Nurs 425 Exam #1 Exam All Possible Questions and Answers with complete solution

Where do we care for patients that require high acuity care? - an ICU, an intermediate-care unit (IMC), or a medical-surgical acute care unit Characteristics of a level 1 ICU - comprehensive care for patients with a wide variety of conditions Characteristics of a level 2 ICU - comprehensive care for most patients, but not specific populations ex. neuro, cardiothoracic, trauma Characteristics of a level 3 ICU - ability to provide initial stabilization for critically ill patients but are limited in their care for comprehensive patients physical issues and stressors for the acutely ill patient - -pain -lack of sleep: cluster your care psychological issues and stressors for the acutely ill patient - -powerlessness & helpless ness: patients have no autonomy, they are fed at certain times, we give meds at certain times etc. -fear: of the unknown, stress of wondering what is going to happen next. Exacerbated by lack of sleep and control -anxiety: reduce this by good communication and involve them in care list some issues and stressors for the acutely ill patient - -environmental: not in their own space -noise -light -sensory overload: too much stimuli -sensory deprivation: not having their normal touch, family interaction ex. covid patients in isolation rooms issues and stressors for families - -high anxiety-denial -anger -remorse -grief illness can heighten/reignite family drama or issues issues and stressors for the nurse - -stressful environment: long hours, short staffed, the trauma of watching pill ill/ be terminally ill. Technology -ethical issues: moral distress, being aware of your own morals and separating that from the patient's wishes -implementing evidence based practice: nurse are required to keep up with the latest science How do we help the high acuity patient and family cope? - asses: ask them what they usally do when things arent going well, how do they usually cope with stress, suggest healthy coping mechanisms maintain hope: be careful not to give false reassurance, acknowledge the situation and explain that you are there for them true or false: restricted visiting in progressive and intensive care areas are based on science - false: it is based on tradition and convenience explain palliative care - managing symptoms and keeping patients comfortable. not synonymous with end of life care explain end of life care - •Many critical care patient deaths are preceded by withholding or withdrawing life sustaining treatments what is an advanced directive - a document that lists who the patient wants to make decisions for them and explains what measures they want to be taken things to stress if life support is being withdrawn - -care itself is not being withdrawn -aggressive palliation will be used to keep the patient comfortable-*time to death is variable* how do we manage dyspnea at end of life - -opioids : systemic or IV -oxygen: may not be use to help them phsically, but it may have a psychological effec to calm them down and manage their breathing -benzodiazepines: decrease SOB, alleviate anxiety -bronchodilators ex. albuterol what is terminal weaning? - -Withdrawal of mechanical ventilation without belief that patient will maintain respiration define these end of life ethical principles autonomy beneficence non maleficence fidelity - -freedom of choice -promoting good -do no harm -keeping promises cardiac output formula - SV x Hr normal is 4-8L/min explain stroke volume - -total amount of blood pumped with each heartbeat normal -determined by the interaction of preload, contractility, and afterload -normal is 50-100ml/beat