Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
119 Cards in this Set
- Front
- Back
|
Why was there a rapid growth in critical nursing?
|
CPR/ ACLS
improved technology medications external pacers golden hour |
|
|
What is Critical care nursing & what are 2 important concepts of the def?
|
specialty within nursing that deals specifically with human responses to life-threatening problems
total human care to their response to actual/potential problems human responses includes the families response |
|
|
What are 2 purposes of the standards of practice & what are they based on?
|
provides a framework within which an individual can provide a particular service- description of expected nursing roles & responsibilities
will be held accountable in a court of law based on nursing process |
|
|
What is Sensory deprivation?
|
decrease in the amount & intensity of meaningful sensory input
Sleep deprivation |
|
|
Who is at risk for sensory deprivation & examples?
|
elderly, hearing impaired, isolation, drug effects, electrolyte imbalance, prolonged immobility
ex: strange noises, unfamiliar faces, no windows/clocks |
|
|
What is Sensory overload?
|
lack of meaningful input & an over abundance of unfamiliar input
seen more often in day shift 2 or more stimuli that are confronting the pt at a greater than normal level ex of behaviors resulting from: confusion, anxiety, aggressiveness, sleep loss, panic, hallucinations, restlessness |
|
|
What is ICU psychosis?
|
syndrome that occurs on the 3-7 day in acute care setting that clears within 48hrs of discharge or transfer
reversible also known as acute confusion or global cognitive impairment |
|
|
Who's at risk for ICU psychosis?
|
elderly, severely ill, prolonged surgery/anesthesia, hx of psych, electrolyte abnormality, meds
|
|
|
Tx for ICU psychosis?
|
decrease sleep deprivation, decrease sensory overload
|
|
|
What are RASS & CAM used for?
|
to assess for delirium in all ICU pts
|
|
|
#1 nosocomial infection in ICU? And why?
|
pneumonia from Staph A
immobility & aspiration |
|
|
How to prevent infections?
|
hand washing, protective gear, id high risk pts, control environment, wipe all equipment w/PDI wipe
|
|
|
Contact isolation is for what infections & what is the room like?
|
C Diff, rotavirus, hep A
private, dedicated equipment no alcohol- wash hands, wear gown & gloves |
|
|
AFB is for what & what is the room like?
|
TB
private negative pressure, door closed wash hands before & after, PAPR mask |
|
|
Droplet precaution is for what & what is the room like?
|
pneumonia, meningitis
private room, mask w/face shield, wash hands before & after |
|
|
PAN culture is?
|
urine, sputum & blood
|
|
|
Steps to tx of threatening organism?
|
ID pt at risk
culture/PAN broad spectrum antibiotics eliminate source adjust antibiotics according to culture results |
|
|
What is dignified dying & what challenge do we face?
|
maintaining personal comfort & control as the end of life approaches
moral distress |
|
|
#1 need for families?
|
cognitive need, then need for hope
|
|
|
What is Ethics?
|
the reasoned examination of decisions which has significant moral dimensions
|
|
|
What is Beneficence?
|
helping the pt
foundation that nursing practice is based on |
|
|
What is Justice?
|
equality
|
|
|
What is assisted suicide?
|
intentional act of providing the means for a person to end their own life (lethal inj, pills, weapons)
|
|
|
What is Euthanasia?
|
act of intentionally terminating another's life to alleviate suffering with/without that persons request
|
|
|
What is physician assisted suicide?
|
physician knowingly facilitates a pt's death by providing the means or info for the pt to end their life
pt is competent & voluntarily request aid of MD |
|
|
What is physician aid in dying?
|
physician knowingly performs action that ends the life of the pt
pt doesn't need to participate, is voluntary & competent |
|
|
What is the Required Request Provision?
|
addition to uniform anatomical gift act that requires hospitals to request donations of organs from all suitable donations
|
|
|
What is the Code fo nurses/interpretative statement?
|
nurses may refuse to participate in a specific type of tx based on conscience when values are violated
|
|
|
What is Patient self-determination act?
|
gave nurse legal responsibility to ask if the pt has an advanced directive/living will
|
|
|
What is brain death?
