TranxCN_NUR141_Prelim 1.pdf

TABLE OF CONTENTS Introduction For Critical Care...

TABLE OF CONTENTS Introduction For Critical Care - p.2 Quality and Safety in Critical Care Nursing - p.6 Types of Outcome - p.7 Critical Care Nurse and Research - p.8 Information and Communication Technologies in the CCU - p.10 Patient’s Safety in Critical Care - p.12 Rights of the Patient - p.14 Nursing Care of Clients with Altered Ventilatory Functions - p.16 Nursing Care of Clients with Altered Ventilatory Functions (Disease Focus) - p.27 BATCH 2025 TRANXCN TEAM DEPUTY HEADS Dangue, Dana Louise C. Tan, Juliana Rose C. TRANXCN TEAM NUR 141 Acuesta, Jenine M. Barreyro, Karlo Gabriel A. Carbonel, Carl Vincent A. Castillo, Angelo D. ACUTE AND Cosio, Mark Angelo B. De Ramos, Arianne D. Gaurano, Samantha Gabrielle C. Gemaguim, Flerisse Jan I. Grafilo, Kyla Isabel H. BIOLOGIC CRISIS Himan, Conn Sigfrid M. Javier, Natalie Faith M. Legaspi, Marcus V. Legaspi, Zerline A. Matutina, Laurie Jed A. Mojica, Mariel May A. Naval, Jann Danielle A. TranxCN: PRELIM RELEASE A.Y. 2024-2025 Novillos, Julliana Mikaela M. Ramirez, Margarette Keith N. Umali, Charles Joseph B. Guidelines: The Tranx CN is NOT FOR SALE and shall only be utilized by the bona fide nursing students from De La Salle medical and Health Sciences Institute. The students are permitted to download and print the Tranx CN. However, reproducing, imitating, altering or tampering any information on the transcriptions is strictly prohibited. Failure to abide by the Tranx CN guidelines will result in immediate termination of access to the transcriptions. Disclaimer: Please use at your own discretion. Tranx CN is not intended as a substitute for resource materials such as handouts, videos, and books provided by the college. All information on these transcripts is provided in good faith and is subjected to quality control. Regardless, the Tranx CN Team makes no representation or warranties of any kind regarding the accuracy, and completeness of any information in the transcripts. The College of Nursing Faculty/Professors are not liable for any mistakes or false information that may inadvertently be included in this transcript.  NUR 141: ACUTE AND BIOLOGIC CRISIS PRELIM RELEASE - NUR141 -BSN43 life-threatening illness or injury and involves multiple skills and specialties Has different specializations OUTLINE A. Critical Care Nursing CRITICAL ILLNESS a. Critical Care Condition where life cannot be sustained without b. Critical Illness invasive therapeutic interventions. c. Critical Care Nursing Not limited to IV insertion only (can be IJ catheter B. Scope of Critical Care Nursing insertion, intubation, megacode, tracheostomy a. Critically Ill Patients care b. Critical Care Nurse c. Critical Care Environment CRITICAL CARE NURSING d. Goals of Critical Care Nursing ​Field of nursing with a focus on the utmost care of C. Principles of Critical Care Nursing the critically ill or unstable patients following a. Efficacy extensive injury, surgery or life-threatening b. Appropriateness diseases. c. Availability a branch of nursing practice that deals with d. Timeliness life-threatening problems that is being supported e. Effectiveness with life saving measures. f. Safety Patient will die if you don’t do something g. Efficiency Extraordinary measures - go beyond what is h. Respect and care expected; maximize all resources i. Ratio ii. Qualifications SCOPE OF CRITICAL CARE NURSING iii. Roles The scope of critical care nursing is defined by the iv. Responsibility / Functions dynamic interactions of the critically ill v. Skill patient/family , the critical care nurse and the D. Standard of Critical Care Nursing Practice critical care environment to bring about optimal E. Development of Critical Care Nursing in the PH patient outcomes through nursing proficiency in an F. Levels of Critical Care Provisions within the PH environment conducive to the provision of this a. Level 1 highly specialized care (CCNAPI, 2014) b. Level 2 c. Level 3 CRITICAL ILL PATIENTS G. Categories of Critical Care Units Are those patients who are at high risk for actual or a. Age group potential life-threatening health problems and they b. Specialty are highly vulnerable, unstable and complex, H. System Operation og Critical Care Units thereby requiring intense and vigilant nursing care. a. Open System Nurses are needed 24/7 in ER. OR, ICU for b. Closed System intensive monitoring I. Physical Design and Equipment Requirements of CCU CRITICAL CARE NURSE a. Layout of ICU A licensed professional nurse who is responsible b. Three Zone Area for ensuring that all critically ill patients and their J. Human Resource Requirements, Support and families receive optimal care. Training Even if the patient is near death the nurse must CRITICAL CARE NURSING provide high quality of care to have dignified death CRITICAL CARE Critical Care (Medicine) is the multidisciplinary CRITICAL CARE ENVIRONMENT healthcare specialty that cares for patients with A specially equipped area designed for the acute, life-threatening illness or injury. treatment of patients with sudden life-threatening Critical Care (Intensive Care) is a healthcare conditions. specialty that cares for patient with acute, ICU set up is not the same as ward set up; modifying the room affects the output of the quality ACUESTA, DANGUE, DE RAMOS, GAURANO, GRAFILO, MOJICA, NAVAL, NOVILLOS 2 of 42 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion.  NUR 141: ACUTE AND BIOLOGIC CRISIS PRELIM RELEASE - NUR141 -BSN43 of management; adjust to compensate the needs Requires adequate knowledge and in-depth of patient observation of the patient's progress during the different stages of the disease and the diagnoses, GOALS OF CRITICAL CARE NURSING deviations, and readiness to act during the different To promote optimal delivery of safe and quality stages of the disease. care to the critically ill patients and their families by For example, if CPR is not performed within five providing highly individualized care so that the minutes of the arrest, a patient with cardiac arrest physiological dysfunction as well as the can lose his life. psychological stress in the ICU are under control; Prioritization is needed / timebounded Not only to patients but also to the family To care for the critically ill patients with a holistic EFFECTIVENESS approach, considering the patient’s biological, The degree of care and interventions