Chapter 1-3 Introduction to Critical Care Exam Questions and Correct Answers

Chapter 1-3: Introduction to Critical Care Exam Questions and Correct Answers What does critical care nursing concern itself with? - Correct Answers: The human response to life threatening problems: - trauma - major surgery - complications of illness What is the focus of critical care nursing? - Correct Answers: - Patient's and families both physical and psychological - prevention and cure - sometimes about providing death and dignity, peace and comfort What does the critical care nurse look like? - Correct Answers: - respect patient's values, beliefs and rights - support a patient's right to autonomous decision making - patient advocate - monitor quality of care - liaison between patients, families, and other care providers - possesses sound clinical judgement - collaborative care provider - educator - team players - protective of patients - have certain quirks History of Critical Care - Correct Answers: - 1950s: polio patients were put in specialized units. Better outcomes were seen b/c there were specialized nurses taking care of these pts. - 1960s: recovery rooms and coronary care units - 1970s: critical care nursing becomes a specialty. Now you can be even more specialized (neuro, cardiac, etc) - future of critical care: there is no limit. eICU (this is where there are tvs with people who pop in and watch the patients from time to time to ensure everything is going good) What are certifications that a critical care nurse can have? - Correct Answers: - CCRN: Critical care RN - PCCN: progressive critical care nurse Helps us remain current What is the AACN? - Correct Answers: - represents critial care nurses - only NURSES are in this - largest nursing specialty in the world - supports creating a health care system driven by the needs of patient and their families What is the synergy model? - Correct Answers: Belief that a healthy work environment = better health outcomes What is the society of critical care medicine? - Correct Answers: - multidisciplinary - dedicated to excellence in critical care through education, research, and advocacy - secure quality of care for all critically ill - require care under intensivist: board certified What are trends and issues in critical care nursing? - Correct Answers: - increasingly sicker patients: multisystem organ failure/dysfunction - elderly population: as age increases so does the amount of comorbidities (typically) and so does length of hospital stay - quality and safety: push to decrease risk for readmission -- Joint commission NPSG -- IHI 5 million lives campaign - effective communication: worst during report -- SBAR** - collaborative practice: we are all one team - technological advances - nursing shortage How can you decrease the risk for readmission? - Correct Answers: - excellent education - case management - social work What was technology meant for? What does it do? - Correct Answers: - Meant to make things easier and faster - It can decrease eye contact and compassion for pts What are aspects of the environment in ICU? - Correct Answers: - Physical environment - communication - collaboration What is important about physical environment in ICU? - Correct Answers: - light: artificial lights can affect circadium rhythm which increases agitation. Lights on in the day time and off at night. - noise: can decrease O2 and would healing which could affect stability - ventilation - warmth: and comfort - cleanliness: sometimes pts are to unstable to move around for a super good bath What is important to know about communication in regards to the environment in the ICU? - Correct Answers: - think about what could distract or decrease communication - SBAR- handoff - Respect for diversity: not just race, also includes job What is important to know about collaboration in regards to the environment in the ICU? - Correct Answers: - bring all ideas to the table to have the best plan of care - multidisciplinary rounds - interprofessional relationships What are stressors for the critically ill patient? - Correct Answers: - physiological: pain, thirst (may be NPO), itch (what if they can't move), etc - psychological: they have no control - sociocultural: money, family - spiritual: bargaining, "I'm too young for this" - developmental What needs does the critically ill patient have? - Correct Answers: - safety: reassurance, date, familiar nurse, objects - communication What is important to remember about diversity in the ICU? - Correct Answers: - cultural sensitivity: think dietary concerns. Any spiritual concerns? - language barriers Why would being discharged from the unit give the patient anxiety? - Correct Answers: - they could get relocation stress b/c the nurses take such good care of them there - they may not feel ready to take care of themselves yet What are geriatric concerns for critically ill patients? - Correct Answers: - increased risk for poor outcomes: r/t losses already experienced (psychosocial and physiological) What is the last sense to go? - Correct Answers: Hearing - so talk to your patient and don't talk shit about them even if they are on the vent What is important to remember about families of the critically ill? - Correct Answers: - family centered care: recognize that illness of fam member affects entire fam - fam assessment -- calgary assessment model -- direcct observation -- crucial questions What are some crucial questions you should ask your patients family? - Correct Answers: - what are your beliefs about illness (death): give insight into fam - what is most important to you right now How can you make a fam feel better when their loved one is in the ICU? - Correct Answers: - learn there names and how they are all related to each other - make sure the visitors are still taking care of themselves (if they take meds, make sure they are. get them to take breaks and spend time for themselves) - find out who pays the bills. if it is the dad in the bed on the vent they could be stressing out, so if they want have someone come talk to them What do families need? - Correct Answers: *COMMUNICATION* :they need to know what is going on - reassurance: b/c they also have a loss of control - close proximity to the pt: if possible and they want to get in the bed w/ the pt, let them - receiving updates: goes along w/ communication How do families' needs manifest themselves in the ICU? - Correct Answers: - families need/want to be part of the care (most families) - they feel a loss of control so give them tasks such as washing the pts hands/feet, put lotion on them, wash their face, etc. What is important about