Critical Care Nursing Exam 1 - Key Concepts and Nursing Practice, Exams of Nursing

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American Association of Critical-Care Nurses (AACN) - correct answer ✅✅Founded in 1969 Largest specialty organization in world Mission Assist nurses to attain knowledge and influence Healthy work environment initiative Web site: www.aacn.org AACN's vision: Create a healthcare system driven by patient's and family's needs in which critical care nurses make their optimum contributions AACN Membership Benefits: Professional journals and continuing education offerings Critical Care Nurse American Journal of Critical Care AACN Advanced Critical Care (reduced rate) Practice Alerts Evidence-based interventions Continuing education National Teaching Institute (NTI) Support from local chapters Scholarships Research grants Student rate for membership

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Discounted rate for certification exams Society of Critical Care Medicine (SCCM) - correct answer ✅✅Founded in 1970 Multiprofessional membership Physicians Nursing section Other critical care team members Web site: www.sccm.org Journal: Critical Care Medicine SCCM Vision: Healthcare system in which all critically ill and injured persons receive care Multiprofessional healthcare team Directed by physician specializing in critical care—intensivist The charge nurse assigns patients based on their acuity and the level of experience of the critical care nurses on duty. This is an example of implementation of: A. SBAR communication B. Healthy work environment C. National patient safety goals D. Synergy model - correct answer ✅✅D. Synergy model Critical Care Certification - correct answer ✅✅Purpose

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Validate knowledge Promote professional excellence Help nurses to maintain up-to-date knowledge AACN Certification Corporation oversees process Based on AACN synergy model for patient care Needs of patients and families drive practice AACN Critical Care Certification Bedside practice CCRN: Adult, Neonatal, and Pediatric PCCN for those working in step-down units Advanced practice CCNS Critical Care Clinical Nurse Specialist ACNPC Acute Care Nurse Practitioner Subspecialty certification Cardiac medicine Cardiac surgery Standards: Guide clinical practice Establish goals for patient care Provide assessment of outcomes AACN Standards for Acute and Critical Care Nursing Practice

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Process of nursing practice Expectation of the nurse Harms Targeted for Reduction - correct answer ✅✅Adverse drug events Infections Catheter-associated urinary tract infections (CAUTI) Central line-associated bloodstream infections (CLABSI) Surgical site infections Ventilator-associated pneumonia (VAP) Injuries from falls and immobility Obstetric adverse events Pressure ulcers Venous thromboembolism (VTE) Importance of Evidence-Based Practice - correct answer ✅✅Implement practice based on evidence Evaluate research Hierarchy of evidence Nurses are encouraged to implement care that is evidence based and to challenge practices that have "always been done" but are not supported by clinical evidence. Research studies are graded by the quality of evidence, with many different schemes used.

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Meta-analysis and systematic reviews are considered the highest level of evidence. This book uses AACN's grading scheme. During report using SBAR, the nurse states, "Since we have just initiated a potassium replacement protocol, the patient will need a potassium level drawn at 1300." This depicts: A. Situation B. Background C. Assessment D. Recommendation - correct answer ✅✅D. Recommendation. Which of the following is a component of a healthy work environment? A. Collaboration B. Use of many agency nurses C. Crew-resource training D. Evidence-based practice - correct answer ✅✅A. Collaboration. Process of gas exchange - correct answer ✅✅Ventilation - movement of gases in and out of the alveoli Diffusion at pulmonary capillaries (oxygen and carbon dioxide @ the alveolar- capillary membrane) Perfusion Diffusion to the cells

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Regulation of Breathing - correct answer ✅✅Respiration stimulated by elevated CO Not true for COPD: stimulus is hypoxia rationale for low oxygen in patients with COPD Work of Breathing - correct answer ✅✅Amount of effort required to maintain ventilation Respiratory pattern changes automatically WOB increases, more energy needed WOB high, respiratory failure Compliance - correct answer ✅✅Distensibility or stretch Determined by elasticity, "recoil" Elastic recoil and compliance are inversely related Types: static - measured under condition of no airflow (inspiratory hold). static compliance in normal lungs ranges 50 - 170 mL/cm H2O (for every 1 cm H2O change of pressure in the lungs, the volume of gas increases by 50 - 170 mL) dynamic - measured while gases flowing. dynamic compliance - normal lung 50 - 80 mL/cm H2O

