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NRSG 301 > Code Management > Flashcards

Code Management Flashcards

1
Q

Why are hospital color codes used?

A
  • notify staff of various emergency situations
  • convey essential info quickly with minimum misunderstandings
  • minimize stress/ prevent panic among pts/ visitors
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2
Q

are the code colours used in hospitals the same around the world?

A

yes

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3
Q

What does code pink mean?

A

pediatric emergency

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4
Q

what does code blue mean?

A

cardiac arrest

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5
Q

what does code yellow mean?

A

missing resident/ patient

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6
Q

what does code amber mean?

A

miss/ abducted child/ infant

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7
Q

what does code white mean?

A

aggression/ violence

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8
Q

what does code red mean?

A

fire

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9
Q

what does code grey mean?

A

system failure

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10
Q

what does code green mean?

A

evacuation

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11
Q

what does code brown mean?

A

hazardous spills

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12
Q

what does code black mean?

A

bomb threat

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13
Q

what does code orange mean?

A

mass casualty/ disaster

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14
Q

what does code purple mean?

A
  • over capacity
  • no longer used
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15
Q

What does code silver mean?

A
  • new code
  • active attacker
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16
Q

what does active attacker mean?

A

1 or more people actively engaged in seriously harming, killing, or attempting to kill people in populated area using weapon

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17
Q

what does code silver refer to?

A

mass-harm incident where the goal of perpetrator(s) is to cause as many casualties as possible

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18
Q

what does code silver outline?

A
  • run
  • hide
  • fight
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19
Q

What does CPR stand for?

A

cardio-pulomanry resuscitation

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20
Q

how many compressions should you perform per minute of CPR?

A

100-120

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21
Q

what is the depth you need to compress to for CPR for adults and children/ infants?

A

adults - 2 inches

children - 1/3 of the diameter of the chest

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22
Q

do you allow full recoil after each compression ?

A

yes

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23
Q

How many breaths do you give after 30 compressions?

A

2

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24
Q

if there is an advanced airway in place how many breaths should you give over much time?

A

1 breath every 6 seconds (10 breaths/ min)

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25
Q

define code blue

A

emergency situation > pt in cardio-pulmonary arrest, requiring code team to rush to specific location/ begin immediate resuscitative efforts

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26
Q

When do you call a code blue?

A
  • pt has a respiratory or cardiac arrest
  • assessment deems necessary (warning signs)
  • when directed to do so
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27
Q

true or false

ideally we want to call a CODE prior to our patients experiencing a full respiratory or cardiac arrest?

A

true

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28
Q

What is the purpose of the 5 rights of clinical reasoning?

A

ability to collect right cues/ take right action for right patient at right time for right reason

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29
Q

what are the 5 rights of clinical reasoning?

A
  • right cues
  • right patient
  • right time
  • right action
  • right reason
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30
Q

in regards to the 5 rights of clinical reasoning, describe the right cues

A
  • physiological/ psychosocial changes
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31
Q

in regards to the 5 rights of clinical reasoning, describe the right patient

A

risk of critical illness/ serious adverse events

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32
Q

in regards to the 5 rights of clinical reasoning, describe the right action

A
  • understanding the priority/ who should perform action
  • policy/ procedure involved
  • who should be notified and when
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33
Q

define failure to rescue

A

inability of clinicians to save pt’s life by timely diagnosis/ treatment when complication develops

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34
Q

research has shown that patients display S&S of impending arrest as early as what?

A

72hrs prior to arrest

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35
Q

when does failure to rescue occur?

A

when health care providers don’t recognize S&S/ fail to take appropriate action to stabilize pt

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36
Q

what is a major cause of mortality in acute care settings?

A

failure to rescue

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37
Q

what are 4 activities to prevent failure to rescue (FTR)?

A
  • surveillance/ assessment
  • timely identification of complications
  • taking action
  • activating a team response
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38
Q

in regards to the 4 activities to prevent failure to rescue, describe surveillance/ assessment

A
  • be ablate identify progression/ trends of assessment changes as benign or pathological
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39
Q

in regards to the 4 activities to prevent failure to rescue, describe timely identification of complications

A

be vigilant to detect trends in assessment changes that can signify critical even

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40
Q

in regards to the 4 activities to prevent failure to rescue, describe taking action

A

take action regarding assessment findings

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41
Q

in regards to the 4 activities to prevent failure to rescue, describe activating a team response

A

need to notify physician/ team appropriately and in timely manner

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42
Q

out of the 4 activities to prevent failure to rescue, which is the most important?

