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CC Exam 2

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  1. What is the largest nursing specialty organization in the world
    AACN
  2. name some ways in which patient responses vary in the CC setting
    • Age
    • Prior illness/hospitalization
    • Social support
    • Coping
    • Life/death beliefs
    • Spirituality
    • Culture
  3. What are some things patient's recall about the CC experience
    • Pain
    • Thirst
    • dysphagia
    • anxiety
    • difficult sleeping
    • physical restraint
  4. Name 4 things that contribute to relocation stress
    • Fear of abandonment
    • New routines
    • New Staff
    • New roomates
  5. What are some post-CC sx
    • fatigue/sleep-disturbance
    • Pain/muscle weakness
    • Poor concentration/impaired memory
    • Poor appetite
    • PTSD
  6. Name 3 categories in Calgary Family Assessment
    • Structural
    • Developmental
    • Functional
  7. Category of Calgary Assessment that includes:
    Who compromises familyDecision maker/spokespersonRace/ethnicity/culture
    Structural
  8. Category of Calgary Assessment that includes: stages, tasks, and attachments
    developmental
  9. Category of Calgary Assessment that includes: How family members interact with each other
    functional
  10. VALUE Mneumonic
    • Value what family tells u
    • Acknowledge family emotions
    • Listen to family
    • Understand patient as person
    • Elicit questions from family
  11. Name some ethical issues CC nurses face every day
    • Informed consent/confidentiality
    • Withholding/withdrawing treatment
    • organ/tissue transplant
    • Distribution of resources
    • Appropriate use of technology
  12. What professional organization includes the code of ethics for nurses and with interpretive statements
    ANA
  13. What are some ethical dilemma warning signs
    • Emotionally charged
    • Significant change in pt condition
    • Confusion about facts
    • Hesitancy about what's right
    • Deviation from customary practice
    • Need for secrecy about actions
  14. 5 steps of Ethical decision-making process
    • Assess
    • Consider options
    • Develop plan
    • Act on plan
    • Evaluate plan
  15. What 3 factors are assessed in the ethical decision-making process
    • Contextual
    • Physiological
    • Personal
  16. What should options be considered on in the ethical decision-making process
    • Patient wishes
    • Burden vs. Benefit
    • Ethical principles
    • Potential outcomes
  17. 7 ethical principles of nursing
    • Authonomy
    • Beneficence
    • nonmaleficence
    • Justice
    • Veracity
    • Fidelity
    • Confidentiality
  18. 2 formal mechanisms of ethical dilemmas
    • Bioethics committee
    • Ethics consultation
  19. Name 3 different opportunities nurses have to contribute to formal ethical decision making
    • Ethics forums/rounds
    • Peer review
    • Institutional review boards
  20. What is the duty of the nurse in a contractual relationship to care for assigned patients (required)
    Duty to treat
  21. What must the nurse to to ensure she does not abandon the patient
    arrange with another nurse, including breaks and lunch
  22. What can the nurse do if she finds herself in a situation that conflicts with her morals
    She does not have to do it, but pt should be transferred to another nurse to avoid abandonment
  23. Name 3 broad elements of Informed consent
    • Competence
    • Voluntariness
    • Disclosure of info
  24. What 6 things are included for disclosure of info during obtaining informed consent
    • Dx
    • Treatment
    • Outcome
    • Benefits/risks
    • Alternative treatments
    • Prognosis if no treatment
  25. 4 factors to consider when giving life-sustaining treatment
    • Constitutional rights
    • Quality of Life
    • Impact of advanced technology
    • Ordinary vs. extraordinary care
  26. What type of care includes common, noninvasive, and tested treatment?
    ordinary
  27. Give some examples of ordinary care
    • Nutrition
    • Hydration
    • Antibiotics
  28. What type of care includes complex, invasive, experimental treatment
    extraordinary
  29. Give some examples of extraordinary care
    • ACLS
    • Dialysis
    • Unproved therapies
  30. What is needed in order to prevent initiation of a code
    DNR
  31. What is useful in guiding decision making PRIOR to a code
    Advance directive
  32. Not initiating life saving measures
    Withholding
  33. Weaning or removing life sustaining measures
    Withdrawal
  34. What is the Patient Self-determination Act
    Patient's right to initiate advance directive and right to consent for or refuse treatment
