Nursing and ICU Overview

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Questions and Answers

Which factor is NOT typically included in the nursing history prior to a physical examination?

Current management of illness

Social history

Emotional health (correct)

Health Status

What is the primary purpose of taking a nursing history?

To perform a comprehensive physical examination

To document patient treatments

To establish rapport with the patient and family (correct)

To identify the patient's family dynamics

Which is a specialized type of intensive care unit?

Post-operative recovery room

Accident and Emergency (A&E)

Medical Intensive Care Unit (MICU) (correct)

General Intensive Care Unit

Which component is NOT included in the psychological and social examination?

Past medical history Signup and view all the answers

Which type of intensive care unit is focused specifically on neonatal patients?

Neonatal Intensive Care Unit (NICU) Signup and view all the answers

What is the ideal nurse-to-patient ratio in a major teaching tertiary care ICU?

1:1 Signup and view all the answers

Which of the following professionals is NOT typically part of the allied services in an ICU?

Cardiac surgeon Signup and view all the answers

What should be actively monitored in a critical care unit?

Continuous health status Signup and view all the answers

What is a key feature of the design of an ICU?

Geographically distinct area with controlled access Signup and view all the answers

In a case of emergency, which of the following should be ready in an ICU?

Emergency trolley/crash cart Signup and view all the answers

What role do nurses play in the emotional care of ICU patients?

Helping patients express fear and grief Signup and view all the answers

What is a significant challenge faced in maintaining the ideal number of nurses in an ICU?

Inadequate hospital budget Signup and view all the answers

What impact does establishing partnerships during crises create in the ICU?

Strengthens bonds between nurses, patients, and families Signup and view all the answers

What is the adult dose range for Diazepam?

0.2 – 0.5 mg/Kg Signup and view all the answers

Which of the following patients should not receive Diazepam?

Myocardial infarction (MI) patients Signup and view all the answers

What is the adult dose for Ketamine in dissociative anaesthesia?

1-3 mg/kg IV Signup and view all the answers

What major role do Clinical Educators play in the ICU?

Ongoing education for ICU nurses Signup and view all the answers

Which of the following is NOT a responsibility of the ICU Ward Clerk?

Directing surgical procedures Signup and view all the answers

What is the primary focus of pastoral care in the ICU?

Ministering to spiritual needs Signup and view all the answers

Which of the following is considered an inotrope?

Dopamine Signup and view all the answers

What essential practice is necessary for infection control during procedures?

Hand washing before, during, and after the procedure Signup and view all the answers

Which condition would require critical care intervention due to hemodynamic instability?

Diabetic ketoacidosis Signup and view all the answers

Who is responsible for the daily communication and coordination within the critical care unit?

Most Responsible Physician (MRP) Signup and view all the answers

What is a necessary condition for drug ingestion to warrant critical care attention?

Hemodynamically unstable drug ingestion Signup and view all the answers

What complication may occur in patients with severe pancreatitis?

Respiratory insufficiency Signup and view all the answers

Which of the following indicates the need for critical care in gastrointestinal disorders?

Life threatening gastrointestinal bleeding Signup and view all the answers

In which scenario would seizures following drug ingestion be concerning?

If the patient is hemodynamically unstable Signup and view all the answers

What type of training do intensive care nurses receive?

Specialized training in critical care Signup and view all the answers

What severe condition can complicate diabetic ketoacidosis?

Respiratory insufficiency Signup and view all the answers

What is a primary responsibility of the ICU Nurse Manager?

Managing the ICU nursing staff and budget Signup and view all the answers

Which of the following procedures is used for emergency hemodialysis?

Central line catheter insertion Signup and view all the answers

What is the antidote for Fentanyl overdose?

Naloxone Signup and view all the answers

What does non-invasive hemodynamic monitoring evaluate?

Blood circulation and heart function Signup and view all the answers

What is Fentanyl primarily used for in the ICU?

Severe pain management Signup and view all the answers

Which of the following is NOT a reason for inserting a central venous catheter (CVC)?

Patient sedation Signup and view all the answers

How often should the culture test of health personnel, equipment, and infrastructures be conducted?

