Exam 1: Unit 1: Overview of Critical Care
What must be done to get a certification?
1 or 2 years in an area of specialty; study for an exam (all through the AACN)
What are the four types of certifications?
1. CCRN 2. PCCN 3. CMC 4. CSC
What are the essentials?
1. Safe, competent care of critically ill with regards to medical diagnosis 2. Interpretation and management cardiac rhythms 3. Hemodynamic Monitoring 4. Circulatory assist devices 5. Airway and ventilator mangement 6. Pharmacology 7. Pain 8. Sedation
Critical Care Units opened across the country in the _________.
1960s
When was the AACN founded? What was it originally called?
1969 the American Association of Cardiovascular Nurses (AACN) Name changed to American Association of Critical Care Nurses (AACN) in 1971
FIO2 for the air we breathe is ____% (room air)
21
What patient : nurse ratio is seen in a PCU?
3:1 ratios
Critical Care Nursing as a "specialty" is less than ____ years old.
50
What will all ICU patients have at their bedside? Why?
A bag-valve mask (Ambu) If on a vent and starts having trouble breathing, the first thing you do is use an Ambu-bag
How does the AACN define critical care nursing?
A specialty dealing with human responses to life-threatening problems [actual or potential]
Providing safe and competent care includes what components to do this?
ADPIE And a lot of collaboration
Which organization credentials advanced practice nurses?
ANCC (not AACN) (American Nurse Credentialing Center)
What is an example of actual vs potential life-threatening problems?
Actual: heart attack, stabbing, MVA, gun shot wound Potential: attempted suicide, DVT could embolize to lung, hypoglycemia, colorectal resection, lung resection, other sx
What are examples of non-invasive hemodynamic monitoring?
BP [calculate mean arterial pressure], pulse ox
What is a CMC? CSC?
CMC: cardiac medicine certification CSC: cardiac sx certification
What are the types of APRNs you can get?
CNS- clinical nurse specialist NP- nurse practitioner DNP- doctor of nursing practice
What is the difference between getting certifications vs APRN?
Certifications are based on nursing models APRN is based more on medical models
What action should an ICU know to take in a code situation?
Check pulse on carotid or femoral pulse
What does CCU stand for? CVICU?
Coronary Care Unit Cardiovascular ICU
What is a CCRN? PCCN?
Critical care registered nurse Progressive critical care nurse
What are two examples of conditions seen in a MICU?
DKA, Sepsis
Why would an ICU need to know about sedation?
Diprovan (Propofol) is used for patients on ventilators
Instead of evaluation, what two things does the E stand for?
Education and Emotional support
Why were critical care speciality units developed?
From recognition that patients with acute, life-threatening illness/injury could be managed more effectively if they were placed on specifically designated units
What is the importance of the ACCN (AACN?) for critical care nurses?
Guides and puts out standards of practice that must be upheld if working in a critical care unit
The critical care environment is highly __________ and highly ___________
Highly complex and highly technical (Multiple lines, Foleys, FlexiSeal, vents)
When would a patient get a long-term left ventricle assistance device?
If waiting for transplant and unstable
What is the function of a APRN from the typical RN?
Independently function from the doctor; prescriptive authority
What two things is there a move towards in the ICU to increase comfort?
Involving the family of an ICU patient more and allowing the family present during a code
Who opened the earliest intensive care unit? When?
John Hopkins in the early 1900s
What is an example of a PCU?
LTAC
What are circulatory assist devices?
Left ventricular pumping devices
What should an ICU nurse gather from the assessment?
Listening, knowing what causes this, and anticipating what might be ordered [hear crackles --> assess breathing, O2 sats --> diuretics]
Why would an ICU nurse need to know about pharmacology?
Lots of tritiation and drips
Are patients at risk for serious complication all unstable?
May not be unstable, but their chances for complications are greater.
What are examples of specialty units for special populations? specialities?
NICU, PICU near, burns, trauma
What type of unit is a PCU?
