Chap. 65

Question 1

Critical Care Nursing

Answer 1

AACN defines CCN as a specialty that manages human responses to life-threatening problems.

Question 2

Critical Care RNs

Answer 2

Care for patients with acute and unstable physiologic problems and their caregivers.

Involves:
Assessing life threatening conditions
starting appropriate interventions
evaluating the outcomes of interventions
providing teaching and emotional support to caregivers

Question 3

Rapid Response Teams (RRT)

Answer 3

Bring rapid and immediate care to unstable patients in noncritical care settings.

Question 4

RRT Interventions

Answer 4

Patients often show early and subtle signs of deterioration (tachypnea, VS changes) 6-8 hours before cardiac or respiratory arrest.

RRT interventions have helped in reducing mortality rates in these patients.

Question 5

Critical Care Patients (CCP)

Answer 5

Care is acute in nature, requiring intense and vigilant nursing care
Patient is generally admitted to the ICU for 1-3 reasons.

Question 6

CCP admit reasons

Answer 6

1st. may be physiologically unstable - advanced clinical judgement

2nd. may be at risk for serious complications - needing frequent assessments, invasive interventions.

3rd. May need intensive and complicated nursing support related to use of IV meds (sedation, titration, thrombolytics) and advance technology

Question 7

Advanced Technology used in Critical Care

Answer 7

Hemodynamic monitoring
mechanical ventilation
continuous renal replacement therapy (CRRT)
ICP monitoring

Question 8

Mortality of ICU patients increased risk

Answer 8

Age of patient
Have co-morbidities (liver disease, obesity)
extended ICU stays

Question 9

ICU facts

Answer 9

ICU does not typically care for patients in a persistent, vegetative state or to prolong the natural process of life

ICU will manage patients who have brain death and meet criteria for donation after cardiac death

Patients not expected to recover are not usually admitted to an ICU

Question 10

Common Problems of CCPs

Answer 10

At risk for immobility, skin problems, and venous thromboembolism due to intubation/mechanical ventilation

Use of multiple invasive devices increases risk of healthcare associated infections

Sepsis and multiple organ dysfunction syndrome

Question 11

Anxiety in ICU patients

Answer 11

main sources include the perceived or expected threat to health or life, loss of control of body functions, and a foreign environment

Question 12

Pain in ICU patients

Answer 12

Pain control is very important -

unrelieved pain is common and can lead to poor outcomes

Inadequate pain control is linked with agitation, fear, and anxiety - adding to stress response

Question 13

Impaired communication in ICU patients

Answer 13

Inability to communicate is distressing for patients who can’t speak due to current situation.

Always explain what will happen or is happening to the patient

When patient is unable to speak, explore other methods of communication (pic boards, notepads, etc)

Question 14

Sleep in ICU patients

Answer 14

*nearly all ICU patients have sleep problems

Causes: noise, anxiety, pain, frequent monitoring, treatments, or care needs

Sleep problems can cause delirium, causing a delay in recovery

Question 15

Sensory - perceptual problems in ICU patients

Answer 15

Changes in mentation

Psychomotor behavior

sleep-wake cycle

ICU psychosis

Question 16

Changes in Mentation

Answer 16

delusions, short attention span, loss of recent memory

Question 17

Psychomotor behavior

Answer 17

restlessness, lethargy

Question 18

Sleep-Wake cycle

Answer 18

daytime sleepiness, nighttime agitation

Question 19

ICU psychosis (delirium)

Answer 19

the patient with these changes is not psychotic but has delirium

Delirium is an acute change in mental status

Prevalence of delirium in ICU patient is as high as 87%

associated with longer hospital stays and higher mortality rates

Question 20

Nutrition in ICU patients

Answer 20

Hypermetabolic states (burns, sepsis)
Catabolic states (acute kidney injury)
Malnourished states (chronic heart, lung, or liver disease)

inadequate nutrition increase mortality and morbidity rates

*Determining whom to feed, what to feed, when to feed, and how is crucial when caring for critically ill patients.

Question 21

Hemodynamic Monitoring

Answer 21

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

Used to assess heart functions, fluid balance, and effects of fluids and drugs on CO

Question 22

Hemodynamic parameters (values)

Answer 22

systemic and pulmonary arterial pressures

central venous pressure (CVP)

pulmonary artery wedge pressure (PAWP)

CO/CI

SV/SV index

When you combine values, you get a pic of patients hemodynamic status and the effect of therapy over time (trends)

Question 23

Hemodynamic Monitoring Accuracy

Answer 23

Attention to accuracy of measurements is import as inaccurate data can result in unnecessary or inappropriate treatment.

Question 24

Cardiac Output (CO)

Answer 24

Describes the amount of blood your heart pumps each minute in liters

Question 25

Central venous pressure

Answer 25

blood pressure in the venae cavae, near the right atrium of the heart

Reflects the amount of blood returning to the heart and the ability of the heart to pump the blood back into the arterial system

Question 26

Peripheral vascular resistance (systemic vascular resistance SVR)

Answer 26

The resistance in the circulatory system that is used to create blood pressure, the flow of blood and is also a component of cardiac function.

When vasoconstriction (vessels constrict) occurs this leads to an increase in SVR
When vasodilation (vessels dilate) occurs it leads to decreased SVR

Question 27

Cardiac index (CI)

Answer 27

the measurement of CO adjusted for body surface area (BSA) - a more precise measurement of the efficiency of the hearts pumping action.

Question 28

Stroke volume index (SVI)

Answer 28

the measurement of SV adjusted for BSA

Question 29

Preload

Answer 29

the volume within the ventricle at the end of diastole

Question 30

pulmonary artery wedge pressure (PAWP)

Answer 30

measurement of pulmonary capillary pressure, reflects left ventricular end diastolic pressure under normal conditions.

Question 31

Afterload

Answer 31

Forces opposing ventricular ejection

increased afterload often results in decreased CO and increased O2 demand

Vasodilator drug therapy can reduce afterload

Question 32

Contractility

Answer 32

is the strength of contraction

Increases when preload is unchanged and the heart contracts more forcefully

Positive inotropes increase contractility results in increased SV and increased myocardial O2 requirements

Negative inotropes reduce contractility

Question 33

Positive inotropes

Answer 33

Epinephrine, norepinephrine, isoproterenol (Isuprel), dopamine, dobutamine, digitalis-like drugs, calcium, and milrinone increase or improve contractility

Question 34

Negative inotropes

Answer 34

calcium channel blockers, β-adrenergic blockers and clinical conditions (e.g., acidosis)

Question 35

Vascular Resistance

Answer 35

SVR

PVR

*Both these measures reflect afterload as described earlier and can be adjusted for body size

Question 36

Systemic vascular resistance (SVR)

Answer 36

is the resistance of the systemic vascular bed

Question 37

pulmonary vascular resistance (PVR)

Answer 37

is the resistance of the pulmonary vascular bed

Question 38

Determining BP

Answer 38

CO and the forces opposing blood flow determine BP

Systemic vascular resistance (SVR) (opposition encountered by the left ventricle) or pulmonary vascular resistance (PVR) (opposition encountered by the right ventricle) is the resistance to blood flow by the vessels

Preload, afterload, and contractility determine SV, and thus CO