are rendered psychological, cultural and spiritual dimensions in the correct manner to achieve the desired or (anointing of the sick) regardless of diagnosis or predicted patient outcome. clinical setting; Nurse's knowledge and skills for proper nursing To use relevant and up-to-date knowledge, caring diagnosis of the patient and efficient operation of attitude and clinical skills, supported by machine/gadgets, administration of treatment appropriate technology for the prevention, early therapies, carrying out diagnostic procedure, detection and treatment of complications to continuous monitoring, documentation, detection facilitate recovery. of deviations and taking necessary action. For prevention, early detection, treatment of Focus on the quality of an output as a nurse complications; for better chances of survivability To provide palliative care (reduce pain and SAFETY discomfort) to the critically ill patients in situations Risk of interruption of the care-environment can be where their health status is progressing to eliminated for patients and others including health unavoidable death, and to help the patients and care providers. families go through their painful sufferings. adherence to the protocol standards of critical care, which have been established and modified PRINCIPLES CRITICAL CARE NURSING based on research conducted or available research EFFICACY into various aspects of safety such as the physical The extent to which care, and nursing interventions care environment, therapies, and procedure, etc. have achieved the project or desired patient Not only the safety of patient but also the HCP outcome. Reverse the complication; provide patient outcome EFFICIENCY like dignified death or post mortem care Depends on the relationship between outcomes and resources used for care, e.g., the level of APPROPRIATENESS competence of care providers, availability of Care and intervention rendered are relevant to the technology needed to rescue/treat the patient, clinical needs of the patient. availability of needed equipment, supplies, Patient centered / individualized care; follow medications, appropriate communication channels protocols like clinical pathway guidelines and effective communication skills. A well-established critical care system that AVAILABILITY provides collaborative, dedicated, and Degree of appropriate care and intervention to compassionate care. meet the needs of the patient and family. (i.e., the Economical resources; being resourceful because critical care units are properly staffed and of limited resources; who will be prioritized and equipped). what to do if unavailable Not only focus on resources but also in staffing RESPECT AND CARE TIMELINESS Patients and family members are involved in The extent to which care, and intervention is making decisions about care and its provided to the patient, family within the implementation; prescribed time. ACUESTA, DANGUE, DE RAMOS, GAURANO, GRAFILO, MOJICA, NAVAL, NOVILLOS 3 of 42 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion.  NUR 141: ACUTE AND BIOLOGIC CRISIS PRELIM RELEASE - NUR141 -BSN43 We must listen carefully to the customer's Supervises patient care and ancillary personnel concerns with sensitivity and respect individual Supports patient adaptation, restores health, and differences in their expression. preserves the patient's rights, including the right to The aim is to promote quality of life rather than just refuse treatment survival. We can ensure this by helping the patient No discrimination to gain control of his or her care through self-care decisions and gradual involvement in care SKILL activities. Admission, Transfer and Discharge of patient Bathe and suction patient if low GCS already; they Bedside Safety (call bell and side rails) have rights regardless if patient is intubated Bedside and Patient Care Planning Documentation RATIO ○ Observation Chart ICU nurse-patient ratio 1:1 for ventilated cases ○ Fluid Balance Chart (high acuity) and 1:2 for other cases. ○ Care Plan 1:2 to 1:3 nurse patient ratios are acceptable for ​Respiratory Care (Airway and Breathing) less seriously sick patients. ○ Airway Management ○ Manual Ventilation QUALIFICATIONS ○ Care of Endotracheal / Tracheostomy tube Should be a registered nurse (RN) ○ Respiratory Support Should preferably have critical-care training course ○ Ventilation or orientation that includes essential ○ Extubation (doctors extubate if patients alive Preferably because it can be trained through but nurses can do it for post mortem care) experience Neurological Care (Disability) ○ Level of Consciousness (AVPU / GCS) ROLES ○ Sedation and analgesia Care provider: Helps the client to obtain Nutritional Care necessary care and supports the basic needs and ○ Enteral Nutrition comprehensive direct care to the patient and ○ Glycemia Control (if fixed HR is ordered no family. need for sliding scale unless ordered) Educator: Provide education based on the Psychosocial / Spiritual Care patient's needs and severity of the condition. Infection Control Also the family teach them health education; Laboratory Investigations prognosis and diagnosis the doctor discuss them nurses doesn't initiate but only reiterate STANDARDS OF CRITICAL CARE NURSING Manager: Coordinates the care provided by PRACTICE various health care. The critical care nurse functions in accordance with Advocate: Protects the patient's rights legislation, common laws, organizational DPA or data privacy act regulations and by-laws, which affect nursing practice. RESPONSIBILITY / FUNCTION The critical care nurse provides care to meet Critical-care nurse will perform actions listed below: individual patient needs on a 24-hour basis. Assesses and implements treatment for patient The critical care nurse practices current critical responses to life-threatening health problems care nursing competently. Provides direct measures to resuscitate, if The critical care nurse delivers nursing care in a necessary way that can be ethically justified. Patient will not be admitted is there is no problem; The critical care nurse demonstrates accountability risk factors can turn into an active problem for his/her professional judgment and actions. Uses independent, dependent, and interdependent The critical care nurse creates and maintains an interventions to restore stability, prevent environment which promotes safety and security of complications, and achieve and maintain optimal patients, visitors and staff. patient responses The critical care nurse masters the use of all Until what extent you can recover but not good as essential equipment, available services and new supplies for immediate care of patients. Provides health education to the patient and family ACUESTA, DANGUE, DE RAMOS, GAURANO, GRAFILO, MOJICA, NAVAL, NOVILLOS 4 of 42 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion.  