Critical care exam 1 (part 1) AACN CCRN Questions and Answers., Exams of Nursing

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Critical care exam 1 (part 1) AACN CCRN

Questions and Answers.

two main professional organizations that support critical care? which one best supports critical care nurses? - \Name the two organizations American Association of Critical-Care Nurses (AACN) Society of Critical Care Medicine (SCCM) Which one do you think best supports critical care nurses? American Association of Critical-Care Nurses (AACN) dedicated to providing knowledge and resources to those caring for acutely and critically ill patients AACN: mission? vision? values? - \Mission: focuses on assisting acute and critical care nurses to attain knowledge and influence to deliver excellence care Vision: supports creating a health care system driven by the needs of patients and families in which critical care nurses make their optimal contributions, which is described as synergy (mixture of nurse, system, and patient along with patient characteristics and nurse competencies) Values: accountability, advocacy, integrity, collaboration, leadership, stewardship, lifelong learning, quality, innovation, and commitment what is the synergy model and how is it used in practice? - \The Synergy Model focuses on the extent to which nurses' competencies match patients' characteristics. The goal of Synergy Model nursing is to "restore the patient to an optimal level of wellness as defined by the patient and family certifications: CCRN? PCCN? ACCNS? ACNPC-AG? why are certifications important? - \CCRN → nurses who provide care for critically ill adult, pediatric, or neonatal populations PCCN → nurses who provide acute care in progressive care, telemetry, and similar units Once nurses achieve the CCRN or PCCN credential, they can be eligible to sit for additional subspeciality certification in cardiac medicine or cardiac surgery ACCNS→ acute and critical care clinical nurse specialist ACNPC-AG→ acute care nurse practitioners Why are certifications important? validates knowledge of critical care nursing, promotes professional excellence, and helps nurse to maintain a current knowledge base What 4 specific projects/organizations are in place to assist nurses in providing safe care? - \The Quality and Safety Education for Nurses (QSEN)

National Patient Safety Goals→ by the Joint Commission Institute of Healthcare Improvement (IHI) rapid response teams/ medical emergency teams what does QSEN do? - \roadmap for integrating quality and safety principles into prelicensure nursing education six core competencies: patient-centered care, teamwork and collaboration, evidence- based practice, quality improvement, informatics, and safety What do national patient safety goals do? - \reduce medical errors and promote an environment that facilitates safe practices reduce infections ex. improve accuracy of patient identification, improve communication among health care providers, improve medication safety, use alarms safely, reduce risk of healthcare- associated infections, identify safety risk, and prevent complications associated with surgery and procedures What does IHI do? - \action plan for reducing health care-associated infections and preventing infections with multidrug-resistant organisms promoted the concept of bundles of care to reduce harms, such as infections bundles→ evidence-based practices that are done as a whole to improve outcomes (ex. ventilator bundle) What is the goal of rapid response teams? - \goal→ identify and manage both stable and unstable patients and those at high risk for cardiopulmonary arrest to prevent unnecessary deaths Can you explain what a bundle of care is? Give an example of one you may see at the bedside? - \Can you explain what a bundle of care is? Bundle of Care→ evidence based best practices that are done as a whole to improve outcomes A "bundle" is a group of interventions related to a disease process that, when executed together, result in better outcomes than when implemented individually. Give an example of one you may see at the bedside Ventilator Bundle What are four barriers to effective handoff communication? Can you give an example of what these would look like at the bedside? - \Physical Setting→ background noise, lack of privacy interruptions Social Setting→ organizational hierarchy and status issues Language→ differences between people of varying racial and ethnic backgrounds or geographic areas Communication Medium→ limitations of communications via telephone, e-mail, paper, or computerized records versus face-to-face

what is the highest risk time of communication breaking down? What four standardized measures have been implemented to help prevent communication breakdown at shift change? - \Shift handoff is when communication is at the highest risk to be broken down. What standardized measures have been implemented to help prevent communication breakdown at shift change? Ask-Tell-Ask→ strategy for encouraging nurses to assess concerns before providing more information, especially when discussing stressful issues with patients and families Tell Me More→encourages information sharing in challenging situations SBAR→ Situation, background, assessment, recommendation Crew Resource Management (CRM) → think like an aircraft crew (everyone depends on precise communication to ensure passenger safety) monitor others actions by double checking, verifying. Situational awareness, trusting your gut Can you give examples of things you may need to communicate during multi- professional rounds? - \discharge needs Greatest safety risk Implementation of critical care "bundles" Assessment and recommended follow-ups cardiac and hemodynamic status volume status neurologic status pain,agitation, and delirium sedation needs gastrointestinal status, including bowel management nutrition skin issues activity infection status (culture results/therapeutic levels of antibiotics) laboratory results radiologic test results assess need for all ordered medications identify whether central lines and invasive catheters and tubes can be removed identify whether indwelling urinary catheter can be removed issues that need to be addressed family needs--educational, psychosocial, spiritual code status advance directives parameters for calling the physician treatment goals and strategies to achieve them plans for discussing care and needs with families

