NR 341
(EDAPT WEEK 1 NOTES)
Complex Adult Health
,COMPLEX HEALT EDAPT WEEK 1
Clients who have complex health issues may require more intensive monitoring or invasive
treatment. This specialized care delivered may require an interdisciplinary team approach.
While intensive care units and emergency departments may be ideal due to their available
resources, a client with complex health issues may also be in rehabilitation areas, step-
down units, or even at home. Complex monitoring may involve ventilators, specialized
monitoring, an interdisciplinary team, and even remote consultations with specialists.
Regardless of the setting, it is important to focus on and understand some of the more
advanced treatments delivered, and how the nurse uses the nursing process to make
clinical decisions for clients with complex health alterations.
Care Unit Client
Trauma unit Young adult with a broken femur and closed head injury
sustained in a motorcycle crash
Intensive care unit (ICU) Middle-Aged adult with recent onset of left-sided weakness and
slurred speech
Orthopedic unit Older adult requiring traction while awaiting surgical repair of
a hip fracture
Medical-Surgical unit Middle-Aged adult after an uncomplicated colon resection surgery
The young adult with injuries sustained in a motorcycle crash should be admitted to the
trauma unit, which has specialty equipment to treat and monitor the injuries and staffing
patterns to allow a low nurse to client ratio.
The middle-aged adult with left-sided weakness is, most likely, experiencing a
cerebrovascular accident (CVA) or stroke, and requires close monitoring and may need
thrombolytic medications to reopen arteries clogged by clots. This therapy should be
administered in an intensive care unit (ICU) setting.
The older adult in traction and the middle-aged adult with post-colon resection are both
medically stable and can be placed on the orthopedic and medical-surgical units,
respectively.
, Need to Use ISBAR No Need to Use ISBAR
Situation
s giving report to the oncoming nurse documenting care
calling the health care provider scheduling radiological tests
regarding a change in the client’s
status
discharging a client to a long-term
care facility
explaining the client’s status to their
family
The introduction, situation, background, assessment, and recommendation (ISBAR)
framework may be used in any communication in which the client’s information is shared,
including
hand-off report
between shifts
transfer from one area of care to another (e.g., from a post-anesthesia care
unit to a medical-surgical unit)
transfer to another care facility
time-critical situations such as medical emergencies or evacuations
communication with members of the health care team
communication with the client and family
Documentation of care is completed using charting by exception and the acronym SOAP
(subjective data, objective data, assessment, and plan). Scheduling a radiological test is
most often completed using a computer.
Which technique can be used to decrease the noise created by the alarms on the
technology used while delivering client care?
Since all clients are unique, tailoring alarm signals of devices to each client’s needs can
reduce the number of false alarms, and therefore reduce the total number of alarms.
Increasing the decibels or using flashing colors will cause more sensory overload. Hiring
more staff is expensive and does not combat alert fatigue.
Aspects of the critical care environment:
Clients with complex alterations in health can be cared for in most areas. Whether they are
admitted with complex health care needs, or their condition deteriorates while in the
facility, the change in status often occurs unexpectedly, with little time to prepare
themselves or their families for the experience. The environment, coupled with a loss of
, privacy and separation from loved ones, can increase stress and anxiety for both the client
and their loved ones.
Review how various aspects of the complex care environment impact clients, their families,
and health care workers, along with actions the nurse can take to lessen the negative
impact.
Physical environment - The Issue
The physical environment can be overwhelming, with the wires, tubes, and machinery used
to provide life-saving care. The constant presence of artificial lighting interferes with
natural circadian rhythms, increasing disorientation and agitation.
The Solution
Orient the client and family to the equipment used for care to decrease stress and
the sense of being overwhelmed.
Keep wires and tubing untangled and out of the way to prevent disruption of care.
Increase natural light in the room, allowing the client to see out the window (if
possible), to promote awareness of day-night cycles (circadian rhythms).
Turn off artificial lights when not needed and close the room door to block light
from hallways.
Noise - The Issue
The optimal level of noise is 35 decibels (dB) during the day and 30 dB at night (Scquizzato
et al., 2020). One study on an intensive care unit found that there were 187 alarms per bed
per day, with 72%-99% of which were false alarms (Drew et al., 2014). Many medical devices
create sound levels between 68 dB when raising the head of the bed and 78 dB when an
infusion pump alarms (Dotson-Kirn & Sole, 2017, chapter 2). The sheer number of loud
noises within the room puts clients', visitors', and caregivers' hearing at risk and can
increase stress-related health alterations.
The Solution
Tailor device alarms to each client’s needs to reduce the number of false alarms.
Close the door to decrease noise from outside the room.
Establish quiet time by blocking calls into client rooms, prohibiting the use of
overhead paging systems, and reinforcing quiet verbal communication during
nighttime hours.