Monthly Signup and view all the answers

Which method of hemodynamic monitoring involves observations while the patient is supine?

Non-Invasive Monitoring Signup and view all the answers

Study Notes

Nursing History

A nursing history is conducted before a physical examination.
The purpose of a nursing history is to establish a rapport with the patient and family.
Elements of a nursing history include health status, cause of present illness, current management of illness, past medical history, social history, and perception of illness.

Includes the client's perception of illness, emotional health, physical health, spiritual health, and intellectual health.

ICU

ICUs are designated areas within a hospital for patients requiring sophisticated medical and nursing care.
Types of ICUs include general, medical, surgical, medical surgical, neonatal, special care nursery, pediatric, coronary, and cardiac surgery.

Design of an ICU

Should have controlled access with a single entry and exit.
Emergency exit points are required.
There should be no through traffic of goods or hospital staff.

Indications for Admission to the ICU

Patients with metastatic malignancy complicated by infection, cardiac tamponade, or airway obstruction.
Status epilepticus.
Severe head injury.
Hemodynamically unstable drug ingestion.
Drug ingestion with significantly altered mental status with inadequate airway protection.
Seizures following drug ingestion.
Life-threatening gastrointestinal bleeding.
Hepatic failure.
Severe pancreatitis.
Diabetic ketoacidosis complicated by hemodynamic instability, altered mental status, respiratory insufficiency, or severe acidosis.

Crisis Intervention and Stress Reduction

Partnerships are formulated during crises.
Bonds between nurses, patients, and families are stronger during hospitalization.
Nurses assist patients to express fear and identify their grieving patterns and provide avenues for positive coping.

Organization of an ICU

Nursing Staff: Highly trained critical care nurses are required in a tertiary care ICU. The ideal nurse-to-patient ratio is 1:1, but a 1:2 ratio is acceptable in some cases.
Allied Services: Respiratory services, nutritionists, physiotherapists, biomedical engineers, technicians, computer programmers, clinical pharmacists, social workers/counsellors, support staff, guards, and grade IV workers are all essential roles.

Prime Responsibilities of a Critical Care Nurse

Continuous monitoring.
Maintaining an emergency trolley/crash cart.
Providing efficient individualized care.

Team of Critical Care Unit

Physicians: The Most Responsible Physician (MRP) is in charge of the patient's care during hospitalization.
Nurses: Intensive care nurses are the minute-to-minute critical care providers, providing and coordinating most aspects of care delivery.
Respiratory Therapists: Respiratory therapists provide care for patients with breathing problems.

Common Drugs Used in Critical Care

Analgesics:
- Fentanyl: 600 times more effective than morphine, used in moder-ate and severe pain.
- Naloxone: Antidote for fentanyl.
Dissociative Anesthesia:
- Ketamine: Used for sedation.
- Propofol: Rapid arousal, used in neuro cases and patients with increased intracranial pressure.
Inotropes:
- Dopamine, dobutamine, nor-adrenaline: Used to increase heart contractility.
Thrombolysis:
- Diazepam, LMWX, heparin flush: Used to dissolve blood clots.

Infection Control

Hand washing before, during, and after procedures.
Maintaining sterility during procedures.
Use of disinfectants.
Weekly high wash.
Monthly culture tests for health personnel, equipment, and infrastructure.
Regular inspections by the infection control team.
Each shift CVP dressing.

Central Venous (CVC) or Central Line Catheter

Insertion of a catheter into a large vein through the subclavian, intra-jugular, or femoral vein for various purposes, including chemotherapy, antibiotics, total parenteral nutrition, and hemodialysis.

Hemodynamic Monitoring

Measures blood circulation and the heart's function.
Indicates the movement of blood throughout the body and the amount of oxygen the body needs.
Two types of hemodynamic monitoring:
- Non-invasive monitoring: Supine, mid-axillary position.
- Invasive monitoring: Direct measurement of pressures within the cardiovascular system using catheters.

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Description

This quiz covers essential topics in nursing history, psychological and social examinations, and the design and types of Intensive Care Units (ICUs). It addresses the processes involved in patient assessment and the specific requirements for caring for critically ill patients in a hospital setting.