Summary NUR 445 Critical Exam 1 Study Guide

Adult Health Exam I

Chpt 1: Critical Care Nursing Practice

 Foundations of Critical Care Nursing
o Healthcare is going under dramatic change at a rapid rate
o This causes challenges
 Such as flexibility and adaptation to change
 Contemporary critical care
o Multidisciplinary team
 In-depth knowledge
 Wide range of disciplines
 A team taking care of pts
 Ex: respiratory therapists, physicians, nurses, advanced practice nurses,
social workers, clergy, chaplains, etc
o High-risk patients
 Require special attention
 Always anticipate what is going to happen
 Use critical thinking and judgement
o Specialized units
 Cardiac, stroke, peds, etc.
o A growing trend in acute care settings is the designation of progressive care units
considered to be part of the continuum of critical care
 Progressive care units: step down units from ICU (acute)
o Patient age
 Determines what type of unit the pt will be in
 Each hospital offers different types of units
 Neonatal
 Pediatric
 Adult
 Geriatric
o Usually combined with adult
o Medical vs surgical problems
 Determine where pt will go
 General ICU: work with providers, physicians, NP’s
 ICU doctors are typically Pulmonologists
 Not every hospital has all the types of intensive care units
 Ex: Ball memorial has regular ICU, but not a pediatric ICU
 Ex: Ball memorial has a unit for pulmonary and neurologic ICU, but not
cardiac ICU
o Special pt populations
 Cardiac
 Pulmonary
 Neurologic
 Critical Care Nursing Roles

, o Expanded-role nursing positions
 Case managers
 Usually RN’s
 Typically, have a 3:1 ratio (3pts to 1 RN) for ICU
 Patient educators
 Difficult to get education to the pt when they are in a critical care setting
 Education starts at the BEGINNING and goes all the way to discharge
 Family is VERY much involved!!
 Cardiac rehabilitation specialists
 Office nurses
 Infection control specialists
 Immune systems are compromised, so they make sure extra infections
are not acquired
****SEDATION DOES NOT EQUAL PAIN CONTROL*****
o Advanced practice nurses (APNs)
 Clinical nurse specialist (CNS)
 Nurse practitioner (NP) or acute care nurse practitioner (ACNP)
 Certified registered nurse anesthetist (CRNA)
o Not only important to take care of the pt, but the family
o More times than not, when it comes to teaching, we spend more time with the family
o Expanded-role nursing positions are determined by pt needs and individual
organizational resources
o What APS’s can do depends on the state they work in as well as practice area
 Critical Care Professional Accountability
o The Society of Critical Care Medicine (SCCM)
 Multidisciplinary, multispecialty, international organization
o American Association of Critical-Care Nurses (AACN)
 Certifications
 National organizations
 Awards
 Establish guidelines and practices for nurses for critical care
 Develop and administer many critical care specialty certification exams
 Ex: pediatric ICU, Neonatal ICU, Adult ICU
 Hospitals push for these exams because it shows that these nurses are qualified
to care for these pts
 More certifications = more positive pt outcomes
 Evidence-Based Nursing Practice
o Research-based interventions
 Early practice based on traditions
 Shift to use of best data available
o Consistent, positive outcomes
o Strive for best practice
o Because research is constantly updated, so are protocols; strive for the best practice!!
o Early practice is based on traditions

,  Research shows that some traditions are useless
 Be willing to look at research and make a change if necessary; this is the best
EBP
o Used to do with what “worked”; but not anymore…focus on EBP; is essential and must
be embraced by ALL nurses
o When we use science as the base of what we are doing, then we can explain and predict
what’s going to happen
o Provide research-based practice with positive outcomes
 Holistic Critical Care Nursing
o Caring
 Merges psychosocial elements with technologic environment
o Individualized care
 Patient’s preferences
 Patient- and family-centered care
o Cultural care
 Reflects society
 Incorporates individual differences
o This is what we want to push in critical care
o EBP shows it is VERY effective in the critical care setting
o It can be VERY hard to show the pt and family that we care; need to work to promote
that
 Do not seem rushed
 NEVER tell the pt what things you have to do; focus on that one pt in the room
o Think: what interventions will specifically best help this pt to progress towards their
desired outcome of their recovery?
o Make sure the family is involved in the decisions made and the care of the pt
o Think about diversity sensitivity and openness to lifestyle, beliefs, etc.
 Look at cultural differences
 Complementary and Alternative Therapies
o Spirituality and prayer
 Might not be religious, but spirituality is important
o Guided imagery
 Helps boost immune system and calm person down
 Low cost
 Decrease pain, anxiety, stress
 ******can be complementary or alternative**********
o Massage
 complementary
o Animal-assisted therapy
 Used more in hospitals
 As long as vaccines are up to date, then can visit pt
o Conventional
 Analgesics, pain meds
o Complementary: additional therapy on top of the standard western model

, o Alternative: replacing traditional (western) model
 Ex: hypnosis before surgery
 Nursing’s Unique Role in Health Care
o Both independent and dependent nursing action
o Interdependence with all health care professionals
o Nurses are the “eyes and ears” to the provider
o Develop trust with providers
o Nurses are the best point of care communicators for providers because they see what is
going on all day
o Be exceptional at communication skills
o Be confident and assertive in communication
o Explain what we want to say and know when we want to intervene on the pts behalf to
help the provider to work through the best plan of action for the pt
o Do not be bossy, but professional
 Critical Care Nursing Practice
o Research
 Studies link between clinical judgment and interventions
 Identifies
o Two major categories of thought and action
 Clinical inquiry and clinical forethought
 Clinical inquiry: looking at problem identification and clinical problem
solving it
 Clinical forethought: anticipating potential problems
 What critical care nurses are known for
 They can see things happening before they happen and anticipate it,
setting interventions before situations happen
o **Nine categories of practice
 Diagnosing and managing life sustaining physiologic function in unstable pts
 Managing a crisis by using skills of known how
 Providing comfort measures for the critically ill
 Caring for pts families
 Preventing hazards in a technological environment
 Facing death end of life care and decision making
 Communicating and negotiating multiple perspectives
 Monitoring quality and managing breakdown
 Exhibiting the skills of known how of clinical leadership
 The coaching and mentoring of others
 Interprofessional Collaborative Practice
o Increases quality of care and services
o Contains or decreases costs
o Core Competencies for Interprofessional Collaborative Practice
 Assess competencies’ relevance
 Develop action plan
o Cost is the big thing you gave to look at