CHAMBERLIN COLLEGE OF NURSING NUR 340 EXAM
1 CRITICAL CARE STUDY GUIDE
EXAM 1 CRITICAL CARE
Critical Care
• Direct delivery of medical care within a specialized unit with specialized personnel
o Mainly for the treatment of life-threatening problems
o Levels of Care
▪ I: Most comprehensive, typically a teaching environment
• Staffed by specialty Drs & RNs
▪ II: Limited care to specialty patients
• burn units
▪ III: Limited availability for comprehensive critical care
• med-evac to a more comprehensive facility if out of scope for care
o Types of Units
▪ Open Unit
• Docs aren't ICU based, so frequent calls out occur
• multidisciplinary team is based in ICU
• Possible use of an Intensivist for patient management
▪ Closed Unit
• Physician collaboration
• Multidisciplinary team with an Intensivist
• Better patient outcomes than with an open unit
o Sentinel Events
▪ actual or potential outcomes that can cause patient harm or death
▪ commonplace in ICUs
o Strategies for Error Prevention
▪ Forcing Functions
• used to correct errors that can occur within the patient care setting
• no mixing of own meds
o done at the pharmacy level or hand delivered to the unit
▪ Use patient constraints
• allergy bands, fall risk identification, height or weights
▪ Restrict number of hours that can be worked in succession
▪ Use timeouts prior to procedures
▪ simplify processes
Ethical Principles
• Advocacy
o act on behalf of the patient foremost, then the family
CHAMBERLIN COLLEGE OF NURSING NUR 340 EXAM
1 CRITICAL CARE STUDY GUIDE
,CHAMBERLIN COLLEGE OF NURSING NUR 340 EXAM
1 CRITICAL CARE STUDY GUIDE
• Autonomy
o patient has the right to determine what, if any medical care they may receive
• Beneficence
o duty to prevent/remove harm & promote good
• Nonmalficence
o do no harm
• Justice
o fair allocation & distribution of health resources to all
• Confidentially
o respect for the right to control patient information
o HIPPA
CC Nurse Stressors
• Moral distress
o providing aggressive care to patients who may not benefit from
it powerlessness
o unable to find meaning in suffering
▪ doing invasive procedures that will not help in the end
o lots of RNs leave ICU environment r/t loss of inability to have compassion for pts
• Compassion Fatigue
o difficulty separating work from personal life
o lowered frustration tolerance
o angry outbursts
o depression
Sources of stress for patients and families
• inability to communicate related to tubes, etc
• anxiety
• sleeplessness
• delirium related to environment, lack of sleep
• pain
Communication with critically ill patients
• difficult for patient & RN
• sedation results in issues with communication
• RN must anticipate what pt needs
• use of writing tools may help with
communication Pain Management
• unpleasant sensory & emotional experience
• Predisposing factors for pain
o disease, procedures, trauma, nursing care
CHAMBERLIN COLLEGE OF NURSING NUR 340 EXAM
1 CRITICAL CARE STUDY GUIDE
,CHAMBERLIN COLLEGE OF NURSING NUR 340 EXAM
1 CRITICAL CARE STUDY GUIDE
o Influence on pain perceptions
▪ expectations & previous pain experiences
▪ emotional & cognitive state
• Assessment Tools
o Numerical pain scoring
▪ 0-10, with 0=no pain & 10=worst pain imaginable
o Wong-Baker faces
▪ useful in children and those who may not speak English well or at all
o Behavioral Pain Scale
▪ Facial expression (1=relaxed up to 4=grimacing)
▪ Upper limbs (1=no movement up to 4=permanently retracted)
▪ Compliance with Vent (1=tolerating movement up to 4=unable to
control ventilation)
o FLACC
▪ Face
▪ Legs
▪ Activity
▪ Cry & Consolability
• Pharmacological Management of Pain
o Opioids (CNS)-watch for resp. depression & hypotension
▪ Morphine sulfate
• Potent with a rapid onset (~5m)
• drug of choice (1st line)
• inexpensive
• duration ~2h, so can be given PRN
▪ Fentanyl
• extremely potent with faster onset than morphine (~1-2m)
• use for acute distress or ongoing hemodynamic instability
o NSAIDs (PNS)-increases risk for GI bleeds, renal (I) or liver (A) insufficiency;
decreases need for opioid medications
▪ Tylenol (Acetominophen)
▪ Motrin (Ibuprofen)
▪ Toradol
• good for use as an all-over anti-inflammatory
o PCAs (patient controlled analgesia)
▪ Patient must be able to manage pump to be effective
▪ best for patients with
• elective surgery
CHAMBERLIN COLLEGE OF NURSING NUR 340 EXAM
1 CRITICAL CARE STUDY GUIDE
, CHAMBERLIN COLLEGE OF NURSING NUR 340 EXAM
1 CRITICAL CARE STUDY GUIDE
• large surgical or traumatic wounds
• normal cognitive/motor skills
Anxiety
• prolonged state of apprehension in response to fear
• agitation, autonomic arousal, pain, sleep deprivation, noises in hospital setting
• predisposing factors
o ET tube
o alarms from monitors
o inability to move freely
o sleep deprivation
Delirium: causes and
assessment.