  35. What includes communication about preferences for treatments if pt is incapacitated
    Advance directive
  36. What includes desired treatment and what should be withheld
    Living will
  37. What determines who makes decisions for health care, health surrogacy or proxy
    Durable power of attorney
  38. Difference between health surrogate and proxy
    Surrogate: you choose, Proxy: appointed
  39. What percent of people die in acute care setting? CC unit?
    • 38%
    • 22%
  40. What 4 things were discovered during SUPPORT study of 1995
    • Lack of clear communication between pt & caregiver
    • High freq of aggressive care
    • Widespread pain/suffering
    • Research on CC for dying pt is lacking/must be national priority
  41. What is a situation in which therapy or interventions will not provide a foreseeable possibility of improvement in pt health condition
    Medical Futility
  42. What is the alleviation of distressing symptoms
    palliation
  43. Who should receive palliative care
    everyone
  44. Common sx at end of life
    • Pain
    • anxiety
    • Thirst/hunger
    • dyspnea
    • n/d
    • Confusion
    • Agitation
    • Sleep disturbances
  45. 5 nursing interventions for palliative care
    • freq repositioning
    • good hygiene
    • skin care
    • peaceful environment
    • pain relief
  46. 3 elements of Palliative Care
    • Early identification
    • Pain management (5th VS)
    • Pharm/Nonpharm
  47. 3 states where euthanasia is legal
    • Montana
    • Oregon
    • Washington
  48. What is the most common withdrawal intervention
    ventilator
  49. What is ventilator withdrawal also known as
    terminal weaning
  50. What does titration of pain and sedation meds help during terminal weaning
    relieve tachypnea, dyspnea, and use of accessory muscles
  51. When should life-sustaining treatment NOT be withdrawn from patients
    PATIENT'S ON PARALYTIC AGENTS
  52. Name 5 commonly withheld therapies
    • Vasopressors
    • Antibiotics
    • Blood
    • Nutrition
    • Deactivation of implanted devices
  53. What IV meds are used for anxiety during comfort of symptom management
    Benzos
  54. What IV med is giving for dyspnea and pain during comfort/sx management
    Morphine
  55. Whites verse black/hispanics in end-of-life options selections
    • White: less aggressive
    • Black/hispanic: more aggressive
  56. Unpleasant sensory and emotional experiennce associated with actual or potential tissue damage
    Pain
  57. Prolonged state of apprehension in response to fear marked by apprehension, agitation, and autonomic arousal
    Anxiety
  58. What fibers does acute pain travel through to the SNS
    A-delta
  59. What fibers does chronic pain travel through?
    C fibers
  60. 3 types of nociceptors
    • Mechanical
    • Chemical
    • Thermal
  61. What center is brain is anxiety linked to
    reward/punishment center
  62. Positive effects of pain/anxiety
    • Increase performance
    • Remove one from harm
    • Fight/flight
  63. Negative responses of pain/anxiety
    • Raise catecholamines
    • Interfere w/ healing
    • Increase O2 consumption
    • Increased Resp effort
  64. What happens when catecholamines are raised in response to pain/anxiety
    tachycardia/HTN
  65. What happens with increased O2 consumption during response to pain/anxiety
    End organ ischemia
  66. Name 5 step assessment to pain using American Pain Society Guidelines
    • Assess, treat promptly, document
    • Engage pt in management of pain
    • Provide preemptive treatment
    • Reassess/treat to meet pt needs
    • Institute quality improvement plan r/t practice/outcomes
  67. 5 characteristics of pain
    • Precipitating cause
    • Severity
    • Location/raditation
    • Duration
    • Alleviating/aggravating factors
  68. PQRST of Chest pain characteristics
    • Provocation/position
    • Quality
    • Radiation
    • Severity/associated sx
    • Timing/triggers
  69. What objective tool completely reflects pt pain level who cannot communicate
    NONE
  70. 3 objective pain tools that can be used for pt who cannot communicate
    • Behavioral Pain Scale
    • CC Pain Observation
    • Checklist of nonverbal pain indicators
  71. What 3 scales is sedation adjustments based on
    • Richmond Agitation-Sedation Scale (RASS)
    • Ramsey Sedation (Ramsey)
    • Sedation-Agitation (SAS)
  72. What test assess brain activity
    EEG
  73. What is an acutely changing mental status
    Delerium
  74. What is the key word of Delirium
    inattention
  75. 3 types of Delirium
    • Hyperactive
    • Hypoactive
    • Mixed
  76. Delirium where pt is agitated, combative, and disoriented
    Hyperactive
  77. Delirium that is quiet
    Hypoactive
  78. 2 assessments used in Delirium
    • CAM-ICU
    • ICDSC
  79. Drug of choice for Delirium
    Haloperidol
  80. Goal of pt with Delirium
    Keep pt safe
  81. ABCDE of preventing Delirium Bundle
    • Awakening
