CC Chapter 2

Regarding the critical care environment, the nurse understands that noise: A) can be eliminated with acoustic ceiling tiles. B) can be minimized by shutting off alarms. C) is something the nurse just has to deal with. D) often exceeds recommended levels.

D Noise levels in a critical care unit often exceed recommended limits. Many strategies, such as acoustic ceiling tiles, can reduce but do not eliminate. Alarm volumes can be adjusted, but critical alarms must not be off. Nurses need to assist in identifying and implementing strategies to reduce noise and not "deal with it."

Which intervention is most helpful in preventing sensory overload in critically ill patients? A) Encourage family members to assist in the reorientation of the patient. B) Increase the amount of noise from equipment in the patient's room. C) Move the patient to a semi-private room with another confused patient. D) Place the patient nearer to the nurses' station for observation.

A Family members who reorient the patient help to increase pleasant sensory input to counteract overload. Increasing noise will add overload. Exposure to another confused patient may add overload. Increasing stimulation will add overload.

Which are strategies for improving collaboration in a critical care setting? (Select all that apply.) A) Interdisciplinary rounds B) Joint continuing educational programs C) Morning briefings D) Excluding family members from rounds

ABC Including family members in rounds fosters collaboration with team members. These might be scheduled family rounds or the daily multiprofessional rounds.

Patients recall many stressors from the critical care experience, including which of the following? (Select all that apply.) A) Difficult communication B) Discomfort C) Feelings of dread D) Sleeping too much E) Thoughts of dying

ABCE Box 2-1 describes many stressors, including difficult communication, discomfort, feelings of dread, and thoughts of death and dying. Most patients remember having difficulty sleeping.

The nurse is on a committee related to family visitation in the critical care unit and discusses evidence to help in the planning. Which statement reflects evidence? A) Allowing children to visit is stressful for the patient and the child. B) Family presence during procedures promotes adaptation. C) Restricted visitation prevents family exhaustion. D) Visitation shapes the critical care experience for the family but not the nurse.

B Family presence during procedures has been shown to promote adaptation and reduce fear and anxiety. Allowing children to visit should be determined on an individual basis. Research has not shown child visitation to be associated with negative effects. Restricted visitation will not prevent family exhaustion and adds to stress. Visitation shapes the critical care experience for both the family and the nurse.

The nurse is participating on a committee to re-model the critical care unit and recommends which features to enhance care delivery and the patient-family experience? (Select all that apply.) A) Headwall systems that look like regular furniture B) Designated space for staff, administration, and education C) Rooms at least 100 sq. ft. in area D) Space for the family within the patient room

BD Best practice designs (Table 2-2) recommend rooms be at least 250 sq. ft. and have room for the family within the room. Designated space for staff, education, and administration is essential. Newer units are incorporating ceiling-mounted equipment rather than traditional headwall systems.

As part of the nursing assessment, the nurse asks the family spokesperson, "Since you have such a large family, can you tell me how well everyone gets along?" This question is part of which assessment? A) Cultural assessment B) Developmental assessment C) Functional assessment D) Structural assessment

C Functional assessment identifies how family members function and behave with each other. Cultural assessment identifies cultural aspects of the family. Developmental assessment relates to the developmental stage of the family.

Which intervention is important in meeting the needs of family members of critically ill patients? A) Allow a minister to meet with the family only in the waiting room. B) Allow the family to visit the patient in large groups whenever they wish. C) Encourage family members to participate in small activities of patient care, such as range of motion exercises. D) Tell the family that "everything will be okay. The patient has the best team in the hospital."

C Involving family in care meets family needs. The minister should be allowed to go to the bedside to provide support to patient and family. Large groups may add to sensory overload. Families should never be given unrealistic hope.

The nurse is meeting with family members of a critically ill patient. Which statement best addresses the psychological needs of the family members? A) "I'm adjusting the alarms on the monitor to reduce the noise level in the room." B) "It would help the patient if you can spend the night in the waiting room." C) "The team has just made rounds on the patient. We are going to begin weaning the patient from the ventilator today since the patient's oxygen is improving." D) "There are coffee and cookies in the waiting room. Why don't you take a short break?

C The need for information is the primary need of family; providing daily updates is an excellent example of meeting family needs. Family should be encouraged to get adequate rest; staying all night may increase stress and fatigue. If they do stay, many hospitals provide in-room sleeping arrangements. Providing food and space meets physical needs for family.

Pleasant sensory stimuli in the critical care unit can be promoted by which interventions? (Select all that apply.) A) Conversing with another nurse about another patients condition B) Discussing other patients conditions within hearing range. C) Moving the patients bed to facilitate looking out the window. D) Providing a clock, calendar, and family pictures in the room. E) Asking Do you know what day it is?

CD Allowing the patient to view out of a window and providing reorientation cues, such as a clock, calendar, and pictures, provide pleasant stimuli. Discussion about other patients adds to stress for the patient. "Do you know what day it is?" is not the best way to reorient the patient.

Factors influencing response to critical illness

age, developmental stage, experience with illness, hospitalization, family relationships, social support, stressful experiences, coping mechanisms, and personal philosphies

PT recollection of critical care experience

difficult communicating, pain, thirst, difficult swallow, anxiety, lack of control, depression, fear, lack of family or friends, physical restraint, feeling dread, inability to get comfortable, difficult sleeping, lonely, death and dying

Nurse interventions to reduce stress

ensure safety, reduce sleep deprivation, minimize noise