Tcu Abt Adult Ii Lecture 1/12/10

Front 1

Describe/Define Critical Care nursing.

Back 1

Specialty dealing with human responses to life-threatening problems.

Front 2

List at least 3 stressors that are associated with critical care areas.

Back 2

Loss of privacy
Artificial lighting
Noise
Lack/Abundance stimuli
Pain

Front 3

By 19__ ICU was a standard unit in most hospitals worldwide.

Back 3

1970

Front 4

What is an EICU?

Back 4

electronic monitoring of an ICU patient from a remote location.

Front 5

What does CI stand for?

Back 5

cardiac index

Front 6

CO

Back 6

Cardiac Output

Front 7

CVP

Back 7

Central Venous Pressure

Front 8

ETCO2

Back 8

End-Tidal Carbon Dioxide

Front 9

FIO2

Back 9

Fraction of inspired oxygen

Front 10

IABP

Back 10

Intraaortic Balloon Pump

Front 11

MAP

Back 11

Mean Arterial Pressure

Front 12

PA

Back 12

Pulmonary Artery

Front 13

PAS, PAD

Back 13

Pulmonary Artery Systolic(pressure)
Pulmonary Artery Diastolic (pressure)

Front 14

PAWP

Back 14

Pulmonary Artery Wedge Pressure

Front 15

PVR

Back 15

Pulmonary Vascular Resistance

Front 16

ScvO2

Back 16

Percent oxygen saturation of hemoglobin in venous blood
(eg: in the superior vena cava)

Front 17

Sp02

Back 17

Percent oxygen saturation of hemoglobin measure by pulse oximetry

Front 18

SvO2

Back 18

Percent oxygen saturation of hemoglobin in mixed venous blood.
(eg: in the pulmonary artery)

Front 19

SV, SVI

Back 19

Stroke Volume
Stroke Volume Index

Front 20

SVR, SVRI

Back 20

Systemic Vascular Resistance
Systemic Vascular Resistance Index

Front 21

VAD

Back 21

Ventricular Assist Device

Front 22

AACN

Back 22

American Association of Critical Care Nurses

Front 23

To be effective a critical care nurse must ______ and ______ effectively with other health team providers.

Back 23

communicate and collaberate

Front 24

There are 6 defined standards for a healthy work environment as defined by the AACN. What are they?

Back 24

1. skilled communication
2. true collaboration
3. effective decision making
4. appropriate staffing
5. meaningful recognition
6. authentic leadership

Front 25

What initials go behind a certified critical care nurse's name?

Back 25

CCRN

Front 26

What does CCNS specialization stand for?

Back 26

Critical Care Nurse Specialist
(Master or Doctorate degree; different than CCRN)

Front 27

What does ACNP specializtion stand for?

Back 27

Acute Care Nurse Practitioner

Front 28

There are 3 reasons a person is generally admitted to the ICU. What are they?

Back 28

1. physiologically unstable
2. risk for serious complications
3. require intensive and complicated nursing support r/t the use of IV polypharmacy and advanced biotechnology

Front 29

The patient who is NOT expected to recover is usually admitted to the ICU.
True or False

Back 29

False. Those expected to NOT recover are NOT admitted to ICU as a general rule.

Front 30

What does PCU stand for?

Back 30

Progressive Care Unit.
aka: high-dependency unit, intermediate care unit, stepdown unit

Front 31

True or False
Patients who can't speak must have someone else make medical decisions for them.

Back 31

False.
Always give the pt a chance to decide for themselves. There are other ways to communicate without talking.

Front 32

C_______ is essential to safe patient care.

Back 32

Communication

Front 33

Communication breakdowns are most risky at what point in patient care?

Back 33

Handoff situations
Change of Shift
Going for Procedures
Moving to a different Floor

Front 34

Name the best way to elimate communication breakdowns at change of shift.

Back 34

Bedside reporting.
Allows for patient to be seen by both parties and assessments to be done together and compared.

Front 35

What does SBAR stand for?

Back 35

S - situation
B - background
A - assessment
R - recommendation

Front 36

What does CUS stand for?