Sensory deprivation - The Issue
Separation from loved ones, being away from home, and the loss of a normal routine can
increase stress and anxiety for both the client and their loved ones. Use of pain medicine
(EDAPT WEEK 1 NOTES)
Complex Adult Health
,COMPLEX HEALT EDAPT WEEK 1
Clients who have complex health issues may require more intensive monitoring or invasive
treatment. This specialized care delivered may require an interdisciplinary team approach.
While intensive care units and emergency departments may be ideal due to their available
resources, a client with complex health issues may also be in rehabilitation areas, step-
down units, or even at home. Complex monitoring may involve ventilators, specialized
monitoring, an interdisciplinary team, and even remote consultations with specialists.
Regardless of the setting, it is important to focus on and understand some of the more
advanced treatments delivered, and how the nurse uses the nursing process to make
clinical decisions for clients with complex health alterations.
Care Unit Client
Trauma unit Young adult with a broken femur and closed head injury
sustained in a motorcycle crash
Intensive care unit (ICU) Middle-Aged adult with recent onset of left-sided weakness and
slurred speech
Orthopedic unit Older adult requiring traction while awaiting surgical repair of
a hip fracture
Medical-Surgical unit Middle-Aged adult after an uncomplicated colon resection surgery
The young adult with injuries sustained in a motorcycle crash should be admitted to the
trauma unit, which has specialty equipment to treat and monitor the injuries and staffing
patterns to allow a low nurse to client ratio.
The middle-aged adult with left-sided weakness is, most likely, experiencing a
cerebrovascular accident (CVA) or stroke, and requires close monitoring and may need
thrombolytic medications to reopen arteries clogged by clots. This therapy should be
administered in an intensive care unit (ICU) setting.
The older adult in traction and the middle-aged adult with post-colon resection are both
medically stable and can be placed on the orthopedic and medical-surgical units,
respectively.
, Need to Use ISBAR No Need to Use ISBAR
Situation
s giving report to the oncoming nurse documenting care
calling the health care provider scheduling radiological tests
regarding a change in the client’s
status
discharging a client to a long-term
care facility
explaining the client’s status to their
family
The introduction, situation, background, assessment, and recommendation (ISBAR)
framework may be used in any communication in which the client’s information is shared,
including
hand-off report
between shifts
transfer from one area of care to another (e.g., from a post-anesthesia care
unit to a medical-surgical unit)
transfer to another care facility
time-critical situations such as medical emergencies or evacuations
communication with members of the health care team
communication with the client and family
Documentation of care is completed using charting by exception and the acronym SOAP
(subjective data, objective data, assessment, and plan). Scheduling a radiological test is
most often completed using a computer.
Which technique can be used to decrease the noise created by the alarms on the
technology used while delivering client care?
Since all clients are unique, tailoring alarm signals of devices to each client’s needs can
reduce the number of false alarms, and therefore reduce the total number of alarms.
Increasing the decibels or using flashing colors will cause more sensory overload. Hiring
more staff is expensive and does not combat alert fatigue.
Aspects of the critical care environment:
Clients with complex alterations in health can be cared for in most areas. Whether they are
admitted with complex health care needs, or their condition deteriorates while in the
facility, the change in status often occurs unexpectedly, with little time to prepare
themselves or their families for the experience. The environment, coupled with a loss of
, privacy and separation from loved ones, can increase stress and anxiety for both the client
and their loved ones.
Review how various aspects of the complex care environment impact clients, their families,
and health care workers, along with actions the nurse can take to lessen the negative
impact.
Physical environment - The Issue
The physical environment can be overwhelming, with the wires, tubes, and machinery used
to provide life-saving care. The constant presence of artificial lighting interferes with
natural circadian rhythms, increasing disorientation and agitation.
The Solution
Orient the client and family to the equipment used for care to decrease stress and
the sense of being overwhelmed.
Keep wires and tubing untangled and out of the way to prevent disruption of care.
Increase natural light in the room, allowing the client to see out the window (if
possible), to promote awareness of day-night cycles (circadian rhythms).
Turn off artificial lights when not needed and close the room door to block light
from hallways.
Noise - The Issue
The optimal level of noise is 35 decibels (dB) during the day and 30 dB at night (Scquizzato
et al., 2020). One study on an intensive care unit found that there were 187 alarms per bed
per day, with 72%-99% of which were false alarms (Drew et al., 2014). Many medical devices
create sound levels between 68 dB when raising the head of the bed and 78 dB when an
infusion pump alarms (Dotson-Kirn & Sole, 2017, chapter 2). The sheer number of loud
noises within the room puts clients', visitors', and caregivers' hearing at risk and can
increase stress-related health alterations.
The Solution
Tailor device alarms to each client’s needs to reduce the number of false alarms.
Close the door to decrease noise from outside the room.
Establish quiet time by blocking calls into client rooms, prohibiting the use of
overhead paging systems, and reinforcing quiet verbal communication during
nighttime hours.
Sensory deprivation - The Issue
Separation from loved ones, being away from home, and the loss of a normal routine can
increase stress and anxiety for both the client and their loved ones. Use of pain medicine