NUR 141: ACUTE AND BIOLOGIC CRISIS PRELIM RELEASE - NUR141 -BSN43 The critical care nurse protects the patients from Medical developing environmental induced infection. Surgical The critical care nurse utilizes the nursing process Cardio-thoracic in an explicit systematic manner to achieve the Cardiac goals of care. Respiratory The critical care nurse carries out health education Neurosurgical for promotion and maintenance of health. Trauma The critical care nurse acts to enhance the professional development of self and others. SYSTEM OPERATION OF CRITICAL CARE UNITS OPEN SYSTEM DEVELOPMENT OF CRITICAL CARE NURSING IN The admitting and other attending doctors dictate THE PHILIPPINES management, change management or perform Former First Lady Imelda Marcos spoke about procedures without consultation or communication eradicating the country’s top 3 killers (heart with a Critical Care Specialist. disease) which prompted in the creation of Philippine Heart Center (PHC) which were CLOSED SYSTEM inaugurated in February 14, 1975. There is a multi-disciplinary team of specially In February 1977, CRITICAL CARE NURSES trained critical care staff ASSOCIATION OF THE PHILIPPINES INC. Management is coordinated by a qualified Critical (CCNAPI) were founded by Amelia Baldovino – Care Specialist. The critical / intensive care Lopez. CCNAPI aims to became an instrument in specialist has clinical and administrative assisting the hospitals outside metropolitan areas responsibility. in providing various training programs relevant to critical care practice. PHYSICAL DESIGN AND EQUIPMENT REQUIREMENTS OF A CCU LEVELS OF CRITICAL CARE PROVISIONS WITHIN LAYOUT OF AN ICU THE PHILIPPINES Should allow rapid access to relevant acute areas LEVEL 1 Station is at the center to see what is happening in Small district hospitals the patients Provide immediate resuscitation & short-term Available, open, round-the-clock communication cardiorespiratory support lines between departments MAJOR ROLE: Monitor & prevent complications of Safe transport of critically-ill patients “at-risk” MS patients Single entry and exit point with receptionist (triage) Areas dedicated to public reception, patient LEVEL 2 management, and support services Larger general hospitals Total floor area = 2.5 – 3 times the area devoted to Provide a high standard of general intensive care patient care Has MICU to cater unstable, acute and ICU rooms are bigger than regular rooms to life-threatening cases accommodate machines and devices connected to patient LEVEL 3 Major tertiary referral hospital THREE ZONE AREA Provide all aspect of intensive care management Patient Care Zone for indefinite period ○ Single room for isolation Different specializations that manage ○ Suitable and safe air quality (HEPA filter) multidisciplinary management and referals ○ Adequate and appropriate lighting for clinical CATEGORIES OF CRITICAL CARE UNITS observation AGE GROUP ○ Patient should be able to be seen at all times Neonatal Inside patient rooms Pediatric Adult Clinical Support Zone ○ Adequate space for staff interaction, SPECIALTY mentoring, and socialization ACUESTA, DANGUE, DE RAMOS, GAURANO, GRAFILO, MOJICA, NAVAL, NOVILLOS 5 of 42 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion.  NUR 141: ACUTE AND BIOLOGIC CRISIS PRELIM RELEASE - NUR141 -BSN43 Staff zone Unit Support Zone Stock room; where devices are stored as well as linens and pantry HUMAN RESOURCE REQUIREMENTS, SUPPORT, AND TRAINING TRAINING OF NURSES FOR CRITICAL CARE SERVICE Orientation Program / Preceptorship and Mentoring program In-Service Training Program Critical Care Nursing Program (Post-Graduate Specialty Program) ○ Post Graduate Courses ○ Certification Courses ○ Continuing Professional Education (CPE) ACUESTA, DANGUE, DE RAMOS, GAURANO, GRAFILO, MOJICA, NAVAL, NOVILLOS 6 of 42 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion.  NUR 141: ACUTE AND BIOLOGIC CRISIS PRELIM RELEASE - NUR141 -BSN43 I PI Qualitative research Intervention Phenomenon of aims to understand the Exposure Interest how and why of certain OUTLINE What do you behaviors, decisions, want to and individual A. Evidence Based Nursing Steps promote experiences. Therefore, B. PICO an a. Patient intervention/exposure b. Intervention per se is not always c. Comparison evident in qualitative d. Outcome research questions EVIDENCE - BASED NURSING STEPS C D The theoretical 1. Ask question Comparison Design framework used in 2. Search Existing qualitative research will 3. Critically appraise Practice determine the research method that is used. As 4. Implement inferential statistics are 5. Evaluate not used in qualitative Basis for research for maintaining or divulging / research, details of the contracting existing program or protocols study design will help to make decisions PICO about robustness of the PEOPLE, POPULATION, OR PROBLEM study and analysis. In Patient, Population, or Problem addition, this might increase the detection How would you describe a group of patients similar of qualitative studies in to yours? What are the most important the databases in which characteristics of the patient? titles and abstracts are unstructured. INTERVENTION Intervention, prognostic factor, or exposure O E Qualitative research has Which main intervention, prognostic factor, or Outcome Evaluation the same end result as What did you quantitative research exposure are you considering? What do you want to find out methods: outcome do for the patient? measures. These differ depending on the COMPARISON research question and What is the main alternative to compare with the might contain more intervention? unobservable and What is the existing idea / practice that were taught subjective constructs when compared to quantitative research OUTCOME (e.g. attitudes and What can you hope to accomplish, measure, views and so forth), so improve or affect? What are you trying to do for the evaluation was deemed patient? more suitable. R Three research types PICO SPIDER JUSTIFICATION Research Type could be searched for: qualitative, quantitative, P S Smaller groups of and mixed methods. Population Sample participants tend to be Problem used in qualitative research than quantitative research, so this term was deemed more appropriate ACUESTA, DANGUE, DE RAMOS, GAURANO, GRAFILO, MOJICA, NAVAL, NOVILLOS 7 of 42 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion.  