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105 Cards in this Set
- Front
- Back
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Illinois Department of Public Health |
prevention and control of disease and injury 1st public health pioneers makes sure we practice under the guidelines "do no harm" |
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Institute of Medicine Public Health IOM |
nonprofit works each year to improve and reinvigorate the healthcare system collaboration with others is key reliance upon evidence-based medicine |
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Illinois Department of Financial and Professional Regulation IDFPR |
made up of 3 divisions: banking, financial, and professional regulations our nursing license comes from here |
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National Council of State Boards of Nursing NCSBN |
makes and maintains NCLEX-RN provides education, service, and research through collaborative leadership to promote evidence-based regulatory excellence for patient safety and public protection |
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Accreditation Commission for Education in Nursing ACEN |
previously known as national league of nursing accreditation commission accreditation for nursing schools base their accreditations of QSEN competencies voluntary peer review process for associates and bachelors degree programs |
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Quality and Safety Education for Nurses QSEN |
competencies *patient-centered care *teamwork and collaboration *evidenced-based practice *Quality improvements *informatics *safety |
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Diagnosis Related Groups DRGs |
a patient classification scheme which provides a means of relating the type of patients a hospital treats to costs incurred by the hospital create an effective framework for monitoring the quality of care and utilization of services in a hospital setting |
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what do DRGs mean to me as the nurse? |
take care of your patients by evaluating the effectiveness of what is being done evaluate good and bad to make sure our interventions are working |
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The Joint Commission TJC |
Not for profit voluntarily surveys hospitals currently at Silver and St. Joe's community should have confidence in hospital with TJC label Establishes standards for patient care |
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6 goals of TJC |
1. improve the accuracy of patient ID 2. Improve effectiveness of communication among caregivers 3. improve safety of medicine usage 6. reduce harm with the use of clinical alarm system 7. reduce risk of healthcare-associated infections 15. ID safety risks inherent to its' patient population |
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Healthcare Facilities Accreditation Program HFAP |
provides certification like TJC currently in Morris and St. James straight-forward approach to accreditation with clear and direct survey standards -high quality services -nationally recognized |
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delegation |
the transferring to an individual the authority to perform a selected nursing ability or task in a selected situation that fits their role |
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in delegation, what does the RN retain? |
professional accountability -whatever our CNA's do, we are accountable |
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What does the ANA grant? |
grants the nurse authority to delegate and clinically supervise assistive personnel |
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magnet status |
awarded by the American Nurses Credentialing Center ANCC not an accrediting body in order to get this, a hospital must have a certain percentage of nurses with BSNs consumers rely on magnet designation as the ultimate credential for high quality nursing |
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primary level of prevention |
planning stage preparedness through sharing of treatment recommendations and protocols with medical providers activate systems to identify potential secondary victims and contain additional spread of infections identify local pharmaceutical inventories and stockpiles reduce panic in a community by relaying appropriate public health information in an emergency to 1st responders, healthcare providers, and the public |
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secondary level of prevention |
any screening is secondary triage our response what we are actively doing in the now |
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START: simple triage and rapid treatment |
can make sense and bring control to a charged, seemingly overwhelming situation must be performed in a safe area must be fast and done in under 15 seconds Green-minor yellow- delayed red-immediate black- death eminent |
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tertiary level of prevention |
how we get back to normal or near normal psychosocial effect on society |
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bioterrorism |
act of exposing a population to a biological agent to cause harm |
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anthrax |
biologic agent spreads by spores through inhalation or eating infected animal parts not spread from person to person treatment with antibiotics for 60 days vaccine available to those at risk standard precautions |
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pneumonic plague |
aerosol release respiratory droplets from infected person in a 6 foot range treatment with antibiotics no vaccine easily destroyed by sunlight airborne precations |
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botulism |
usually from canned foods standard precautions cannot transfer from person to person |