Patients who are hemodynamically stable without liability in vital signs (no arrhythmias), but for some reason they are not ready to be extubated (need more time to be weaned from the vent) Titrating cardiac drugs, etc. will require a specialty floor Step down- don't need the excessive monitoring in ICU but aren't stable enough to be on a regular floor
What are examples of someone who is at risk for serious complications?
Pressers, vent Patient went in for surgery and has more co-morbidity that puts them at increased risk. Craniotomies, high risk post-op surgical patients
What does PCU stand for?
Progressive Care Unit (aka Intermediate Care Units)
What causes discomfort?
Rest, positioning, loss of control, trust, helplessness, isolation of social support
How did Florence Nightingale contribute to specialty units?
She described the advantages of placing patients recovering form surgery in a separate area (People with surgical wounds do not go next to people with infections)
What does SICU/MICU stand for?
Surgical-ICU, Medical-ICU
What is an example of a pulmonary artery catheter? What does it do?
Swan Ghanz Sits in the PA and able to measure pressures and get an idea of the function/pressure of the left side of the heart
Which organization is concerned with critical care units?
The American Association of Critical Care Nurses (AACN)
What does providing care with regards to medical diagnosis mean?
The diagnosis guides the admission to a critical care unit (ACS, acute MI, Trauma)
What does the scope and standards for acute and critical care nurses outline?
The expected level of practice and professional performance and articulates the contributions of acute and critical care nursing to a patient and family-centered healthcare system
Why do ICU nurses need to know about pain?
The majority of the time the patients experience acute pain (for less than 6 months)—this might require stronger narcotics or opioids
Which two rhythms should an ICU nurse know you should shock?
V fib and pulseless V Tach
Which rhythms should an ICU nurse be able to identify as lethal rhythms?
V fib, pulseless V Tach, Torsades, PEA, complete heart block
What two world events influenced the development of specialty units?
World War II and Korean wars (mass units opened up to care for these patients)
Do certifications need to be renewed?
Yes, by either retesting or getting enough CE hours to renew automatically
What additional requirement is needed to get a CMC or CSC?
You must have a CCRN or PCCN first
If the patient is having anxiety and pain—always treat the _________ first.
anxiety
What is required to get your Advance Practice Registered Nurse (APRN)?
at least 2 more years of school
What does the essentials of AACN/CCRN refer to?
core information that new clinicians must understand to provide safe, competent nursing care to all critically ill patients, regardless of their underlying medical diagnoses
Why would someone with IV polypharmacy be in the ICU?
multiple drips- active titration or doing it to maintain a blood pressure they need to be in ICU so the nurse can monitor it safely
For what 4 reasons would someone be admitted to the ICU?
o Physiologically unstable o At risk for serious complications o Require intensive, complicated nursing support and advanced biotechnology o Require IV polypharmacy
What are three types of hemodynamic monitoring?
o Pulmonary artery catheter o Non invasive o Stroke Volume variation monitoring
What is the impel?
pump inside the heart
If the patient is on room air and is in respiratory distress, what would an ICU nurse do?
put on 2L of oxygen.
Why is there a lot of collaboration in the ICU?
the physician will leave you "standing orders"—have more autonomy
What are examples of intensive, complicated nursing support and advanced biotechnology?
§ PA Catheter § LVAD (left ventricular assistant device) § CRRT (continuous renal replacement therapy)
What are examples of physiologic instability?
§ Septic § Hemodynamic instability § Overdose § Altered LOC § Decreased pulse ox, crappy chest x-ray, tachypnea § Bradycardia, V Tach § Distension, rigid abdomen, ileus
What are the five types of speciality units?
· ICU · CCU & CVICU · SICU/MICU · Special Populations/Specialties · Progressive/Intermediate Care Units
What are three types of circulatory assist devices?
· Intra-arterial Balloon pump · Impella · Long-term left ventricle assistance device
Who owns comfort?
·The nurse ·The nurse ·The nurse
