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Overview of Critical Care nursing (Chapters 1-5) 10 Questions and answers
AACN Certification Corporation oversees - the critical care certification process CCRN certification is available for - nurses who provide care of critically ill adult, pediatric, or neonatal populations CCRN-E credential is available for - nurses working in the eICUs PCCN is for - nurses who provide acute care in progressive care, telemetry, and similar units Built Environment - physical layout of a critical care unit has a subtle but profound effect on patients, families, and the critical care team Sensory overload could be a result of - The noise level alone is enough stimulation to cause a patient discomfort and sleep deprivation, and it is a major factor contributing to sensory overload Sensory deprivation has been connected to an increase in ... and what could decrease this? - - perceptual disturbances such as hallucinations, especially in older adults
- Providing stimulation by interacting with the patient and encouraging visitation of friends and family can decrease its occurrence. Patients in ICU three top stressors - ♣ Being in pain ♣ Not being able to sleep ♣ Financial worries Family assessment (Calgary family assessment model) three categories - Structural, Developmental, and Functional
Structural Assessment - done upon admission, and it identifies immediate family, extended family, and the decision makers Developmental Assessment - includes information related to the family's developmental stages, tasks, and attachments Functional Assessment - reveals how family members function and behave in relation to one another Three cultural questions to be asked - - What are your specific religious and spiritual practices?
- What are your beliefs about illness (and death)?
- What is most important to you and your family at this time? The family bundle is based on what 5 concepts - - evaluate
- plan
- involve
- communicate
- support Value pneumonic for communication with family - • Value what the family tells you
- Acknowledge family emotions
- Listen to the family members
- Understand the patient as a person
- Elicit (ask) questions of family members ethical dilemma - is a difficult problem or situation in which conflict arise during the process of making morally justifiable decisions
o Disclosure of information Competence (or capacity) - refers to a person's ability to understand information regarding a proposed medical or nursing treatment; it is a legal term and is determined in court 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 authorized by state statute to make health care decisions for the person Surrogate - A competent adult designated by a person to make health care decisions should that person become incapacitated Do not resuscitate (DNR) order - 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 Patient Self-Determination Act - this act requires that all health care facilities that receive Medicare and Medicaid funding inform their patients about their right to initiate an advanced directive and the right to consent to or refuse medical treatment The American Association of Critical-Care Nurses (AACN) hs developed a framework for dealing with moral distress known as the - • Ask
- Act Palliation - is the provision of care interventions that are designed to relieve symptoms of illness or injury that negatively affect the quality of life of the patient or family Hospice Care - is generally reserved for those with a prognosis of less than 6 months to live and is usually in place of aggressive life-sustaining or restorative care Terminal weaning - consist of titration of ventilator support to minimal levels, removal of the ventilator but not the artificial airway, or complete extubation Hospice - is a model of care that emphasizes comfort rather than a cure and views dying as a normal human process withheld therapies in hospice - • Vasopressors
- Antibiotics
- Blood and blood products
- Dialysis
- Nutritional support Pain - an unpleasant sensory and emotional experience associated with actual or potential tissue damage; subjective experience; the patient becomes the true authority on the pain that is being experienced Anxiety - a state marked by apprehension, agitation, autonomic arousal, fearful withdrawal, or any combination of these; a prolonged state of apprehension in response to a real or perceived fear Fast (sharp) pain signals are transmitted to the spinal cord by - slowly conducting, thinly myelinated A- delta afferent fibers
Agitated (RASS) - frequent non-purposeful movements; fights ventilator 2+ Restless (RASS) - anxious or apprehensive but movements are not aggressive or vigorous 1+ Alert and Calm will get you a (RASS) score of - 0 Drowsy (RASS) - not full alert, but has sustained (>10 sec) wakening, with eye contact, to loud voice
Light Sedation (RASS) - briefly awakens (<10 sec) with eye contact to loud voice
Moderate Sedation (RASS) - any movement (but no eye contact) to loud voice
Deep Sedation (RASS) - no response to voice, but any movement to physical stimulation
Unarousable (RASS) - no response to voice or physical stimulation
Delirium (acute brain dysfunction) - characterized by an acutely changing or fluctuating mental status, inattention, disorganized thinking, and altered levels of consciousness Hyperactive delirium - Agitation, restlessness, attempts to remove catheters or tubes, hitting, biting, and/or emotional lability Hypoactive delirium - Withdrawal, flat affect, apathy, lethargy, and/or decreased responsiveness Mixed delirium - Concurrent or sub-sequential appearance of some features of both hyperactive and hypoactive delirium Non modifiable risk factors for delirium - - Baseline cognitive impairment
- Baseline hypertension
- Advanced age (>70)
- Respiratory failure Modifiable risk factors for delirium - - Alcohol, narcotic, benzodiazepine dependence
- Medication-induced coma
- Uncontrolled pain