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smallpox |
aerosol released contact from person to person: direct and prolonged, face to face, bodily fluids and contaminated objects no proven treatment, only supportive therapy vaccine available |
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inhalation tularemia |
insect bites, handling of infected animals, consuming contaminated food or water, inhalation of airborne bacteria cannot be spread from person to person antibiotic therapy no vaccine can remain alive in soil and water for up to 2 weeks |
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viral hemorrhagic fever |
from viral reservoirs: rodents, arthropods, or animal hosts may be transmitted from person to person via close contact and bodily fluids, objects that contaminated from bodily fluids supportive therapy: no established cure needs a reservoir to survive |
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biologic agent |
a live agent used for bioterrorism |
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chemical agent |
chemical used for terrorism not considered bioterrorism |
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ricin |
biotoxin agent chemical poison in the form of a powder, mist, or pellet cannot be spread from person to person supportive care stable agent not affected by heat or cold death usually occurs within 36 to 72 hours if they make it past 72 hours, they will most likely survive |
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sarin |
nerve agent human made chemical, clear and odorless can be liquid or gas clothing can retain and release gas for up to 30 minutes heavy vapor sinks to low lying areas must remove body from area immediately supportive care antidote is available if given ASAP |
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radiation |
forms of energy manmade or natural can be cumulative or acute supportive care survival depends on dose full recovery make take a few weeks to years |
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shock |
syndrome characterized by impaired cellular metabolism and low tissue perfusion results when there is an imbalance between supply and demand for O2 |
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MAP |
Systolic X 2(diastolic) ______________________ 3 |
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hypovolemic shock |
occurs when there is a loss of intravascular fluid volume reduction results in a decreased venous return to the heart, decreased preload, decreased stroke volume, and decreased stroke volume, and decreased CO |
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absolute volume loss |
fluid loss through hemorrhage, GI, fistula drainage, diabetes insipidus, hyperglycemia, or diuresis |
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relative volume loss |
third spacing fluids sepsis, bowel obstructions, loss of blood volume, and burns |
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when does irreversible tissue destruction occur? |
more than 40% blood loss |
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patient may compensate for a blood loss of...? |
up to 15%, or 750mL |
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blood result of more than 15% or 750 mL may result in...? |
SNS mediated response |
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SNS response: |
increased HR increased CO tachypnea |
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clinical manifestations of hypovolemic shock |
SNS response decreased stroke volume anxiety: confused, agitated, scared decreased urine output cool, clammy skin decreased bowel sounds BP trending downward |
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what does hypovolemic shock mean in regards to hemoconcentration? |
the higher BUN is in relation to a low HGB, more more concentrated the HGB is, therefore fluid replacement must be slow because too fast will drop HGB quickly |
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lab values for hypovolemic shock |
decreased HCT: in hemmorhaging decreased HGB: in hemmorhaging increased lactate increased urine specific gravity changes in electrolytes |
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fluid resuscitation rule for hypovolemic shock |
3:1 3 mL isotonic crystalloid for every 1 mL of estimated fluid loss |
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potential complications of fluid resuscitation |
fluid volume overload crackles in lungs |
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septic shock |
a systemic inflammatory response to a documented or suspected infection. Occurs when there is sepsis present with hypotension despite fluid resuscitation along with the presence of inadequate fluid perfusion. |
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severe sepsis |
sepsis complicated by organ dysfunction |
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what happens to blood during septic shock? |
release of platelet activating factors that result in the formation of microthrombi and obstruction of microvasculature -have clots in different organs |
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clinical manifestations of septic shock |
decreased ejection fraction hyperventilation resp. alkalosis (early because of hyperventilation) later resp. acidosis and hypoxemia resp. failure ARDS pulmonary hypertension crackles decreased urine output agitation/AMS GI bleed/paralytic ileus |
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lab diagnostics in septic shock |
increase or decrease in WBC decreased platelets increased lactate increased glucose increased specific urine gravity decreased urine sodium positive blood cultures low albumin low total protein |
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stages of shock |
compensatory progressive refractory or irreversible |
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what is one of the first signs of shock? |
a decrease in BP |
