Summary
Summary NUR 445 Critical Exam 1 Study Guide
- Course
- NUR 445
- Institution
- Indiana Wesleyan University
This is a comprehensive and detailed study guide on Exam 3 for Nur 445. *Essential!! *For Effective Exam Prep!!
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Adult Health Exam IChpt 1: Critical Care Nursing Practice
Foundations of Critical Care Nursing
o Healthcare is going under dramatic change at a rapid rate
o This causes challenges
Such as flexibility and adaptation to change
Contemporary critical care
o Multidisciplinary team
In-depth knowledge
Wide range of disciplines
A team taking care of pts
Ex: respiratory therapists, physicians, nurses, advanced practice nurses,
social workers, clergy, chaplains, etc
o High-risk patients
Require special attention
Always anticipate what is going to happen
Use critical thinking and judgement
o Specialized units
Cardiac, stroke, peds, etc.
o A growing trend in acute care settings is the designation of progressive care units
considered to be part of the continuum of critical care
Progressive care units: step down units from ICU (acute)
o Patient age
Determines what type of unit the pt will be in
Each hospital offers different types of units
Neonatal
Pediatric
Adult
Geriatric
o Usually combined with adult
o Medical vs surgical problems
Determine where pt will go
General ICU: work with providers, physicians, NP’s
ICU doctors are typically Pulmonologists
Not every hospital has all the types of intensive care units
Ex: Ball memorial has regular ICU, but not a pediatric ICU
Ex: Ball memorial has a unit for pulmonary and neurologic ICU, but not
cardiac ICU
o Special pt populations
Cardiac
Pulmonary
Neurologic
Critical Care Nursing Roles
, o Expanded-role nursing positions
Case managers
Usually RN’s
Typically, have a 3:1 ratio (3pts to 1 RN) for ICU
Patient educators
Difficult to get education to the pt when they are in a critical care setting
Education starts at the BEGINNING and goes all the way to discharge
Family is VERY much involved!!
Cardiac rehabilitation specialists
Office nurses
Infection control specialists
Immune systems are compromised, so they make sure extra infections
are not acquired
****SEDATION DOES NOT EQUAL PAIN CONTROL*****
o Advanced practice nurses (APNs)
Clinical nurse specialist (CNS)
Nurse practitioner (NP) or acute care nurse practitioner (ACNP)
Certified registered nurse anesthetist (CRNA)
o Not only important to take care of the pt, but the family
o More times than not, when it comes to teaching, we spend more time with the family
o Expanded-role nursing positions are determined by pt needs and individual
organizational resources
o What APS’s can do depends on the state they work in as well as practice area
Critical Care Professional Accountability
o The Society of Critical Care Medicine (SCCM)
Multidisciplinary, multispecialty, international organization
o American Association of Critical-Care Nurses (AACN)
Certifications
National organizations
Awards
Establish guidelines and practices for nurses for critical care
Develop and administer many critical care specialty certification exams
Ex: pediatric ICU, Neonatal ICU, Adult ICU
Hospitals push for these exams because it shows that these nurses are qualified
to care for these pts
More certifications = more positive pt outcomes
Evidence-Based Nursing Practice
o Research-based interventions
Early practice based on traditions
Shift to use of best data available
o Consistent, positive outcomes
o Strive for best practice
o Because research is constantly updated, so are protocols; strive for the best practice!!
o Early practice is based on traditions
, Research shows that some traditions are useless
Be willing to look at research and make a change if necessary; this is the best
EBP
o Used to do with what “worked”; but not anymore…focus on EBP; is essential and must
be embraced by ALL nurses
o When we use science as the base of what we are doing, then we can explain and predict
what’s going to happen
o Provide research-based practice with positive outcomes
Holistic Critical Care Nursing
o Caring
Merges psychosocial elements with technologic environment
o Individualized care
Patient’s preferences
Patient- and family-centered care
o Cultural care
Reflects society
Incorporates individual differences
o This is what we want to push in critical care
o EBP shows it is VERY effective in the critical care setting
o It can be VERY hard to show the pt and family that we care; need to work to promote
that
Do not seem rushed
NEVER tell the pt what things you have to do; focus on that one pt in the room
o Think: what interventions will specifically best help this pt to progress towards their
desired outcome of their recovery?
o Make sure the family is involved in the decisions made and the care of the pt
o Think about diversity sensitivity and openness to lifestyle, beliefs, etc.
Look at cultural differences
Complementary and Alternative Therapies
o Spirituality and prayer
Might not be religious, but spirituality is important
o Guided imagery
Helps boost immune system and calm person down
Low cost
Decrease pain, anxiety, stress
******can be complementary or alternative**********
o Massage
complementary
o Animal-assisted therapy
Used more in hospitals
As long as vaccines are up to date, then can visit pt
o Conventional
Analgesics, pain meds
o Complementary: additional therapy on top of the standard western model
, o Alternative: replacing traditional (western) model
Ex: hypnosis before surgery
Nursing’s Unique Role in Health Care
o Both independent and dependent nursing action
o Interdependence with all health care professionals
o Nurses are the “eyes and ears” to the provider
o Develop trust with providers
o Nurses are the best point of care communicators for providers because they see what is
going on all day
o Be exceptional at communication skills
o Be confident and assertive in communication
o Explain what we want to say and know when we want to intervene on the pts behalf to
help the provider to work through the best plan of action for the pt
o Do not be bossy, but professional
Critical Care Nursing Practice
o Research
Studies link between clinical judgment and interventions
Identifies
o Two major categories of thought and action
Clinical inquiry and clinical forethought
Clinical inquiry: looking at problem identification and clinical problem
solving it
Clinical forethought: anticipating potential problems
What critical care nurses are known for
They can see things happening before they happen and anticipate it,
setting interventions before situations happen
o **Nine categories of practice
Diagnosing and managing life sustaining physiologic function in unstable pts
Managing a crisis by using skills of known how
Providing comfort measures for the critically ill
Caring for pts families
Preventing hazards in a technological environment
Facing death end of life care and decision making
Communicating and negotiating multiple perspectives
Monitoring quality and managing breakdown
Exhibiting the skills of known how of clinical leadership
The coaching and mentoring of others
Interprofessional Collaborative Practice
o Increases quality of care and services
o Contains or decreases costs
o Core Competencies for Interprofessional Collaborative Practice
Assess competencies’ relevance
Develop action plan
o Cost is the big thing you gave to look at
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