Summary NR 340 Week 3 Exam 1 Studyguide.docx

NR340 Exam 1 Chapters 1, 2, 3, 5, 7, 9, 14, pgs 228-324 Page 1 of 36


Chamberlain College of Nursing


NR340 Exam 1

Overview of CC
Critical Care Nursing
 Deals with human responses to critical illness or injury
o Physiological
o Psychological
 Focus on both the patient’s and family’s responses
 Critical Care Overview
 Not always centered in an “ICU setting”
o Inpatient
o Outpatient
o Home Care
o eICU
o Tele-stepdown
o Post anesthesia
o Flight nursing-transport
 Professional Organizations
o American Association of Critical-Care Nurses
o Society of Critical Care Medicine
Trends and Issues
 Critical care patients more complex
 Increasing costs for care
 Facilities for long term ventilators
 Reduces stays in hospitals: more risk for infection
 Better for patient to be at home
Focus on Quality and Safety
 Errors and harm must be prevented
o Communication is a big error
o On record where to find items
o Medication errors
o Documentation errors
o Handwashing
o Falls
 Nurses are challenged to reduce errors and promote a safe environment
 Several initiatives
o Joint Commission National Patient Safety Goals
o Institute for Healthcare Improvement
o Quality and Safety Education for Nurses (QSEN)
National Patient Safety Goals
 The Joint Commission National Patient Safety Goals
 Examples relative to critical care nursing
o Communication

,NR340 Exam 1 Chapters 1, 2, 3, 5, 7, 9, 14, pgs 228-324 Page 2 of 36
o Medication safety
o Reduce infections
o Reconcile medications
o Telephone orders- SAY BACK
o TALL letters for similar drug names




Harms Targeted for Reduction
 Adverse drug events
 Infections
o Catheter-associated urinary tract infections (CAUTI)
o Central line–associated bloodstream infections (CLABSI)
o Surgical site infections
o Ventilator-associated pneumonia (VAP)
 Injuries from falls and immobility
 Obstetric adverse events
 Pressure ulcers
 Venous thromboembolism (VTE)
Communication
 Communication important for safe care
 Standardized approaches
o SBAR and SBAP
 Situation
 Background
 Assessment
 Recommendation (Plan)
 Collaboration
o Nurse/ doctor
o Debreifing
Other Trends and Issues
 Reducing hospital readmission rates
o Chronic illness (HF)
 Increasing use of technology
o Electronic medical records
o Physician order entry
 Ethical issues associated with prolonging life and futile treatment
 Telemedicine and eICU
 Aging population and workforce
 Shortage of CC nurses
The Critical Care Environment
 Stressful
 Noisy
 Sleep Deprivation
 Concerns of the Critically Ill Patient
o Patients responses do vary
 Loss of control (even breathing)
 ↓ Communication (d/t vent)
 ↓Mobility, ↓Comfort
Psychosocial Support (HIGHEST CONCERN)

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 Ensure safety
 Reduce sleep deprivation
 Reduce noxious sensory overload
 Increase pleasant sensory input



 Provide reorientation
o Strategies
 Mimic night/ day
 Calendar/ clock
 Tell them what you are doing
 Talk to the patient
 Allow for rest periods
 Provide pleasant area
Geriatric Concerns
 Diminished ability to adapt to, or cope with, stressors of critical illness
 At greater risk for negative outcomes
 May not bounce back
Ethical Issues
 Critical care nurses confront in everyday practice
o Informed consent and confidentiality
o Withholding or withdrawal of treatment
o Organ and tissue transplantation
o Distribution of healthcare resources
o Appropriate use of technology
 Greater frequency in critical care
Ethical Principles
 Autonomy
o Body
o Ability to make decisions for self
 Beneficence
o To do good
o To benefit the patient
 Nonmalificence
o To do no harm
 Justice
o People getting what they deserve/ need
 Veracity
o Be truthful
 Fidelity
o Be faithful
 Confidentiality
Nurse Involvement in Ethical Decision Making
 Advocacy
o Open communication of patient’s wishes and ethical concerns
o True collaboration with healthcare team members
 Dilemmas can result in moral distress
 Formal mechanisms (The Joint Commission)
o Bioethics committees

, NR340 Exam 1 Chapters 1, 2, 3, 5, 7, 9, 14, pgs 228-324 Page 4 of 36
o Ethics consultation
 Opportunities for critical care nurses
o Ethics forums and rounds
o Peer review
o Institutional review boards (research)

Selected Issues
 Informed Consent
o Have to insure that patient is actually informed
o No remaining questions about procedure/outcome
 Advanced Directives
 Organ and tissue donation
o Call gift of hope – Nurses only responsibility
 Life-sustaining treatment
Forum to Resolve Issues
 Bioethics Committees
 Ethics Consultation
Concerns of the Critically Ill
 Pain
o Physiology
o Predisposing Factors
 Disease process can cause pain
 Changing dressing, movement, etc.
 Ischemia
o Assessment
 Subjective
 Pain is what the patient says it is
 Objective
 Vital signs
 Non-verbal
 Facial expressions
 Moaning/Groaning
 Grimiacing
 Guarding
 Body Movement
 Pain Management (acute pain)
o Nonpharmacologic
 Heat, cold, massage, breathing, guided imagery, etc.
o Prevention
 Opioids
 Fentanyl
 Dilaudid
 Morphine
 Concern is respiratory depression
 Antidote is narcan
o Epidural
o NSAIDS
o PCA
 Anxiety
o Prolonged stated of apprehension in response to fear