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NR 340 Week 3 Exam 1 Study guide-(Version-1), Chamberlain College of Nursing
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NR 340 Week 3 Exam 1 Study guide-(Version-1), Chamberlain College of Nursing
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NR340 Exam 1 Chapters 1, 2, 3, 5, 7, 9, 14, pgs 228-324 Page 1 of 36NR340 Exam 1
Overview of CC
Critical Care Nursing
Deals with human responses to critical illness or injury
o Physiological
o Psychological
Focus on both the patient’s and family’s responses
Critical Care Overview
Not always centered in an “ICU setting”
o Inpatient
o Outpatient
o Home Care
o eICU
o Tele-stepdown
o Post anesthesia
o Flight nursing-transport
Professional Organizations
o American Association of Critical-Care Nurses
o Society of Critical Care Medicine
Trends and Issues
Critical care patients more complex
Increasing costs for care
Facilities for long term ventilators
Reduces stays in hospitals: more risk for infection
Better for patient to be at home
Focus on Quality and Safety
Errors and harm must be prevented
o Communication is a big error
o On record where to find items
o Medication errors
o Documentation errors
o Handwashing
o Falls
Nurses are challenged to reduce errors and promote a safe environment
Several initiatives
o Joint Commission National Patient Safety Goals
o Institute for Healthcare Improvement
o Quality and Safety Education for Nurses (QSEN)
National Patient Safety Goals
The Joint Commission National Patient Safety Goals
Examples relative to critical care nursing
o Communication
o Medication safety
,NR340 Exam 1 Chapters 1, 2, 3, 5, 7, 9, 14, pgs 228-324 Page 2 of 36
o Reduce infections
o Reconcile medications
o Telephone orders- SAY BACK
o TALL letters for similar drug names
Harms Targeted for Reduction
Adverse drug events
Infections
o Catheter-associated urinary tract infections (CAUTI)
o Central line–associated bloodstream infections (CLABSI)
o Surgical site infections
o Ventilator-associated pneumonia (VAP)
Injuries from falls and immobility
Obstetric adverse events
Pressure ulcers
Venous thromboembolism (VTE)
Communication
Communication important for safe care
Standardized approaches
o SBAR and SBAP
Situation
Background
Assessment
Recommendation (Plan)
Collaboration
o Nurse/ doctor
o Debreifing
Other Trends and Issues
Reducing hospital readmission rates
o Chronic illness (HF)
Increasing use of technology
o Electronic medical records
o Physician order entry
Ethical issues associated with prolonging life and futile treatment
Telemedicine and eICU
Aging population and workforce
Shortage of CC nurses
The Critical Care Environment
Stressful
Noisy
Sleep Deprivation
Concerns of the Critically Ill Patient
o Patients responses do vary
Loss of control (even breathing)
↓ Communication (d/t vent)
↓Mobility, ↓Comfort
Psychosocial Support (HIGHEST CONCERN)
,NR340 Exam 1 Chapters 1, 2, 3, 5, 7, 9, 14, pgs 228-324 Page 3 of 36
Ensure safety
Reduce sleep deprivation
Reduce noxious sensory overload
Increase pleasant sensory input
Provide reorientation
o Strategies
Mimic night/ day
Calendar/ clock
Tell them what you are doing
Talk to the patient
Allow for rest periods
Provide pleasant area
Geriatric Concerns
Diminished ability to adapt to, or cope with, stressors of critical illness
At greater risk for negative outcomes
May not bounce back
Ethical Issues
Critical care nurses confront in everyday practice
o Informed consent and confidentiality
o Withholding or withdrawal of treatment
o Organ and tissue transplantation
o Distribution of healthcare resources
o Appropriate use of technology
Greater frequency in critical care
Ethical Principles
Autonomy
o Body
o Ability to make decisions for self
Beneficence
o To do good
o To benefit the patient
Nonmalificence
o To do no harm
Justice
o People getting what they deserve/ need
Veracity
o Be truthful
Fidelity
o Be faithful
Confidentiality
Nurse Involvement in Ethical Decision Making
Advocacy
o Open communication of patient’s wishes and ethical concerns
o True collaboration with healthcare team members
Dilemmas can result in moral distress
Formal mechanisms (The Joint Commission)
o Bioethics committees
, NR340 Exam 1 Chapters 1, 2, 3, 5, 7, 9, 14, pgs 228-324 Page 4 of 36
o Ethics consultation
Opportunities for critical care nurses
o Ethics forums and rounds
o Peer review
o Institutional review boards (research)
Selected Issues
Informed Consent
o Have to insure that patient is actually informed
o No remaining questions about procedure/outcome
Advanced Directives
Organ and tissue donation
o Call gift of hope – Nurses only responsibility
Life-sustaining treatment
Forum to Resolve Issues
Bioethics Committees
Ethics Consultation
Concerns of the Critically Ill
Pain
o Physiology
o Predisposing Factors
Disease process can cause pain
Changing dressing, movement, etc.
Ischemia
o Assessment
Subjective
Pain is what the patient says it is
Objective
Vital signs
Non-verbal
Facial expressions
Moaning/Groaning
Grimiacing
Guarding
Body Movement
Pain Management (acute pain)
o Nonpharmacologic
Heat, cold, massage, breathing, guided imagery, etc.
o Prevention
Opioids
Fentanyl
Dilaudid
Morphine
Concern is respiratory depression
Antidote is narcan
o Epidural
o NSAIDS
o PCA
Anxiety
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