NR341 Complex Lecture Notes -> (Week 1) Complete
Study Guide 2026/2027. Chamberlain
It began with polio units (1950s), recovery rooms, and coronary care units (1960s)
▪Patient outcomes improved ▪ Intensive Care Units (1970s)
What does it take to be a Critical Care Nurse?
▪In-depth knowledge of anatomy, physiology, pathophysiology, pharmacology, advanced assessmen skills, and the a
to use advanced technology.
▪A Critical Care Nurse looks at the patient, and the trends in their physiological parameters/hemodyna and makes deci
in their care based on the data they collect. ▪The ICU nurse faces ethical and emotional dilemmas frequently.
▪Multitask and Prioritize.
Trends and Challenges: Critical care patients are more complex
▪Multisystem organ dysfunction
▪Complicated by an aging population
▪Increasing costs for care
▪Challenged to reduce costs and length of stay
▪Transfer of higher acuity patients from the critical care unit to other units or home
Quality and Safety - Errors and harm must be prevented ▪Nurses are
challenged to reduce errors and promote a safe environment ▪Several initiatives
▪The Joint Commission National Patient Safety Goals
▪Institute for Healthcare Improvement
▪Quality and Safety Education for Nurses (QSEN)
Safety Concerns and How to Limit Them -
▪Adverse drug events
▪Infections
▪Injuries from falls and immobility
▪Pressure ulcers
▪Venous thromboembolism (VTE)
Safety Concerns and How to Limit Them:
▪Adverse drug events
▪Infections
▪Injuries from falls and immobility
▪Pressure ulcers
▪Venous thromboembolism (VTE)
During the report using SBAR, the nurse states, “Since we have just initiated a potassium replacement protocol, the
patient will need a potassium level drawn at 1300.” This depicts Recommendation. What is ISBAR? Identify, Situation
Background, Assessment, and Recommendation
➢ Ex: Giving a report, calling HCP regarding a change in client status, explaining status to family, and
transferring a client to long-term care
Collaboration: Create a culture of safety where everyone works together
▪Mutual respect
▪Mutual recognition
▪Aim during multidisciplinary daily rounds at the bedside
,▪Briefings are another approach
Other Trends: Reducing hospital readmission rates
▪Increasing use of technology
▪Electronic medical records
▪Physician order entry
▪Ethical issues associated with prolonging life and futile treatment
▪Telemedicine and eICU
▪Aging population
▪Aging workforce
Critical Care Environment:
Designed for efficient, lifesaving interventions
Patients and Families are not prepared for stress or anxiety Sensory
Overload: Light
▪Noise
▪Loss of privacy
▪Multiple caregivers
▪Multiple people in and out of the unit and room
▪Lack of nonclinical physical contact
▪Emotional and physical pain
Sensory Deprivation: Increased perceptual disturbances
▪Treatment
▪Visitors
▪Photos
▪Soothing music ▪Lighting
Which is associated with high levels of noise in the critical care unit? Sleep Disruptions
The critically ill patient -
Patient responses vary according to:
▪Age
▪Developmental stage
▪Prior illness or hospitalization experience
▪Family relationships and social support
▪Coping mechanisms
▪Beliefs about life and death
▪Spirituality
▪Cultural considerations
Top Stressors: Pain, Inability to Sleep, Financial
How does a complex care environment impact clients, families, and workers?
➢ Physical environment : orient client/family to the equipment to decrease stress, keep things untangled,
increase natural light, and turn off artificial lights.
➢ Noise: Tailor device alarms to each client's needs, close doors, and quiet time
➢ Sensory Deprivation: Allow visitors to speak and touch clients, and objects from home, and ensure a
clock and calendar are visible
, It is important to involve and understand who is part of the client's family. EPICS →
EVALUATE, PLAN, INVOLVE, COMMUNICATE, and SUPPORT.
★ Assessment: Level of consciousness, airway, breathing, and circulation
Proper handoff includes: accountability, clarity of information, verbal communication, and acknowledgment by the
receiver
Psychosocial Support:
Ensure safety
Reduce sleep deprivation
Reduce noxious sensory overload
Increase pleasant sensory input
Provide reorientation Families in
the ICU:
Use Value to interact with families. Value
what the family tells you.