|
irreversible loss of cortical & brain stem function
|
|
|
What is Uniform anatomical gift act?
|
establishes rules about who can make an anatomical gift, how gifts are executed & rights & duties at death
|
|
|
What is Positive apnea test?
|
absent respiratory movements & PCO2 60 or >
|
|
|
What does the Initial assessment include?
|
as much info as possible
hx including when, where emergency occurred, what was done, & health problems of pt |
|
|
What does AMPLE stand for?
|
Allergies & reactions
Medicating currently taking, OTC & herbals PMH/surg hx Last meal (time, amount, type) Events preceding the emergency & care rendered |
|
|
Primary assessment & its purpose?
|
ID & intervene w/life threatening injuries
illnesses & ABCs |
|
|
Secondary assessment & its purpose?
|
Head to toe assessment concentrating on c/o
ID all injuries look for other injuries |
|
|
Priority nursing interventions for all DEM pts?
|
ABCs, airway patency, supplemental O2, C-spine precautions & immobilization, CPR, brief neuro exam
|
|
|
What is acceleration, deceleration, shearing & compression?
|
speed of object
sudden stop twisting of the brain pressure/crushed |
|
|
What is blunt trauma?
|
body stops & tissues & organs continue to move forward
|
|
|
What is penetrating trauma?
|
break in skin integrity
|
|
|
What is an internal disaster?
|
facility itself in danger
need to protect pts & employees code amber |
|
|
What is an external disaster?
|
large scale emergency outside the faciltiy
code conval ex: flood, tornado, 911 |
|
|
4 questions triage should ask themselves?
|
is the pt dying? is this pt who shouldn't wait? how many resources will this pt need? what are the pt's vs?
|
|
|
Level 1 of triage?
|
unstable pt that needs immediate intervention or resuscitation, 1:1 nursing
ex: intubated, trauma code/alert, unresponsive, <90% O2, resp distress |
|
|
Level 2 of triage?
|
threatened pt that needs multiple nurses & interventions performed
ex: chest pain, needle stick, stroke signs, chemo pt w/fever, SI, chemicals in eye |
|
|
Level 3 of triage?
|
stable pt that needs medium resources, 2+
ex: abd pain, kidney stone, asthma attack w/good breathing |
|
|
Level 4 of triage?
|
stable pt that requires 1 resource
ex: fever >102, H/A, laceration |
|
|
Level 5 of triage?
|
stable pt w/ no resources
|
|
|
What are ex of resources?
|
labs, ECG, radiology, IV fluids, IV/IM/nebulized meds, specialty consultation
|
|
|
What are not ex of resources?
|
H&P, saline/heparin lock, PO meds, tetanus shot, rx refills, phone call to PCP, simple wound care, crutches, spints, slings
|
|
|
What are the phases of trauma?
|
pre-hospital resuscitation- golden hr
DEM resuscitaiton- primary assessment, CPR/ACLS, C spine, ABCDEs resuscitation- shock, hemorrhage, restore volume, monitor secondary assessment- head to toe, hx, dx studies, monitor |
|
|
What is an artificial airway?
|
device used to maintain airway patency
|
|
|
Purpose of an oropharyngeal airway?
|
keeps tongue out of the way
unconscious, suctioning, aids in ventilation, prevents pt from biting on ETT |
|
|
OPA contra, measurement & removal?
|
contra- facial trauma, recent oral surgery..
measure- tip of lips to angle of jaw/ear removal- don't need order Q12H oral care for gagging |
|
|
Purpose of a nasal airway?
|
suctioning
conscious or unconscious, easily tolerated, not as easy to dislodge, rotate nares Q24H |
|
|
Major disadvantage of nasal airway?
|
sinusitis
|
|
|
Purpose of endotracheal airway?
|
maintain airway for pt that can't protect their own airway
obstruction, aspiration, secretions |
|
|
Disadvantages of ETT?
|
uncomfortable, manipulated by tongue, occlusion, pt can bite tube, secretions, taped/holder
|
|
|
What needs maintained w/cuffed ETT?
|
cuff needs inflated at all times
|
|
|
What happens if the cuff is deflated?
|
feel & hear air going in & out, pt will talk
ok to deflate if moving or removing |
|
|
What does the RN do for care of ETT?
