445.pdf/445.pdf/445.pdf, Exams of Nursing

Download 445.pdf/445.pdf/445.pdf and more Exams Nursing in PDF only on Docsity! 445 - Week 1 - High Acuity Nursing. admission to ICU (4 ways) - *Emergency department* - comes into ED = critical enough → straight to ICU *Operating room* (go to ICU after surgery) - planned (knows after surgery Pt will be sent to ICU) - unplanned (supposed to be fine after surgery but they did not recover) *Transfer from elsewhere in hospital* (4) - RRT - transfer following consult - planned transfer for a high-risk therapy (some drugs / meds make u unstable / risky, even tho they help u) - code (least desirable) *Direct admit *? ? ? What is it like to be an ICU or critically ill? - Noisy, scary, overwhelming Uncertainty about future Bottom line → what it's like & what Pt's remember is extremely dependent on nursing care what is ICU patient like? - Pt is acutely ill, unstable, & requires intensive Tx & monitoring that cannot be provided outside of ICU - mechanical ventilation - continuous vasoactive drug infusions ICU limits on extent of intended interventions? - NO limits on extent of intended interventions Some exceptions: - if hospital can not do a certain thing / therapy / procedure - they would be transferred to a dif hospital ICU examples of ICU patients - *Postoperative* or *acute respiratory failure* Pt's requiring *mechanical ventilator* support *Shock* or *hemodynamically unstable* Pt's receiving *invasive monitoring* &/or *vasoactive drugs* what does IMC stand for - intermediate medical care units what are IMC's for? - intermediate medical care units Intended for Pt's needing *close observation but NOT in need of life-saving, critical interventions* Able to manage those Pt's *too complex for traditional medical surgical unit* IMC's examples (don't need to know?) - Pt's with chronic comorbid conditions who develop acute severe medical or surgical illness ICU Priority 3 (don't need to know?) - Critically ill & unstable, with a reduced likelihood of recovery b/c of underlying disease or nature of acute illness ICU Priority 3 are there limits on extent of intended interventions? (don't need to know?) - May receive intensive Tx to relieve acute illness BUT, there are limits on therapeutic efforts may be set - such as no intubation or cardiopulmonary resuscitation ICU Priority 3 examples (don't need to know?) - metastatic malignancy complicated by infection cardiac tamponade airway obstruction ICU Priority 4 (don't need to know?) - Pt is generally not appropriate for ICU admission ICU Priority 4 admission determination? (don't need to know?) - Determination of admission should be made on an individual basis, under unusual circumstances, & at discretion of ICU director advantages of technology in the ICU (4) - Allows for *close monitoring *of Pt Provides a *programmed approach to decision making* Provides* programs to diagnose* Pt disorders Source of readily available *reference information* who belongs in an ICU (what is considered for placement) - *Health care needs* of Pt & *skill mix available* must be deciding factors Assignment of Pt's to units requires a close review of *available resources* Additional considerations must be given to* ethical, economic, & legal concerns* also *age* & *seriousness of illness* goal of ICU admission - a goal is to ensure that those Pt's requiring greatest level of care will be cared for in intensive care unit ICU Priority 4 examples - Pt's with peripheral vascular surgery Pt's with stable diabetic ketoacidosis Pt's with unconscious drug OD Pt's with terminal & irreversible illness facing immediate death what are severity scales? - models used to determine which Pt's will benefit most from intensive care services one code bed always remains open what are controversial variables in assignment of intensive care beds? (2) - age seriousness of illness disadvantages of technology in the ICU (2 - 3) - *Depersonalization of Pt* - difficulties arise when machines become focus of care of high-acuity Pt - technology may evoke fear in Pt's contribute to anxiety about recovery process - never go in room & go straight to equipment, talk to Pt & let tell what you're doing Suchman's Stages of Illness - restitution - what stage is it? - definition - stage 4 dx is accepted sadness & crying attempts to improve relationships with family & friends Suchman's Stages of Illness - resolution - what stage is it? - definition - stage 5 Pt's identity is changed Pt may openly participate in care Suchman's Stages of Illness - resolution - interventions - promote self-care & independence Suchman's Stages of Illness - restitution - interventions - assist Pt with problem solving Suchman's Stages of Illness - awareness - - interventions (2) - provide consistent nursing care do NOT argue with Pt Suchman's Stages of Illness - denial - interventions - nurse is noncritical clarify statements but do NOT stress reality Suchman's Stages of Illness - shock & disbelief - interventions - provide accurate information when asked communication requirements of family - Openness Honesty Direct Frequent Ongoing needs of family of Pt with high-acuity illness - Information Comfort Support Accessibility Assurance what to use to cope with acute illness - *Complementary & Alternative Therapies* - aromatherapy - therapeutic humor - massage therapy & therapeutic touch - guided imagery goal of educating the high-acuity Pt (2) - reduce stress promote comfort importance of Pt-nurse relationship - *facilitates trust *in nurse & will promote *security* & *facilitate learning* barriers to learning for the high-acuity Pt (4) - Condition-related fatigue Communication barriers what does it mean / stand for? - Consider *culture* Show* respect* *Assess & affirm* differences Show *sensitivity & self-awareness* Provide care with *humility* - (let them know u are human) palliative & cure? - Palliative does NOT mean we cannot cure u can have palliative care even if you're trying to cure at the same time barriers to palliative care (4) - Difficulty transitioning from a "cure perspective" Limited collaboration b/t physicians & nurses Inconsistent communication Fragmented care palliative care & cost? - Palliative care models allow needs of Pt's & families to be met in a cost-effective manner what does SPA stand for - stressors & sensory perceptual alterations it's all the alarms, noises, & beeps going on in room environmental stressors & sensory perceptual alterations (SPA) (4) causes? - Sensory overload Sensory deprivation Pain Loss of sleep palliative care - what type of approach/what types of health disciplines?? - what is it geared toward? - multidisciplinary approach - includes all health disciplines geared toward improving quality of life & relieving suffering environmental stimuli & unconscious Pt - Assessment of normal stimuli for unconscious Pt must be completed Nurse might need to consult a friend or family member about normal stimuli for Pt role of nurse for high - acuity Pt - *Assess Pt's normal environmental stimuli* - provide normal stimuli, if possible *Promote adequate rest & sleep* - privacy - quiet time - turning off lights *Reduce unnecessary environmental noise* - give meds, get vitals, etc. all at same time if possible so u don't have to interrupt them as much (make sure parameters are set but don't set alarms that don't need to be - don't have too small / uneeded alarms) answer to 'barriers to palliative care' - these barriers can be managed with education what is delirium - fluctuating awareness impaired ability to attend to environmental stimuli disorganized thinking BIG PROB IN ICU, esp for geriatric *risk factors* - big surgery - age Pt looks: - confused - withdrawn (not communicating) - acting weird (hanging from light fixture, pulling chest tube out)