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what happens when the SNS system is activated in the compensatory stage of shock? |
blood flow is redirected to the most essential organs (the brain and heart) myocardium increases O2 demand: increases HR and contractility coronary arteries dilate to meet O2 demands decreased blood flow to lungs-increases physiologic dead space arterial O2 levels will decrease-then have compensatory increase in rate and depth of respirations decreased blood flow to GI tract: impaired motility decreased blood flow to skin: becomes cool and clammy decreased blood flow to kidneys: activates renin-angiotensin system-causes vasoconstriction |
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what is the anatomical dead space? |
the amount of air that cannot reach the gas exchanging units any air that cannot participate in gas exchange results in a ventilator/perfusion mismatch portions of the lungs are not participating in gas exchange |
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compensatory stage of shock |
^ HR ^ respirations MAP greater than or equal to 65 decreased cardiac output decreased renal circulation decreased GI circulation: decreased GI motility slight LOC change: restless pale, cool, clammy skin temp can be normal/abnormal ^ BUN |
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progressive stage of shock |
^HR ^RR decreased BP decreased resp. compliance r/t atelectisis crackles decreased response to stimuli decreased blood blood flow to the brain MAP <60 increased capillary permeability: 3rd spacing (decreased albumin) edema GI bleed, paralytic ileus decreased urine output ^BUN/Cr ratio start to see MODS watch DIC hypo/hyperthermia cold/pale/dusky |
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refractory/irreversible stage of shock |
decreased HR respiratory failure decreased BP unresponsive pupils non-reactive, dilated anuria ischemia gut DIC progresses mottling/cyanotic metabolic change-acidosis |
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diagnostics for shock |
H and P thorough medical and surgical HX of recent events (chest pain, traumas, surgeries, etc.) obtain labs such as lactate and base 12 lead EKG telemetry CXR continuous pulseox hemodynamic pressure monitoring: arterial pressure, central venous pressure |
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clinical management for shock |
ensure there's a patent airway: O2 sats above 90%: increase O2 supply and decrease O2 demand fluid resuscitation: increase circulating blood volume drug therapy: correct tissue perfusion- sympathomimetic drugs, vasodilator drugs nutritional therapy: counteract hypermetabolism of shock-start enteral nutrition w/in 1st 24 hrs |
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nursing assessments for shock |
goals for patient: show evidence of adequate perfusion, restore normal or baseline BP, return/recover organ function, and avoid complications from prolonged states of hypoperfusion focus initially on ABC's assess for tissue perfusion assess LOC |
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primary prevention of shock |
early ID of those at risk monitoring of fluid levels monitoring for signs of infection anything we're doing to prevent shock |
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secondary prevention of shock |
monitor ongoing physical status watch trends to detect changes in condition plan and implement nursing interventions and therapy evaluate the response provide emotional support anything we do to treat shock |
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tertiary prevention of shock |
monitoring for indications of complications at home may require care in a skilled nursing/rehab facility after care |
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normal BUN ratio |
10:1 |
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normal MAP |
>70 |
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key to remembering ARDS |
Assault to the pulmonary system Respiratory distress Decreased lung compliance Severe respiratory failure |
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what is ARDS? |
a gas exchange issue end result of an aggressive inflammatory process that damages the aveolar capillary membrane |
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what does the inflammation result in in ARDS? |
increased permeability of pulmonary capillaries and alveoli protein rich pulmonary edema surfactant depletion pulmonary fibrosis develops after 5-7 days |
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classic symptom of ARDS |
pulmonary HTN with no history of heart disease |
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3 main signs of ARDS |
1. rapid breathing pattern 2. can't get enough air; dyspnea, poor gas exchange 3. decreased O2 levels in blood |
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indirect causes of ARDS |
sepsis drug overdose increased intracranial pressure transfusions DIC pancreatitis trauma eclampsia |
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What is the most common cause of ARDS? |
sepsis |
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direct causes of ARDS |
aspiration pneumonia near-drowning oxygen toxicity prolonged mechanical ventilation chest or lung injury radiation inhalation of a toxic substance |
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what does it mean when a patient has a ventilatory function problem? |
inability to effectively inhale and exhale |
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difference between a ventilatory and an oxygenation failure |
ventilatory: physical barrier oxygenation: not enough O2 |
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ventilatory failure causes |
COPD pulmonary embolism and pneumothorax ARDS asthma pulmonary edema fibrosis of lung tissue neuromuscular disorders elevated intracranial pressure |
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oxygenation failure causes |
