Podcast
Questions and Answers
Which condition is associated with acute gastrointestinal issues?
Which condition is associated with acute gastrointestinal issues?
What nursing management aspect is crucial during an emergency situation?
What nursing management aspect is crucial during an emergency situation?
Which assessment is key when managing clients with diabetic ketoacidosis (DKA)?
Which assessment is key when managing clients with diabetic ketoacidosis (DKA)?
Intra-abdominal hypertension can lead to which serious condition?
Intra-abdominal hypertension can lead to which serious condition?
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Which nursing practice is essential for ensuring compliance with legal principles in care provision?
Which nursing practice is essential for ensuring compliance with legal principles in care provision?
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What condition is characterized by the criteria of Risk, Injury, and Failure?
What condition is characterized by the criteria of Risk, Injury, and Failure?
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What should be included in the management plan for a client in renal failure?
What should be included in the management plan for a client in renal failure?
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Which of the following is not a high acuity condition mentioned?
Which of the following is not a high acuity condition mentioned?
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Which skill is considered of optimal importance when caring for critically ill clients?
Which skill is considered of optimal importance when caring for critically ill clients?
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What is a primary responsibility of nurses caring for critically ill clients?
What is a primary responsibility of nurses caring for critically ill clients?
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Which of the following conditions is categorized as critical?
Which of the following conditions is categorized as critical?
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What approach is emphasized in ICU management?
What approach is emphasized in ICU management?
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What is a potential risk for professionals caring for critically ill clients?
What is a potential risk for professionals caring for critically ill clients?
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Who shares co-responsibility for ICU management?
Who shares co-responsibility for ICU management?
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Which of the following is NOT part of the team dynamics in ICU care?
Which of the following is NOT part of the team dynamics in ICU care?
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What is a key consideration when managing critically ill patients according to ICU care practices?
What is a key consideration when managing critically ill patients according to ICU care practices?
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What is the primary reason for measuring intra-arterial blood pressure?
What is the primary reason for measuring intra-arterial blood pressure?
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Which condition is NOT an indication for hemodynamic monitoring?
Which condition is NOT an indication for hemodynamic monitoring?
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What complication is associated with the use of a pressure bag in invasive monitoring?
What complication is associated with the use of a pressure bag in invasive monitoring?
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What does a central venous pressure (CVP) monitoring primarily assess?
What does a central venous pressure (CVP) monitoring primarily assess?
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What is the primary purpose of the flush system in invasive monitoring?
What is the primary purpose of the flush system in invasive monitoring?
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What is an air embolism a possible complication of?
What is an air embolism a possible complication of?
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What role does the transducer serve in hemodynamic monitoring?
What role does the transducer serve in hemodynamic monitoring?
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What condition might result in decreased urine output that warrants hemodynamic monitoring?
What condition might result in decreased urine output that warrants hemodynamic monitoring?
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What is one of the primary benefits of Synchronized Intermittent Mandatory Ventilation (SIMV)?
What is one of the primary benefits of Synchronized Intermittent Mandatory Ventilation (SIMV)?
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Which condition may lead to increased lung compliance according to the respiratory information provided?
Which condition may lead to increased lung compliance according to the respiratory information provided?
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What may be a result of increased intrathoracic pressure during mechanical ventilation?
What may be a result of increased intrathoracic pressure during mechanical ventilation?
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What is the primary purpose of delivering a predetermined number of breaths at selected tidal volume?
What is the primary purpose of delivering a predetermined number of breaths at selected tidal volume?
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What complication can arise from the stimulation of antidiuretic hormone due to decreased venous return?
What complication can arise from the stimulation of antidiuretic hormone due to decreased venous return?
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Which factor increases the risk of oxygen toxicity in ventilated patients?
Which factor increases the risk of oxygen toxicity in ventilated patients?
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What is a potential hazard associated with using PEEP in ventilation?
What is a potential hazard associated with using PEEP in ventilation?
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In what scenario would Synchronized Intermittent Mandatory Ventilation (SIMV) be indicated?
In what scenario would Synchronized Intermittent Mandatory Ventilation (SIMV) be indicated?
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What is the primary role of nurse-educators in the context of patient care?
What is the primary role of nurse-educators in the context of patient care?
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Which component is NOT typically associated with advanced directives?
Which component is NOT typically associated with advanced directives?
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What best describes the role of case-managers in patient care?
What best describes the role of case-managers in patient care?
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Which of the following is an indication of brain death?
Which of the following is an indication of brain death?
