Critical care Flashcards
Reason for admitted to ICU
Clinical judgements d/t Physiologically unstable
Risk for serious complications and need frequent assessments
Need advanced technology
Incidence of death is HIGHER in ICU
a) Certification in critical care nursing by the American Association of Critical Care nurse indicates that the nurse?
b) What are appropriate nursing interventions for the pt with delirium in the ICU?
a) has a practice in critical care and successfully completed a test of critical care knowledge.
b) use a clock and calendar to maintain orientation
sedate the pt with appropriate drugs to protect the pt from harmful behaviors
identify physical factors that may be contributing to the pt’s confusion and irritability
a) to establish hemodynamic monitoring for a pt, the nurse zeros the?
b) The hemodynamic changes the nurse expects to find after successful initiation if Intra aortic balloon pump therapy in a pt with cardiogenic choice include?
a) pressure monitoring system to the level of the atrium, or the photostatic axis
b dec SVR, PAWP myocardial O2 consumption and inc diastolic BP
Critical care
Stressors
Artificial lighting (Sensory Overload)
Loss of sensory input (Sensory deprivation)
Lack of meaningful stimulation
Loss of privacy
Pain
Noise
Communication
What strategies are using?
SBAR
S-situation
b-background
a-assessment
r-recommendation
CUS
c-I’m confused
u-I’m uncomfortable
s-This isn’t sage
Discuss in what way the concern is related to safety.
SBAR
details
“ICU Syndrome/Delirium”
Prevention Measures ?
Institute more liberal visiting policies
Minimize shift changes in the nursing staff caring for a patient
Coordinate lighting (day-night cycle)
Place clocks and calendars in patient view
Frequent reorientation and reassurance
Minimize excessive stimuli/noise
Limit interruptions in sleep and rest
Patients’ Recall About Critical Care
Lack of family
Feelings of dread
Discomfort
Difficulty sleeping
Loneliness
Thoughts of dying
Physical restraint
Difficult communication
Pain
Thirst
Difficult swallowing
Anxiety
Lack of control
Depression
Fear
Family Needs
Receiving assurance
Remaining near the patient
Receiving information
Being comfortable
Having support available
GABG
Pre-ope
revasculazation
consent
baseline assessment
administer prophylactic meds
teaching deep breathing, coughing,how to prevent complications
laying down=CO redce
GABG
Post-ope
hypotenstion result glaft collaps
hypertension result bleeding
chest tube drainage >150 mL/hr= hemorrhage
Monitor renal blood supply
ambulate first day of postop day
GABG
a) what artery is most used?
b) CABG is a cure or not?
c) what are needed for Q2?
a) internal mammmary
b) NOT cure. only prolongs life
c) turning, coughing, and deep breathing
CABG
Complications
Dysrhythmias
Impaired contractility (low CO)
Intra-operative MI
Pericardial tamponade
Respiratory insufficiency
Pain
Emboli; stroke
Cardiopulmonary bypass (CPB)
a) alters?
b) requires?
a) Alters normal hemodynamics
b) Heparinization
Hemodilution
Hypothermia
Heart transplant
post-care
Immunosuppression required
Heart denervated (loss of vagal stimulation)
HR approx. 100
Not responsive to certain medications
Pt may no longer feel chest pain
infection,rejection and sudden cardiac death
