PICOT: Evidence-Based Practice in Critical Care Nursing, Exams of Nursing

Download PICOT: Evidence-Based Practice in Critical Care Nursing and more Exams Nursing in PDF only on Docsity! N123 Med Surg 1st Test - PICOT Evidence Based Practice using - PICOT - P for patient population I for intervention C for comparison O for outcome T for Time PICOT problem solving in clinical decision making - 0. Inquiry spirit 1. PICOT question 2. Collect most relevant best evidence 3. Appraise/Synthesize evidence 4. Integrate evidence w/ clinical expertise and patient preferences and values then make a practice decision or change 5. Evaluate practice decision or change 6. Share outcome of practice decision or change PICOT QUESTION - P for patient population In adult cardiac surgery patients I for intervention: use morphine C for comparison: or fentnyl O for outcome: more effective in reducing pain T for time: on the first postoperative day Nursing Diagnosis + Interventions or NIC + Raionales + Outcomes or NOC using ADPIE - Diagnosis: Activity intolerance Plan/Intervention: NIC Energy Managemtn - using activities P/outcome and E: NOC Activity Tolerance RRT's Rapid Response Team - Critical care nurse Respiratory Therapist Critical care physician Advanced practice registered nurse (APRN) Early/subtle signs of deterioration - happens 6-8 hours before cardiac/respiratory arrest and - early intervention decreases mortality rates - mild confusion tachypnea ICU - Monitors - ECG BP O2 CO - cardiac output Intracranial pressure Temperature More advanced ICU monitoring - Cardiac index CI Stroke Volume SV Stroke volume variation SVV Ejection Fraction EF End-Tidal CO2 Tissue O2 consumption Ongoing ICU Support - Mechanical Ventilators Intraaortic balloon pumps IABPs Circulatory assist devices CADs when enteral is not adquate or contraindicated use parenteral: paralytic ileus, diffuce peritonitis, intestinal obstruction, pancreatitis, GI ischemia, abdominal trauma or surgery, severe diarrha ICU Anxiety - express feelings patients ask questions state their needs anti-anxiety drugs music therapy bring personal items and photos ICU Pain - 70% of patients will have moderate to sever pain increased anxiety and stress medical conditions with ischemic, infections, inflammatory processes immobilized patients invasive monitoring devices such as endotracheal tubes invasive and noninvasive procedures sedation with propofol called Diprivan and fentanyl called Sublamaze Patients need to take a pain break for nurse to perform neurological exam ICU Impaired Communication - sedative and paralyzing drugs and or endotracheal tube use picture boards, note pads, magic slates, computer keyboard, hand gestures, eye contact. touch and talk to patient even if unresponsive ICU Sensory-Perceptual Problems - delirium 80% of patients anxiety sleep deprivation sensory overload immobilization risk factors for delirium - dementia alcohol hypertension severe illness hemodynamic instability hypoxemia hypercarbia electrolyte disturbances severe infections CAM - confusion assessment method Intensive Care Delirium Screening Checklist - oxygenation perfusion electrolytes Orient Patient - clocks calendars caregiver helps decrease agitation Sensory overload - limit alarms patient experiencing hyperactivity, insomnia, delusions - sedative drugs with anxiolytic eeffect such as dexmedetomidine called Precedex ICU Sleep Problems - benzodiazepines such as temazepam called Restoril similar to zolpidem called Ambien scheduled rest periods dimming lights for nighttime open curtains daytime disturb patient as little as possible limit noise massage ICU Caregiver Issues - caregivers need guidance and support active listening decrease anxiety support upset and angry family acknowledge feelings accept and support decisions with chaplains, psychologists, patient represenatives ICU Caregivers Need - information reassurance convenience access to patient more visiting hours helps patients prepare caregiver for patient appearance and physical environment with equipment and noise inviting environment wnat to be present for CPR and central line insertion etc to reduce their anxiety and fear advanced directives person present death and dying issues ICU Culturally competent Care -