|
bilateral breath sounds, assess chest expansion, monitor cm at lip line, change tape/holder, daily CXR, skin breakdown, oral care, suctioning prn, comfort
|
|
|
Extubation involves what?
|
suction ETT & oropharynx, deflate cuff, remove w/deep breath, cough then suction, O2 by AFM set at same setting, assess status
|
|
|
Purpose of trachestomy?
|
long term airway, upper airway obstruction, secretions, trauma to face
|
|
|
Pieces of tracheostomy?
|
outer & inner cannula & obturator
|
|
|
Purpose of a Fenstrated tube?
|
inner cannula removed to allow pt speech, allows air to move in & out
|
|
|
Trach care procedure?
|
sterile, change inner cannula, clean stoma w/sterile water/NSS, change trach ties, apply dry dressing to site after removal
|
|
|
2 main nursing dx?
|
ineffective airway clearance, verbal communication
|
|
|
What is ventilation?
|
moving air in & out of the lungs
doesn't make 02 go into the blood or tissues |
|
|
What is dead space ventilation?
|
where air exchange doesn't take place, no gas exchange
|
|
|
What is alveolar ventilation?
|
air in the alveoli that's available for gas exchange
|
|
|
What is alveolar ventilation?
|
air in the alveoli that's available for gas exchange
|
|
|
What is respiration? External & internal?
|
exchange of 02 & CO2 in the body
external- in the lungs internal- cellular level, tissues & organs |
|
|
What is Tidal Volume (TV)?
|
amount of air breathed in & out
10-15mL/kg |
|
|
What is FIO2?
|
% or decimal of 02
|
|
|
What is frequency (f)?
|
# of breathes machine will give
|
|
|
What is Peak inspiratory pressure (PIP)?
|
amount of pressure required to get air into the lungs (TV)
If PIP is high = pt worsening |
|
|
Purpose of mechanical ventilation?
|
acute resp failure
improve alveolar O2/gas exchange maintain ABG WNL of pt provide O2 to pt |
|
|
What is the mode of ventilation?
|
way the vent delivers the breath & how much the pt participates in process
|
|
|
Common modes of ventilation?
|
CMV, AC, IMV, SIMV, PRVC, APRV, PSV
|
|
|
What is controlled madatory ventilation (CMV)?
|
vent delivers preset TV & rate
no active role by pt stops pt's effort to breath |
|
|
Why would a pt need CMV?
|
CNS dysfunction, chest trauma, drug induced paralysis, simplest
|
|
|
Disadvantages of CMV?
|
pt can't initiate breath, rate doesn't vary, out of sync w/pt breathing efforts
|
|
|
What is Assist Control Mode?
|
pt & vent work together, pt triggers vent w/inspiratory effort = vent delivers TV, mandatory rate is set, no spontaneous resp
|
|
|
Settings included in AC?
|
FIO2, TV, f, PEEP
|
|
|
Advantages of CM?
|
pt initiates own breathing, inspiratory muscles exercised, preserves pulmonary muscle tone
|
|
|
Disadvantages of CM?
|
hyperventilation, sedation may be required, change in mode
|
|
|
What is Intermittent mandatory ventilation (IMV)?
|
pt breathes spontaneously between preset vent breaths
vent provides preset # of breaths at reg intervals not sensitive to pt breathing |
|
|
What settings are included in IMV?
|
TV, f, FIO2, PEEP
|
|
|
What is Synchronized intermittent mandatory ventilation (SIMV)?
|
delivers preset TV at preset rate
synchronizes mandatory breath w/pt efforts vent senses pt's efforts, normal breathing pattern |
|
|
What is SIMV used for?
|
weaning pt off vent
decrease # of breaths |
|
|
What is Pressure regulated volume controlled ventilation (PRVC)?
|
vent calculates pressure needed to deliver TV
pressure adjusted breath to breath, pressure controlled = more comfortable delivers # of breaths (f) & vary inspiratory pressure to deliver TV |
|
|
Settings for PRVC?
|
FIO2, PEEP, TV, f
|
|
|
What is Pressure control ventilation (PCV)?
