of analgesia and sedation

The D in the ABCDEF Bundle

delirium assessment and management

The E in the ABCDEF Bundle

early mobility and exercise

The F in the ABCDEF Bundle

family engagement and empowerment

Delirium

acute change in mental status

hyperactive delirium

agitated, restless, combative, disoriented, attempts to remove lines/tubes

hypoactive delirium

quiet delirium, withdrawal, flat affect, lethargy

drug of choice for delirium

haloperidol

nonpharmacologic pain/anxiety management

frequent reorientation

manipulate the environment

guided imagery

music therapy

animal therapy

pharmacologic pain/anxiety management

opiods

epidural analgesia

NSAIDS

sedatives/anesthetics

neuromuscular blockade

chemical full paralysis

requires intubation and mechanical ventilation

have no sedative effect

administer sedative first

opiods

fentanyl

morphine

hydromorphone

sedatives/anesthetics

ativan

propofol

precede