visitation in the ICU? - Correct Answers: - this is widely researched in critical care - visiting hours: unrestricted is best for pts - children: based on age and physical wellbeing if they will be allowed - pet therapy: they would have to be up on their shots and not be crazy. controversial Should family be present during resuscitation? - Correct Answers: - literature SUPPORTS the presence - promotes pts condition of fam knowledge, shows everything was done, decreases fear and anxiety, promotes adaptation of life to death What are the cons of a family being present during resuscitation? - Correct Answers: CONS: - limited space in the room, dignity of pt (gown likely to fly up), confidentiality, have to have dedicated staff member to explain everything to fam, increase anxiety of staff (someone is watching everything), may have increased litigation, increase stress on fam What is included in ethical and legal issues in critical care nursing? - Correct Answers: - informed consent - withholding and withdrawing treatment - organ and tissue transplantation - confidentiality - justice ** the big concern is being able to honor and follow pts wishes when we have the technology to change the outcome What 2 professional organizations promote ethical decision making? - Correct Answers: - ANA (code of ethics) - AACN What are "s/sx" of an ethical dilemma like if you saw these would you think ethical dilemma? - Correct Answers: - situation is emotionally charged - significant change in pt condition - confusion/conflict about the facts - hesitancy about the right course of action - deviation from customary practice - secrecy surrounding proposed plan of action ** once identified nurses have to reassess and follow a systemic guide to decision making while not imposing their own beliefs/values. Ethical principles - Correct Answers: - Autonomy: pt can make decisions w/ regard to their own health - beneficence: do good - nonmaleficence: do no harm - justice: being fair - veracity: tell the truth - fidelity: being faithful to commitments - confidentiality How do we create an ethical environment? - Correct Answers: - increasing nurses' involvement in decision making - moral distress: take care of everyone (ex: gay, abortion, murderer, criminal) - interprofessional collaboration: mutual respect for other disciplines - bioethics committees - critical care nurses work to create an environment that focuses on best practices, to improve quality, pt satisfaction, and retention Informed consent - Correct Answers: - based on principle of autonomy What must be present for informed consent? - Correct Answers: - competence: pain free and sedative free. w/o meds - voluntariness: no pressure from anyone - disclosure of info: must understand d/x, duration, purpose of tx, probable outcome, risk vs benefits, and what happens if they don't get tx What is the nurses job in informed consent? - Correct Answers: WITNESS THE SIGNATURE - nurses do NOT explain conditions of test, procedure, exam, surgery, etc - we DO ensure that the 3 principles of autonomy are upheld and we can give additional info AFTER physician gives them info Imporant to know about life sustaining treatment - Correct Answers: - the right to die - appropriate use of technology - ability of the pt to make decisions regarding healthcare What is ordinary care vs. extraordinary care in regards to life sustaining treatment? - Correct Answers: - ordinary: common NONINVASIVE tx, abx therapy, nutrition and hydration - extraordinary: complex. INVASIVE sometimes experimental therapies. CPR, dialysis, trials ** ordinary can become extraordinary when burden outweighs the benefit (ex: feeding tube) When can you stop CPR? - Correct Answers: - if efforts are deemed futile by physician - if pt has made desires previously known - mutually agreed decision between Dr and fam What is the difference between DNR and AND - Correct Answers: - DNR= do not resucitate - AND= allow natural death: not hasting it but not preventing it What is the difference between withdrawing and withholding treatment? - Correct Answers: - withdrawing: taking away treatment. ex: terminal extubation, stopping hemodialysis. - withholding: never starting a needed treatment. ex: if pt doesn't want to be on vent. *we will NEVER withhold comfort* - stress the value of communication w/ pts and fam EARLY in care regarding what the pt would want End of life - Correct Answers: - patient self determination act - advanced directives What is the patient self determination act? - Correct Answers: states that all hospitals receiving medicare/medicaid funding must inform pts of their rights to make decisions regarding advanced directives - at self they are asked when they are admitted - early communication w/ pts and their fam is important What are 2 types of advanced directives? - Correct Answers: - living will: pt can choose to withhold what they want. not always legally binding in all states - durable power of attorney: choose someone to protect their interest if they were to become unable to What is a nurses' job during end of life? - Correct Answers: - open communication - legal responsibility is to provide care according to the pt's advance directives even if they conflict w/ your beliefs - have knowledge of facilities policy regarding DNR orders. Can you take a telephone order? At self you can but there has to be 2 nurses. Dr has 24 hrs to write it What is important to know about organ and tissue transplantation? - Correct Answers: - the difference between brain death and cardiac death and what can be recovered between both - right to donate organs - determination of suitability - transplant coordinator manages pt within the ICU - UNOS - Surgeons recover organs - transfer body to funeral home: pt can still have open casket What is brain death? - Correct Answers: complete and irreversible cessation of brain activity - norm body temp - everything can be recovered What is cardiac death? - Correct Answers: - irreversible cessation of circulation and resp function - kidney, liver, and pancreas are typically all that can be recovered (bc lungs and heart died and you can't bring that back) - when heart stops beating they take the organs - pt has 60 mins while in the OR to die an then organs will be recovered. If it takes longer than 60 mins they are transferred back to ICU and given comfort care by transplant coordinator (usually specially trained RN, BSN) Do nurses approach families about organ transplantation? - Correct Answers: NO - NEVER ask a family about organ donation. don't even bring it up - if they bring it up then you can talk about it and give them info