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Critical Care Guided Notes Chapter 1-4 Exam Questions & Answers., Exams of Career Counseling

Critical Care Guided Notes Chapter 1-4 Exam Questions & Answers. 2 professional organizations for critical care nurses - ANS American Association of Critical-Care Nurses (AACN) Society of Critical Care Medicine (SCCM) mission of the AACN - ANS focuses on assisting acute and critical care nurses to attain knowledge and influence to deliver excellence care vision of the AACN - ANS 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 of the AACN - ANS accountability, advocacy, integrity, collaboration, leadership, stewardship, lifelong learning, qua

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2023/2024

Available from 12/03/2024

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Critical Care Guided Notes Chapter 1-4 Exam Questions &

Answers.

2 professional organizations for critical care nurses - ANS American Association of Critical-Care Nurses (AACN) Society of Critical Care Medicine (SCCM) mission of the AACN - ANS focuses on assisting acute and critical care nurses to attain knowledge and influence to deliver excellence care vision of the AACN - ANS 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 of the AACN - ANS accountability, advocacy, integrity, collaboration, leadership, stewardship, lifelong learning, quality, innovation, and commitment Synergy Model of Care - ANS focuses on the extent to which nurses' competencies match patients' characteristics goal of the synergy model - ANS "restore the patient to an optimal level of wellness as defined by the patient and family" who can get the CCRN certification - ANS nurses who provide care for critically ill adult, pediatric, or neonatal populations who can get the PCCN certification - ANS nurses who provide acute care in progressive care, telemetry, and similar units what other certifications are available after a nurse gets CCRN or PCCN certified - ANS subspeciality certification in cardiac medicine or cardiac surgery who can get the ACCNS certification - ANS acute and critical care clinical nurse specialist who can get the ACNPC-AG certification - ANS acute care nurse practitioners

why are certifications important? - ANS validates knowledge of critical care nursing promotes professional excellence helps nurse to maintain a current knowledge base What 4 specific projects/organizations are in place to assist nurses in providing safe care? - ANS 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 measures does the QSEN implement - ANS roadmap for integrating quality and safety principles into prelicensure nursing education what are the 6 core competencies of the QSEN - ANS patient-centered care teamwork and collaboration evidence-based practice quality improvement informatics safety purpose of the national patient safety goals - ANS reduce medical errors and promote an environment that facilitates safe practices reduce infections purpose of the IHI - ANS action plan for reducing health care-associated infections and preventing infections with multidrug-resistant organisms what organization developed the concept of the bundle - ANS IHI bundle of care - ANS evidence-based practices that are done as a whole to improve outcomes (ex. ventilator bundle)

Goal of Rapid Response Team - ANS identify and manage both stable and unstable patients and those at high risk for cardiopulmonary arrest to prevent unnecessary deaths bundle - ANS a group of interventions related to a disease process that, when executed together, result in better outcomes than when implemented individually. 4 barriers to effective handoff communication - ANS physical setting social setting language communication medium examples of physical setting barriers - ANS background noise, lack of privacy, interruptions examples of social setting communication barriers - ANS organizational hierarchy and status issues examples of language communication barriers - ANS differences between people of varying racial and ethnic backgrounds or geographic areas examples of communication medium communication barriers - ANS limitations of communications via telephone, e-mail, paper, or computerized records versus face-to- face what 4 techniques have helped prevent communication breakdown during shift change? - ANS ask-tell-ask tell me more SBAR crew resource management (CRM) ask-tell-ask - ANS strategy for encouraging nurses to assess concerns before providing more information, especially when discussing stressful issues with patients and families tell me more - ANS encourages information sharing in challenging situations

SBAR - ANS Situation Background Assessment Recommendation Crew Resource Management (CRM) - ANS 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 what types of things in the ICU contribute to sensory overload - ANS light and noises loss of privacy lack of nonclinical physical contact emotional and physical pain adverse effects of noise in the ICU - ANS sleep deprivation decreased O elevated BP delayed wound healing adverse effects of light in the ICU - ANS override patients natural circadian rhythms, which increase disorientation and agitation what types of things contribute to sensory deprivation in the ICU - ANS patients can experience this in an environment that is very different from their usual surrounding adverse effects r/t sensory deprivation in the ICU? what age range is most likely to be affected? - ANS perceptual disturbances (hallucinations) elderly ways nurses/hospitals can combat sensory overload - ANS 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 ways nurses/hospitals can combat sensory deprivation - ANS encourage visitation of family and friends posting family photos providing music or television that the patient usually enjoys What age-related demographic is at a high risk for negative outcomes in the ICU? - ANS 65+ what types of situations --> family conflict being present - ANS 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 support the family and help them cope - ANS receiving information, receiving assurance, remaining near the patient, being comfortable, and having support available strong communication with family and medical team family bundle components of the family bundle - ANS evaluate plan involve communicate support What is the main cause of emotional outbreak or inappropriate responses from family members? - ANS lack of communication/information