Back 36

C - Concerned
U - Uncomfortable
S - this isn't Safe

Front 37

____ hours are required for full REM.

Back 37

Two

Front 38

List some common problems related to Critical Care Patients.
(7 listed in book)

Back 38

Immobility
Nutrition
Anxiety
Pain
Impaired Communication
Sleep
Sensory Perception problems

Front 39

How is enteral nutrition delivered?

Back 39

Via the GI tract

Front 40

How is parenteral nutrition delivered?

Back 40

Intravenously

Front 41

__________ is associated with fewer complications and less expensive.
enteral or parenteral

Back 41

enteral

Front 42

Critical care patients need to feel safe. What are some nursing interventions that will accomplish this? (5)

Back 42

1. technical competence
2. vigilant response - do what you say when you said you would
3. family at bedside
4. be informative
5. orient patient/family

Front 43

What are some clinical indicators of anxiety that may manifest themselves in your patient?

Back 43

agitation
increased blood pressure
increased heart rate
restlessness
verbalization of anxiety

Front 44

What is a drawback to sedating a critically ill patient?

Back 44

inability to assess patient's neurological status

Front 45

What is a "sedation vacation" or a "drug holiday"?

Back 45

a scheduled interruption of sedation in order to assess nuerological status

Front 46

Identify some ways to communicate other than verbal.

Back 46

Picture boards, computer keyboards, notepads, eye-blinking, magic slates,etc

Front 47

What are the 3 parts of ICU psychosis?

Back 47

1. alterations in mentation -
delusions, memory loss
2. psychomotor behavior -
restlessness/lethargy
3. sleep-wake cycle
day sleep/nigh agitation

Front 48

What age group is considered the "core business" of health care institutions?

Back 48

Odler adults

Front 49

Describe 3 ways a family can contribute to an ICU patients well being.

Back 49

1. provide a link to pt's personal life
2. advising the pt in health care decisions of function in that role
3. provide positive, caring support

Front 50

Define Hemodynamic Monitoring.

Back 50

The measurement of pressure, flow and oxygenation within the cardiovascular system.

Front 51

The volume of blood pumped in one minute is known as __________.

Back 51

Cardiac Output

Front 52

When CO is adjusted with regards to a patients height and weight, this is known as __________.

Back 52

Cardiac Index

Front 53

Problems in the ICU should be _____ centered.

Back 53

Patient
Your problem might be FVE but the patient's problem is constipation.

Front 54

Critical Illness/Injury affects the whole family. What are some areas that are most affected?

Back 54

Financial
Spiritual
Emotional
Physical - physically exhausting to travel to/from

Front 55

The first intensive care units were _____ rooms.

Back 55

Recovery

Front 56

When in a person's life are the most healthcare dollars spent?

Back 56

End of life.
The neonate; The 102 y.o. male.

Front 57

Why are "bundles of care" important?

Back 57

They promote EBP and prevent complications. It is a protocol of how to do something. If everyone is doing it the same, then source of breakdown/failure easy to identify/eliminate.

Front 58

Certification in critical care nursing by the American Association of Critical Care nurses indicates that a nurse
a. is an advanced practice nurse in the care of acutely ill patients
b. may practice independently to provide symptom management for the critically ill
c. has earned a master's degree in the field of providing advanced critical care nursing
d. has practiced in critical care and successfully completed a test of critical care knowledge.

Back 58

D

Front 59

An appropriate intervention for the patient with delirium in the ICU is to
A. use tranquilizers to establish normal sleeping patterns
B. identify the factors contributing to the patient's confusion and irritability
C. silence all alarms, overhead pagin, and conversations around the patient
D. sedate teh patient with psychotropic drugs to protect teh patient from harmful behaviors

Back 59

B

Front 60

The critical care nurse recognizes that an ideal plan for family involvement includes
a. a family member at the bedside at all times
B. allowing family at teh beside at preset, brief intervals
C. an individually devised plan with the family involved in care and comfort measures
D. restriction of visiting in the ICU because the environment is overwhelming

Back 60

C

Front 61

_____ is a result of tissue injury and ____ has only psychogenic aspects.
Anxiety, Pain, Distress

Back 61

Pain
Anxiety

Front 62

What is the number one anxiety reported by patients in critical care settings?