• acutely changing mental status & inattention
o hyperactive-agitated, combative, disoriented, restless
▪ pt may be hard to keep in bed
o hypoactive-quiet, depression, withdrawn, flat affect, lethatgic
o mixed-fluctuation between hyper/hypo states
▪ sundowning
• Assessment
o CAM-ICU
▪ worksheet to watch for acute changes in pt
o ICDSC
▪ watches for disorganized thinking and decreased alertness
• Predisposing factors
o polypharmacy
o benzodiazepine & narcotic use
o infection/sepsis
o preexisting dementia & sleep disruptions
• Management
o medication & environmental control
▪ Sedatives
• Haldol (5 mg)
• Ativan (2 mg)
▪ calm environment
• quiet with limited stressors, i.e. bright lights, loud sounds
• provide patient with glasses, hearing aids, etc
▪ review current medications & make changes as needed
• decrease or discontinue drugs that cause delirium
CHAMBERLIN COLLEGE OF NURSING NUR 340 EXAM
1 CRITICAL CARE STUDY GUIDE
1 CRITICAL CARE STUDY GUIDE
EXAM 1 CRITICAL CARE
Critical Care
• Direct delivery of medical care within a specialized unit with specialized personnel
o Mainly for the treatment of life-threatening problems
o Levels of Care
▪ I: Most comprehensive, typically a teaching environment
• Staffed by specialty Drs & RNs
▪ II: Limited care to specialty patients
• burn units
▪ III: Limited availability for comprehensive critical care
• med-evac to a more comprehensive facility if out of scope for care
o Types of Units
▪ Open Unit
• Docs aren't ICU based, so frequent calls out occur
• multidisciplinary team is based in ICU
• Possible use of an Intensivist for patient management
▪ Closed Unit
• Physician collaboration
• Multidisciplinary team with an Intensivist
• Better patient outcomes than with an open unit
o Sentinel Events
▪ actual or potential outcomes that can cause patient harm or death
▪ commonplace in ICUs
o Strategies for Error Prevention
▪ Forcing Functions
• used to correct errors that can occur within the patient care setting
• no mixing of own meds
o done at the pharmacy level or hand delivered to the unit
▪ Use patient constraints
• allergy bands, fall risk identification, height or weights
▪ Restrict number of hours that can be worked in succession
▪ Use timeouts prior to procedures
▪ simplify processes
Ethical Principles
• Advocacy
o act on behalf of the patient foremost, then the family
CHAMBERLIN COLLEGE OF NURSING NUR 340 EXAM
1 CRITICAL CARE STUDY GUIDE
,CHAMBERLIN COLLEGE OF NURSING NUR 340 EXAM
1 CRITICAL CARE STUDY GUIDE
• Autonomy
o patient has the right to determine what, if any medical care they may receive
• Beneficence
o duty to prevent/remove harm & promote good
• Nonmalficence
o do no harm
• Justice
o fair allocation & distribution of health resources to all
• Confidentially
o respect for the right to control patient information
o HIPPA
CC Nurse Stressors
• Moral distress
o providing aggressive care to patients who may not benefit from
it powerlessness
o unable to find meaning in suffering
▪ doing invasive procedures that will not help in the end
o lots of RNs leave ICU environment r/t loss of inability to have compassion for pts
• Compassion Fatigue
o difficulty separating work from personal life
o lowered frustration tolerance
o angry outbursts
o depression
Sources of stress for patients and families
