Chap. 65 Flashcards
Critical Care Nursing
AACN defines CCN as a specialty that manages human responses to life-threatening problems.
Critical Care RNs
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
Rapid Response Teams (RRT)
Bring rapid and immediate care to unstable patients in noncritical care settings.
RRT Interventions
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.
Critical Care Patients (CCP)
Care is acute in nature, requiring intense and vigilant nursing care
Patient is generally admitted to the ICU for 1-3 reasons.
CCP admit reasons
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
Advanced Technology used in Critical Care
Hemodynamic monitoring
mechanical ventilation
continuous renal replacement therapy (CRRT)
ICP monitoring
Mortality of ICU patients increased risk
Age of patient
Have co-morbidities (liver disease, obesity)
extended ICU stays
ICU facts
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
Common Problems of CCPs
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
Anxiety in ICU patients
main sources include the perceived or expected threat to health or life, loss of control of body functions, and a foreign environment
Pain in ICU patients
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
Impaired communication in ICU patients
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)
Sleep in ICU patients
*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
Sensory - perceptual problems in ICU patients
Changes in mentation
Psychomotor behavior
sleep-wake cycle
ICU psychosis
Changes in Mentation
delusions, short attention span, loss of recent memory
Psychomotor behavior
restlessness, lethargy
Sleep-Wake cycle
daytime sleepiness, nighttime agitation
ICU psychosis (delirium)
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
Nutrition in ICU patients
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.
Hemodynamic Monitoring
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
Hemodynamic parameters (values)
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)
Hemodynamic Monitoring Accuracy
Attention to accuracy of measurements is import as inaccurate data can result in unnecessary or inappropriate treatment.
Cardiac Output (CO)
Describes the amount of blood your heart pumps each minute in liters