what does research say about family visitation in the ICU - ANS although there are concerns about visitation in the ICUs, visitation has been shown to improve patient outcomes what should determine if a child is allowed to visit a loved one in the ICU - ANS age and developmental stage family being present during CPR helps family members to - ANS 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 during CPR facilitates family members - ANS need to be together with their loved one need to help and support their loved one sense of closure and grieving should death occu autonomy - ANS 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 - ANS actions intended not to harm or bring harm to others nonmaleficence - ANS actions intended not to harm or bring harm to others justice - ANS 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 what are bioethics committees - ANS bioethical committees are a formal mechanism to address patients ethical concerns roles of the bioethic commity - ANS education and policy-making body and in some cases provide ethics consultation on a case-basis purpose of a bioethics committee - ANS to improve the process and outcomes of patient care by helping to identify, analyze, and resolve ethical problems

what different types of professionals make up a bioethics committee - ANS physicians, nurses, chaplains, social workers, and if available bioethicists what types of situations warrant and ethics consult - ANS 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 what 3 factors must be present in order for informed consent to be taken - ANS competence (capacity) voluntariness disclosure of information what basic info must be present for decision making - ANS 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? - ANS 1) guardian appointed by the court (if the guardian is within scope of authority)

  1. attorney-in-fact appointed by the pt in a durable power of attorney
  2. a spouse of the pt unless they are separated
  3. an adult child of the pt (if there are multiple, use majority of adult children reasonably available for consultation)
  4. parent of the pt
  5. adult sibling of the pt (if there are multiple, use majority of adult siblings reasonably available for consultation)
  6. grandparent of the pt (if there are multiple, use majority of grandparents reasonably available for consultation)
  7. 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)
  8. a person given authority to make health decisions fo the pt by another statutory provision
  9. 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 - ANS 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). advance directive - ANS 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 - ANS a witnessed written document or oral statement voluntarily executed by a person that expresses the person's instructions concerning life-prolonging procedures

proxy - ANS 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 - ANS a competent adult designated by a person to make health care decisions should that person be incapacitated terminal condition - ANS a condition in which there is no reasonable medical probability of recovery and can be expected to cause death without treatment Persistent Vegetative State (PVS) - ANS 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 - ANS complete and irreversible cessation of brain function DNR - ANS 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 - ANS an alternate term with less-negative connotations but essentially meaning DNR withdraw of care - ANS withholding of life support, withdrawing life support, BOTH withholding care - ANS Specific life sustaining treatments may not be offered or used withdrawaing care - ANS removing previous interventions when a pt is withdrawn from care what becomes the priority - ANS comfort measurs what model is used to determine with withdraw of care decisions - ANS ethical decision- making model medical fulity - ANS 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 - ANS 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 a prognosis of <____ months qualifes a pt for hospice care - ANS 6 hospice care - ANS reserved for terminally ill pts how are palliative care and hospice care different - ANS palliative care is used for comfort in addition to live saving treatments while hospice care is used in place of life saving treatments what distressing symptoms does palliative care address - ANS pain, anxiety, hunger, thirst, dyspnea, diarrhea, nausea, confusion, agitation, and disturbance of sleep patterns s/sx seen with ventilator withdrawal - ANS respiratory distress; tachypnea, dyspnea, or use of accessory muscles what is the nurses' role in caring for a pt being removed from the vent at the EOL - ANS ensure the pt is comfortable what should the nurse assess in a pt after they are removed from the vent at the EOL? - ANS breathing patterns and comfort level what types of therapies are stopped durign withdrawal of care - ANS ventilator vasopressors, antibiotics, blood and blood products dialysis nutritional support where is euthanasia legal in the US - ANS california montana oregon vermont washington how is withdraw of care different than euthanasia - ANS withdrawal of care is making the patient comfortable and shifting to palliative care vs. cure