NRS 440 - Exam 1 Questions with Correct Answers Graded A+

critical care nursing - play a very important role in facilitating recovery for very sick/injured patients have much more advanced monitoring/support devices than can be found on a general care unit form the bases of rapid response teams; which equals earlier tx of potentially crashing patients - fewer codes what are the common problems r/t the critically ill patient - anxiety environmental stressors (sensory overload/deprivation) delirium sleep deprivation pain nutritional alterations physiological instability emergency situation (codes, ICU psychosis) end of life issues (death is higher in the ICU pt population) what interventions can be used in the critical care setting to decrease negative pt outcomes - avoiding restraints keeping the noise down medication management: optimize pt's orientation/awareness what are some of the changes in health care delivery that we must consider as high acuity nurses? - higher acuities, advancing technologies older population: complex health problems/ multiple co-morbidities increase in nosocomial infections limited reimbursements advent of RRT nurses requiring advanced certifications what are challenges with acute vs chronic illness management in the hospital and the community? - home - hospital - LTC -coordination and communication -continuity of care lack of resources increasing preventable health problems increasing co-morbidities older adults and high acuity nursing - make up more than half of pts in critical care units important to know and understand the characteristics and system changes in older adults so that therapeutic interventions are provided summary of changes in older adults - decreased adaptability many physiologic changes impaired stress response greater risk for fxnal decline CCN must consider all physiologic and psychologic factors to provide the best care CV system changes - aorta and other arteries become stiff and less pliable - increased workload on heart to perfuse tissue systolic and diastolic pressures increase, along with increase in systemic vascular resistance (SVR) and decrease in CO loss of capacity in myocardium and arterial system and decreased ability to respond and recover from periods of physiologic and psychologic stress respiratory system - lung tissue stiffens diffusion of gases is impaired by 8% per yr after 65 yo there is a decrease in vital capacity and maximal breathing capacity renal system - decreased renal blood flow - decreased GFR and decreased renal tubule fxn decreased elimination of physiologic substances older adults are predisposed to developing metabolic acidosis, volume depletion, and hyperchloremia GI system - decreased gastric emptying, splenic blood flow, and GI motility increased GI pH and thinning or reduction of absorptive surface of gut H. pylori infection and med effects increase the risk for GI bleeding decreased absorption rates neurological system - changes in gyro fxn, formation in neurofibrillary tangles, decrease in brain volume, and increase in size of cerebral ventricles increase plaque formation changes in neurotransmitter synthesis and fxn, and degeneration of blood-brain barrier immune system - increased gamma/delta and helper t-cells decreased suppressor/cytotoxic T lymphocytes decreased germinal centers of lymph nodes increased plasma cells and lymphocytes in bone marrow changed cell surface characteristics of lymphocytes impaired humoral immune and antibody responses pharmokinetics - loading and maintenance doses of certain drugs should be reduced reduced clearance of drugs by kidneys from dehydration may be reversible by rehydration liver and kidney fxn tests need to be repeated at regular intervals or when new meds are added nonessential meds should be limited, and pts should be monitored for toxic effects associated with new meds