NUR 141: ACUTE AND BIOLOGIC CRISIS PRELIM RELEASE - NUR141 -BSN43 to tie them together into a cohesive unit that must be adhered to for every patient, every time. ○ Eg. Fall Risk Assessment tool, Catheter OUTLINE associated Infection Control Tool (CAUTI) etc. A. Clinical Practice Guidelines To make sure no complications will happen B. Quality and Safety Monitoring a. Care Bundles Checklist CONTINUOUS QUALITY IMPROVEMENT b. Continuous Quality Improvement Continuous Quality Improvement (CQI) is a c. Plan, Do, Check, Act progressive incremental improvement of processes, safety, and patient care. The goal of CLINICAL PRACTICE GUIDELINES CQI may include improvement of operations, This serves as a framework for clinical decisions outcomes, systems processes, improved work and supporting best practices. Clinical practice environment, or regulatory compliance. Process guidelines are statements that include improvement may be "gradual" or "breakthrough" in recommendations intended to optimize patient care. nature They are informed by a systematic review of ○ Eg. decreasing the number of episodes of evidence, and an assessment of the benefits and incontinence or decreasing pain levels for one harms of alternative care options. client through collaboration between nursing, CPGs should follow a sound, transparent occupational therapy, and medical services methodology to translate best evidence into clinical Existing guidelines of institutions practice for improved patient outcomes. Additionally, evidence-based CPGs are a key aspect of patient-centered care. PLAN, DO, CHECK, ACT Clinical practice guidelines should be developed using rigorous evidence-based methodology with the strength of evidence for each guideline explicitly stated: ○ Clinical practice guidelines should be feasible, measurable, and achievable. SMART ○ Clinical performance measures may be developed from clinical practice guidelines and used in quality improvement initiatives. When these performance measures are incorporated into public reporting, accountability, or pay for performance programs, the strength of evidence and magnitude of benefit should be sufficient to justify the burden of implementation. ○ In the clinical setting, implementation of clinical practice guidelines should be prioritized to those that have the strongest supporting evidence, and the most impact on patient population morbidity and mortality. ○ Research should be conducted on how to effectively implement clinical practice guidelines, and the impact of their use as quality measures. QUALITY AND SAFETY MONITORING CARE BUNDLES CHECKLIST It has the appearance of a checklist with specific elements that make it unique. Well established best practices, performed uniformly, making treatment and patient outcomes reliable. A care bundle aims ACUESTA, DANGUE, DE RAMOS, GAURANO, GRAFILO, MOJICA, NAVAL, NOVILLOS 8 of 42 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion.  NUR 141: ACUTE AND BIOLOGIC CRISIS PRELIM RELEASE - NUR141 -BSN43 IMPLEMENTATION AND TRANSLATION OF OUTLINE RESEARCH FINDINGS A. Nurses’ Role as Part of Research Once research findings are obtained, nurses are key a. Clinical Expertise and Insight to implementing new evidence-based practices b. Research Design and Planning within the ICU. c. Data Collection and Management They help translate research outcomes into clinical d. Patient Advocacy and Ethical Oversight protocols and educate their peers about these new e. Implementation and Translation of Research practices. Findings f. Collaboration and Interdisciplinary Communication g. Leadership and Mentorship NURSES’ ROLE AS PART OF RESEARCH TEAM EXPERTISE AND INSIGHT Nurses provide valuable clinical insights that help identify relevant research questions. Their hands-on experience in patient care allows them to recognize gaps in current practices and areas where evidence is lacking, which can guide the focus of research projects. Based from RLE and duties; by the book is different from onsite COLLABORATION AND INTERDISCIPLINARY RESEARCH DESIGN AND PLANNING COMMUNICATION Nurses collaborate with the research team in Nurses facilitate communication between different designing studies, ensuring that the research members of the research team, including protocols are practical and applicable in the ICU physicians, statisticians, and other healthcare environment. professionals. They contribute to the development of protocols Their ability to coordinate effectively ensures that that align with patient safety, care standards, and the research progresses smoothly and that all team ethical guidelines. members are informed. DATA COLLECTION AND MANAGEMENT LEADERSHIP AND MENTORSHIP Nurses play a crucial role in the collection and Experienced nurses often take on leadership roles management of data. within research projects, guiding less experienced Their responsibilities include administering staff and fostering a culture of evidence-based interventions, monitoring patients, and ensuring the practice. accuracy and integrity of data. They may also mentor other nurses in research Their familiarity with electronic health records methodologies and critical thinking skills (EHRs) and other technologies enhances the efficiency of data collection. ROLE & PATIENT / RESEARCH ADVOCACY RESEARCH ADVOCACY PATIENT ADVOCACY AND ETHICAL OVERSIGHT PARTICIPANT Nurses ensure that patients and their families ADVOCACY understand the research process, thus facilitating informed consent. Clinical Nurse Care and Carry out They also monitor patients for adverse events and Application of advocacy for the procedures advocate for their rights and well-being throughout research to our patient rights and consistent with patients well-being the research plan, the study, ensuring that ethical standards are throughout the and/or reporting maintained. research process symptoms and ACUESTA, DANGUE, DE RAMOS, GAURANO, GRAFILO, MOJICA, NAVAL, NOVILLOS 9 of 42 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion.  