NUR 445: Critical Care Exam 1 Brady Questions and Answers

NUR 445: Critical Care Exam 1 Brady Questions and Answers critical care nursing - answer- being a direct care provider by being highly vigilant and using their intelligence and cognition to do tasks and quickly pull together multiple data to make decisions regarding subtle and/or deteriorating conditions DNR order is influenced by - answer- goals of care, co-morbidities, pace of clinical decline, availability of surrogate decision makers, and provider practice patterns DNR policies - answer- 1) should be entered into pt's record with full documentation by the responsible physician about the pts prognosis and the pts agreement, or alternatively, the family's concern 2) DNR orders should require concurrence of another physician as standard policy 3) policies should specify that orders are reviewed periodically 4) pts with capacity must give their informed consent 5) for pts w/o capacity that incapacity must be thoroughly documented, along with the diagnosis, prognosis and fam consensus 6) if applicable, DNR orders should be consistent with advance directives, or if not the reason for those differences should be documented and explained. ****NEEDS TO BE RENEWED AT EVERY ADMISSION TO HOSPITAL (so has to be an order// doesn't count as a standing order)** if pt has advance directive that says they do not want extreme measures, then the dr can sign off on a DNR order of decision making for end of life care - answer- -pt (if able to speak/decide for themselves) -living will or healthcare power of attorney -fam closest to the pt comfort care - answer- in the name; no intervention is given/done that will cause discomfort, even if it may be in the pts best interest. (if pt has a fever and it turns out to be an infxn, you will tx the fever bc it makes them uncomforable, but you will not tx the infxn bc you're not tx issues that will help the pt get better, just what will make them more COMFORTable)// order has to be placed POLST (Physician Orders for Life-Sustaining Treatment) - answer- medical orders that are honored across all tx settings and are especially important to emergency responders in the community. -completed by the physician and the pt in the presence of a serious chronic illness -should be incorporated into medical orders on admission to the hospital or skilled nursing facility pt rights - answer- a competent pt has the right to refuse any tx pt without decision making capacity and their rights - answer- -some state laws allow a guardian to be appointed for all or some decisions -living wills, advance directives, durable powers of attorney, physician orders for life-saving tx for pts who were competent but for some reason or another are no longer considered competent pts who were never or not yet competent and their rights - answer- -law for "best interest"; parents and legal guardians of children have a legal obligation to make informed decisions based on the best interests of the pt - there are procedures in every state to petition the court on an emergent basis to evaluate and rule on what is in the best interest of the pt Patient Self-Determination Act of 1990 - answer- designed to encourage competent patients to consider what they would want in the event of a serious illness and to facilitate them to complete advance directives -all adults must be provided written information regarding an individual's rights under state law to make medical decisions, including the right to refuse tx and the right to formulate advance directives -providers must have written policies and procedures to INFORM all adult pts at initiation of tx of their right to execute an advanced directive and of the provider's policies on the implementation of that right, to DOCUMENT in the medical record whether an individual has executed an advanced directive, to NOT CONDITION care and tx or otherwise discriminate on the basis of whether a pt has executed an advance directive, to COMPLY with state laws on advance directives, and to PROVIDE info and education to staff and the community on advance directives General Adaptation Syndrome (GAS) stages - answer- stage 1: alarm stage 2: resistance or adaptation stage 3: exhaustion an alarm reaction is initiated by the.... - answer- hypothalamus reactive response to stress - answer- Physiologic response to a psychologic stressor It's not a physical stressor present anticipatory response to stress - answer- anticipates a disruption in homeostasis conditional response to stress - answer- associates a stimulus with danger; may cause PTSD or phobias affects of the combination of norepinephrine and epinephrine - answer- VASOCONSTRICTION: increased BP, pallor, increased sweat gland action, goosebumps, increased pupillary dilation, decreased GFR, nausea, stress ulcers effects of epinephrine - answer- bronchodilation, increased cardiac output, increased BP, more alert, increased muscle tone, vasodilation to skeletal muscles, increased lipolysis (increased circulating free fatty acids), glycogenolysis and gluconeogenesis (increased blood glucose) effects of cortisol on the body - answer- increased blood glucose, increased serum amino acids, delayed healing, stabilize cardiovascular system, increased gastric secretion, delayed allergic rxn, decreased WBC, atrophy of lymphoid tis