NURSING 3770 (NURSING3770) Critical Care Final Study Guide LATEST VERSION 2022.
ICU Environment
• Open ICU: physician responsible for pt. admits the pt. to ICU & keeps formal responsibility
for pt. & their tx. Intensivist is a consultant w/o primary responsibility
• Closed ICU: pt. is admitted to ICU & responsibility for pt. & tx is transferred to intensivist
• Sensory Overload
o Noise
o Bright lights
o Loss of privacy- multiple caregivers, people in & out of room
o Lack of nonclinical physical contact
o Emotional & physical pain
▪ Confusion ▪ Lack of control
▪ Sleep deprivation ▪ Thirst
▪ Anxiety ▪ Pain
▪ Depression ▪ Difficult communication
• Sensory Deprivation
o Lack of visitors o White walls
o Staff stay out of room to o No stimulation
give privacy o Tv & phone $$
o
• Modification of environment
o Noise reduction: soothing music, acoustical tiles/designs, private areas
for communication for caregivers & family members
o Adequate lighting: natural lighting, night/day synchronization
o Design of new units to promote health & safety: nature in the view, bring family
into experience
o Reorient every time you walk in the room!
o
o
o Palliative Care
• Designed to relieve sx that negatively effect the pt. or the family
• Should be implemented with all patients not just the dying
• Elements:
o Early identification of end-of-life pts.
o Pain management
o Pharm & non pharm interventions to relieve: pain, anxiety, & other distressing sx
▪ Pain ▪ Thirst
▪ Anxiety ▪ Dyspnea
▪ Hunger ▪
1
, NURSING 3770 (NURSING3770) Critical Care Final Study Guide LATEST VERSION 2022.
• Nursing interventions: ▪ Nausea
▪ Diarrhea
▪ Confusion
▪ Agitation
▪ Sleep disturbance
2
, NURSING 3770 (NURSING3770) Critical Care Final Study Guide LATEST VERSION 2022.
o Frequent repositioning o Peaceful environment
o Good hygiene o Pain relief
o Skin care o Spiritual needs
o
o End of Life Care in ICU
• Prep the family—not an event but a process
• Emphasizes comfort rather than cure
• Philosophy of care, not a place
• Views ding as a normal process
o Terminal Weaning
• Let both the pt & family know what happens—may or may not pass away immediately
• Ensure pt. is comfortable
• Look right at the patient, make physical contact when explaining what is happening
• Pain medication (morphine) enough to decrease WOB & antianxiety med (benzos)
o Titrate pain meds & sedation throughout relieves tachypnea, dyspnea, & use of
accessory muscles
o Ongoing assessment of response to therapy & comfort
• Patient specific for comfort, ask about religious preferences
• “Plug is pulled” by RN & RT
• Comfort cart for family
• Family may take part in post-mortem care
• Unforeseen death, ET tube & IV left in until medical examiner is present
• Family has a right to refuse autopsy however cannot refuse medical examiner
• Up to family to call funeral home
• If family wants to turn off the machine for the wrong reasons call ethics committee—no
longer need MD order
o
o MOLST Form
• Mutually agreed on between the provider & pt. or surrogate
• Clearly specifies the kind of care the pt. prefers at the end of life
o
o Ethics Committee
• Multidisciplinary
• Can say their finding contraindicates healthcare proxy’s request if it is immoral & unethical
petition court
• Nurse’s share in the moral responsibility of their institution to ensure that the best ethical
decision making process is in place to meet pt. needs, uphold the institution’s philosophy, &
preserve the integrity of the nursing profession.
o Trauma
• Look for mechanism of injury “ how did it happen?” , did their plane change? Height
3
, NURSING 3770 (NURSING3770) Critical Care Final Study Guide LATEST VERSION 2022.
or surfaces they fell from?
• Prioritize tx to ABC’s
• If neck is not stabilized stabilize w/ cervical collar—no backboards in NY
4
ICU Environment
• Open ICU: physician responsible for pt. admits the pt. to ICU & keeps formal responsibility
for pt. & their tx. Intensivist is a consultant w/o primary responsibility
• Closed ICU: pt. is admitted to ICU & responsibility for pt. & tx is transferred to intensivist
• Sensory Overload
o Noise
o Bright lights
o Loss of privacy- multiple caregivers, people in & out of room
o Lack of nonclinical physical contact
o Emotional & physical pain
▪ Confusion ▪ Lack of control
▪ Sleep deprivation ▪ Thirst
▪ Anxiety ▪ Pain
▪ Depression ▪ Difficult communication
• Sensory Deprivation
o Lack of visitors o White walls
o Staff stay out of room to o No stimulation
give privacy o Tv & phone $$
o
• Modification of environment
o Noise reduction: soothing music, acoustical tiles/designs, private areas
for communication for caregivers & family members
o Adequate lighting: natural lighting, night/day synchronization
o Design of new units to promote health & safety: nature in the view, bring family
into experience
o Reorient every time you walk in the room!
o
o
o Palliative Care
• Designed to relieve sx that negatively effect the pt. or the family
• Should be implemented with all patients not just the dying
• Elements:
o Early identification of end-of-life pts.
o Pain management
o Pharm & non pharm interventions to relieve: pain, anxiety, & other distressing sx
▪ Pain ▪ Thirst
▪ Anxiety ▪ Dyspnea
▪ Hunger ▪
1
, NURSING 3770 (NURSING3770) Critical Care Final Study Guide LATEST VERSION 2022.
• Nursing interventions: ▪ Nausea
▪ Diarrhea
▪ Confusion
▪ Agitation
▪ Sleep disturbance
2
, NURSING 3770 (NURSING3770) Critical Care Final Study Guide LATEST VERSION 2022.
o Frequent repositioning o Peaceful environment
o Good hygiene o Pain relief
o Skin care o Spiritual needs
o
o End of Life Care in ICU
• Prep the family—not an event but a process
• Emphasizes comfort rather than cure
• Philosophy of care, not a place
• Views ding as a normal process
o Terminal Weaning
• Let both the pt & family know what happens—may or may not pass away immediately
• Ensure pt. is comfortable
• Look right at the patient, make physical contact when explaining what is happening
• Pain medication (morphine) enough to decrease WOB & antianxiety med (benzos)
o Titrate pain meds & sedation throughout relieves tachypnea, dyspnea, & use of
accessory muscles
o Ongoing assessment of response to therapy & comfort
• Patient specific for comfort, ask about religious preferences
• “Plug is pulled” by RN & RT
• Comfort cart for family
• Family may take part in post-mortem care
• Unforeseen death, ET tube & IV left in until medical examiner is present
• Family has a right to refuse autopsy however cannot refuse medical examiner
• Up to family to call funeral home
• If family wants to turn off the machine for the wrong reasons call ethics committee—no
longer need MD order
o
o MOLST Form
• Mutually agreed on between the provider & pt. or surrogate
• Clearly specifies the kind of care the pt. prefers at the end of life
o
o Ethics Committee
• Multidisciplinary
• Can say their finding contraindicates healthcare proxy’s request if it is immoral & unethical
petition court
• Nurse’s share in the moral responsibility of their institution to ensure that the best ethical
decision making process is in place to meet pt. needs, uphold the institution’s philosophy, &
preserve the integrity of the nursing profession.
o Trauma
• Look for mechanism of injury “ how did it happen?” , did their plane change? Height
3
, NURSING 3770 (NURSING3770) Critical Care Final Study Guide LATEST VERSION 2022.
or surfaces they fell from?
• Prioritize tx to ABC’s
• If neck is not stabilized stabilize w/ cervical collar—no backboards in NY
4