|
pressure controlled breaths time triggered by preset rate
no set TV pt sedated used in pts w/ARDS & to decrease risk of barotrauma |
|
|
What is Airway pressure release ventilation (APRV)?
|
mode that allows unrestricted spontaneous breathing
high & low CPAP increased gas flow to dependent lungs decreased sedation uses time cycled release w/decreased pressure for short time |
|
|
What is Pressure support ventilation (PSV)?
|
spontaneous breathing mode
preset positive pressure that helps pt w/inhalation pt controls rate, inspiratory flow & TV |
|
|
What is PEEP?
|
application of positive pressure to the pt's airway, applied to exhalation
provides alveoli w/constant amount of positive pressure at the end of expiration (alveoli don't collapse) |
|
|
PEEP does what?
|
improves oxygenation
keeps alveoli open improves lung compliance lungs partially inflated even during end expiration doesn't help w/perfusion |
|
|
Advantages of PEEP?
|
prevents atelectasis (collapse of alveoli)
improves gas exchange, prevents O2 toxicity |
|
|
Disadvantages of PEEP?
|
trauma injury, decreased CO, causes shock, hypotension, decreased renal perfusion
|
|
|
What is Continuous positive airway pressure (CPAP)?
|
spontaneous breathing w/o vent
4-20cm open airway on expiration |
|
|
What is Noninvasive positive pressure ventilation (NPPV)?
|
combines PSV & PEEP by vent or IPAP/EPAP by BiPAP
delivered via mask or mouth piece decreased level of pressure that works on both phases, noninvasive |
|
|
Complications of mechanical ventilators?
|
decreased CO, barotrauma, O2 toxicity, nosocomial infection, positive water balance, GI, psychological trauma
|
|
|
What is Ventilator bundle?
|
elevate HOB >30, sedation holiday, SQ Lovenox, daily oral care, suction
|
|
|
Weaning from ventilator involves?
|
pt physically & psychologically ready, length of time, rested, good vent drive & resp muscle function
ABG WNL of pt, stable VS, pt's appearance & LOC |
|
|
Methods of weaning?
|
SIMV, CPAP, PSV, T-piece trials & weaning protocols/guidelines
|
|
|
Cause of a high pressure alarm?
|
increased secretions, kinked tubing, pt biting ETT, water in tubing, barotrauma, ETT in R mainstem bronchus, bronchospasm
|
|
|
Cause of a low pressure alarm?
|
disconnected tubing, cuff leak, extubation, removed trach
|
|
|
Cause of low volume alarm?
|
exhaled volume too low
|
|
|
What does the RN do for alarms?
|
Check pt 1st, fix cuff or tubing, assess for symptoms, notify MD
|
|
|
Why are Superbugs increasing & harder to tx?
|
becoming drug resistant r/t farm animals being fed antibiotics to promote their growth
|
|
|
What is the criteria for brain death?
|
coma, absence of brainstem reflexes, apnea by CO2 test, ancillary tests (angiography, EEG, doppler)
|
|
|
Misconceptions about organ donation?
|
ppl are killed for their organs, ppl can recover from brain death, discrimination, rich/famous get tx, need donor's characteristics, age, mutilation of the body, family accrues cost, life won't be saved, religion
only religions against donation are J witness, christian scientist & a japanese faith |
|
|
What are important steps in the management of evidence?
|
don't pull object out, cut clothing on seam away from scene of crime, paper bag hands & evidence tape, detective collects clothing, don't give family anything
|
|
|
What are the triage colors & their meaning?
|
red- emergency
yellow- observation green- can wait white- dismiss black- die not matter what |
|
|
What is the effect of PEEP on airways?
|
keeps alveoli available for gas exchange
|
|
|
What do you assess for PEEP & why?
|
bilateral breath sounds
PEEP could cause pneumothorax or rupture the alveolis |
|
|
Why does an ETT cuff need to be inflated & complications?
|
to get TV, no TV = problems
cuff seperates upper & lower airways |
|
|
What is alveolar ventilation?
|
air in alveolar available for gas exchange
|
|
|
How does positive pressure ventilation work?
|
changes body's natural way to breath
increases thoracic pressure, no air in other areas = air stays in upper lobes |
