High acuity nursing Flashcards
What is a key part of patient step down?
vigilance; vigilance decides when the care goes from continuous to intermittent.
What are the purpose of house wide bed flow meetings?
purpose is to improve allocation of resources and optimal patient bed assignments
What is the HR have to be for a rapid response team?
- greater than 140
- less than 40
What is the RR have to be for a rapid response team?
- greater than 28
- less than 8
What is the BP have to be for a rapid response team?
- BP greater than 180
- less than 90
What is the O2 sat have to be for a rapid response team?
- <90%
What is the urine output have to be for a rapid response team?
< 50 cc over 4 hours
What is another indicator of a rapid response team?
acute change in mental status
What is the number 1 indicator of acute stress?
respiratory rate above 20 is the number 1 indicator
What are the 6 indicators of a healthy work environment?
- Skilled communication –> convey critical needs effectively
- True collaboration –> interdisciplinary rounds. Include the family
- Effective decisions making –> Patients and families being involved, nurses have a voice as well.
- Appropriate ratios and/or staffing–>
- meaningful recognition
- Authentic leadership –> Trust between middle managers and higher managers and staff.
Describe level 1 trauma care:
a. Hospitals with ICUs that provide comprehensive care for patients with a wide range of disorders.
b. SPECIALIZED CARE is available
c. Sophisticated equipment
d. Units are staffed with specialized nurses and healthcare providers
Describe level 2 trauma care:
a. Hospitals with ICUs that have the capability of providing comprehensive care to most critically ill patients but not to specific patient populations (neurons, immunology)
Describe level 3 trauma care:
a. Hospitals with ICUs that have the ability to provide initial stabilization of critically ill patients but are limited in their ability to provide comprehensive care for the patients.
b. These hospitals are able to care for ICU patients requiring routine care and monitoring.
Who are most affected by environmental stressors?
- Elderly
- very young
- post op pts.
- unconscious pts
What are causes of stressors?
- Nutrition
- Anxiety
- Pain: Invasive equipment and procedures that are done in ICU; Assume that there is pain
- Impaired communication: Sedative drugs. Limited connection with reality
- Sensory-Perceptual problems; Sensory overload lights are on, alarms are on, telephones are on; Try to decrease sensory stimulation to allow time for rest.
- Delirium; Preceded by anxiety and restlessness; Can cause long term morbidity and mortality; Optimal healing environment
- Sleep problems
What is the RAAS?
i. 0 = calm
a. +1 - +5: agitation scale
b. -1 - -5: sedation scale: -1 = drowsy (most ideal). -5 = not responsive to anything
What does the CAM-ICU test for?
delirium; either positive or negative
What are non-pharmacologic interventions in the hospital?
- headphones
- Closing doors: Sometimes not allowed
- Posting signs – quite time (min 2 hours). Most patients only get 2 hours – so risk of delirium is high
- Day/Night Schedule
- Use assistive devices: Connect to reality and environment
What are advantages of high tech environments?
- Close monitoring
- programmed approach
- Programs available for diagnosis
- readily available reference info!
What are disadvantages?
- depersonalization
- overload
- heavy reliance
What is a huge stressor on families while pt.’s are in the ICU?
finances
What is the first stage of Suchman’s Stages of Illness?
symptoms experience
What is the second stage of Suchman’s Stages of Illness?
seeking confirmation of illness from social network. Try to stay home
a. Assumption of the sick role
What is the third stage of Suchman’s Stages of Illness?
seeking care. Medical contact
What is the fourth stage of Suchman’s Stages of Illness?
entering into the health care environment. Patient is passive and accepting.
a. Dependent patient
b. They know people can get them better
What is the fifth stage of Suchman’s Stages of Illness?
Recovery or rehabilitation
How can family visitation be destructive?
physiologically; they can be distracting and make sleep very difficult.