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Overview of Critical Care
nursing (Chapters 1-5) 10
Questions with Accurate
Answers
AACN Certification Corporation oversees correct answer the critical care certification process Advanced directive correct answer Witnessed written document or oral statement in which instructions are given by a person to express desires related to health care decisions. The directive may include, but is not limited to, the designation of a health care surrogate, a living will, or an anatomic gift Agitated (RASS) correct answer frequent non-purposeful movements; fights ventilator 2+ Alert and Calm will get you a (RASS) score of correct answer 0 Anxiety correct answer a state marked by apprehension, agitation, autonomic arousal, fearful withdrawal, or any combination of these; a prolonged state of apprehension in response to a real or perceived fear autonomy correct answer states that all persons should be free to govern their lives to the greatest degree possible; this means to respect their freedom of choice and to allow them to make their own Beneficence correct answer the duty to provide benefits to others when in a position to do so and to help balance harms and benefits
Built Environment correct answer physical layout of a critical care unit has a subtle but profound effect on patients, families, and the critical care team CCRN certification is available for correct answer nurses who provide care of critically ill adult, pediatric, or neonatal populations CCRN-E credential is available for correct answer nurses working in the eICUs Combative (RASS) correct answer overly combative or violent; immediate danger to staff 4+ Competence (or capacity) correct answer refers to a person's ability to understand information regarding a proposed medical or nursing treatment; it is a legal term and is determined in court Deep Sedation (RASS) correct answer no response to voice, but any movement to physical stimulation
Delirium (acute brain dysfunction) correct answer characterized by an acutely changing or fluctuating mental status, inattention, disorganized thinking, and altered levels of consciousness Developmental Assessment correct answer includes information related to the family's developmental stages, tasks, and attachments Do not resuscitate (DNR) order correct answer A medical order that prohibits the use of cardiopulmonary resuscitation and emergency cardiac care to reverse signs of clinical death. The DNR order may or may not be specified in patients' advance directives Drowsy (RASS) correct answer not full alert, but has sustained (>10 sec) wakening, with eye contact, to loud voice
Identify and treat cause(s) of delirium or altered mental status correct answer o Infection or sepsis o Dehydration, hypoglycemia o Sleep deprivation o Alcohol, benzodiazepine, or home medication withdrawal o Medications: anticholinergics, benzodiazepines, opiates, steroids Informed Consent correct answer based on the principle of autonomy; competent adults have the right to self-determination or to make decisions regarding their acceptance or rejection of treatment Justice correct answer requires that health care resources be distributed fairly and equitably among groups of people Light Sedation (RASS) correct answer briefly awakens (<10 sec) with eye contact to loud voice
Living will correct answer A witnessed written document or oral statement voluntarily executed by a person that expresses the person's instructions concerning life-prolonging procedures Mixed delirium correct answer Concurrent or sub-sequential appearance of some features of both hyperactive and hypoactive delirium Moderate Sedation (RASS) correct answer any movement (but no eye contact) to loud voice
Modifiable risk factors for delirium correct answer - Alcohol, narcotic, benzodiazepine dependence
- Medication-induced coma
- Uncontrolled pain
- Cigarette smoking
- Immobility
- Sleep deprivation Moral distress correct answer occurs when the nurse knows the ethically appropriate action to take but is unable to act on it or when the nurse acts in a manner contrary to personal and professional values Non modifiable risk factors for delirium correct answer - Baseline cognitive impairment
- Baseline hypertension
- Advanced age (>70)
- Respiratory failure Nonmaleficence correct answer the explicit duty to not inflict harm on others intentionally Pain correct answer an unpleasant sensory and emotional experience associated with actual or potential tissue damage; subjective experience; the patient becomes the true authority on the pain that is being experienced Palliation correct answer is the provision of care interventions that are designed to relieve symptoms of illness or injury that negatively affect the quality of life of the patient or family Patient Self-Determination Act correct answer this act requires that all health care facilities that receive Medicare and Medicaid funding inform their patients about their right to initiate an advanced directive and the right to consent to or refuse medical treatment Patients in ICU three top stressors correct answer ♣ Being in pain ♣ Not being able to sleep ♣ Financial worries PCCN is for correct answer nurses who provide acute care in progressive care, telemetry, and similar units
Terminal weaning correct answer consist of titration of ventilator support to minimal levels, removal of the ventilator but not the artificial airway, or complete extubation The American Association of Critical-Care Nurses (AACN) hs developed a framework for dealing with moral distress known as the correct answer • Ask
- Affirm
- Assess
- Act The family bundle is based on what 5 concepts correct answer - evaluate
- plan
- involve
- communicate
- support Three cultural questions to be asked correct answer - What are your specific religious and spiritual practices?
- What are your beliefs about illness (and death)?
- What is most important to you and your family at this time? To identify an ethical dilemma what must be met? correct answer ♣ More than one solution must exist ♣ There is no clear "right" or "wrong" ♣ Each solution must carry equal weight and must be ethically defensible Unarousable (RASS) correct answer no response to voice or physical stimulation
Value pneumonic for communication with family correct answer • Value what the family tells you
- Acknowledge family emotions
- Listen to the family members
- Understand the patient as a person
- Elicit (ask) questions of family members Veracity correct answer states that persons are obligated to tell the truth in their communication with others Very Agitated (RASS) correct answer pulls on or removes tubes or catheters or has aggressive behavior towards staff 3+ Visceral Pain correct answer diffuse, poorly localized, and often referred What elements must be present for a person to consent or decline treatment correct answer o Competence o Voluntariness - without coercion o Disclosure of information withheld therapies in hospice correct answer • Vasopressors
- Antibiotics
- Blood and blood products
- Dialysis
- Nutritional support
