Leadership in Complex/Critical Care and Cardiovascular Alterations

QUESTION

EXAM 1 STUDY GUIDE What is Complex/Critical Care? What is Moral Distress? What is a DNR? How can an ICU/Critical Care Nurse involve the family in the care of their loved one? What drugs are used to assist with the “death rattle” in patients in hospice care at the end of life? How do you identify brain death? What is sensory deprivation and what are some nursing interventions that can help with this? Oxygenation Review Acid Base – ABG’s What does compensation and Decompensation mean? What type of ABG would you see in a code? (Hint: the client is not breathing) Conditions resulting in hypoventilation result in which type of Acid Base Imbalance? Give two examples. A nonrebreather mask is the highest level of oxygen via a mask. The flow meter is set at _____liters. Review NPPV – what types of clients are candidates? What types of clients are contraindicated? What is the purpose of a mechanical ventilator? Who is a candidate for a vent? What are the criteria? What is VAP and why is it important? What are the criteria for weaning from a mechanical ventilator? What is failed weaning and what does the nurse look for? Pneumonia COPD – exacerbated Asthma – exacerbation Pulmonary Embolism What are the signs of a pneumothorax? How is it diagnosed? What is the treatment? Who is at risk for ARDS? Why is ARDS so dangerous? What are the signs and symptoms of ARDS? Why is PEEP so important in ARDS treatment? Cardiovascular  Why is learning about heart rhythms so important?  Beginning interpretation of a rhythm strip. PQRST- which letter represents the depolarization of the ventricles? Which section represents the repolarization of the heart?  What is the difference between defibrillation and synchronized cardioversion? Give an example when to use each.  What are common Atrial Arrhythmias and which ones need intervention?  Identify life threatening arrhythmias from the ventricles. What interventions are appropriate? 1. 2. 3.  If you think your patient has a life- threatening rhythm, what do you do first?  When do you perform chest compressions?  What is symptomatic bradycardia versus another bradycardia?  Identify causes of Sinus Tachycardia and treatments  Describe PEA and the 6 causes. Identify treatment for each. 1. 2. 3. 4. 5. 6. Briefly discuss the difference between a:  Permanent Pacemaker-  Transcutaneous Pacemaker-  Transvenous Pacemaker-  Identify two causes of Premature Ventricular Contractions and treatment modalities. P-Wave: Positive inflection normal 0.06-0.12 sec- Shows the amount of time it takes for the passage of the electrical impulse through the atrium and causing atrial contraction. PR Interval: 0.12-0.20- Includes the time it takes for impulse to spread through the atria, AV node, Bundle of His, Bundle branches, and Purkinje fibers. QRS- Interval: <0.12 sec. Shows the time it takes for complete ventricular contraction. ST Segment: 0.12 sec. – the time between ventricular depolarization and repolarization (diastole) T Wave: 0.16 sec. – time it takes for the ventricular repolarization  What inflection represents the impulse of the SA node? _____________________ Rhythm Practice Questions to Ask when looking at Rhythm strip. (6 second strip) 1. Are There P waves? Yes 2. Is the rate regular? Measure between R to R wave is it the same through the strip? Yes 3. Is there a P wave for every QRS? Yes 4. What is the Ventricular Rate (QRS complex) __70____? 5. What is the PR interval? The same each time 6. What is the Rhythm? _____Normal Sinus Rhythm_____________ What intervention? This is normal – this is what we want to restore with every rhythm. 6 second strip method is the quickest and easiest way to count the rate. Strip must be 6 seconds long. Atrial Fibrillation: Irregular rhythm, no discernible P waves, irregular baseline, skinny QRS (most of the time). Management of care includes: 1 2 3 4 Atrial Flutter: Usually regular rhythm, sawtooth baseline, no Pwaves, skinny QRS Management is the same as which rhythm? Sinus Tachycardia: Rate > 100.  Is it regular or irregular?  How can you determine rate without a heart monitor?  Identify common causes and management of care of sinus tachycardia.  When do you call a code blue?  When do you call a rapid response? Ventricular rhythms: requires rapid defibrillation Ventricular Fibrillation: Pulseless, irregular, chaotic rhythm on monitor. No pulse = no cardiac output. Management of Care includes:  What needs to happen quickly? Ventricular Tachycardia: wide complex QRS, rapid, no P waves . Recognize on sight. First nursing activity – assess – Check your patient! Remember no pulse = no cardiac output. Torsade’s de Point (polymorphic ventricular tachycardia)  Classic rolling presentation – What essential medication is needed? Paced Rhythm – found in Pacemaker recorded lecture, ATI and Lewis text.  What symptoms are seen with a pacemaker malfunction?  What is wrong with this pacemaker? Failure to __________  What is wrong with this pacemaker? Failure to _____________  What intervention? Have it interrogated for wire malfunction or muscle damage?  Where does the patient generally have the pacemaker routinely interrogated?  What’s wrong with this pacemaker? Failure to______________ – problem low battery  This is a heart block. Identify which one.  What is the management of care?  The client is Pulseless and unresponsive. This is the Rhythm. What do you do? Rhythm_________  Management of Care: Cardiac medications found in exam 1: Digoxin: (what is the therapeutic range and signs and symptoms of toxicity?) Amiodarone Adenosine Atropine Nitroglycerin Epinephrine Diltiazem Heparin What is the difference between the normal PTT and a therapeutic PTT? Metoprolol Warfarin (therapeutic PT INR for Atrial Fibrillation) Clopidogrel TPA Coronary Artery Disease Signs and Symptoms – men versus women Cardiac Catheterization – care of the client and education STEMI – Management of Care Unstable versus Stable Angina – symptoms and management of care Signs of Ineffective tissue perfusion Care of elderly with CAD Tachycardia in presence of MI PCI – Percutaneous Coronary Intervention PTCA and STENT Common diagnostic tests: 12 lead EKG Transesophageal Echocardiogram Echocardiogram Cardiac Catheterization Stress Test (Treadmill) Inflammatory Heart Disease Pericarditis: what is it and how is it treated? Endocarditis: what is it ad how is it treated? What is the gold standard diagnostic test to evaluate endocarditis? Hypertensive Crisis What are the parameters for hypertensive crisis? What are the signs and symptoms of hypertensive crisis? Drugs to treat Hypertensive Crisis: Labetalol Nicardipine Hydralazine Nitroglycerine Nitroprusside/Nipride VASCULAR ALTERATIONS What is an aortic aneurysm? What are the signs and symptoms of aortic aneurysm? What are the complications of aortic aneurysm