Acknowledge family emotions
Listen to family members
Understand the patient as a person
Elicit questions from family members
Being present during a code can assist family members in
Witnessing that everything has been done
The nurse explains to a patient with advanced cancer the differences between hospice and palliative care. Which
statement, if made by the patient, indicates that teaching was effective? Hospice care will help my family and I
prepare for death
Palliative care Hospice care
(You DO NOT have to die) Goals: - Provide comfort/Support during the dying process
- No longer trying to cure the patient - Improve the quality of the clients' remaining life
- Patient comfort to relieve pain - Help ensure a dignified death
- Promote active living - Nurses spend more time with patients near the end of
- Support holistic care life than any other healthcare professionals
- Provide relief from symptoms - Pain - Provide holistic care: focus on symptom management
- Offer support to the family - Respect, dignity, and comfort are important Pain
- Support holistic care/Enhance the quality of life management is a KEY component of this care Assisted
- Assist the client to live as actively as possible suicide/Providing doses of medication large enough
You can have aggressive surgeries to cause death is against the nursing Code of
It starts when the patient is going to live NO longer than Ethics
6 months (Terminal Illness) Goals: - Addressing a client's pain/SOB may assist the client
- Pain control, symptom management, spiritual Available 24/7, 7 days a week
assessment, and family needs End of Life - Hospital, Home Health, Community of Freestanding
- Provide emotional support for the family programs
Brain death is legal death: One will be on a vent and it is not sustainable - Irreversible loss of ALL brain functions
including the brainstem
- Once diagnosed, you're legally dead
, Death: Occurs when all vital organs and body systems cease to function. ▪Irreversible
cessation of cardiovascular, respiratory, and brain function Respiratory
▪Irregular breathing
▪Cheyne-Stokes respiration ▪Alternate apnea & deep, rapid breaths
▪Inability to cough or clear secretions▪Grunting, gurgling, or noisy congested breathing (“deat Sensory System:
▪Hearing and Touch
▪Taste, Smell and Sight
▪Decreased sense of taste and smell
Psychosocial:
Altered decision making
Anxiety and fear
Life review
Peacefulness
Saying goodbyes
Helpless
Restless
Unusual communication
Withdrawal
Bereavement is a period following the death of a loved one.
▪Grief is experienced, it is the reaction to the loss
Spiritual needs for the patient and family: existential meaning and
Spirituality —beliefs, values, and practices that relate to the search for
purpose ▪May or may not include a belief in
a higher power/supreme being
▪Does not necessarily equate to religion ▪Note
preferences; make referrals
Organ and Tissue Donation:
▪Any body part or the entire body may be donated
▪Decided by a person before death (donor card, license) or with family permission after death
▪Document in medical record &/or nursing care plan
▪Follow legal guidelines
▪Notification and timing important
Advanced care planning—a process that involves having patients think through, talk about, and document their values
and goals for treatment
- Advance directives are the written documents of those wishes and the designated
Spokesperson
- Document in medical records and/or nursing care plan Resuscitation:
Patients and families have the right to decide whether CPR will be used
▪Physician’s orders should specify:
▪Full Code — all heroic measures
▪Chemical Code—drugs but no CPR
Study Guide 2026/2027. Chamberlain
It began with polio units (1950s), recovery rooms, and coronary care units (1960s)
▪Patient outcomes improved ▪ Intensive Care Units (1970s)
What does it take to be a Critical Care Nurse?
▪In-depth knowledge of anatomy, physiology, pathophysiology, pharmacology, advanced assessmen skills, and the a
to use advanced technology.
▪A Critical Care Nurse looks at the patient, and the trends in their physiological parameters/hemodyna and makes deci
in their care based on the data they collect. ▪The ICU nurse faces ethical and emotional dilemmas frequently.
▪Multitask and Prioritize.
Trends and Challenges: Critical care patients are more complex
▪Multisystem organ dysfunction
▪Complicated by an aging population
▪Increasing costs for care
▪Challenged to reduce costs and length of stay
▪Transfer of higher acuity patients from the critical care unit to other units or home
Quality and Safety - Errors and harm must be prevented ▪Nurses are
challenged to reduce errors and promote a safe environment ▪Several initiatives
▪The Joint Commission National Patient Safety Goals
▪Institute for Healthcare Improvement
▪Quality and Safety Education for Nurses (QSEN)
Safety Concerns and How to Limit Them -
▪Adverse drug events
▪Infections
▪Injuries from falls and immobility
▪Pressure ulcers
▪Venous thromboembolism (VTE)
Safety Concerns and How to Limit Them:
▪Adverse drug events
▪Infections
▪Injuries from falls and immobility
▪Pressure ulcers
▪Venous thromboembolism (VTE)
During the report using SBAR, the nurse states, “Since we have just initiated a potassium replacement protocol, the
patient will need a potassium level drawn at 1300.” This depicts Recommendation. What is ISBAR? Identify, Situation
Background, Assessment, and Recommendation
➢ Ex: Giving a report, calling HCP regarding a change in client status, explaining status to family, and
transferring a client to long-term care
Collaboration: Create a culture of safety where everyone works together
▪Mutual respect
▪Mutual recognition
▪Aim during multidisciplinary daily rounds at the bedside
,▪Briefings are another approach
Other Trends: Reducing hospital readmission rates
▪Increasing use of technology
▪Electronic medical records
▪Physician order entry
▪Ethical issues associated with prolonging life and futile treatment
▪Telemedicine and eICU
▪Aging population
▪Aging workforce
Critical Care Environment:
Designed for efficient, lifesaving interventions
Patients and Families are not prepared for stress or anxiety Sensory
Overload: Light
▪Noise
▪Loss of privacy
▪Multiple caregivers
▪Multiple people in and out of the unit and room
▪Lack of nonclinical physical contact
▪Emotional and physical pain
Sensory Deprivation: Increased perceptual disturbances
▪Treatment
▪Visitors
▪Photos
▪Soothing music ▪Lighting
Which is associated with high levels of noise in the critical care unit? Sleep Disruptions
The critically ill patient -
Patient responses vary according to:
▪Age
▪Developmental stage
▪Prior illness or hospitalization experience
▪Family relationships and social support
▪Coping mechanisms
▪Beliefs about life and death
▪Spirituality
▪Cultural considerations
Top Stressors: Pain, Inability to Sleep, Financial
How does a complex care environment impact clients, families, and workers?