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Which organ is NOT typically included in organ donation considerations?
Which organ is NOT typically included in organ donation considerations?
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What is the main focus of clinical nurse specialists in healthcare?
What is the main focus of clinical nurse specialists in healthcare?
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Which statement accurately reflects effective nursing care management?
Which statement accurately reflects effective nursing care management?
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What aspect is most critical in the discharge planning process managed by case-managers?
What aspect is most critical in the discharge planning process managed by case-managers?
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Study Notes
Critical Care Nursing
- Critical Care Nursing Concepts:
- Assess and teach patients and families about their needs
- Evaluate the effectiveness of teaching
- Teach colleagues
- Possess excellent interpersonal skills
- Advance directives and End-of-life decisions
- Resuscitation
- Informed consent
- Brain death:
- Whole-brain death: the permanent, irreversible cessation of functioning of all brain areas
- Complete loss of consciousness
- Absent corneal, oculovestibular, oropharyngeal, ventilatory reflexes
- Whole-brain death: the permanent, irreversible cessation of functioning of all brain areas
- Organ donation:
- Heart & lungs
- Kidneys
- Liver
- Corneas
- The more compromised the client, the more severe or complex are their needs.
- Involves collaboration of all personnel who provide care.
Nurse-Educators
- Assess patients’ and families’ learning needs
- Plan and implement teaching strategies to meet those needs
- Evaluate effectiveness of teaching
- Educate peers and colleagues
Nurse-Managers
- Act as administrative representatives of the units
- Ensure effective and quality nursing care is provided in a timely and fiscally sound environment
Case-Managers
- Manage comprehensive care of an individual patient
- Encompasses the patient’s entire illness episode, crosses all care settings, and involves all personnel providing care
- Involved in discharge planning and making referrals
- Identify community and personal resources
- Arrange for equipment and supplies needed by the patient on discharge
Clinical Nurse Specialists
- Participate in education and direct patient care
- Consult with patients and family members
- Collaborate with other nurses and health care team members to deliver high-quality care
Care of Critically Ill Clients
- Provide direct one to one client care
- Responsible for making life and death decisions
- At high risk of injury or illness from possible exposure to infections
- Communication skills are of optimal importance
Critical Conditions
- Any persons with life-threatening conditions
- Patients with:
- Acute Respiratory Failure
- AMI
- Cardiac Tamponade
- Severe Shock
- Heart Block
- Acute Renal Failure
- Poly Trauma, Multiple Organ Failure and Organ treatment such as drugs and mechanical support
Critically Ill Clients
- At high risk for actual or potential life-threatening health problems
- Require more intensive and careful nursing care
Multidisciplinary and Collaborative Approach to ICU Care
- Medical and Nursing Directors: co-responsibility for ICU management
- Team approach:
- Nurses, doctors, respiratory therapists, pharmacists
- Use of standard, protocol, guidelines for a consistent approach to all issues
- Dedication to coordination and communication for all aspects of ICU management
- Emphasis on research, education, ethical issues, patient advocacy
Team Dynamics
- Multidisciplinary team to effectively attain specified objectives.
- Intra-arterial blood pressure measurement
- Evaluate the effectiveness of cardiovascular function such as cardiac output and index.
Indications for Hemodynamic Monitoring
- Deficits or loss of cardiac function:
- Myocardial infarction
- Congestive heart failure
- Cardiomyopathy
- All types of shock:
- Cardiogenic shock
- Neurogenic shock
- Anaphylactic shock
- Decreased urine output from:
- Dehydration
- Hemorrhage
- G.I. bleed
- Burns or surgery
Specialized Equipment Needed for Invasive Monitoring
- CVP, pulmonary arterial catheter
- Flush system:
- Intravenous solution
- Tubing stop cocks
- Flush device providing continuous and manual flushing of the system
- Pressure bag maintained at 300mmHg pressure
- Transducer to covert pressure into an electrical signal
- Amplifier or monitor to increase the electrical signal for display on an oscilloscope
Complications of Hemodynamic Monitoring
- Local destruction with distal ischemia
- External hemorrhage
- Massive ecchymosis
- Dissection
- Air embolism
- Blood loss
- Pain
- Arteriospasm
- Infection
Central Venous Pressure (CVP)
- Pressure in the vena cava or right atrium
- Used to assess right ventricular function and venous blood return to the right side of the heart
Mechanical Ventilation
- Assists or controls breathing
- Types:
-
Positive-pressure ventilation (PPV):
- Pressure-controlled ventilation (PCV): ventilator delivers preset pressure to the lung at each breath.