A

surveillance/ assessment

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43
Q

in regards to the neurological bell curve, what are the things you need to watch for from lowest to highest risk

A
  • restless
  • anxious
  • irritable
  • agitated
  • confused
  • combative
  • lethargic
  • inresponsive
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44
Q

in regards to the respiratory bell curve, what are the things you need to watch for from lowest to highest risk

A

respirations/ min in the following order:

  • 20
  • 24
  • 30
  • increasing 40s
  • 4-10
  • apnea
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45
Q

in regards to the cardiac bell curve, what are the things you need to watch for from lowest to highest risk

A
  • > 100bpm
  • PVC
  • shapes
  • couplets
  • patterns
  • runs V tach
  • V tach
  • V fib
  • asystole
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46
Q

if these 3 electrolytes go high or low together they could indicate a potential cardiac arrest. What are they?

A
  • potassium
  • sodium
  • calcium
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47
Q

What are the major causes of instability?

A

compensation for:
- hypoxia
- hypo-perfusion

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48
Q

what systems could cue you to a pathological change?

A
  • neuro
  • respiratory
  • cardiac
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49
Q

what are an exceptionally accurate and timely predictor of clinical instability or impending adverse outcome?

A

ventricles

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50
Q

the cardiac system requires 4 main elements that maintain stability and function efficiently. What are they?

A
  • oxygenation
  • perfusion
  • electrolytes
  • acid/ base imbalance
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51
Q

What are the stages of hypoxia?

A
  • early
  • intermediate
  • late
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52
Q

describe the early stage of hypoxia

A
  • restlessness
  • change in metal status
  • anxiety
  • headache
  • fatigue
  • tachycardia
  • dysthymia
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53
Q

describe the intermediate stage of hypoxia

A
  • increased confusion
  • agitation
  • increased oxygen requirements
  • decreased oxygen saturation
  • lethargy
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54
Q

describe the late stage of hypoxia

A
  • cyanosis
  • diaphoresis
  • unresponsive
  • respiratory arrest
55
Q

what are different things you can do to manage acute respiratory failure?

A
  • provide supplemental oxygen
  • improve ventilation/ promote adequate gas exchange
  • give medication
56
Q

in regards to the different things you can do to manage acute respiratory failure, describe improving ventilation

A
  • put pt on positive end-expiratory pressure (BiPaP)
  • endotracheal intubation
57
Q

how much oxygen can be administered in L/min and what % can be delivered through nasal prongs?

A
  • can administer 1-6L/min
  • deliver 24-44% oxygen
58
Q

how much oxygen can be administered in L/min and what % can be delivered through a simple mask?

A
  • can administer 6-10L/min
  • deliver 35-55% oxygen
59
Q

how much oxygen can be administered in L/min and what % can be delivered through a non-rebreathing mask?

A
  • can administer 10-15L/min
  • deliver 60-80% oxygen
60
Q

in regards to the different things you can do to manage acute respiratory failure, what medications would you give?

A
  • bronchodilators
  • steroids
  • analgesics
  • sedatives
  • antibiotics
61
Q

when someone goes into cardiac arrest how do you determine cardiac instability ?

A

change in heart rhythm plus one of the following:
- hypotension
- dizziness
- chest pain
- shortness of breath
- new or worsening heart failure

62
Q

What can cause an arrhythmia?

A
  • MI
  • fluid/ electrolyte imbalance
  • drug/ medication induced
  • genetics
  • diseases
63
Q

what is an arrhythmia?

A

irregular heart rhythm > can be life threatening

64
Q

What is pulseless electrical activity (PEA)?

A
  • there is an ECG rhythm but heart not pumping
65
Q

how do you know if someone is experiencing a PEA?

A

ECG monitor shows rhythm, but there is NO PULSE on palpation

66
Q

what can cause a PEA?

A

reversible cause

67
Q

What are S&S of arrhythmias?

A
  • palpations
  • anxiety
  • lethargy
  • fatigue
  • weak pulse
  • diaphoresis
  • cyanosis
  • chest discomfort
  • nausea
  • dizziness
  • lightheadedness
  • SOB
  • unresponsiveness
68
Q

How do you diagnose if someone has an arrhythmia?

A
  • ECG
  • troponin
69
Q

what are the treatments for an arrhythmia?

A
  • pacemaker
  • ICD
  • rhythm control medication
  • shock
  • cardio version
70
Q

What does CCOT stand for?

A

rapid response team

71
Q

who can activate the CCOT team if there are concerns that their client is deteriorating?

A

primary nurse

72
Q

What are early warning signs of a PRE-CODE?