➢ Physical environment : orient client/family to the equipment to decrease stress, keep things untangled,
increase natural light, and turn off artificial lights.
➢ Noise: Tailor device alarms to each client's needs, close doors, and quiet time
➢ Sensory Deprivation: Allow visitors to speak and touch clients, and objects from home, and ensure a
clock and calendar are visible
, It is important to involve and understand who is part of the client's family. EPICS →
EVALUATE, PLAN, INVOLVE, COMMUNICATE, and SUPPORT.
★ Assessment: Level of consciousness, airway, breathing, and circulation
Proper handoff includes: accountability, clarity of information, verbal communication, and acknowledgment by the
receiver
Psychosocial Support:
Ensure safety
Reduce sleep deprivation
Reduce noxious sensory overload
Increase pleasant sensory input
Provide reorientation Families in
the ICU:
Use Value to interact with families. Value
what the family tells you.
Acknowledge family emotions
Listen to family members
Understand the patient as a person
Elicit questions from family members
Being present during a code can assist family members in
Witnessing that everything has been done
The nurse explains to a patient with advanced cancer the differences between hospice and palliative care. Which
statement, if made by the patient, indicates that teaching was effective? Hospice care will help my family and I
prepare for death
Palliative care Hospice care
(You DO NOT have to die) Goals: - Provide comfort/Support during the dying process
- No longer trying to cure the patient - Improve the quality of the clients' remaining life
- Patient comfort to relieve pain - Help ensure a dignified death
- Promote active living - Nurses spend more time with patients near the end of
- Support holistic care life than any other healthcare professionals
- Provide relief from symptoms - Pain - Provide holistic care: focus on symptom management
- Offer support to the family - Respect, dignity, and comfort are important Pain
- Support holistic care/Enhance the quality of life management is a KEY component of this care Assisted
- Assist the client to live as actively as possible suicide/Providing doses of medication large enough
You can have aggressive surgeries to cause death is against the nursing Code of
It starts when the patient is going to live NO longer than Ethics
6 months (Terminal Illness) Goals: - Addressing a client's pain/SOB may assist the client
- Pain control, symptom management, spiritual Available 24/7, 7 days a week
assessment, and family needs End of Life - Hospital, Home Health, Community of Freestanding
- Provide emotional support for the family programs
Brain death is legal death: One will be on a vent and it is not sustainable - Irreversible loss of ALL brain functions
including the brainstem
- Once diagnosed, you're legally dead
, Death: Occurs when all vital organs and body systems cease to function. ▪Irreversible
cessation of cardiovascular, respiratory, and brain function Respiratory
▪Irregular breathing
▪Cheyne-Stokes respiration ▪Alternate apnea & deep, rapid breaths
▪Inability to cough or clear secretions▪Grunting, gurgling, or noisy congested breathing (“deat Sensory System:
▪Hearing and Touch
▪Taste, Smell and Sight
▪Decreased sense of taste and smell
Psychosocial:
Altered decision making
Anxiety and fear
Life review
Peacefulness
Saying goodbyes
Helpless
Restless
Unusual communication
Withdrawal
Bereavement is a period following the death of a loved one.
▪Grief is experienced, it is the reaction to the loss
Spiritual needs for the patient and family: existential meaning and
Spirituality —beliefs, values, and practices that relate to the search for
purpose ▪May or may not include a belief in
a higher power/supreme being
▪Does not necessarily equate to religion ▪Note
preferences; make referrals
Organ and Tissue Donation:
▪Any body part or the entire body may be donated
▪Decided by a person before death (donor card, license) or with family permission after death
▪Document in medical record &/or nursing care plan
▪Follow legal guidelines
▪Notification and timing important
Advanced care planning—a process that involves having patients think through, talk about, and document their values
and goals for treatment
- Advance directives are the written documents of those wishes and the designated
Spokesperson
- Document in medical records and/or nursing care plan Resuscitation:
Patients and families have the right to decide whether CPR will be used
▪Physician’s orders should specify:
▪Full Code — all heroic measures
▪Chemical Code—drugs but no CPR