ANSWER

Leadership in Complex/Critical Care and Cardiovascular Alterations

Introduction

Complex/critical care is a specialized area in nursing that deals with the care of critically ill patients with life-threatening conditions. It requires highly skilled and knowledgeable nurses who can provide prompt and appropriate interventions to ensure positive patient outcomes. In this study guide, we will explore key concepts related to complex/critical care and cardiovascular alterations and their implications for nursing practice.

Leadership in Complex/Critical Care

In complex/critical care settings, leadership plays a pivotal role in ensuring efficient and effective patient care. An example of collaborative leadership in complex/critical care can be seen when a nurse manager coordinates with various healthcare professionals, such as physicians, respiratory therapists, and pharmacists, to develop a comprehensive care plan for a critically ill patient. This collaborative approach ensures that all team members are aligned with the same goals and objectives, promoting better communication and coordination of care.

However, there are instances where leadership in complex/critical care can be improved by greater collaboration. For example, during a code blue situation, the leadership team could benefit from involving bedside nurses in decision-making processes. Nurses who are directly caring for the patient may have valuable insights and observations that could influence the course of action during resuscitation efforts. By encouraging open communication and active participation from all team members, the leadership can foster a culture of collaboration and shared responsibility, leading to better patient outcomes.

Cardiovascular Alterations

Cardiovascular alterations encompass a wide range of conditions affecting the heart and blood vessels. Nurses play a crucial role in identifying and managing these alterations to ensure optimal patient care.

One common cardiovascular alteration is hypertension, which can lead to hypertensive crisis if not managed promptly. Nurses must closely monitor blood pressure levels and intervene promptly when it exceeds the critical parameters. The management of hypertensive crisis often involves the administration of intravenous antihypertensive medications, such as nitroglycerine, nitroprusside, or nicardipine, to lower blood pressure and prevent complications.

In complex/critical care, another cardiovascular alteration that requires close monitoring and intervention is acute myocardial infarction (AMI). Rapid and accurate assessment of the patient’s cardiac status is essential for early intervention, which may include administering thrombolytic therapy or arranging for percutaneous coronary intervention (PCI) to restore blood flow to the affected area.

Conclusion

In complex/critical care, collaborative leadership is vital for effective patient care, while involving bedside nurses in decision-making processes during critical situations can lead to improved outcomes. Cardiovascular alterations demand prompt and accurate assessment, followed by timely interventions to prevent further complications. As nurses in complex/critical care settings, understanding the importance of leadership and staying updated on evidence-based practices for cardiovascular alterations are essential for providing high-quality patient care.