A
  • RR
  • systolic BP
  • HR
  • change in LOC
  • SpO2
  • urine output
  • skin
  • bleeding
  • seizures
  • chest pain
  • failure to respond to treatment
  • signs of sepsis
73
Q

in regards to the early warning signs of PRE-CODE, describe RR

A

> 25 or < 8 breaths/ min or increased WOB

74
Q

in regards to the early warning signs of PRE-CODE, describe systolic BP

A

< 90mmHg or drop of more than 30mmHg

75
Q

in regards to the early warning signs of PRE-CODE, describe HR

A

> 120 or < 50 bpm

76
Q

in regards to the early warning signs of PRE-CODE, describe change in LOC

A

GCS < 10

77
Q

in regards to the early warning signs of PRE-CODE, describe oxygen saturation

A

< 90% c supplemental O2 > 50%

78
Q

in regards to the early warning signs of PRE-CODE, describe urine output

A

< 80mL over the last 4 hours

79
Q

in regards to the early warning signs of PRE-CODE, describe skin

A
  • pale
  • diaphoretic
  • mottling on trunk of body
80
Q

in regards to the early warning signs of PRE-CODE, describe significant bleeding

A

unexpected significant bleeding

81
Q

in regards to the early warning signs of PRE-CODE, describe seizures

A

new, repeated or prolonged seizures

82
Q

in regards to the early warning signs of PRE-CODE, describe chest pain

A

unrelieved by nitro spray ordered

83
Q

in regards to the early warning signs of PRE-CODE, describe failure to respond to treatment

A

not responding to acute problem/ symptom

84
Q

When would you call MRP/ CCOT/ RRT instead of code blue?

A
  • client still responsive but sudden deterioration in patient status
  • respiratory distress
  • oxygen sat, BP, HR, dropping or bellow normal
85
Q

when would you call a code blue instead of MRP/ CCOT/ RRT?

A
  • client unresponsive
  • no respiration
  • no pulse
86
Q

during the process before calling a code blue, what valuable information do you need to know first?

A
  • perform assessment/ know whats going on c pt
  • know pts code status
  • use SBAR to communicate situation to MRP
87
Q

during the process before calling a code blue, would you notify the MRP?

A

yes, if pt condition and time allows

88
Q

during the process before calling a code blue, would you notify the CCOT?

A

yes, if appropariate

89
Q

during the process before calling a code blue, if the client deteriorates before/ during interventions what do you do?

A

call code blue

90
Q

What can be found in the ward emergency cart?

A
  • back board
  • bag valve mask with bag
  • oral airways
  • intubation supplies
  • suction supplies
  • IV solution/ tubing
  • check lists
  • resuscitation records
  • orange cone
  • code charing
91
Q

how often should the emergency ward cart be checked/ ensure all supplies is in it?

A

weekly

92
Q

who should be familiar with the contents/ equipment of the emergency ward cart?

A

all RNs

93
Q

when do you cancel a code blue ?

A

cannot cancel code button until all members of code team arrive

94
Q

What is the role/ responsibility of ward nurse 1?

A

responsible for patient including:
- assessment
- call for help
- initiate CPR

95
Q

What is the role/ responsibility of ward nurse 2?

A

role is to assist by
- calling code
- bring emergency equipment to scene
- assist with CPR

96
Q

What is the role/ responsibility of ward nurse 3?

A

responsible for environment including:
- bring pt chart to bedside
- start IV
- remove headboard

97
Q

who is in a code team?

A
  • team lead > ICU/ ER physicians
  • critical care RN
  • primary/ unit RN
  • respiratory therapist
  • other RN’s/ LPN’s
  • social worker
  • PCC or charge nurse
98
Q

what in the role of a team (ICU/ ER physician) during a code?

A

led and direct the code

99
Q

what in the role of a critical care RN during a code?

A
  • attach/ interpret monitor
  • defibrillate/ initiate IV
  • administer medications
  • documentation on cardiac arrest record
100
Q

what in the role of a primary/ unit RN during a code?

A
  • provide pt info to code team
  • notify MRP/ airway if no RT
  • document on pt progress notes
101
Q

what in the role of a respiratory therapist during a code?

A
  • airway/ ventilation
102
Q

what in the role of other RN’s/ LPNs during a code?

A

perform cardiac compressions

103
Q

what in the role of a social worker during a code?

A

provide support to family members

104
Q

what in the role of the PCC or charge nurse during a code?

A

coordinate possible transfer to ICU/ communication

105
Q

What is the role of the ward 1 nurse during a code?

A

remain on scene and document

106
Q

What is the role of the ward 2 nurse during a code?

A

remain on scene and run errands

107
Q

what is the role of the ward 3 nurse during a code?

