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47 Cards in this Set

  • Front
  • Back
specialty dealing with human responses to life-threatening problems. it is ONGOING ASSESSMENT and EARLY RECOGNITION and management of complications to bring about healing and recovery.
critical care nursing defined
How is the critical care nursing role accomplished?
1.Nursing process - ADPIE
2.Prioritization
a.ABC’s
b.Maslow’s Hierarchy
c.Important vs. Non-Important and Urgent vs. Non-urgent
what is evidence based practice?
the use of evidence (from research) to improve quality & outcomes of healthcare
Why do we do what we do? Why do we turn patients Q2hr and not Q4 hr
Summary – collecting everything and based on data make recommendations on what is to be done.
Important – it is a continuous process
practice reflects current state of science not ritualistic
optimal pt outcomes achieved
example of EBP regarding aspirin
Aspirin – given to reduce risk of CAD
Ongoing assessment showed ulcers
Now give 81 mg & teach s/s of bleeding
what is a bundle?
a structured way of improving the processes of care and patient outcomes: a small, straightforward set of practices, generally 3-5 that when performed collectively & reliably, have been proven to improve pt outcomes.
what is the purpose of Joint Commission 2009 safety goals?
use at least 2 patient identifiers when providing care, treatment & services.
also, label containers used for specimens in presence of patient.
What did the Safe Medical Device Act of 1990 provide?
report of death to manufacturer or any problems with devices (pacemakers, knees). Ways for pts to be contacted if their device is defective.
what do the Agency for Healthcare Research and Quality (AHRQ) and Institute of Healthcare Improvement (IHI) do?
give recommendations for evidence based practice
EBP Sacred Cow - suctioning
Suctioning – saline used to be instilled to loosen secretions and then suctioned out, studies show no evidence to support, actually have 5 times more bacteria, longer to get back to O2 baseline. Recommendation – only when absolutely necessary (copious secretions), not routine
EBP Sacred Cow - NG Tube placement
on insertion – air bolus, exam fluids, recommendation is chest x-ray. pH can be changed by meds (prevacid)
EBP Sacred Cow - Blood pressures
cuff size, arm at heart level
EBP Sacred Cow - Lead placement
5 leads instead of 3, Lead 2 for atrial problems (a fib, sick sinus problems), V1 for ventricular problems
EBP Sacred Cow - mobility
turn Q2 hrs, sit up when possible
EBP Sacred Cow - neuro assessment
Glasgow Coma Scale has limitations (HOH, meds, language, mental status) recommend to use more than one scale – Ramsey scale (get on Thursday). Everyone use same scale in hospital.
what organization sends out practice alerts?
AACCN
What method shows promise for proper NG tube placement?
Carbon dioxide detector
Critically ill pts who are hemodynamically stable can be repositioned, have HOB elevated 30 degrees, dangle legs, stand, & walk or all the above
all of these are possible with hemodynamically stable patient
best practices for oral care in the critically ill include:
Oral Care – brush teeth, gums tongue 2x/day, oral moisturizing Q2-4 hrs, chlorhexidine gluconate 2x/day perioperative period for pts undergoing cardiac surgery.
best practices for central line care (Bundle)
key components:
hand hygiene
barrier precautions, chlorhexidine scrub, optimal site selection (subclavian preferred), daily review of line necessity.
best practice for sternal wound infection
remove hair via clippers, prophylactic antibiotics, tight glycemic control, standardized wound care, convenient gels for hand hygiene, sign reminders, & peer pressure
1. Insulin
2. Albuterol
3. Morphine sulfate
4. Potassium chloride
5. Heparin
6. Cefazolin
7. Warfarin
8. Furosemide
9. Levofloxacin
10. Vancomycin
Top ten meds misused or mishandled in order of frequency
1. wrong dose
2. wrong time (freq)
3. wrong route
4. missed dose
5. wrong technique
6. illegible order
7. duplicate therapy
8. known allergy
9. wrong drug/wrong pt
10. drug-drug interaction
top 10 med mistakes from most to least frequent
the only drug approved by the FDA for short term sedation in a critical care setting
diprovan (propofol)
how often must Diprovan be replaced?
Q6 hrs due to lipid base
EBP recommendation for daily Diprovan use
sedation vacation to assess patient condition
T/F-patient may require less Diprovan with combined use of opiod
True
T/F-Diprovan wears off in minutes
True - short half-life
T/F-IV sedation with Diprovan also provides pain relief to the client
false - IV sedation from Diprovan only prevents a response to pain but does not provide pain relief.
computerized provider order entry
incl pharmacist on rounds
pharmacist available on call after hours
special procedures/protocols for high risk IV & oral meds
improve error detection & reporting, promote nonpunitive atmosphere
standardize Rx writing - avoid abbreviations
bar coding technology
EBP suggestions for reducing med errors in hospital care
most common pain meds used are opioid agonists
morphine & fentanyl
opioid agonist discouraged for use greater than 48 hours
demerol
opioid overdose triad
Pinpoint pupils, respiration depression & coma
drug that should always be available in case of opioid OD
Narcan (naloxone)
common side effects of opioids
constipation (most common)
nausea/vomiting
sedation
respiratory depression
pruritis
how would pain be assessed in cognitively impaired patients?
Pain would be assessed by facial expressions, guarding, breathing, moaning, rigid or stiff, wincing, shutting eyes, clenching fists, BP elevated
examples of parenteral routes for pain management
continuous IV infusion
IV bolus
PCA
Epidural
Intrathecal
what is the primary cause of inadequate pain mgmt in the ICU?
lack of appropriate pain mgmt
what are the increased patient responses to procedural pain?
body movement, verbal & facial responses
preemptive analgesia is defined as
administration of analgesic agents before the pt experiences a noxious stimulus
CNS sensitization caused by hyperexcitability can result in what?
persistent pain
continuously changing physiologic states with varying pt behaviors & responses result in what continuum?
agitation
abnormalities in VS common in agitated patients are (3)
tachycardia, tachypnea, & hypertension
ICU delirium can occur in what percentage of patients?
80%
why is it important to consider patient safety when monitoring and treating delirium?
it is a risk factor for increased length of stay & 6-month mortality
what are the 3 subtypes of delirium?
hypoactive
hyperactive
mixed
what medication is recommended by the SCCM guidelines for the tx of delirium?
haloperidol
which 3 meds can contribute to delirium?
anticholinergics
sedatives
analgesics