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poor compliance requires higher ventilatory pressures to achieve adequate lung volume Resistance - correct answer ✅✅Opposition to gas flow in the airways airway length airway diameter: small tube, spasms, mucus flow rate of gasses: increased breathing effort airway resistance increases when the airway is lengthened or narrowed resistance increases when gas flow is increased increased airway resistance may result in decreased lung volume and inadequate ventilation Lung Volumes and Capacities - correct answer ✅✅nursing responsibilities: Assess baseline function, Monitor responses spirometer Tidal Volume (VT) - correct answer ✅✅normal breath; 500 mL or 5 to 7 mL/kg Functional Residual Capacity (FRC) - correct answer ✅✅volume of gas remaining in the lungs at normal resting expiration average: 2300 mL

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Vital Capacity (VC) - correct answer ✅✅maximum volume of gas forcefully expired after maximum inspiration average: 4600 mL Respiratory Assessment - correct answer ✅✅Health History: oral and inhalant respiratory medications, OTC drugs, allergies (medication and environmental), last chest x-ray and tuberculosis screen, tobacco pack per year history, occupational history, sputum production, shortness of breath, dyspnea, cough, anorexia, weight loss, and chest pain Physical Examination: Inspection - head, neck, fingers, and chest. accessory muscles, sternal retractions, nasal flaring, asymmetrical chest movements, open-mouth breathing, and gasping breaths Respiratory Rate - tachypnea: rate > 20, bradypnea: rate < 10, assess rate and depth and altered patterns Abnormal Breathing Patterns: Cheyne-Stokes: cyclical with apneic periods Biot's: cluster breathing Kussmaul's: deep, regular, and rapid Apneustic: gasping inspirationsd Palpation: evaluate chest wall excursion, tracheal deviation, chest wall tenderness, subcutaneous crepitus, tactile fremitus

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Percussion: Resonance - normal lung sound Dullness - denser than normal tissue Flatness - air is absent Hyperresonance - increased amount of air Tympany - air-filled area Auscultation: assess breath sounds, presence of adventitious lung sounds, voice sounds. quiet environment. systematic approach. Breath Sounds: Normal - bronchial, bronchovesicular, vesicular Adventitious sounds - crackles, rhonchi, wheezes, pleural friction rub, stridor Arterial Blood Gases (ABGs) - correct answer ✅✅adequacy of oxygenation and ventilation acid-base status interpret in conjunction with: clinical history, physical assessment ABG normal range: pH: 7.35 - 7. PaO2: 80 - 100

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PaCO2: 35 - 45 HCO3: 22 - 26 SaO2: 93%-100% Oxygenation PaO SaO2 - correct answer ✅✅PaO2 - partial pressure of oxygen dissolved in arterial blood normal value 80 - 100 mm Hg decreased in elderly value < 60 mm Hg treated SaO2 - amount of oxygen bound to hemoglobin normal value 92%-99% frequently measured via pulse oximetry (SpO2) pH - correct answer ✅✅concentration of hydrogen ions (H+) normal range 7.35 - 7. pH < 7.35 = acidosis ph > 7.45 = alkalosis PaCO2 - correct answer ✅✅Partial pressure of carbon dioxide in arterial blood normal value 35 - 45 mm Hg

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PaCO2 > 45 = acidosis PaCO2 < 35 = alkalosis resp acidosis (retention of CO2): hypoventilation, CNS depression, trauma, restrictive lung diseases, COPD, acute airway obstruction resp alkalosis: hyperventilation, hypoxemia, anxiety, pain, stimulants, fever, excessive ventilatory suport HCO3 - Bicarbonate - correct answer ✅✅