What types of things contribute to this sensory overload/deprivation? what is deleterious effect? - \sensory stimulation → light and noises, loss of privacy, lack of nonclinical physical contact, and emotional and physical pain Noise is a major factor contributing to sensory overload high levels of noise create a deleterious effect (sleep deprivation, decreased O2, elevated BP, delayed wound healing) Light→ override patients natural circadian rhythms, which increase disorientation and agitation sensory Deprivation→ patients can experience this in an environment that is very different from their usual surrounding increase in perceptual disturbances such as hallucinations (elderly) What types of interventions can nurses implement to combat sensory overload/deprivation? - \Sensory Stimulation placing patients in private rooms installing sound-absorbing ceiling tiles modifying overhead paging systems initiating programs to raise awareness among staff about their tole reducing noise "sedative" music Sensory Deprivation encourage visitation of family and friends posting family photos providing music or television that the patient usually enjoys What types of stressors do patients identify from their critical care experience? - \difficulty communicating pain thirst difficulty swallowing anxiety lack of control depression fear lack of family or friends physical restraint feelings of dread inability to get comfortable difficulty sleeping loneliness thoughts of death and dying What age-related demographic is at a high risk for negative outcomes in the ICU? what types of situations do you think could contribute to family conflict being present? -

\older adult patients (65+) // knowing the patient's role (not knowing their role), family coping strategies (may be different throughout family members) socioeconomic status, previous medical background trauma with family or themselves, addressed concerns regarding the patient's condition and care, underlying conflicts How can nurses best support the family members of patients and assist them in coping (five parts of family bundle)? What is the main cause of emotional outbreak or inappropriate responses from family members? - \receiving information, receiving assurance, remaining near the patient, being comfortable, and having support available strong communication with family and medical team family bundle→ evaluate, plan , involve, communicate, and support // lack of communication What does research say about family visitation in the ICU? What are the benefits to allowing family presence during cardiopulmonary resuscitation (codes)? - \special considerations for visitation of children in ICU should be based on age and developmental stage although there are concerns about visitation in the ICUs, visitation has been shown to improve patient outcomes // family being present helps family members to: remove doubt about the patient's condition witness everything done decrease anxiety and fear about what is happening to their loved one family being present facilitates Family members: need to be together with their loved one need to help and support their loved one sense of closure and grieving should death occur ethics: what is autonomy? beneficence? nonmaleficence? justice? - \Autonomy→ respect for the individual and the ability of individuals to make decisions with regard to their own health and future (the basis for the practice of informed consent) Beneficence → an act of charity, mercy, and kindness with a strong connotation of doing good to others including moral obligation Nonmaleficence → actions intended not to harm or bring harm to others Justice → being fair or just the wider community in terms of the consequences of an action, in health care justice is described as the fair allocation or distribution of health care resources ethical decisions: What are bioethics committees? team members? - \bioethical committees are a formal mechanism to address patients ethical concerns serve as an education and policy-making body and in some cases provide ethics consultation on a case-basis purpose→ to improve the process and outcomes of patient care by helping to identify, analyze, and resolve ethical problems

members consist of: physicians, nurses, chaplains, social workers, and if available bioethicists What types of situations may warrant an Ethics consult? - \disagreement of conflict exists on whether to pursue aggressive life-sustaining treatment in a seriously ill patient, such as cardiopulmonary resuscitation, or emphasize comfort and palliative care family demands to provide life-sustaining treatment, such as mechanical ventilation or tube feeding, which the physician and nurses consider futile competing family members are present and want to make critical decisions on behalf of the patient a seriously ill patient is incapacitated and does not have a surrogate decision maker or an adcance directive Identify what must be present in order for a patient to provide consent for themselves? What basic information must be present for decision making? - \Identify what must be present in order for a patient to provide consent for themselves competence (or capacity) → refers to the person's ability to understand information evaluated by healthcare provider ruled on legally voluntariness disclosure of information What basic information must be present for decision making? a diagnosis of the patient's specific health problem and condition the nature, duration, and purpose of the proposed treatment or procedures the probable outcome of any medical or nursing intervention the benefits of medical or nursing interventions the potential risks that are generally considered common or hazardous alternative treatments and their feasibility short-term and long-term prognosis if the proposed treatment or treatments are not provided What is the order of decision makers in South Carolina? - \1) guardian appointed by the court (if the guardian is within scope of authority)