Back 62

Anxiety

Front 63

List the postive effects of pain/anxiety.

Back 63

Increased performance levels
Removal from harm
Fight or flight response
No pain, No gain

Front 64

Should older critical care patients be on PRN pain medications? Why/Why not?

Back 64

No - scheduled administration
susceptivle to abuse
more time to respond
resistant to new drugs

Front 65

Chronic pain is pain lasting longer than __ months.

Back 65

3 - three

Front 66

PQRST is a type of pain assessment acronym. What does it stand for?

Back 66

P - provocation or position
Q - quality
R - radiation
S - severity or associated symptoms
T - timing or triggers

Front 67

When using the Wong Face scale assessment tool, which group(s) would be least accurate.

Back 67

Men and some cultures who restrict outward emotion.
(Think of the crying faces - Men don't cry)

Front 68

BPS stands for what?

Back 68

Behavioral Pain Scale

Front 69

What does FLACC stand for?

Back 69

F - face
L - legs
A - arms
C - cry
C - consolability

Front 70

How is anxiety usually treated in ICU?

Back 70

sedation

Front 71

Ramsey and Sedation Agitation are examples of what?

Back 71

Sedation

Front 72

What is BIS and what does it measure

Back 72

measures the hypnotic level of the patient

Front 73

What is the best way to know your patient is sedated?

Back 73

assessment/look at them

Front 74

What is a NMBA?

Back 74

Neuromuscular Blockate

Front 75

List 2 reasons for using NMBA.

Back 75

1. increased ICP
2. when any energy expenditure is too much

Front 76

NMBA does not have ____ or ____ properties.

Back 76

sedative or analgesic

Front 77

True or False
A person who is breathing on their own is paralyzed.

Back 77

False!

Front 78

What is a Triple Cocktail made of?

Back 78

analgesic, paralytic, and sedative

Front 79

What is TOF?

Back 79

Train of Four

Front 80

What nerves are assessed in TOF?

Back 80

ulnar or facial

Front 81

If you had MD orders that read, "titrate to keep TOF 2 or less", what does that mean?

Back 81

It means that the thumb/eye will twitch 2 times or less when the ulnar/facial nerves are electrically stimulated

Front 82

What are the 3 most common drips in ICU?

Back 82

Nimbex, Versed, and Morphine

Front 83

Can you do a neuro assessment on a paralyzed patient?

Back 83

No - you can only assess the eyes.

Front 84

Give at least 3 examples of nonpharmacological management of pain/anxiety in the ICU.

Back 84

1. enviromental manipulation - lights, bedding, etc
2. Guided imagery - directed daydreaming
3. Music Therapy - best is 60 -80 bpm

Front 85

2 concerns in pain management with meds are:

Back 85

respiratory depression and hypotension

Front 86

What are 2 risks associated with NSAIDS being used as adjuvent therapy in pain management?

Back 86

risk of bleeding
renal insufficiency

Front 87

Which is strong and by how much?
Fentanyl or Morphine

Back 87

Fentanyl by 10x's

Front 88

Fentanyl is classified as a ____.

Back 88

anesthetic

Front 89

What are 3 benefits of opioid use in ICU?

Back 89

1. rapid onset
2. easy to titrate
3. cheap
4. lack of accumulation(short 1/2 life)

Front 90

List 3 common meds that are given for anxiety.

Back 90

Versed, Valium and Ativan

Front 91

Propofol(Diprivan) can be hung for ___ hours.

Back 91

12

Front 92

Before administering propofil what must the nurse do? Why?

Back 92

Check the triglycerides. The med is attached to fat and can cause severe metabolic acidosis when overdosed.

Front 93

What can you expect in regards to Benzos and elder patients?

Back 93

Slower elimination - slower to be able to assess.

Front 94

Why would a NSAID be given in ICU?

Back 94

decrease the need of opioid or as adjuvant therapy