CRITICAL CARE FIRST TEST
What is critical care - Answer- Critical care defined.....
•
•"Direct delivery of medical care for a critically ill or injured patient. To be considered
critical an illness or injury must acutely impair one or more vital organ systems so
that a patient's survival is jeopardized."
•(Department of Health & Human Services, 2001)
One or more vital organ systems
Once the patietns body start shutting down you can see it
It is a cascade and the patient becomes sicker and sicker
Have to have good clinical judgement
How do you know the patient is getting sicker
Some patients do well and others do not
Critical Care = Critical Thinking - Answer- This is going to be important
AACN talk about clinical judgement, advocacy and they join together to make the
strong nurse
Need critical thinking and judgement
As you go up the bloom's, the lower the level is on the bottom
Remember: potassium 3.5-5
Evaluating s how to know this is bad
We want to be at applying, the patient is on glucocorticoids and this raizes their
glucose level and their risk of infection
Have to anazlyse the situation, no one holds up a sign that says MI
Look at analyses level and application
ICU room: see a ventilator, 3 bed rails are up, the bed is not all the way down, there
is an NG tube feeding, this is not prone positioning, parenteral through the IV, and
the enteral is tube feeds, NG or OG because of the salem sump, they have a drain,
they can have drain from the endotracheal suction, they have an ECG monitor
The red line shows that it an a line that is in the bracial or femerol artery, it can be
very positional and can change quickly, the SPo2 the a line has to have anice wave
form as well. If it has a notche then you can trust. Awlays trust the respitory rate on
the ventilatory becase it is most accurate
The cardiac monitor respirory rate is not as accurate
IV and fluids are going in all at the same time. It is probably not going in at a fast
rate. It ca be vasoactive drugs
It can be inotrops- they increase the strength of contractility, it can be vasopressor
such as epi or noroepi raises BP
The pressure bag, the pressured tubing infuses at 3cc or ml an hour
They cant bend it as much so that's what allows to read the pressure
CRRC- renal failure machine, their body cannot tolerate hemodialysis, it cause
smassage fluid shift, so the contiuous dialysis runs 24 hours a day,
There is a travel pack if we leave the room. The patient is likely sedated
,If caring for the nurse and need to bring f
Critical Thinking Skills in Nursing - Answer- •Critical thinking includes identifying a
problem, determining the best solution and choosing the most effective method of
reaching that solution.
•After executing the plan, critical thinkers reflect on the situation to figure out if it was
effective and if it could have been done better.
•Think about a problem in a different way......go beyond memorizing
•NCLEX questions: rationales behind answers
The most effective method, what could we have done better
Go beyond memorizing
Use a concept map
Look at rationals with concept questions
Care given in a specialized unit
How non ICU nurses are being trained
Elements of Critical Illness/Injury - Answer- •Impairment of one of more vital organs
•Patient survival jeopardized
•Care given in specialty unit with specialized personnel and equipment
AACN puts out a lot about this is ventilator care
It is scary but it is an interesting time for nurses
Give scope and standards of practice
Role of the Nurse - Answer- •Legal, ethical, and moral responsibilities of the
profession
•ANA
•Scope & Standards of Professional Practice
•Nursing Code of Ethics
•Nursing Social Policy Statement
•State Board of Nursing
•Must practice within scope
•Decision-making guided by evidence-based practice
When we think of scope we do not prescribe or diagnosis
We are critical thinkers
What does the diagnosis do to affect our patient
State board of nursing tells us what to do
We have to practice with in our scope of nursing
1 ml of morphine may not be enough but you should not up a dose because that is
prscribing
If you don't feel like the medication is not enough then contact the doctor and gather
data
American Association of Critical-Care Nurses (AACN) - Answer- AACN
•The AACN defines progressive & critical care nursing as "the specialty that
manages human responses to actual or potential life-threatening problems."
,•Sets the Scope and Standards for Acute and Critical Care Nursing Practice
vAACN scope of practice document clarifies the practice role of progressive &
critical care nurses when caring for patients & families & the impact of the
work environment on the provision of nursing care (AACN, 2019)
Critical care nurses, nurses are life long learners, it is a great resource
AACN Synergy Model - Answer- vCritical care nursing should be defined more by
the needs of patients and those of their families than by the environment in which
care is delivered or the diagnosis of the patients.
•
vPatient/family needs + Nurse competencies = Optimal patient outcomes
Clinical paper work
If I have a super sick patient then you need a strong nurse
Have to think about who is the best nurse for this patient
syngery - Answer- Want someone who is strong with advocacy
Evidence based practice guides our practice
Cathereter assossiated UTI, this guides what we have to do
Critical Care is... - Answer- •Critically ill patients with potentially life threatening
conditions
•Variety of specialized units
•CCU, TICU, SICU, MICU, PACU, NICU, CVICU
•Advanced training - specialized artificial airways, mechanical ventilation, ACLS
training
Patient to RN ratio 2:1,1:1, 1:3
Can be a variety of specialized units
Advanced training and mechanical ventilator
We need to know whats going on and the 100 percent ventilator ration
Usually 1 nurse to 2 patients
Patient is super sick then 1 to 1
If patient is crashing contiously then that is a 1 to 1
Typically this is 3 patients to 1 nurse
Not many times that we have 3 patients
It is helpful to talk about the ventilator and the endotracheal tube
What is in an ICU room? - Answer- •Monitor system
•Alarms
•Oxygen delivery/source
•Suction equipment
•Ambu bag & mask
•IV pumps
•Backboard (CPR)
I think teaching is the most important
It brings people about to a shock
, Where is the patient under all of this
Warning the patients family, evaluate the patients family
Stand neck to the person if they are shakey are going down
The loss of control
We feel like there is not a lot of control
Sometimes when we hear the patients family are needy its because they want to do
something, so can have them do a little task, such as putting lotion on their feet or
doing passive range of motion
Table 2-2
Patient can have a temp, suction equipement at the bed side
If the patient arrest and needs intubated, ambu bag and mask
The mask can be taken off and ambulate the trache patient
Can use the backboard for CPR
Nutritional support- tube feeds the best confirmation is by x-ray and should be done
prior to tube feeding or if there is dislodgement
A PH test alone does not suffice
Aspiration is a huge risk, or if the tube was just placed then we need x-ray
Parenteral- can cause hyperglycemia, and infection
The increase glucose in the IV fluids and a dedicatd centeral line can cause infection
Evidence based practice- when you are thinking about monitoring, and then the
patient arrest, the family presenceduring resessitaiton is benefital
It allows patient family to see that the nursing and medical staff are doing everything
possible
Family whitnessed resessitation is important, someone should be with the family
member explaining
Want to have a nurse to explain to the family
If the patient sees family whitness ressisitation they are less likely to sue
Monitoring in the ICU - Answer- We can have 5 lead
We go to lead 2
Wave form is the plef
The notch is the dicrotic notche
If the aline is positional- if the patient bends their arm will see a decreased wave
form
Dirchotic notch is good
They need to have auible alarms or the patient will die
Alarms set with appropriate permaters
Do not want the low alarm to set at 50 the heart rate, want to set at 55 so it will alarm
at 52
Do not mute the alarm, thinking about things that elevate, pain, anxiety and fear
Think about the pain assessment, increased BP, increased pulse, increased
respirations
ICU delirium - Answer- Watch this ICU delirum
Patients can have hyper or hypodelirum
Little old lady, she had an introducer with the right IJ with the sutures
Had the suture scissors and threatened the nurse
Was having hypoactive delirum by saying she wanted out of the jail
Sometimes they need restrained if on a breathing tube