2. attorney-in-fact appointed by the pt in a durable power of attorney
3. a spouse of the pt unless they are separated
4. an adult child of the pt (if there are multiple, use majority of adult children reasonably available for consultation)
5. parent of the pt
6. adult sibling of the pt (if there are multiple, use majority of adult siblings reasonably available for consultation)
7. grandparent of the pt (if there are multiple, use majority of grandparents reasonably available for consultation)
8. any other adult blood relative by blood or marriage who reasonably is believed by the healthcare professional to have a close relationship with the pt (if there are multiple, use majority of adult relatives reasonably available for consultation)

9. a person given authority to make health decisions fo the pt by another statutory provision
10. person who had a relationship with the pt who is acting in good faith and reliably convey the pt's wishes (NOT paid caregiver or healthcare provider) When would a healthcare proxy/next of kin be used for decision making? - \if the patient is not mentally capable of providing consent, informed consent is obtained from the designated health care surrogate or legal next of kin (proxy) what is advanced directive? living will? proxy? surrogate? - \Advanced Directive → witnessed written document or oral statement in which instructions are given by a person to express desires related to health care decisions. the directive may include, but is not limited to, the designation of a health care surrogate, a living will, or an anatomic gift Living Will → a witnessed written document or oral statement voluntarily executed by a person that expresses the person's instructions concerning life-prolonging procedures Proxy → a competent adult who has not been expressly designated to make health care decisions for an incapacitated person, but is authorixed by stat stature to make health care decisions for the person Surrogate → a competent adult designated by a person to make health care decisions should that person be incapacitated what is terminal condition? persistent vegetative state? brain death? DNR? allow natural death? - \Terminal Condition → a condition in which there is no reasonable medical probability of recovery and can be expected to cause death without treatment Persistent Vegetative State → a permanent, irreversible unconsciousness condition that demonstrates an absence of voluntary action or cognitive behavior, or an inability to communicate or interact purposefully with the environment Brain Death → complete and irreversible cessation of brain function DNR→ a medical order that prohibits the use of cardiopulmonary resuscitation and emergency cardiac care to reverse signs of clinical death. The DNR order may or may not be specified in patients' advance directives Allow Natural Death→ an alternate term with less-negative connotations but essentially meaning DNR what is withdraw of care and how are decisions made? - \Withdraw of Care→ withholding of life support, withdrawing life support, BOTH, can range from not initiating hemodialysis (withholding) terminal weaning from mechanical ventilation (withdrawing) comfort is taken when withdrawal of care is decided decisions are made based off ethical decision-making model what is medical futility? palliative care? hospice care? What distressing symptoms does palliative care address? - \Define medical futility

situation in which therapy or interventions will not provide a foreseeable possibility of improvement in the patient's health condition, or a lack of attainable goals of care. Palliative Care: what is the difference between palliative care and hospice care? Palliative Care → provision of care interventions that are designed to relieve symptoms of illness or injury that negatively affect the quality of life of the patient of family Hospice Care → reserved for terminally ill patients (those with a prognosis of less than 6 months to live and in usually in place of aggressive-life sustaining or restorative care) What distressing symptoms does palliative care address? pain, anxiety, hunger, thirst, dyspnea, diarrhea, nausea, confusion, agitation, and disturbance of sleep patterns how would you educate families on what withdraw/withhold of care is? - \symptoms that will begin to appear: dyspnea during ventilator withdrawal and medicate to alleviate such symptoms s/sx→ respiratory distress; tachypnea, dyspnea, or use of accessory muscles nurses role is to make sure the patient is comfortable nurses are assessing comfort of patient and breathing patterns what types of therapies are held/stopped during withdraw of care? - \ventilator vasopressors, antibiotics, blood and blood products dialysis nutritional support how is withdraw of care different from euthanasia? - \euthanasia is assisted suicide not legal all over the US (only california, montana, oregon, vermont, and washington) withdrawal of care is making the patient comfortable and shifting to palliative care vs. cure emotional care: In what manner should we communicate with families? What types of things should we allow/provide for family members? - \In what manner should we communicate with families? carefully assess what the patient's and family needs are and instead of making assumptions nonjudgmental assessment use a calm manner voice and maintain a quiet and private environment, and allow unrestricted family presence before, during, and after death provide items for family comfort (tissues, refreshments, charis) What types of things should we allow/provide for family members? clear consistent, and accurate information about the patient's condition what to expect with the withdrawal and dying process reassurance the patient will not suffer during the dying process bereavement counselors, social workers, spiritual care providers, and licensed mental health professionals

Nursing Interventions to Support Care at the End of Life - \assess patient's and family members' understanding of the condition and prognosis to address educational needs educate family members about what will happen when life support is withdrawn to decrease their fear of the unknown assure family members that the patient will not suffer assure family members that the patient will not be abandoned provide for any needed emotional support and spiritual care resources, such as grief counselors and spiritual care providers facilitate physician communication with the family provide for visitation and presence of family and extended family. most family members do not want to patient to die alone