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critical care > test 1 > Flashcards

test 1 Flashcards

1
Q

types of ethical dilemmas

A

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

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2
Q

process of ethical decision making

A

specify ethical dilemma
assess factors
develop plan
act on plan
evaluate

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3
Q

autonomy

A

right of self determination concerning medical care

ex- pt has right to decline treatment

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4
Q

beneficence

A

duty to prevent harm, remove harm, and promote good

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5
Q

nonmaleficence

A

not to intentionally inflict harm, but could have caused it

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6
Q

justice

A

equal treatment to all patients

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7
Q

veracity

A

truthfulness

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8
Q

fidelity

A

commitment to pt. advocate

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9
Q

confidentiality

A

respect right to control information. HIPPA

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10
Q

what is needed for advocacy

A

open communication of pt wishes
collaboration of healthcare team

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11
Q

abandonment of pt

A

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

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12
Q

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

A

no, but care must be transferred to someone else

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13
Q

elements of informed consent

A
  1. competence- ability to understanding
  2. voluntariness- consent with out pushing a decision
  3. disclosure of info
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14
Q

what does disclosure of info include

A

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

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15
Q

who gets consent

A

Drs, we just witness it

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16
Q

ordinary care

A

common, noninvasive, and tested treatment

ex- nutrition, hydration, abx

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17
Q

extraordinary care

A

complex, invasive, experimental treatment

ex- ACLS, dialysis, unproved therapies

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18
Q

how to know if a pt should be coded

A

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

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19
Q

if pt is getting surgery can they be DNR

A

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

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20
Q

patients self determination act

A

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

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21
Q

types of advanced directives

A

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

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22
Q

brain death criteria

A

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

23
Q

how to know when pts end is coming

A

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

24
Q

organs that can be taken in brain death vs cardiac death

A

brain- all
cardiac- kidneys, pancreas and liver only

25
Q

unreceived pain can do what to pts

A

disorientation
anxiety
inadequate sleep

26
Q

negative effects of pain/anxiety

A

activates sympathetic nervous system

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

27
Q

what to do for icu pt

A

cluster care, promote rest, reorient

28
Q

Richmond agitation sedation scale (RASS)

A

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

29
Q

bispectral sedation index (BIS)

A

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

30
Q

types of delirium

A

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

31
Q

assessment for delerium

A

CAM-ICU (confusion assessment method)

32
Q

drug for delirium

A

haloperidol

33
Q

neuromuscular blockades

A

chemical paralysis

in icu used for - intubation, ventilation, control in ICP, procedures

must admin sedative prior to this

common drugs- Rocuronium, denatonium

34
Q

train of 4

A

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
35
Q

what sedative is drug of choice in icu

A

precedex. it has mild analgesia unlike propofol

monitor for rebound bradycardia

36
Q

what does propofol contain

A

lipids

change lipid tubing every 12 hours

37
Q

when should nutritional assessment be done

A

first 24 hours by RN

38
Q

what’s included in nutritional assessment

A

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

39
Q

Enteral feeding

A

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

40
Q

parenteral feeding

A

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

41
Q

salem pump vs dobbhoff

A

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

42
Q

trophic feeding

A

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

43
Q

targeted hourly feeding

A

50-100 mL/hr

44
Q

volume based feeding

A

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

45
Q

signs of intolerance of internal nutrition

A

n/v
absent bowel sounds
abdominal distention
cramping
diarrhea

46
Q

drug that helps speed up GI tract w enteral feedings

A

promotility (reglan)

47
Q

AACN guidelines for aspiration for enteral feedings

A

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

48
Q

PPN vs TPN

A

PPN delivered into peripheral IV. isotonic

TPN into large central vein (PICC). hypertonic

49
Q

behavioral pain scale

A

assess facial expression, upper limps and compliance with vent

worst score- 12
best - 3

50
Q

critical care pain observation scale

A

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

51
Q

diff between critical care from 1950s vs now

A

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

52
Q

ICU noises affects what the most

A

sleep

53
Q

medication reconciliation

A

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

54
Q

VALUE mnemonic

A

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

critical care (4 decks)

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