NUR 141: ACUTE AND BIOLOGIC CRISIS PRELIM RELEASE - NUR141 -BSN43 side effects that may be important to the research questions Clinical Trials Keeps in mind Works closely Nurse / what is the best with or for the Coordinator for the patient principal Complications (benefits investigator to outweigh the risk) successfully and ethically conduct the research Nurse Primary Anticipates Implements Investigator possible conflict rigorous and between what is quality research best for the design and patient and what implementation, is best for the conducted in an research ethical manner ACUESTA, DANGUE, DE RAMOS, GAURANO, GRAFILO, MOJICA, NAVAL, NOVILLOS 10 of 42 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion.  NUR 141: ACUTE AND BIOLOGIC CRISIS PRELIM RELEASE - NUR141 -BSN43 patient or via review of tests and images collected remotely. Newer technologies, such as mobile device applications, allow for a wider range of OUTLINE telehealth possibilities Video conferencing A. Advance Monitoring / Telehealth a. Synchronous Telehealth ELECTRONIC MEDICAL RECORD / CLINICAL b. Asynchronous Telehealth INFORMATION SYSTEM c. Remote Monitoring Clinical Information System (CIS) is a B. Electronic Medical Record / Clinical Information computer-based system that is meant to gather, System store, and alter clinical data on patients. These a. Computerized Provider Order Entry (CPOE) systems may be used at single locations or across with Clinical Decision Support System entire healthcare systems. b. Handheld Technology Also known as Health Information System (HIS) c. Barcode Scanning for Meds Administration where all data are stored in a computer d. Computer on Wheels ADVANCE MONITORING / TELEHEALTH COMPUTERIZED PROVIDER ORDER ENTRY (CPOE) Telehealth is the use of a technology-based virtual WITH CLINICAL DECISION SUPPORT SYSTEM platform to deliver various aspects of health application that allows health care providers to use information, prevention, monitoring, and medical a computer to directly enter medical orders care. electronically in inpatient and ambulatory settings, replacing the more traditional order methods of SYNCHRONOUS TELEHEALTH paper, verbal, telephone, and fax. Synchronous refers to the delivery of health Pattern through the use on an app; once doctor information in real time. This allows for a live orders something it will notify the nurses discussion with the patient or provider to deliver medical expertise. Another type of live (or synchronous) telemedicine visit is a facilitated virtual visit (FVV). An example of a facilitated virtual visit occurs when the patient is located at an accessible site (ie, clinic ) where diagnostic equipment is available, and the medical provider is at a distant site. A telefacilitator (ie, medical assistant, nurse, etc) gathers objective measures using equipment (ie, digital stethoscope, thermometer, pulse oximeter, etc) and transmits this data to the provider. Doctors can still access results of labs even if they at home ASYNCHRONOUS TELEHEALTH HANDHELD TECHNOLOGIES Asynchronous telemedicine refers to the Point of Care Tests (POCT) is a clinical laboratory "store-and-forward" technique. In contrast, a patient testing conducted close to the site of patient care or physician collects medical history, images, and where care or treatment is provided pathology reports and then sends them to a All test are done at the same time in one machine; specialist physician for diagnostic and treatment results are out in minutes expertise. If there are many samples it can mix with other In-house setting (HIS) patients sample REMOTE MONITORING Finally, remote patient monitoring involves continuous evaluation of a patient's clinical status, whether through direct video monitoring of the ACUESTA, DANGUE, DE RAMOS, GAURANO, GRAFILO, MOJICA, NAVAL, NOVILLOS 11 of 42 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion.  NUR 141: ACUTE AND BIOLOGIC CRISIS PRELIM RELEASE - NUR141 -BSN43 BARCODE SCANNING FOR MEDS ADMINISTRATION Barcode in the wristbands contains the list of medications COMPUTER ON WHEELS Only the nurses has the access; on the cabinets it has emergency drugs View lab results, diagnostics and charting ACUESTA, DANGUE, DE RAMOS, GAURANO, GRAFILO, MOJICA, NAVAL, NOVILLOS 12 of 42 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion.  NUR 141: ACUTE AND BIOLOGIC CRISIS PRELIM RELEASE - NUR141 -BSN43 syringes, cups and basins. Do this in the area where medicines and supplies are set up. ○ Take extra care with patients who take OUTLINE medicines to thin their blood. A. Four Domain of a Patient Safety Program ○ Record and pass along correct information a. 1st Domain about a patient’s medicines. Find out what b. 2nd Domain medicines the patient is taking. Compare those c. 3rd Domain medicines to new medicines given to the d. 4th Domain patient. Make sure the patient knows which e. 5th Domain medicines to take when they are at home. Tell B. Ethical and Legal Consideration in the Case of the patient it is important to bring their Critically Ill up-to-date list of medicines every time they a. Ethical Principles in Critical Care Nursing visit a doctor b. Legal and Ethical Issue sin Critical Care Use alarms safely Nursing ○ Make improvements to ensure that alarms on C. Scope of Nursing Practice Based on RA 9173 medical equipment are heard and responded a. Section 28: Scope of Nursing to on time. Prevent infection FOUR DOMAINS OF A PATIENT SAFETY PROGRAM ○ Use the hand cleaning guidelines form the Centers for Disease COntrol and Prevention or the World Health Organization. Set goals for improving hand cleaning. Use the goals to improve hand cleaning. ○ Use proven guidelines to prevent infections that are difficult to treat. ○ Use proven guidelines to prevent infection of the blood from central lines. ○ Use proven guidelines to prevent infection after surgery. ○ Use proven guidelines to prevent infections of the urinary tract that are caused by catheters. Identify patient safety risks ○ Find out which patients are most likely to try to commit suicide. Prevent mistakes in surgery ○ Make sure that the correct surgery is done on the correct patients and at the correct place on the patient’s body. 1ST DOMAIN: Patient Safety Regulations ○ Mark the correct place on the patient’s body Identify patients correctly where the surgery is to be done. ○ Use at least 2 ways to identify patients. For ○ Pause before the surgery to make sure that a example, use the