Foundations

Question 1

Standards of Care

Answer 1

ADPIE

Question 2

Truth

Answer 2

Veracity

Question 3

Fairness

Answer 3

Justice

Question 4

Self-Determination

Answer 4

Autonomy

Question 5

To do Good

Answer 5

Beneficence

Question 6

To prevent Harm

Answer 6

Non-malifiecence

Question 7

Hold faithful or Confidential

Answer 7

Fidelity

Question 8

Elements of professional negligence

Answer 8

Duty
Breath of Duty
Causation
Injury

Question 9

Living Will

Answer 9

Specific requests made by competent clients regarding medical care

Question 10

DPOA

Answer 10

most protective of clients’ interests

Question 11

10 times more potent than Morphine
Used for hemodynamically unstable (low BP, bradycardia)
SA analgesic, stronger than Morphine

Answer 11

Fentanyl

Question 12

Respiratory Depression
Hypotension
Antidote = Narcan

Answer 12

Morphine

Question 13

Change tubing q12h

Milky appearance

Answer 13

Diprivan / Propofol

Question 14

Given for ICU delirium
Elderly
Acute confusion Psychosis

Need to measure QT interval - can prolong it

Answer 14

Haldol / Haloperidol

Question 15

Depolarizing Muscle Relaxant

Answer 15

Succinylcholine

Question 16

Malignant Hyperthermia

Answer 16

genetic HX problem, occurs by gases and succinylcholine
can occur during induction, during or 72 hours after surgery

Emergent situation: Tachycardia, increase CO2, muscle rigidity in jaw (early), hyperthermia with temp of 106 (late)

Treatment: Dantrolene - slows action of muscle rigidity
Cool patient, treat hyperkalemia

Question 17

Short term sedation
Do not use if head trauma can cause HTN
Antidote = Remazicon

Answer 17

Versed / Midazolam

Question 18

Client not able to verbalize pain

Answer 18

Neuromuscular blockage agents (Pavulon)

Question 19

Improve oxygenation

Answer 19

Give blood / blood products

Question 20

Nutrition for the intubated client

Answer 20

Enteral feeding through dobhoff

Question 21

Pre-Operative

Answer 21

Assessment: baseline values
NPO
Pre-Meds: atropine or scopaline (dry them up)
GI Meds: pepcid, zantac, nexium (due to increased metabolic rates)
Teaching DONE HERE! - explain what will happen before, during, after

Question 22

Intra-Operative

Answer 22

General inhalation anesthetics
IV sedations: barbiturates, narcs, tranquilz (morphine, versed)
Locals: BIER blocks - close reduction (lidocaine)
Manage anesthesia care (MAC)
Muscle Relaxants: depolarizing (succinylchoine) & non-depolarizing (pancuronium)

Question 23

Post-Operative

Answer 23

Transfer to floor - always assess!
Report: name age, DX, allergies, HX, old vitals, obtain new vitals, incision/dressing, fluids, IV’s, I&O
Their meds and last pain meds given
Equipment, orders, family, belongings

Receiving Department: assessment and orders with plan of care

Question 24

PAR (Aldrete) Score

Answer 24

score patient at admission, 15 min, 15 min, 30 min
Needs to score 8 for discharge

Activity: able to move, voluntarily or on command
Respiration: able to breath deep and cough freely, dyspnea, apnea
Circulation: BP within 20 mmHG of preoperative
Oxygen Saturation: sats >92%, sats

Question 25

PACU

Answer 25

focused assessment ABC's Specific assessments for surgery Pain, safety, incisions, equipment Aldrete (PAR) score

Question 26

Stressors for Staff

Answer 26

``` Technology High Acuity Patients Dying Patients Families in crisis Overtime Mandatory call time ```

Question 27

Stressors for Clients

Answer 27

``` Presence of invasive lines loss of control (powerless) sleep deprivation alterations in circadian rhythms sensory deprivation sensory overload ```

Question 28

ICU Psychosis

Answer 28

(occurs 48 hours after admission in ICU & resolves 2 days after leaving ICU) ``` perceptual distortions - paranoia decreased attention span disorientation memory loss labil emotions ``` *have family stay to reorient patient* Give HALDOL When entering room: say name, date, time, location, why here to reorient

Question 29

Response to Acute Illness or Injury

Answer 29

``` culture Developmental stage general health social support personality type (A or B) Financial resources Previous experiences ```

Question 30

Alterations in Consciousness

Answer 30

alterations in circadian rhythm sleep pattern disturbances medications / intoxicants (can affect patients minds) age over 60 years

Question 31

Nutrition

Answer 31

Assessment of Needs: LOC, trauma, N/V, fatigue pre-illness status enteral vs parenteral routes (increases BS) Hasn't eaten for 3 days - need dobhoff! Pre-albumin: acute conditions (15-32 g/dL) serum-albumin: chronic conditions (protein / nutrients) [3.5 - 5 g/dL]

Question 32

Correct Hypoxia

Answer 32

administer O2 monitor sats intubate if needed

Question 33

Improve Cardiac Output

Answer 33

optimize preload (volume in) and contractility Administer anti-dysrhythmic drugs Give IV fluids give interpose (increase squeeze, contractions) Diuretics and Vasodilators Correct fluids and electrolytes

Question 34

Improve O2 Carrying Capacity

Answer 34

give blood or blood products (hemoglobin checks nutrient status

Question 35

Decrease Metabolic Demands

Answer 35

``` relieve pain and anxiety keep client warm and dry control fever allow clients to rest suction PRN ```

Question 36

O2 Demands

Answer 36

sedate or use NMB drugs (paralyzes) if needed | need to do both or may increase anxiety due to paralysis!

Question 37

Professional organization

Answer 37

American Association of Critical Care Nurses (AACN)

Question 38

CCRN: Critical care Nursing Certification

Answer 38

VALIDATES KNOWLEDGE OF CRITICAL CARE NURSING

Question 39

Assessments

Answer 39

Assessments done more frequently to q4h In ICU: head to toe assessments done 3x q4h @ 8, 12, 1600 In PACU / ER: focused assessment - focus on chief complain! make sure to document assessment at each & every assessment

Question 40

Abandonment

Answer 40

UNILATERAL SEVERANCE of a professional relationship while the client is still in need of health care CC Nurses are responsible for their client's safe and continuous care Nurses have a contractual relationship, an agreement on their shift to the patient

Question 41

Elements of informant Consent

Answer 41

``` competence voluntaries disclosure (of information) understanding (of information) decision Authorization ```