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27 Cards in this Set
- Front
- Back
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Critical Care
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direct delivery of medical care for a critically ill or injured patient. To be considered critical an illness or injury must acutely impair one or more vital organ systems so that a patient's survival is jeopardized
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Level 1 Critical Care Units
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most comprehensive care available. usually in teaching hospitals. specialty physicians, nurses, and equipment continuously available. comprehensive support services
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Level 2 Critical Care Units
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Limited care for some specific patients (ex: cardiothoracic surgical patients). Must have transfer plan to Level 1 facilities for patients with specific disorders for which the unit does not provide care
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Level 3 Critical Care Units
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provide initial stabilization of critically ill patients. limited ability to provide comprehensive critical care. should have written policies for patient transfer if required.
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Technology Increases Errors
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- elminates need for human decision-making
- increases workload when it fails or is inadequate - nurses forget how to calculate drips - equipment is highly sophisticated, non-standard and demands precision for use |
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Technology can affect patient care
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- nurses may fail to touch patients
- best assessment occurs when nurses assess in addition to what technology provides - technology can predispose to errors in delivery of care - devices may fail and contribute to error (ex. extubation, failure of infusion devices) |
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QSEN: Quality and Safety Education for Nurses
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1. Patient centered care
2. teamwork and collaboration 3. evidence based practice 4. quality improvement 5. safety 6. informatics |
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Providers can enhance safe, effective care by:
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developing a multidisciplinary team approach, encouraging a culture of safety, instituting a closed unit, providing adequate staffing, limiting work hours
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Synergy MOdel
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critical care nurses should be defined more by the needs of patients and those of their families than by the environment in which care is delivered or the diagnosis of the patient. Patient/family needs + Nurse competencies = optimal patient outcomes
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Synergy MOdel of Critical Care Nurse Competencies
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- clinical inquiry
- clinical judgement - caring - advocacy - systems thinking -facilitator of learning - response to diversity - collaboration |
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Skilled Communication
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optimal patient care is not possible without skilled communication. TWO components: Appropriate CONTENT for the message, DELIVERY of content
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SBAR technique
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Situation- who you are calling about (pt. name, location); state specific problem, patient assessment, and specific concern
Background- patient's immediate history, physical findings, and treatments Assessment- what you think the problem is Recommendation- state or request desired course of action |
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Two Challenge Rule
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rule for disagreement for the proposed course of action.
- respectfully state concerns about the intervention twice; then seek help from supervisor - assertive communication- nurse should state disagreement and present concerns respectfully |
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Essential for Communication
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Logical, clear reporting of information and respectful presentation of opinion to disagreement enhances patient safety.
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Collaboration (link between teamwork and patient outcomes)
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Characteristics that influence collaboration:
- emotional maturity - understanding perspectives of others - team goal is patient well-being - negotiate respectfully - manage conflict wisely |
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Moral Distress
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distress suffered by nurses from being involved in patient situations that they perceive to be morally wrong
Rise above moral distress- Ask; Affirm; Assess; Act |
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Moral Distress impact on health care
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nurses leave ICU, nurses lose capacity to care for patients, nurses experience physiological and psychological problems
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Compassion Fatigue
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state of tension and preoccupation with the suffering of those being helped that is traumatizing for the helper
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Symptoms of Compassion Fatigue
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- difficulty separating work form personal life
- intrusive thoughts/ image of patient situations/trauma -lowered frustration tolerance- outbursts of anger - dread working with certain patients- depression - increase in ineffective and self-destructive behavior - hyper vigilance - decreased functioning in nonprofessional situations - loss of hope |
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Standards for Self-Care to establish and maintain wellness
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-make commitment to self-care
- develop strategies to let go of work - develop strategies for rest and relaxation - plan strategies for daily stress reduction |
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Strategies to Prevent Compassion Fatigue
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-enhance phsyical well-being
- enhance psychological well-being - enhance social/interpersonal well-being - enhance professional well-being |
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Stressors for Critically Ill Patients
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being thirsty
having tubes in mouth and nose being unable to communicate being restricted by tube/lines being unable to sleep being unable to control themselves |
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Pain assessment
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rate intensity on scale of 0-10
point to location of pain indicate where pain radiates describe pain indicate any associated symptoms- nausea, SOB, dizziness Head to toe and pain assessment done q 4 hours |
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Pain medication
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morphine
dilaudid fentanyl Given IV or PCA. NEed to reassess patient in 30 minutes |
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General pain med administration
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acute pain- administer analgesics IV for immediate onset of action ( IV morphine, IV Fentanyl)
subsequent doses may be given IV or orally on a regular schedule around the clock give additional boluses of pain meds and sedation prior to procedures post-op and post-traumatic pain should decrease over time daily interruption of analgesics and sedative infusions |
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General sedation administration
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sedation managed IV propofol (dirpovan) or IV lorazepam (ativan)
sedation vacation every day so physician can evaluate neurostatus |
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management of delirium
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treatment includes medication and environment and supportive strategies. Give IV haloperidol (haldol) or IV dexmedetomidine (Precedex)
Precedex does not impact respiratory status Propofol will repress respiratory status- usually put pt on ventilator |