pneumonia hypoventilation hypovolemic shock pulmonary edema low hemoglobin low concentrations of O2 |
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what is the most common cause of hypoxemia? |
V/Q mismatch |
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what does it mean if the V/Q is increased? |
means ventilation is higher and perfusion is lower -creates a high O2 saturation |
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what does it mean if the V/Q is decreased? |
means ventilation is lower and perfusion is increased -creates low O2 mismatch |
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injury or exudative phase of ARDS |
increased cap permeability engorgement of bronchial and vascular spaces causing interstitial edema fluid from interstitial space enters alveolar space intrapulmonary shunt develops-blood can't be oxygenated |
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reparative or proliferative phase of ARDS |
influx of WBC's lungs regenerate diseased lung becomes dense with fibrous tissue hypoxemia worsens |
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fibrotic phase of ARDS |
lung tissue completely remodeled by fibrous tissue: become firm diffuse scarring resulting in decreased lung compliance surface area for gas exchange significantly reduced pulmonary HTN occurs or becomes increased ABG becomes more acidic may go into systemic failure metabolic acidosis |
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initial signs and symptoms of ARDS |
dyspnea tachypnea cough restlessness and agitation normal or fine, scattered crackles ABG's reveal mild hypoxemia and respiratory alkalosis CXR shows normal or evidence of scattered interstitial infiltrates or atelectisis |
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progressive signs and symptoms of ARDS |
increased fluid accumulation tachypnea with intercostal retractions PFT shows decreased lung compliance and decreased lung volumes: not in acutely ill tachycardia diaphoresis cyanosis diffuse crackles and ronchi CXR shows diffuse and extensive bilateral interstitial and alveolar infiltrates low PO2 and respiratory acidosis |
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later progression signs and symptoms of ARDS |
profound respiratory distress requiring endotracheal intubation CXR shows whiteout, or white lung severe hypoxemia <65% hypercapnia (excessive carbon dioxide in the bloodstream, typically caused by inadequate respiration.respiratory acidosis) symptoms of multiple organ hypoxia multiple organ failure |
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medical Dx for ARDS |
CXR ABG's refractory hypoxemia pre-disposing condition for ARDS within 48 hours ECG shows no cardiac conditions |
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swan ganz |
pulmonary artery catheter measures pulmonary pressure |
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medical management of ARDS |
no cure treatment is supportive -maintenance of adequate oxygenation, CO, and nutritional support prevention of secondary complications -pneumonia -infections -ventilator induced lung injury |
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complications of ARDS |
hospital acquired pneumonia barotrauma: rupture of distended alveoli during mechanical ventilation-air can escape into pleural space physiologic stress ulcers renal failure |
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temporary mechanical ventialtion |
oral and nasal intubation |
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long term ventilation |
tracheostomy |
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goal of mechanical ventilation |
adequate controlled ventilation relief of hypoxia without hypercapnia relief of work of breathing access to airways |
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criteria to put on vent |
apnea or impending inability to breathe acute respiratory failure -pH <7.25 -pCO2 >50 severe hypoxia -pO2 <50 respiratory muscle fatigue |
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speed of ventilation on mechanical ventilator |
if alkalotic, slow the rate of breaths if acidotic, increase the rate of breaths |
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what is PEEP? |
positive end-expiratory pressure |
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what does PEEP do? |
keeps a fixed amount of pressure and hold lungs open at the end of a breath |
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higher levels of PEEP do what? |
maintain a healthy PaO2(>60 mmHg) reduce amount of O2 needed |
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indications for PEEP? |
pulmonary condition with widespread alveolar collapse ARDS pulmonary edema |
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how does PEEP help with ARDS? |
increases lung compliance keeps alveoli from collapsing decreases intrapulmonary shunting increases PO2 and allows lower FIO2 below 60% |
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what does PEEP do for pulmonary edema? |
allows decrease in FIO2 below 60% may increase extravascular lung water |
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low pressure alarms |
circuit leaks airway leaks chest tube leaks patient disconnection |
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high pressure alarms |
patient coughing secretions or mucus in the airway patient biting tube: may need sedation airway problems reduced lung compliance: ex. pneumothorax patient fighting the ventilator accumulation of water in the circuit kinking in the circuit |
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CPAP |
continuous positive airway pressure one level of air all the time for obstructive sleep apnea |
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BIPAP |
Bi level or Bi phasic positive airway pressure 2 sets of air pressure: one for inspiration, one for expiration for central sleep apnea |
