test 1

Question 1

types of ethical dilemmas

Answer 1

emotionally charged
significant change in pt condition
confusion about facts (pt or fam)
hesitancy about correct set of actions
deviation from custody practice - something that’s not typically done
need for secrecy regarding actions

Question 2

process of ethical decision making

Answer 2

specify ethical dilemma
assess factors
develop plan
act on plan
evaluate

Question 3

autonomy

Answer 3

right of self determination concerning medical care

ex- pt has right to decline treatment

Question 4

beneficence

Answer 4

duty to prevent harm, remove harm, and promote good

Question 5

nonmaleficence

Answer 5

not to intentionally inflict harm, but could have caused it

Question 6

justice

Answer 6

equal treatment to all patients

Question 7

veracity

Answer 7

truthfulness

Question 8

fidelity

Answer 8

commitment to pt. advocate

Question 9

confidentiality

Answer 9

respect right to control information. HIPPA

Question 10

what is needed for advocacy

Answer 10

open communication of pt wishes
collaboration of healthcare team

Question 11

abandonment of pt

Answer 11

nurse must assure pt is cared for if nurse has to step out

Question 12

is a nurse requires ro practice if a situation violates their moral or religious beleif

Answer 12

no, but care must be transferred to someone else

Question 13

elements of informed consent

Answer 13

1. competence- ability to understanding
2. voluntariness- consent with out pushing a decision
3. disclosure of info

Question 14

what does disclosure of info include

Answer 14

diagnosis
proposed treatment
probable outcome
benefits and risks
alternative treatment
prognoses if treatment is not provided

Question 15

who gets consent

Answer 15

Drs, we just witness it

Question 16

ordinary care

Answer 16

common, noninvasive, and tested treatment

ex- nutrition, hydration, abx

Question 17

extraordinary care

Answer 17

complex, invasive, experimental treatment

ex- ACLS, dialysis, unproved therapies

Question 18

how to know if a pt should be coded

Answer 18

CHECK THE CHART.
if there is not a DNR order then resuscitate.

Question 19

if pt is getting surgery can they be DNR

Answer 19

no, but they can change it back as soon as they are out of surgery

Question 20

patients self determination act

Answer 20

pt right to initiate advance directive
pt right to consent to or refuse treatment

Question 21

types of advanced directives

Answer 21

DNR
living will
communication about preferences for treatments if pt is incapacitated
natural death

Question 22

brain death criteria

Answer 22

No cough, no gag, no corneal (blink reflux), no motor function (complete flaccid), no pupillary

Question 23

how to know when pts end is coming

Answer 23

when they start posturing.
this is when to call organ services

Question 24

organs that can be taken in brain death vs cardiac death

Answer 24

brain- all
cardiac- kidneys, pancreas and liver only

Question 25

unreceived pain can do what to pts

Answer 25

disorientation anxiety inadequate sleep

Question 26

negative effects of pain/anxiety

Answer 26

activates sympathetic nervous system tachycardia/htn increased o2 consumption tachypnea pup dilation urinary retention sleep disturbance gluceonogenesis nausea/constipatoin

Question 27

what to do for icu pt

Answer 27

cluster care, promote rest, reorient

Question 28

Richmond agitation sedation scale (RASS)

Answer 28

Sedation tool for ICU pt score goes from negative 5 to pos 4 4 is insanely combative 0 is alert and calm -5 is completely unarousable we want them to be in a light sedation, score -2 to +1

Question 29

bispectral sedation index (BIS)

Answer 29

Probe that goes on head to monitor anesthesia/sedation level 0 to 100 0 is completely unarousable Above 90 is completely awake Goal is 40-60

Question 30

types of delirium

Answer 30

hyperactive- agitated, combative, disoriented hypoactive- quiet delirium mixed- fluctuating btwn the two

Question 31

assessment for delerium

Answer 31

CAM-ICU (confusion assessment method)

Question 32

drug for delirium

Answer 32

haloperidol

Question 33

neuromuscular blockades

Answer 33

chemical paralysis in icu used for - intubation, ventilation, control in ICP, procedures must admin sedative prior to this common drugs- Rocuronium, denatonium

Question 34

train of 4

Answer 34

used to monitor paralytic agent Leads go on either the ulnar nerve or facial nerve- they give a impulse which causes a twitch 0 twitches= complete paralysis. Decrease drug 4 twitches= no paralysis. Increase drug The goal is 2 of 4 twitches

Question 35

what sedative is drug of choice in icu

Answer 35

precedex. it has mild analgesia unlike propofol monitor for rebound bradycardia

Question 36

what does propofol contain

Answer 36

lipids change lipid tubing every 12 hours

Question 37

when should nutritional assessment be done

Answer 37

first 24 hours by RN

Question 38

what's included in nutritional assessment

Answer 38

A&O gag reflux swallow study labs- f&e, BG hx

Question 39

Enteral feeding

Answer 39

should start within 24-48 hours if no PO intake Delivers into GI tract via nose or mouth Must be hemodynamically stable, no N/V, intact GI, have access (a tube) cant be NPO

Question 40

parenteral feeding

Answer 40

should be started immediately if enteral not possible through vein used for those who can't tolerate enternal related to GI issue tubing change every 24 hours may contain insulin and dextrose must be its own line, no meds can be pushed or can cause electrolyte issues due to electrolytes in solution

Question 41

salem pump vs dobbhoff

Answer 41

salem pump can be from mouth to nose to stomach. placement must be verified by chest x-ray dobbhoff bypasses stomach and goes straight to intestine from nose. nurse must have certification to do this both are enteral feedings

Question 42

trophic feeding

Answer 42

Trophic is small volume 10-30 mL/hr. usually start out with this then advance as tolerated

Question 43

targeted hourly feeding

Answer 43

50-100 mL/hr

Question 44

volume based feeding

Answer 44

bolus feeding, large volume over 24 hours. This is for more longterm feedings

Question 45

signs of intolerance of internal nutrition

Answer 45

n/v absent bowel sounds abdominal distention cramping diarrhea

Question 46

drug that helps speed up GI tract w enteral feedings

Answer 46

promotility (reglan)

Question 47

AACN guidelines for aspiration for enteral feedings

Answer 47

HOB at least 30 degrees unless contraindicated use sedatives sparingly placement= 4 hour intervals tolerance= 4 hour intervals avoid bolus if high risk for aspiraron swallow study before oral feedings restarted maintain ETT pressure 20-30 cm H2o

Question 48

PPN vs TPN

Answer 48

PPN delivered into peripheral IV. isotonic TPN into large central vein (PICC). hypertonic

Question 49

behavioral pain scale

Answer 49

assess facial expression, upper limps and compliance with vent worst score- 12 best - 3

Question 50

critical care pain observation scale

Answer 50

looks at facial expression, body movements, muscle tension in upper extremities and either compliance with vent to if not vented then vocalization best score is 0 worst score is 10

Question 51

diff between critical care from 1950s vs now

Answer 51

more specialized now for ex, cardiac icu, neuro icu, etc

Question 52

ICU noises affects what the most

Answer 52

sleep

Question 53

medication reconciliation

Answer 53

Taking meds they take at home and compare them to the ones they are taking in hospital

Question 54

VALUE mnemonic

Answer 54

Value what the family tells you Acknowledge family emotions Listen to family members Understand the pt as a person Elicit questions from family members