    • Breathing coordination
    • Choice of sedation
    • Delirium monitoring
    • Early mobility/exercise
  82. What reasons might a physician decide to use a Neuromuscular blockade (NMB)
    • Emergency/difficult intubation
    • Improve tolerance of mechanical ventilation
    • Manage Elevated ICP
  83. Interventions for pt on NMB
    • Mechanical ventilation & airway management
    • Eye lubrication
    • DVT prophylaxis
    • Reposition/ROM
    • Oral care
    • Urinary Cath
    • Routine VS/assessments
  84. 4 benefits of opioid use in CC setting
    • Rapid onset
    • Ease of titration
    • Lack of accumulation
    • Low cost
  85. Name 3 opioids commonly used in CC setting
    • Fentanyl
    • Morphine
    • Hydromorphone
  86. Which opioid has fastest onset
    Fentanyl
  87. Which opioid has longest duration
    Morphine
  88. 2 concerns of opioid use in CC
    • respiratory depression
    • hypotension
  89. How would opioids be administered in CC settings
    • IV bolus
    • IV infusions
    • PCA
    • Fentanyl patches
  90. What Pharmacological pain management method facilitates mobility and pulmonary hygiene
    Epidural
  91. What meds can decrease the need of opioids
    NSAIDs
  92. What are the risks of NSAID use
    GI bleed, renal (ibprofen) or liver (acetaminophen) insufficency
  93. Name 3 sedatives used in CC to treat anxiety
    • Benzo
    • Propofol
    • Dexmedetomidine (precedex)
  94. Pts best suited for a PCA pump
    • elective surgery
    • Large surgical or traumatic wounds
    • NL cog funtion
    • NL motor skills
  95. Where is food first broken down
    mouth-saliva
  96. What does stomach do with food
    • Mix w/ gastric secretions
    • Secrete intrinsic factor for Vit B12 absorption
    • Secrete fluid high in Na & K
  97. Where do pancreas and liver empty in the stomach
    Duodenum
  98. Where in the stomach is water-soluble vitamins absorbed
    Jejunum
  99. Where in the stomach is protein broken down and absorbed
    Ileum
  100. Where is fat-soluble vitamins absorbed
    Ileum
  101. What absorbs Na+ & K+
    Colon
  102. Where is Vit K formed
    Colon
  103. Where is water reabsorbed
    Colon
  104. Where is short-chain fatty acids absorbed
    colon
  105. What secretes digestive enzymes
    Pancreas
  106. What assists in emulsifying fats
    Gallbladder
  107. When does a patient who cannot meet needs orally require support
    >3 days
  108. Where does enteral nutrition deliver nutrients
    GI tract
  109. What is the preferred method of nutrition delivery and why
    • Enteral
    • Lower risk of infection/less expensive
  110. What 2 things are used for long-term nutrition
    PEG or jejunostomy
  111. How many calorie per mL is standard for enteral feeds
    1 calorie/mL
  112. 4 specialized formula examples
    • Elemental
    • High protein
    • Fiber enriched
    • Wound healing
  113. 3 types of short-term enteral feedings (routes)
    • NG
    • Nasoduodenal
    • Nasojejunal
  114. Feeding schedule for gastric? small bowel?
    • Gastric: intermittent
    • Small bowel: continuous
  115. Signs of feeding intolerance (EN)
    • N/V
    • Absent bowel sounds
    • Abd distention
    • Cramping
  116. Feeding delivered into blood stream called?
    Parenteral
  117. Type of feeding solutions that can go through a central line (TPN)
    Hypertonic
  118. Type of feeding solutions that can go through peripheral line (PPN)
    Isotonic
  119. When is Parenteral nutrition used
    When unable to tolerate enteral
  120. What conditions may require PN
    • GI obstruction
    • Intractable vomiting or diarrhea
    • NPO >1 week
    • Pt admitted malnourished
  121. 4 complications of Parenteral Nutrition
    • Infection (sepsis)
    • Electrolyte imbalance
    • Fluid imbalances
    • Hyperglycemia
  122. When should u flush when administering meds via enteral route
    before and after each med
  123. What should be suspected for infection r/t PPN/TPN
    Malnourishment
  124. What type of malnutrition should be assessed in elderly
    protein-energy
  125. 3 complications of PPN/TPN
    • Refeeding syndrome
    • DM/Glucose intolerance
    • Liver function (parenteral)
  126. Potential cause of diarrhea r/t nutrition feeds
    Cdiff
  127. When do half of all communication breakdowns occur
    Handoff
  128. 4 barriers of effective handoff communication
    • Physical setting
    • Social setting
    • Language
    • Communication medium
  129. Difference between situation and background from SBAR
    • Situation: what's happening now
    • Background: What led up to the situation now
  130. Ventilator Bundle
    • HOB elevated
    • Titrate sedation/assess readiness to extubate
    • Prophylaxis PUD
    • Prophylaxis VTE
  131. Which Legal case led to the Self-Determination Act
    Nancy Cruzan
  132. endogenous cytokines that suppress pain indication
    endorphins
  133. 3 elements of behavioral pain scale used for mechanically ventilated patients
