EXAM 1 CCM WITH COMPLETE SOLUTIONS
100% 2023/2024
critical care history
nursing units specifically for the critically and acutely ill
1800s- clustering concept- put sickest patients in same unit (Nightingale)
early 1900s- neurosurgical ICU (first ICU in US- Johns Hopkins)
1950s- specialty units for airway management and ventilation run by professional experts
1960s- monitoring capabilities and new use of nursing management protocols- arterial line, EKG, etc.
1970s- ICU "standard"- every hospital has one
critical care units
wide range of technology always evolving
continuous monitoring- ECG, BP, temp, ICP, O2 sats
advanced monitoring- end tidal CO2, PA catheter, stroke volume, cardiac index, Licox monitoring, ICP
monitoring
constant support- mechanical vents, intraaortic balloon pumps
specialized critical care units
neuroscience critical care unit
neurosurgery ICU
coronary care unit
cardiovascular ICU
medical ICU
surgical ICU
trauma ICU
burn ICU
peds ICU
NICU
E-ICU
electronic/virtual monitoring of patients from another location
Tele-ICU
benefits- extra eyes on patient and VS/lab results, medical professional for consultation
cons- no patient contact, don't get feel for the room or patient
critical care nurse
ongoing assessment skills
early recognition of patient changes
avoid complications with appropriate nursing actions
focus on recovery
holistic care
care for patient and family
care for 1-2 patients
"intensive" care
complete care
very in tune to the needs of patient and family
at the bedside
specialized nursing through in depth orientation
critical care nurse proficient in
anatomy and physiology
,pharm
pathology
critical thinking
techno-savvy
advanced physical assessment
communication
collaboration
American Association of Critical Care Nurses (AACN)
critical care certification (CCRN) in neonates, peds, and adult critical care nursing
written test
continuing education and critical care nursing requirements
confirms RN's critical care knowledge
advanced cardiac life support (ACLS)
critical care nurses
ED and lifeflight nurses
crisis nurses
nurse and physician collaboration
rapid response team (RRT)
collborative
crisis nurse
respiratory therapist
doctor/APN
assess, plan care, and implement nursing actions for unstable patients
standing orders/order sets
critical care APN/APRN
graduate degree (masters or doctorate)
tons of roles
clinical nurse specialist (CNS)
nurse practitioner (NP)
doctor of nursing practice (DNP)
certifications for acute and critical care
array of duties
collaboration with physicians
ICU patient
admit to ICU
patient at risk for complications
requires frequent assessments for changes
unstable so critical thinking and care needed by the nurse
intensive nursing support needed
cluster by disease and acuity
ICU
not for long term coma or delaying death process
death common due to severity of illness
, progressive care units (PCUs)
between ICU and general floor
lower risk of complications than ICU
heart monitoring
long term vent weans
minimal titrating drips
more cost effective
critical care patient problems
impaired skin integrity due to immobility- pressure sores (activity, up to chair, q2 turns)
sepsis- frequent handwashing, PPE (immunocompromised, may have invasive lines)
nutritional concerns
anxiety
pain
sensory- perceptual troubles
sleep disorders
communication issues
nutrition in ICU
malnutrition associated with elevated morbidity and mortality
how to feed- tube feed, PO, NG tube, IV
collaborative care- bedside swallow assessment, speech pathologist
primary goal is to prevent or correct nutritional deficiencies
enteral feedings
goes straight to stomach, G tube, PO feed, NG tube, OG tube, keofeed (in nose, smaller bore tube
than NG, cannot suction, only used for giving meds or feed or flush, easier to place, nurses cannot
place)
less expensive
preserves function of the gut
help prevent relocation of gut bacteria- can trigger MODS if bacteria moves
OG vs NG vs keofeed vs G tube
fewer complications than parenteral feeds
parenteral feedings
IV, PICC line, central venous, TPN, cannot be in peripheral IV- higher risk for infection
bypasses GI tract
only when unable to give enteral (can trigger MODS)
indications- severe vomiting or diarrhea, obstruction, paralytic ileus
anxiety in the ICU
causes- equipment, environment, knowledge deficit, prognosis, LDAs, incontinence, finances, family,
fear of unknown, sleeplessness, impaired communication, isolation, loss of control and independence
families and patients
threat (perceived or predicted)
critical care setting- lights and noise, high tech equipment, rapid pace
clinical manifestations of anxiety
increased BP and heart rate
agitation and restlessness
similar to pain
100% 2023/2024
critical care history
nursing units specifically for the critically and acutely ill
1800s- clustering concept- put sickest patients in same unit (Nightingale)
early 1900s- neurosurgical ICU (first ICU in US- Johns Hopkins)
1950s- specialty units for airway management and ventilation run by professional experts
1960s- monitoring capabilities and new use of nursing management protocols- arterial line, EKG, etc.