- Volume-controlled ventilation (VCV): ventilator delivers preset volume of air with each breath.
-
Positive-pressure ventilation (PPV):
Hazards of Mechanical Ventilation
- Barotrauma: air escaping into the tissues of the lungs or chest wall.
- Volutrauma: injury to the alveoli.
- Ventilator-associated pneumonia (VAP): infection of the lungs.
- Atelectasis: collapse of the alveoli.
- Oxygen toxicity: damage to the lungs caused by high levels of oxygen.
- Pneumothorax: air in the space between the lungs and chest wall.
Ventilator Modes
- Assist-control ventilation (ACV): Provides breaths when the patient’s breathing is insufficient,
- Synchronized intermittent mandatory ventilation (SIMV): Allows patients to breathe at their own rate and volume spontaneously, while providing periodic mechanical breaths.
- Pressure support ventilation (PSV): Provides a continuous, assist-controlled ventilatory mode that helps to support spontaneous breathing.
- Continuous positive airway pressure (CPAP): Provides continuous flow of positive pressure to maintain lung inflation and increase oxygenation,
- Positive end-expiratory pressure (PEEP): Provides positive pressure to maintain lung inflation.
Considerations for Ventilator Use
- Monitor patient's respiratory status: to identify and adjust respiratory support as needed.
- Titrate ventilatory settings based on patient’s clinical condition.
- Monitor hemodynamic stability : for changes in blood pressure, heart rate, and urine output.
Nursing Care for Clients on Mechanical Ventilation
- Monitor for signs and symptoms of ventilator-associated pneumonia (VAP): such as fever, increased sputum production, and changes in respiratory rate and effort.
- Provide oral care: to prevent VAP.
- Turn and reposition the patient: to prevent atelectasis (collapse of the alveoli) or airway obstruction.
- Maintain adequate hydration : to improve lung function and decrease thick secretions.
Weaning the Patient from Mechanical Ventilation
- Gradual reduction of ventilator settings: to allow the patient to regain respiratory strength and assume more of the work of breathing.
- Assess the patient’s ability to breathe independently: to determine if the patient is ready for weaning.
- Monitor the patient’s response to weaning: to ensure that the patient is tolerating the decreased ventilatory support.
- Provide emotional support : to help the patient cope with the weaning process.
Nursing Management of Clients with Alterations in Metabolic GI, Liver Function
Acute GI Bleeding
-
Nursing Interventions:
- Assess for signs and symptoms of bleeding:
- Melena
- Hematemesis
- Hematochezia
- Abdominal pain.
- Assess for signs and symptoms of bleeding:
- Support and monitor airway, breathing, and circulation (ABCs).
- Monitor vital signs for a decrease in blood pressure and increase in pulse.
- Monitor laboratory values for changes in blood clotting.
- Administer medications, such as proton pump inhibitors, H2 blockers, or antacids.
- Provide fluid resuscitation to replace blood volume.
- Prepare the patient for possible endoscopy or surgery to stop bleeding.
Intra-abdominal Hypertension and Compartment Syndrome
-
Nursing Interventions:
- Monitor for signs and symptoms of intra-abdominal hypertension (IAH) and compartment syndrome:
- Abdominal distention.
- Decreased urine output.
- Increased respiratory rate.
- Decreased bowel sounds.
- Pain with palpation of the abdomen.
- Monitor vital signs for decreases in blood pressure and increases in heart rate.
- Monitor laboratory values for changes in blood clotting.
- Monitor for signs of organ dysfunction:
- Respiratory distress
- Oliguria
- Altered mental status
- Administer antibiotics to prevent infection.
- Patient may need treatment in a surgical ICU due to possible surgery for a condition such as decompression of the abdomen.
- Provide emotional support to the patient and their family
- Monitor for signs and symptoms of intra-abdominal hypertension (IAH) and compartment syndrome:
Liver Failure
-
Nursing Interventions:
- Monitor for signs and symptoms of liver failure:
- Jaundice
- Ascites
- Hepatic encephalopathy
- Coagulopathy
- Assess daily for changes in mental status, including signs of confusion or altered consciousness.
- Monitor vital signs for changes, including fever, hypotension, tachycardia, and tachypnea.
- Monitor laboratory values for liver function tests (LFTs) and blood clotting studies.
- Assess intake and output to monitor volume status and for signs of fluid overload.
- Administer medications, such as diuretics, lactulose, and vitamin K.
- Provide supportive care, including nutritional therapy, and fluid and electrolyte management.
