ECCO Global Perspectives in Critical Care: Part 2

Which patient is at greatest risk for developing erosive gastritis?

A patient who was placed on the ventilator the day prior and with INR 2

Which patient is demonstrating complete recovery from anesthesia? A patient:

Able to deep breathe and having BP 20 mm Hg of baseline

Which intervention should the nurse employ first to prevent delirium and control pain in a patient on mechanical ventilation?

Analgesic

Which statement is true regarding pain in patients who are sedated?

Pain should be treated before sedating patients.

You are caring for a patient with a BMI 40 kg/m^2 with sepsis. She smoke half a pack of cigarettes per day. Which intervention should the nurse implement to help prevent a VTE?

Apply pneumatic sequential compression devices.

In addition to using a closed suctioning system, which action will decrease the likelihood of VAE/VAP in patients?

Change airway humidifiers every 5-7 days, as indicated.

You are caring for a patient undergoing a bedside colonoscopy under moderate sedation. The patient becomes agitated. Which action has the highest initial priority?

Check the patients SpO2 When a patient undergoing moderate sedation develops agitation, check the SpO2, vital signs, and patient responsiveness to determine if the patient is hypoxemic.

Which tools should the nurse use to assess delirium in a critically ill patient?

Confusion Assessment Method for the ICU (CAM-ICU); Intensive Care Delirium Screening Checklist (ICDSC)

You admitted a patient with sepsis. In addition to unit protocols, what factor should the nurse consider about the frequency of reassessments?

Degree of hemodynamic instability Frequency of reassessments is based to some degree on unit protocols, but adjusted to greater frequency based on patient needs. The more unstable the patient, the more frequent reassessments should be, and focused to the most unstable body system.

You are admitting a patient with sepsis who is intubated and on mechanical ventilation. Norephinephrine (Levophed) is being titrated based on MAP. Which are the patient's priority needs?

Ensuring patency of airway is maintained; Assessing hemodynamic status The patient has sepsis, and is on the ventilator with a norephinephrine drip being titrated. Ensuring airway patency and hemodynamic status are very high priorities. Some of the routine measures associated with admitting a patient can wait until these priorities are addressed.

Which strategy should the nurse implement to help prevent PICS?

Foster coping skill while in the ICU.

A patient with end-stage kidney disease (ESKD) managed with hemodialysis is hypotensive. The nephrologist agrees there are no options. The family agrees the patient is end of life. A DNR order is signed. Which has the highest priority?

In the situation described, the patient has a DNR order, and the provider and family agree the patient is at end of life and that further hemodialysis is not indicated due to the patient's hypotension. The nurse's next priority is to explain to the family what to expect the patient's response and care to be as hemodialysis is discontinued.

A patient is terminally ill and at end of life. The family asks for mechanical ventilation to be withdrawn. Once the provider writes the necessary orders, which intervention is indicated?

In the situation described, where the family and provider agree on withdrawal of mechanical ventilation in a patient who is at end of life, once the necessary orders are written the nurse's next action is to gradually withdraw ventilatory support while managing patient symptoms.

A patient is receiving morphine (Duramorph) and midazolam (Versed). The patient does not respond to verbal commands and has a CPOT score of 3 (out of 8). Which should the nurse anticipate?

Increasing the morphine infusion rate A CPOT score of 3 indicates the patient is experiencing pain, so increasing the morphine infusion rate is appropriate. Remember to always treat pain before addressing sedation (analgosedation).

What are the care priorities for a patient in the immediate postoperative period?

Maintaining airway and normothermia, monitoring vital signs and indications of recovery from anethesia, managing pain, and recognizing and intervening for complications.

Which potential complications should the nurse monitor for in a patient receiving moderate sedation?

Monitor the patient receiving moderate sedation for the following potential complications: oversedation, undersedation, hypoventilation, hypotension, and dysrhythmias.

A patient is recovering from moderate sedation with fentanyl (Sublimaze). The patient's BP is 30 mm Hg from baseline. Which should the nurse anticipate?

Monitor vital signs every five minutes.

A patient hospitalized with acute respiratory distress syndrome (ARDS) is now told he will be discharged soon. Which statements or actions may indicate PICS?

Patient is unable to recall medication instructions he was taught yesterday.

In caring for a patient who will undergo procedural sedation, what are the nurse's pre-procedure care priorities?

Perform team time-out to validate correct procedure and patient; Verify the type of procedure with patient and family, if possible; Mark procedure site for side or level.

Which action should the nurse implement prior to a patient undergoing a procedure with moderate sedation in order to ensure patient safety?

Perform the Universal Protocol

A patient is being seen by the palliative care team for management of dyspnea. SpO2 is 90% on room air. In addition to administration of low-dose opioids, which should the nurse anticipate?

Performing guided imagery as needed Palliative management of dyspnea includes administration of low-dose opioids, adjusting the environment, complementary treatments, and psychosocial and interpersonal treatments such as guided imagery. Oxygen would be appropriate if the patient is hypoxic.

Which interventions should the nurse anticipate to prevent delirium?

Promote early mobility Mobility is the only nonpharmacologic intervention that has been demonstrated to prevent delirium.

In caring for a sedated post-procedure patient, what are the nurse's patient care priorities?

Record vital signs, sedation level, and oxygenation until patient is at pre-sedation LOC and function until the patient returns to pre-sedation state, as well as monitoring for pain and reorienting the patient as needed. If necessary, encourage the non-ventilated patient to take deep breaths.

Which intervention should the nurse implement to help prevent a CAUTI?

Remove catheter if not indicated.

Which tool should the nurse use to assess a patient's quality and depth of sedation?

Sedation-Agitation Scale (SAS) or Richmond Agitation-Sedation Scale (RASS)

Upon extubation, a postoperative patient develops stridor, anxiety, and an inability to speak. Which intervention is initially indicated?

Stridor, anxiety, and inability to speak in a postoperative patient who was just extubated indicate laryngospasm. Immediate bag-valve mask ventilation is needed while other interventions such as NIPPV are prepared.

Which should the nurse employ to decrease a patient's risk of hospital-acquired pressure ulcers (HAPU)?

Turn patient at a 30-degree angle with HOB elevated to 30 degrees.

How should the nurse assess a patient's pain?

Use Critical-Care Pain Observation tool (communication-impaired patient); Ask patient to score on a numeric or visual analog scale; Behavioral Pain Scale For patients who can interact, ask them to rate pain on a numeric or visual analog scale. For patients unable to self report, use the Behavioral Pain Scale or the Critical-Care Pain Observation Tool

In addition to clustering interventions to allow for uninterrupted sleep time, which strategy should the nurse use to help the patient receive adequate sleep?

Use diurnal lighting (24-hour darkness/light pattern).

in caring for a patient with a CVC, which intervention is indicated to help prevent CLABSI?

replace transparent dressing every 7 days