    • Facial expression
    • Upper limbs
    • Compliance with Ventilation
  134. Whats the target level of sedation
    calm patient thats easily aroused
  135. Which sedation scale is used for post-op patients emerging from general anesthesia
    RAMSAY
  136. Which sedation scale is used for pts on sedation over consecutive days of CC unit
    RASS
  137. What value on an EEG indicates fully conscious? Deep sedation? complete sedation?
    • Fully conscious: >90
    • Deep Sedation: 40-60
    • Complete sedation: 0
  138. What BIS score is associated with pt awareness and recollection
    >60
  139. What BIS value is goal in CC
    <60
  140. Most prevalent type of Delirium
    Hypoactive
  141. Using the CAM-ICU, what is considered positive delirium
    • 1: Acute mental status change
    • 2: Inattention
    • 3: Disorganized thinking OR 4. Altered LOC
  142. What can a long-acting NMB help with
    • Improved chest wall compliance
    • Reduce peak airway pressure
    • Prevent pt from ventilator dyssynchrony
  143. WHAT SHOULD YOU REMEMBER WHEN ADMINISTERING NMB!!??
    • Does not possess sedative or analgesic properties
    • MUST ALSO USE SEDATION
  144. What is the Train of four test?
    NMB test using peripheral nerve stimulator to assess number of twitches present
  145. What does 4 twitches of thumb or face indicate? 0 twitches?
    • 4: incomplete
    • 0: Complete
  146. What is the TOF goal
    2 out of 4 twitches
  147. How often should propofol infusion set be changed
    q 12 hrs
  148. Pt criteria for use of propofol
    intubated and mechanically ventilated
  149. What should be monitored for with pt on precedex
    Bradycardia
  150. What should be avoided with fentanyl patches? When should they be changed?
    • Heat
    • Q 72 hours
  151. Two side effects of aspirin
    • bleeding
    • tinnitus
  152. Name 2 NMB drugs
    • Atracurium
    • Succinylcholine
  153. Major SE of Succinylcholine
    HYPEKALEMIA
  154. 2 major SE of Haloperidol
    • NMS
    • Prolonged QT interval
  155. What may be given prophylactically to prevent alcohol withdrawal
    ethanol
  156. What may be given to pt with hx of alcoholism to prevent Wernicke encephalopathy
    Thiamine
  157. How often should pt on restraints be assessed for sensation and perfusion
    q hr
  158. What meds have paradoxical effects in the elderly? SE?
    Benzos, Agitation
  159. What vitamin is critical for formation of RBC
    Vitamin B12
  160. When should nutritional screening be conducted when pt arrives at hospital
    within 24 hours after admission
  161. What waist circumference indicates abdominal obesity for women? Men?
    • >35 in W
    • >40 in M
  162. Normal BMI?
    Overweight?
    Obese?
    Extremely obese?
    • 18.5-24.9
    • 25-29.9
    • 30-39.9
    • >40
  163. When should enteral feeding begin following pt who can't meet their demands orally
    24-48 hrs
  164. first step in formulating nutrition care plan
    estimate protein and caloric requirements
  165. What PN formula is given during the first week of critical illness
    PN WITHOUT SOY-based lipid
  166. When is elemental formula indicated
    GI dysfuntions: SBS, Impaired digestion
  167. When is calorie dense formula indicated
    HF or liver disease
  168. When is immune-modulating formula indicated
    • Acute lung injury
    • ARDS
    • Sepsis
  169. When are feeding tubes generally flushed? How many mL of water
    • q 4 hrs: continuous
    • b4 & after feeds/meds: intermittent
    • 30 mL
  170. How often is GRV checked? What should be of concern? When should feeding be held
    • q 4 hr
    • 200-250 mL
    • >500 mL
  171. What should you do when administering phenytoin via enteral route
    stop infusion 1-2 hr before & after administration
  172. What to do to prevent tube obstruction
    • flush w/ 30 mL
    • administer with elixir diluted w/ water
  173. What to do if tube is obstructed
    irrigate w/ warm water or pancreatic enzyme
  174. What to do to prevent aspiration r/t nutrition tube feeds
    • mark tube exit
    • monitor GRV & place q 4 hrs
    • HOB 30-45 degrees
  175. What should you consider if GRV 200-250
    promotility agent
  176. What to do in case of dumping syndrome (abdominal distention and cramping)
    slow rate and frequency of feeding bolus
  177. What lab value indicates protein deficiency
    albumin <3.5
  178. If triglycerides are elevated what needs to be assessed and evaluated
    • feeding route/formula
    • propofol or lipids need adjustment
  179. What lab value can indicate malnutrition and /or malabsorption
    mg <1.9
  180. What lab value can indicate malnutrition, sepsis, Inc calcium
    Phos <1.0
  181. What can glucose >200 indicate
    Inability to tolerate glucose in PN and/or carb load in EN
Author
jwhughes
ID
315617
Card Set
CC Exam 2
Description
Exam 2
Updated
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