- Monitor for signs and symptoms of liver failure:
Acute Pancreatitis
-
Nursing Interventions:
- Monitor for signs and symptoms of acute pancreatitis:
- Severe abdominal pain
- Nausea and vomiting
- Fever
- Tachycardia
- Hypotension
- Monitor vital signs for changes in blood pressure, pulse, respiratory rate, and temperature.
- Monitor laboratory values for changes in pancreatic enzymes (amylase and lipase).
- Assess pain and provide pain management.
- Provide IV fluid replacement: to help prevent dehydration.
- Monitor for potential complications: such as fluid overload, respiratory distress, and infection.
- Provide emotional support to the patient and their family,
- Monitor for signs and symptoms of acute pancreatitis:
Bariatric Surgery
-
Nursing Interventions:
- Provide nutritional counseling to the patient in order to support their weight loss,
- Monitor for signs and symptoms of complications from the surgery such as bleeding, infection, or leaking (anastomotic leak).
- Encourage ambulation to prevent DVT (deep vein thrombosis),
- Provide psycho-social support to the patient and family.
Nursing Management of Clients with Alterations in Elimination
Diabetic Ketoacidosis (DKA)
-
Nursing Interventions:
- Monitor for signs and symptoms of DKA:
- Hyperglycemia
- Polyuria
- Polydipsia
- Kussmaul respirations
- Acetone odor on breath
- Abdominal pain
- Nausea
- Vomiting
- Monitor vital signs for tachycardia, tachypnea, and hypotension.
- Monitor laboratory values for blood glucose, electrolytes, and ketones.
- Administer insulin to lower blood glucose.
- Provide IV fluids, such as normal saline, to rehydrate your body.
- Administer potassium to correct hypokalemia.
- Provide emotional support to the patient.
- Educate the patient about managing their diabetes and prevention of future DKA episodes.
- Monitor for signs and symptoms of DKA:
Renal Failure
-
Nursing Interventions:
-
Acute Renal Failure (ARF):
-
Causes of ARF:
- Decreased blood flow to the kidneys (prerenal failure)
- Damage to the kidneys (intrarenal failure)
- Blockage of the urinary tract (postrenal failure)
-
Monitor for signs and symptoms of ARF:
- Decreased urine output (oliguria or anuria)
- Fluid retention (edema)
- Elevated blood pressure
- Electrolyte imbalances
- Nausea and vomiting
- Weakness and fatigue
- Confusion and lethargy
- Monitor vital signs for changes in blood pressure, heart rate, respiratory rate, and temperature.
- Monitor laboratory values for electrolytes, BUN (blood urea nitrogen), creatinine, and urine output.
- Provide supportive care, including diet restrictions, fluid management, and medication management.
- Educate the patient about managing their renal failure.
-
Causes of ARF:
-
Chronic Renal Failure (CRF) / End Stage Renal Disease (ESRD):
-
Monitor for signs and symptoms of CRF:
- Fatigue
- Nausea and vomiting.
- Shortness of breath.
- Swelling in the legs, ankles, and feet.
- High blood pressure.
- Monitor vital signs for changes in blood pressure, heart rate, and respiratory rate.
- Monitor laboratory values for creatinine, BUN (blood urea nitrogen), electrolytes, and hemoglobin.
- Provide supportive care, including diet restrictions, fluid management, dialysis, and medication management.
- Educate the patient about managing their CRF and living with their disease
-
Monitor for signs and symptoms of CRF:
-
RIFLE Criteria for Diagnosis of ARF
-
Risk: Increased creatinine by 1.5 times from baseline
-
Injury: Increase in creatinine to two times baseline, or urine output less than 0.5 ml/kg/hr for six hours
-
Failure: Increase in creatinine to three times baseline, or a urine output of less than 0.5 ml/kg/hr for 12 hours
-
Loss: Complete loss of kidney function for more than four weeks
-
End-Stage Renal Disease (ESRD): Complete loss of kidney function for more than three months
Management of Renal Failure
-
Dialysis:
- Hemodialysis: Removes waste products and excess fluid from the blood.
- Peritoneal dialysis: Uses the lining of the abdominal cavity to filter the blood.
- Kidney Transplant: Replacement of a failing kidney with a healthy kidney from a donor.
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Description
Test your knowledge on essential nursing management strategies in critical care settings. This quiz covers acute conditions, diabetes management, and the responsibilities of nurses in the ICU. Evaluate your understanding of key concepts and practices necessary for providing high-quality care to critically ill patients.
