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47 Cards in this Set
- Front
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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.
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critical care nursing defined
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How is the critical care nursing role accomplished?
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1.Nursing process - ADPIE
2.Prioritization a.ABC’s b.Maslow’s Hierarchy c.Important vs. Non-Important and Urgent vs. Non-urgent |
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what is evidence based practice?
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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 |
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example of EBP regarding aspirin
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Aspirin – given to reduce risk of CAD
Ongoing assessment showed ulcers Now give 81 mg & teach s/s of bleeding |
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what is a bundle?
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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.
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what is the purpose of Joint Commission 2009 safety goals?
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use at least 2 patient identifiers when providing care, treatment & services.
also, label containers used for specimens in presence of patient. |
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What did the Safe Medical Device Act of 1990 provide?
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report of death to manufacturer or any problems with devices (pacemakers, knees). Ways for pts to be contacted if their device is defective.
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what do the Agency for Healthcare Research and Quality (AHRQ) and Institute of Healthcare Improvement (IHI) do?
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give recommendations for evidence based practice
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EBP Sacred Cow - suctioning
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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
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EBP Sacred Cow - NG Tube placement
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on insertion – air bolus, exam fluids, recommendation is chest x-ray. pH can be changed by meds (prevacid)
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EBP Sacred Cow - Blood pressures
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cuff size, arm at heart level
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EBP Sacred Cow - Lead placement
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5 leads instead of 3, Lead 2 for atrial problems (a fib, sick sinus problems), V1 for ventricular problems
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EBP Sacred Cow - mobility
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turn Q2 hrs, sit up when possible
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EBP Sacred Cow - neuro assessment
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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.
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what organization sends out practice alerts?
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AACCN
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What method shows promise for proper NG tube placement?
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Carbon dioxide detector
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Critically ill pts who are hemodynamically stable can be repositioned, have HOB elevated 30 degrees, dangle legs, stand, & walk or all the above
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all of these are possible with hemodynamically stable patient
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best practices for oral care in the critically ill include:
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Oral Care – brush teeth, gums tongue 2x/day, oral moisturizing Q2-4 hrs, chlorhexidine gluconate 2x/day perioperative period for pts undergoing cardiac surgery.
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best practices for central line care (Bundle)
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key components:
hand hygiene barrier precautions, chlorhexidine scrub, optimal site selection (subclavian preferred), daily review of line necessity. |
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best practice for sternal wound infection
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remove hair via clippers, prophylactic antibiotics, tight glycemic control, standardized wound care, convenient gels for hand hygiene, sign reminders, & peer pressure
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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
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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
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the only drug approved by the FDA for short term sedation in a critical care setting
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diprovan (propofol)
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how often must Diprovan be replaced?
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Q6 hrs due to lipid base
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EBP recommendation for daily Diprovan use
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sedation vacation to assess patient condition
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T/F-patient may require less Diprovan with combined use of opiod
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True
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T/F-Diprovan wears off in minutes
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True - short half-life
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T/F-IV sedation with Diprovan also provides pain relief to the client
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false - IV sedation from Diprovan only prevents a response to pain but does not provide pain relief.
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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
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most common pain meds used are opioid agonists
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morphine & fentanyl
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opioid agonist discouraged for use greater than 48 hours
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demerol
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opioid overdose triad
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Pinpoint pupils, respiration depression & coma
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drug that should always be available in case of opioid OD
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Narcan (naloxone)
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common side effects of opioids
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constipation (most common)
nausea/vomiting sedation respiratory depression pruritis |
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how would pain be assessed in cognitively impaired patients?
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Pain would be assessed by facial expressions, guarding, breathing, moaning, rigid or stiff, wincing, shutting eyes, clenching fists, BP elevated
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examples of parenteral routes for pain management
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continuous IV infusion
IV bolus PCA Epidural Intrathecal |
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what is the primary cause of inadequate pain mgmt in the ICU?
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lack of appropriate pain mgmt
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what are the increased patient responses to procedural pain?
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body movement, verbal & facial responses
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preemptive analgesia is defined as
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administration of analgesic agents before the pt experiences a noxious stimulus
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CNS sensitization caused by hyperexcitability can result in what?
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persistent pain
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continuously changing physiologic states with varying pt behaviors & responses result in what continuum?
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agitation
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abnormalities in VS common in agitated patients are (3)
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tachycardia, tachypnea, & hypertension
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ICU delirium can occur in what percentage of patients?
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80%
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why is it important to consider patient safety when monitoring and treating delirium?
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it is a risk factor for increased length of stay & 6-month mortality
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what are the 3 subtypes of delirium?
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hypoactive
hyperactive mixed |
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what medication is recommended by the SCCM guidelines for the tx of delirium?
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haloperidol
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which 3 meds can contribute to delirium?
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anticholinergics
sedatives analgesics |