patient’s name and date of mistake is not being made. birth. This is done to make sure that each patient gets the correct medicine and 2ND DOMAIN: Responding to Adverse Effects treatment. While patient safety regulations address hazards ○ Make sure that the correct patient gets the that are believed to be universal in healthcare (eg. correct blood when they get a blood requiring confirmation of patient identification prior transfusion. to administering medications), investigating Improve staff communication adverse events and implementing corrective ○ Get important test results to the right staff actions are opportunities to address issues that person on time. may be organization specific. Use medicines safely What intervention to control or minimize effects ○ Before a procedure, label medicines that are not labeled. For example, medicines in ACUESTA, DANGUE, DE RAMOS, GAURANO, GRAFILO, MOJICA, NAVAL, NOVILLOS 13 of 42 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion.  NUR 141: ACUTE AND BIOLOGIC CRISIS PRELIM RELEASE - NUR141 -BSN43 3RD DOMAIN: Patient Safety Best Practices 4. Fidelity and veracity There are many approaches to improving patient Fidelity - loyalty to what you say safety that are not required by regulation, and not Veracity - truth telling implemented as a direct response to an adverse event. They are good ideas, with strong evidence Legal and Ethical Issue sin Critical Care Nursing to support their effectiveness in preventing errors 1. End-of-life issues and avoiding complications. Many of these best E.g. patients relative request to remove tube; it was practices are appropriate in a critical care setting. raised to the ethical board but was not approved; ○ Teamwork the patient’s family will b the one to deflate the ○ Simulation balloon in the ambulance on the way home taught ○ Critical Care Staffing by the doctor; they will sign HAMA ○ Telemedicine What is the best practice to apply in the insitution 2. Informed consent Consent for procedure or operation 4TH DOMAIN: Pay-for-Performance and Public 3. Advance directives Reporting What you want to happen if you don’t have the Pay-for-performance is a new approach for driving capacity to decide improvement in medical care by using financial 4. Use of restraints incentives to ireward hospitals that perform well on Be careful this can cause false imprisonment if not pre-established safety and quality measures. properly documented Payments, leaves, increase salary to promote and enhance performance like a reward system SCOPE OF NURSING PRACTICE BASED ON RA 9173 5TH DOMAIN: Innovative and Research Section 28: Scope of Nursing Excerpt from the Institute of Medicine Report “To A person shall be deemed to be practicing nursing Err is Human” within the meaning of this Act when he/she singly ○ Why Do Errors Happen? “The common initial or in collaboration with another, initiates and reaction when an error occurs is to find and performs nursing services to individuals, blame someone. However, even apparently families and communities in any health care single events or errors are due most often to setting. It includes, but not limited to, nursing care the convergence of multiple contributing during conception, labor, delivery, infancy, factors. Blaming an individual does not change childhood, toddler, preschool, school age, these factors and the same error is like to adolescence, adulthood, and old age. As recur. Preventing errors and improving safety independent practitioners, nurses are primarily for patients require a systems approach in responsible for the promotion of health and order to modify the conditions that contribute prevention of illness. As members of the health to errors. People working in health care are team, nurses shall collaborate with other health among the most educated and dedicated care providers for the curative, preventive, and workforce in any industry. The problem is not rehabilitative aspects of care, restoration of bad people; the problem is that the system health, alleviation of suffering, and when needs to be made safer.” recovery is not possible, towards a peaceful Errors in medication cannot be eradicated but it death. can be minimized. ○ Provide nursing care through the utilization of the nursing process. Nursing care ETHICAL AND LEGAL CONSIDERATION IN THE includes, but not limited to, traditional and CASE OF CRITICALLY ILL innovative approaches, therapeutic use of self, executing health care techniques and Ethical Principles in Critical Care Nursing procedures, essential primary health care, 1. Autonomy and beneficence comfort measures, health teachings, and Autonomy - self rights patient decide for administration of written prescription for themselves treatment, therapies, oral topical and parenteral Beneficence - do good to others medications, internal examination during labor in the absence of antenatal bleeding and 2. Nonmaleficence - do no harm delivery. In case of suturing of perineal 3. Justice - fairness to all ACUESTA, DANGUE, DE RAMOS, GAURANO, GRAFILO, MOJICA, NAVAL, NOVILLOS 14 of 42 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion.  NUR 141: ACUTE AND BIOLOGIC CRISIS PRELIM RELEASE - NUR141 -BSN43 laceration, special training shall be provided according to protocol established ○ establish linkages with community resources and coordination with the health team; ○ Provide health education to individuals, families and communities; ○ Teach, guide and supervise students in nursing education programs including the administration of nursing services in varied settings such as hospitals and clinics; undertake consultation services; engage in such activities that require the utilization of knowledge and decision-making skills of a registered nurse; and ○ Undertake nursing and health human resource development training and research, which shall include, but not limited to, the development of advanced nursing practice ACUESTA, DANGUE, DE RAMOS, GAURANO, GRAFILO, MOJICA, NAVAL, NOVILLOS 15 of 42 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion.  