Summary
Summary Nur 463 Exam 1 Study Guide
- Institution
- University Of Rhode Island
This is a comprehensive and detailed study guide on Exam 1 for Nur 463. *Essential Study Material!!
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Readings Sole, Klein & Moseley
o Ch. 1, 2, 7, 10, Review 12, 8, 9
Lewis
o Ch. 36, 37, 66
Overview Of Critical/Acute Care Nursing
Critical care nursing : deals w/ human responses to critical illness/injury (physiologic,
psychologic) ; both pt & family responses
Critical Care Environment
Can cause a lot of stress and anxiety
Sensory overload
o Lights, noises, loss of privacy
Modification of environment
o Noise reduction (Acoustical tiles/designs; Soothing music; Private areas for
communication between caregivers and with family members)
o Adequate lighting (natural ; night/day synchronization)
Critically Ill Patient
Response may vary according to…
o Age, Prior illness or hospitalization experience, Family relationships and
social support, Coping mechanisms, Beliefs about life and death, Spirituality,
Cultural considerations
, Psychosocial support
o Ensure safety, reduce sleep deprivation, reduce noxious sensory overload,
increase pleasant sensory input, provide reorientation
Quality of life after critical care
o Relocation stress
Fear of abandonment, learning new routines, new staff, new
roommates
o Prepare pt and family
o Post critical care symptoms
Fatigue/sleep probs; pain; muscle weakness; poor concentration;
impaired memory; poor appetite
Fostering Hope
Positive outlook; deep inner faith; goals/plans
Critical attributes
o Future oriented, reality based, goal attainment, uncertainty, multidimentional
Complex Cardiovascular Disorders
EKG interpretation
EKG/ECG : electro-cardio-gram ; produces wave form picture of electrical impulse conduction of
heart
12-Lead ECG (only 10 physical leads placed b/c conduction patterns form 12 readings)
Leads
, o 3 standard limb leads
I, II, III (form triangular conduction pattern)
Lead I (placed on left arm)
Record flow from right arm to left arm
Lead II (on right arm)
Records flow from right arm to left leg
Lead III (on left leg)
Records flow from left arm to left leg
o 3 augmented limb leads
record flow from heart to lead
o 6 precordial leads
V1: 4th intercostal space, right sternal border
V2: 4th intercostal space, left sternal border
V3: halfway between V2 and V4
V4: 5th intercostal space, left midclavicular line
V5: 5th intercostal space, left anterior axillary line
V6: 5th intercostal space, left midaxillary line
Impulses
o toward electrodes = positive QRS (points up)
o away from electrodes = negative QRS (points down)
, Cardiac monitoring in ICUs
5-lead system
o limb leads and 1 precordial lead
telemetry 3-lead (I, II, III, or V1)
6 sec stip q4hrs
ST segments
o Elevated = STEMI ; damage to multiple/all layers
o Normal = NSTEMI ; damage to only 1 layer
Dysrhythmias
Daily 12 lead for cardiac pt
Analyzing Cardiac Rhythm
Horizontal boxes
o Small = 0.04 sec
o Large = 0.20 sec (5 lg boxes = 1 sec)
Vertical boxes
o Small box = 0.1 mV
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