• inability to communicate related to tubes, etc
• anxiety
• sleeplessness
• delirium related to environment, lack of sleep
• pain
Communication with critically ill patients
• difficult for patient & RN
• sedation results in issues with communication
• RN must anticipate what pt needs
• use of writing tools may help with
communication Pain Management
• unpleasant sensory & emotional experience
• Predisposing factors for pain
o disease, procedures, trauma, nursing care
CHAMBERLIN COLLEGE OF NURSING NUR 340 EXAM
1 CRITICAL CARE STUDY GUIDE
,CHAMBERLIN COLLEGE OF NURSING NUR 340 EXAM
1 CRITICAL CARE STUDY GUIDE
o Influence on pain perceptions
▪ expectations & previous pain experiences
▪ emotional & cognitive state
• Assessment Tools
o Numerical pain scoring
▪ 0-10, with 0=no pain & 10=worst pain imaginable
o Wong-Baker faces
▪ useful in children and those who may not speak English well or at all
o Behavioral Pain Scale
▪ Facial expression (1=relaxed up to 4=grimacing)
▪ Upper limbs (1=no movement up to 4=permanently retracted)
▪ Compliance with Vent (1=tolerating movement up to 4=unable to
control ventilation)
o FLACC
▪ Face
▪ Legs
▪ Activity
▪ Cry & Consolability
• Pharmacological Management of Pain
o Opioids (CNS)-watch for resp. depression & hypotension
▪ Morphine sulfate
• Potent with a rapid onset (~5m)
• drug of choice (1st line)
• inexpensive
• duration ~2h, so can be given PRN
▪ Fentanyl
• extremely potent with faster onset than morphine (~1-2m)
• use for acute distress or ongoing hemodynamic instability
o NSAIDs (PNS)-increases risk for GI bleeds, renal (I) or liver (A) insufficiency;
decreases need for opioid medications
▪ Tylenol (Acetominophen)
▪ Motrin (Ibuprofen)
▪ Toradol
• good for use as an all-over anti-inflammatory
o PCAs (patient controlled analgesia)
▪ Patient must be able to manage pump to be effective
▪ best for patients with
• elective surgery
CHAMBERLIN COLLEGE OF NURSING NUR 340 EXAM
1 CRITICAL CARE STUDY GUIDE
, CHAMBERLIN COLLEGE OF NURSING NUR 340 EXAM
1 CRITICAL CARE STUDY GUIDE
• large surgical or traumatic wounds
• normal cognitive/motor skills
Anxiety
• prolonged state of apprehension in response to fear
• agitation, autonomic arousal, pain, sleep deprivation, noises in hospital setting
• predisposing factors
o ET tube
o alarms from monitors
o inability to move freely
o sleep deprivation
Delirium: causes and
assessment.
• acutely changing mental status & inattention
o hyperactive-agitated, combative, disoriented, restless
▪ pt may be hard to keep in bed
o hypoactive-quiet, depression, withdrawn, flat affect, lethatgic
o mixed-fluctuation between hyper/hypo states
▪ sundowning
• Assessment
o CAM-ICU
▪ worksheet to watch for acute changes in pt
o ICDSC
▪ watches for disorganized thinking and decreased alertness
• Predisposing factors
o polypharmacy
o benzodiazepine & narcotic use
o infection/sepsis
o preexisting dementia & sleep disruptions
• Management
o medication & environmental control
▪ Sedatives
• Haldol (5 mg)
• Ativan (2 mg)
▪ calm environment
• quiet with limited stressors, i.e. bright lights, loud sounds
• provide patient with glasses, hearing aids, etc
▪ review current medications & make changes as needed
• decrease or discontinue drugs that cause delirium
CHAMBERLIN COLLEGE OF NURSING NUR 340 EXAM
1 CRITICAL CARE STUDY GUIDE