NUR 141: ACUTE AND BIOLOGIC CRISIS PRELIM RELEASE - NUR141 -BSN43 5. When disclosure of material information to patient will jeopardize the success of treatment, in which case, third party disclosure and OUTLINE consent shall be in order; B. RIGHT OF THE PATIENT 6. When the patient waives his right in writing. a. Right to Appropriate Medical Care and 7. When his mental or physical condition is in Humane Treatment. controversy and the appropriate court, in its b. Right to Informed Consent discretion, order him to submit to a physical or c. Right to Privacy and Confidentiality mental examination by a physician; d. Right to Information 8. When the public health and safety so demand; e. Right to Choose Health Care Provider & Facility ○ IN THE ORDER OF PRIORITY: f. Right to Self-Determination 1. Spouse; g. Right to Religious Belief 2. Son or daughter of legal age; h. Right to Medical Records 3. Either parent; i. Right to Refuse Participation in Medical 4. Brother or sister of legal age, or Research 5. Guardian j. Right to Correspondence and to Receive Visitors RIGHT TO PRIVACY AND CONFIDENTIALITY k. Right to Express Grievances The HCT is not authorized to divulge any l. Right to be Informed of His Rights and information to a third party without the patient’s Obligations as a Patient consent EXCEPT: D. CPD in Critical Care Nursing 1. When such disclosure will benefit public health E. ICU Nurse as a Patient’s Advocate and safety; F. Professional Decorum in Critical Care 2. When it is in the interest of justice and upon the G. Advocacy: Access to Social Care Services order of a competent court; 3. When the patients waives in writing the RIGHTS OF THE PATIENT confidential nature of such information Senate Bill No. 812 – Magna Carta of 4. When it is needed for continued medical Patient’s Rights Section 4bb treatment or advancement of medical science RIGHT TO APPROPRIATE MEDICAL CARE AND subject to de-identification of patient and HUMANE TREATMENT shared medical confidentiality for those who If the patient has to wait for care, he shall be have access to the information. informed of the reason for the delay. Patients in emergency shall be extended RIGHT TO INFORMATION immediate medical care and treatment without any Result of the evaluation of the nature and extent of deposit, pledge, mortgage or any form of advance his/her disease. payment for treatment. Any other additional or further contemplated medical treatment on surgical procedure or RIGHT TO INFORMED CONSENT procedures, including any other additional EXCEPT in the following cases: medicines to be administered and their generic 1. In emergency cases, the physician can perform counterpart including the possible complications any diagnostic or treatment procedure as good and other pertinent facts, practice of medicine dictates without such Statistics or studies, regarding his/her illness, consent; Any change in the plan of care before the change is 2. When the health of the population is dependent made, the person's participation in the plan of care on the adoption of a mass health program to and necessary changes before its implementation, control epidemic; The extent to which payment may be expected 3. When the law makes it compulsory for everyone from Philhealth or any payer and any charges for to submit a procedure; which the patient may be liable, the disciplines of 4. When the patient is either a minor, or legally health care practitioners who will furnish the care incompetent, in which case. A third party and the frequency of services that are proposed to consent Is required; be furnished. ACUESTA, DANGUE, DE RAMOS, GAURANO, GRAFILO, MOJICA, NAVAL, NOVILLOS 16 of 42 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion.  NUR 141: ACUTE AND BIOLOGIC CRISIS PRELIM RELEASE - NUR141 -BSN43 RIGHT TO CHOOSE HEALTH CARE PROVIDER & 8. Scientists in charge must be prepared to FACILITY terminate the experiment when injury, disability, Hospital or death is likely to occur. Consultant/Specialist Second Opinion and Subsequent Opinions RIGHT TO CORRESPONDENCE AND TO RECEIVE ○ EXPECT: VISITORS 1. Under the care of a service facility RIGHT TO EXPRESS GRIEVANCES & 2. When public health and safety so demands RIGHT TO BE INFORMED OF HIS RIGHTS AND 3. When the patient expressly waives this right in OBLIGATIONS AS A PATIENT writing. CPD IN CRITICAL CARE NURSING Basic Life Support & Advanced Cardiac Life RIGHT TO SELF-DETERMINATION Support CLI S/he is informed of the medical consequences of his choice; ICU NURSE AS A PATIENT’S ADVOCATE S/he releases those involved in his care from any End of Life Care -is provided by nurses, which obligation relative to the consequences of his aims to alleviate the suffering of individuals in the decision dying process and to provide patients with a good His/her decision will not prejudice public health death experience and safety. Palliative Care for Critically Ill - aims to prevent and relieve suffering by early identification, RIGHT TO RELIGIOUS BELIEF assessment, and treatment of physical and RIGHT TO MEDICAL RECORDS psychological symptoms EXCEPT: Safe Practice in the ICU - applying the ethical 1. Psychiatric Notes concept of non-maleficence. 2. Other incriminatory information obtained about third person. PROFESSIONAL DECORUM IN CRITICAL CARE The critical care nurse acts in a manner that RIGHT TO LEAVE maintains active ongoing involvement in activities related to the nursing profession such as ICU S/he is informed of the medical consequences of conference, workshop, and course; and promotes his/her decision the professional image of nursing. S/he releases those involved in his/her care from ○ The critical care nurse: any obligation relative to the consequences of his 1. Asserts professionally in the health care team decision; 2. Shows concerns about the public interest His/her decision will not prejudice public health regarding health promotion and maintenance and safety. 3. Acts in the manner of a knowledgeable, competent, responsible, accountable, and caring professional with critical thinking to RIGHT TO REFUSE PARTICIPATION IN MEDICAL achieve the aimed objective RESEARCH 4. Supports activities run by professional Declaration of Helsinki organization such as microteaching and sharing 1. Human subjects should provide voluntary session of clinical experiences consent and know the risks of participation. 5. Promotes spirit of professional cohesiveness 2. The experimental results must be for the greater 6. Acts for the collective interest of the profession good of society. 