1970s- ICU "standard"- every hospital has one
critical care units
wide range of technology always evolving
continuous monitoring- ECG, BP, temp, ICP, O2 sats
advanced monitoring- end tidal CO2, PA catheter, stroke volume, cardiac index, Licox monitoring, ICP
monitoring
constant support- mechanical vents, intraaortic balloon pumps
specialized critical care units
neuroscience critical care unit
neurosurgery ICU
coronary care unit
cardiovascular ICU
medical ICU
surgical ICU
trauma ICU
burn ICU
peds ICU
NICU
E-ICU
electronic/virtual monitoring of patients from another location
Tele-ICU
benefits- extra eyes on patient and VS/lab results, medical professional for consultation
cons- no patient contact, don't get feel for the room or patient
critical care nurse
ongoing assessment skills
early recognition of patient changes
avoid complications with appropriate nursing actions
focus on recovery
holistic care
care for patient and family
care for 1-2 patients
"intensive" care
complete care
very in tune to the needs of patient and family
at the bedside
specialized nursing through in depth orientation
critical care nurse proficient in
anatomy and physiology
,pharm
pathology
critical thinking
techno-savvy
advanced physical assessment
communication
collaboration
American Association of Critical Care Nurses (AACN)
critical care certification (CCRN) in neonates, peds, and adult critical care nursing
written test
continuing education and critical care nursing requirements
confirms RN's critical care knowledge
advanced cardiac life support (ACLS)
critical care nurses
ED and lifeflight nurses
crisis nurses
nurse and physician collaboration
rapid response team (RRT)
collborative
crisis nurse
respiratory therapist
doctor/APN
assess, plan care, and implement nursing actions for unstable patients
standing orders/order sets
critical care APN/APRN
graduate degree (masters or doctorate)
tons of roles
clinical nurse specialist (CNS)
nurse practitioner (NP)
doctor of nursing practice (DNP)
certifications for acute and critical care
array of duties
collaboration with physicians
ICU patient
admit to ICU
patient at risk for complications
requires frequent assessments for changes
unstable so critical thinking and care needed by the nurse
intensive nursing support needed
cluster by disease and acuity
ICU
not for long term coma or delaying death process
death common due to severity of illness
, progressive care units (PCUs)
between ICU and general floor
lower risk of complications than ICU
heart monitoring
long term vent weans
minimal titrating drips
more cost effective
critical care patient problems
impaired skin integrity due to immobility- pressure sores (activity, up to chair, q2 turns)
sepsis- frequent handwashing, PPE (immunocompromised, may have invasive lines)
nutritional concerns
anxiety
pain
sensory- perceptual troubles
sleep disorders
communication issues
nutrition in ICU
malnutrition associated with elevated morbidity and mortality
how to feed- tube feed, PO, NG tube, IV
collaborative care- bedside swallow assessment, speech pathologist
primary goal is to prevent or correct nutritional deficiencies
enteral feedings
goes straight to stomach, G tube, PO feed, NG tube, OG tube, keofeed (in nose, smaller bore tube
than NG, cannot suction, only used for giving meds or feed or flush, easier to place, nurses cannot
place)
less expensive
preserves function of the gut
help prevent relocation of gut bacteria- can trigger MODS if bacteria moves
OG vs NG vs keofeed vs G tube
fewer complications than parenteral feeds
parenteral feedings
IV, PICC line, central venous, TPN, cannot be in peripheral IV- higher risk for infection
bypasses GI tract
only when unable to give enteral (can trigger MODS)
indications- severe vomiting or diarrhea, obstruction, paralytic ileus
anxiety in the ICU
causes- equipment, environment, knowledge deficit, prognosis, LDAs, incontinence, finances, family,
fear of unknown, sleeplessness, impaired communication, isolation, loss of control and independence
families and patients
threat (perceived or predicted)
critical care setting- lights and noise, high tech equipment, rapid pace
clinical manifestations of anxiety
increased BP and heart rate
agitation and restlessness
similar to pain