A
  • direct traffic
  • resume ward duties
  • care for nurse 1 and 2’s patients
108
Q

what is included in a primary survey during a code?

A
  • rapid assessment of pt/ environment
  • ABCD’s
109
Q

in regard to a primary survey during a code, describe the D in ABCD’s.

A

A = alert
V = respond to verbal stimuli
P = responds to painful stimuli
U = unresponsive

110
Q

every minute without CPR and defibrillation reduces survival rates up to what?

A

10%

111
Q

survival rate is highest if someone is defibrillated within what?

A

3 minutes of collapse

112
Q

during cardiopulmonary resuscitation it is important to search for reversible causes of the arrest and then treat the possible causes. What are the 5 H’s?

A
  • hypovolemia
  • hypoxia
  • hydrogen ions (acidosis)
  • hypokalemia/ hyperkalemia
  • hypothermia
113
Q

during cardiopulmonary resuscitation it is important to search for reversible causes of the arrest and then treat the possible causes. What are the 5 T’s?

A
  • tension pneumothorax
  • cardiac tamponade
  • toxins
  • pulmonary thrombosis
  • coronary thrombosis
114
Q

during CPR what other things do you need to rely on besides an ECG?

A
  • patient and their pulse
115
Q

during a code, what are the on-going ABC assessment and reassessment things you are completing?

A
  • monitor VS and pulse
  • recognize oxygen desaturation
  • position pt that promotes best ventilation for them
  • have emergency respiratory equipment accessible
116
Q

the post-resuscitation period is the time between what?

A

between return of spontaneous circulation and the transfer to intensive care

117
Q

during post-resuscitation care the emphasis if this care period is to what?

A
  • maintain optimal tissue oxygenation and perfusion
  • identify cause of arrest/ initiate treatment
118
Q

after a code is done what is the role of the ward nurse 1?

A
  • complete charting
  • ensure family notified
  • transfer pt
119
Q

after a code is done what is the role of the ward nurse 2?

A

assist nurse 1

120
Q

after a code is done what is the role of the ward nurse 3?

A

continue to care for nurse 1 and 2’s patients

121
Q

what makes a resuscitation team function well?

A
  • identifiable leadership
  • clear communication of roles
122
Q

what is a primary cause of inadvertent patient harm in the hospital?

A

communication failure

123
Q

what are areas that could be improved in a resuscitation team?

A
  • decreasing # of people attending code with no specific role
  • increasing access to most code blue training
  • debriefing after crisis
124
Q

what are elements of an effective resuscitation team dynamic?

A
  • effective communication
  • clear message
  • clear roles/ responsibilities
  • know one’s limitations
  • share knowledge
  • constructive intervention
  • re-evaluate/ summarize
  • mutual respect
125
Q

in regards to elements of an effective resuscitation team dynamic, describe effective communication

A

acknowledging the message was heard and give clear response back

126
Q

in regards to elements of an effective resuscitation team dynamic, describe clear message

A

clear distinctive speech in a calm direct manner with confirmation repeated back

127
Q

in regards to elements of an effective resuscitation team dynamic, describe share knowledge

A

communicate changes in the patient’s condition

128
Q

in regards to elements of an effective resuscitation team dynamic, describe constructive intervention

A

intervene if action is contraindicated

129
Q

families can be present during resuscitation. What can this provide to them?

A
  • helpful/ comforting
  • helps family comprehend seriousness of pt’s condition
  • may ease grieving
130
Q

how can you support a family during a code?

A
  • ask if they want to stay or leave
  • provide them with a support person before, during and after
  • follow up with family/ give them opportunity to share experience
  • follow policies/ procedures in place
131
Q

what else are you going to do when you start CPR?

A
  • give oxygen
  • attach defibrillator/ AED
132
Q

after you start CPR, you check and find that your patient does not have a shockable Rhythm, what are you going to do? What are they in?

A
  • asystole/ PEA
  • administer epinephrine Q3-5 mins and continue CPR for 2 more minutes
  • consider advanced airway
  • assess for shockable rhythm
  • continue CPR/ shock
133
Q

after you start CPR, you check and find that your patient has a shockable Rhythm, what are you going to do? What are they in?

A
  • VF/pVT
  • shock
  • CPR 2 mins
  • ensure IV access
  • if rhythm is shockable administer epinephrine Q3-5 minutes
  • consider advanced airway
  • continue shock/ CPR
134
Q

what are the different types of lethal rhythms?

A
  • 3rd degree atrial ventricular (AV) block
  • ventricular tachycardia
  • ventricular fibrillation

NRSG 301 (5 decks)

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