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Summary Nur 463 Exam 1 Study Guide

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This is a comprehensive and detailed study guide on Exam 1 for Nur 463. *Essential Study Material!!

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  • September 16, 2024
  • 33
  • 2019/2020
  • Summary
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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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