7. Adopts continuous quality improvement in 3. Experiment should avoid unnecessary nursing physical/mental suffering. ADVOCACY: ACCESS TO SOCIAL CARE SERVICES 4. No experiments should be conducted if it is Republic of the Philippines Health of Department believed to cause death/disability. PhilHealth 5. Benefits must always outweigh the risks. DSWD 6. Experiments should be used to protect PCSO subjects. PAGCOR 7. Subject should always be at liberty to stop at Local Government Unit any time. ACUESTA, DANGUE, DE RAMOS, GAURANO, GRAFILO, MOJICA, NAVAL, NOVILLOS 17 of 42 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion.  NUR 141: ACUTE AND BIOLOGIC CRISIS PRELIM RELEASE - NUR141 -BSN43 q. Nutritional and Dietary Therapy i. Tube Feedings ii. Fluid Therapy and Parenteral Feeding OUTLINE iii. High CHON, High Calorie Supplements A. Respiratory System r. Health Education a. Functions s. Evaluation b. Anatomical Structures t. Report and Documentation c. Events of Respiration RESPIRATORY SYSTEM i. Understanding Boyle’s Law: Critical A biological system comprising of organs and Care and Emergency Nursing airway passages that facilitate the intake and Perspective exchange of O2 and CO2 between the body and d. Events of Respiration the environment. e. Gas Exchange Also termed as the oxygen delivery system, f. Pulmonary Diffusion, Perfusion, Compliance respiratory apparatus, and ventilator system of the g. Physiologic Processes: Lung Volume (T.I.R.E.) body. h. Physiologic Processes: Lung Capacities (V.I.F.T.) FUNCTIONS i. Subjective Data Olfaction - ability to detect odor j. Common Respiratory Symptoms Humidification - axillary anatomy in the i. Dyspnea nasopharyngeal airway those short hair within ii. Cough nasal lining provide humidification iii. Sputum production O2 Supplier - several airways where oxygen pass iv. Chest pain through like the nose and mouth v. Wheezing Passageway - structures that allows air to reach vi. Hemoptysis the lungs like URT, LRT vii. Nasal and Sinus Complaints Gas exchange - in the alveoli k. Objective Data Regulation of pH - e.g. air traffic - CO2 increase i. General Approach: Thorax Examination oxygen diffusion rate ii. Inspection Voice production - creases found in the vocal folds iii. Percussion of the larynx iv. Diaphragmatic Excursion Innate immunity - from the reticuloendothelial l. Diagnostic Procedures system infection control i. Pulmonary Function Test ii. Pulse Oximetry ANATOMICAL STRUCTURES iii. Arterial Blood Gas Upper Respiratory System iv. Pulmonary Capillary Wedge Pressure ○ Nose v. Pulmonary Angiogram Paranasal sinuses vi. V/Q Scan Turbinates (Conchae Bullosa) vii. Capnography ○ Pharynx, Tonsils, & Adenoids m. Nursing Diagnosis ○ Larynx, Epiglottis n. Goal Lower Respiratory System i. Implementation ○ Trachea o. Medical-Surgical Management ○ Main bronchi i. Mobilization of Secretions ○ Lungs ii. Artificial Airway Management ○ Bronchial Tree iii. Administering O2 Therapy ○ Alveoli iv. Mechanical Ventilation v. Thoracic Ventitlation vi. Thoracic Surgeries vii. Postoperative care viii. Nursing Consideration p. Pharmacological Management i. Complementary/Alternative Medicines ACUESTA, DANGUE, DE RAMOS, GAURANO, GRAFILO, MOJICA, NAVAL, NOVILLOS 18 of 42 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion.  NUR 141: ACUTE AND BIOLOGIC CRISIS PRELIM RELEASE - NUR141 -BSN43 gas exchange and causing symptoms like shortness of breath and chest pain. Treatment involves removing air from the pleural cavity to re-expand the lung, using needle aspiration or a chest tube. In a pneumothorax, the relationship described by Boyle's Law is disrupted because the change in volume and pressure is no longer occurring within a closed system, leading to the collapse of the lung. EVENTS OF RESPIRATION Pulmonary Ventilation (Breathing) ○ Inspiration - flow of air into the lungs (relax state) ○ Expiration - movement of air away from the lungs (contract state) Boyle’s Law: volume changes lead to pressure changes, which lead to the flow of gases to EVENTS OF RESPIRATION equalize pressure External Respiration - oxygen is unloaded from the Diaphragm - division of respiratory from abdominal blood organs. Respiratory Gas Transport - diffusion between alveoli and within the blood vessel Internal Respiration - gas exchange in your pulmonary blood and alveoli Intrapleural pressure ○ Always negative UNDERSTANDING BOYLE’S LAW: CRITICAL CARE GAS EXCHANGE AND EMERGENCY NURSING PERSPECTIVE Fick’s law: the rate of diffusion increases when Pneumothorax occurs when air enters the pleural distance is shorter and greater surface area is cavity, causing pressure increase and a decrease observed. in lung volume. Occurs at the alveolar level when blood is This decrease can lead to a collapsed lung oxygenated, and CO2 is removed. because the pressure difference is lost, affecting ACUESTA, DANGUE, DE RAMOS, GAURANO, GRAFILO, MOJICA, NAVAL, NOVILLOS 19 of 42 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion.  NUR 141: ACUTE AND BIOLOGIC CRISIS PRELIM RELEASE - NUR141 -BSN43 Site of diffusion: alveoli (air sacs) inhaled after a Reticuloendothelial system (pulmonary alveolar normal macrophages) protects the lungs inhalation Two types of alveoli: ○ type 1 (major gas exchange role), and Residual RV Volume of air 1200 ml Increased ○ type 2 (surfactant production) - maintains the Volume remaining in with elasticity of alveoli the lungs obstructi after a ve maximum disease UNDERSTANDING FICK’S LAW: CRITICAL CARE exhalation AND EMERGENCY NURSING PERSPECTIVE COPD is a disease that can be understood through Expiratory ERV Maximum 1,100ml Decrease Fick's Law. Reserve volume of air d with In COPD, the alveolar walls are damaged, reducing Volume that can be restrictive the surface area for gas exchange. Additionally, the exhaled condition walls may thicken, increasing the diffusion distance forcibly after s for gases. a normal (obesity, This reduces the efficiency of gas exchange, exhalation ascites, pregnanc making it harder for oxygen to enter the blood and y) carbon dioxide to exit. This results in hypoxemia and hypercapnia, symptoms like shortness of breath, chronic cough, PHYSIOLOGIC PROCESSES: LUNG CAPACITIES and fatigue. (V.I.F.T.) The impairment in gas exchange is a direct Lung Sym Description Norm Signific consequence of these changes. Capacity bol al ance Value PULMONARY DIFFUSION, PERFUSION, COMPLIANCE Vital VC Maximum 4,600 Decrease PD: O2 and CO2 are exchanged from areas of high Capacity volume of air ml d in concentration to areas of low concentration at the exhaled from neuromu air–blood interface. the point of scular Capillary and alveolar system maximum disease, PP: actual blood flow through the pulmonary