Early Warning Signs
Most commonly overlooked vital sign that is an early indicator of deterioration
What is respiratory rate?
First physiological response to hypoxia
What is tachypnea?
Early neurological sign of deterioration
What is confusion?
Two common early warning scoring tools
What are MEWS and NEWS?
Primary goal of the rapid response team
What is to prevent cardiac arrest?
How long before a cardiac arrest do patients often show warning signs?
What is 6–24 hours?
Why tachypnea occurs in metabolic acidosis
What is to blow off CO₂?
Early cardiovascular response to stress
What is tachycardia?
What does a higher early warning score indicate
What is higher risk of deterioration?
When should you call a rapid response
What is when there is acute change or concern?
Name one early sign of clinical deterioration
What is tachypnea / confusion / tachycardia?
Name one sign of increased work of breathing
What is accessory muscle use / retractions / nasal flaring?
Late sign indicating failure of compensation
What is hypotension?
Score range for Epic’s deterioration index
What is 0–100?
Name one member of the rapid response team
What is ICU nurse / RT / provider?
This subjective factor alone is enough to trigger a rapid response
What is staff concern?
Why SpO₂ can be misleading early in deterioration
What is it may remain normal due to compensation or oxygen therapy?
What does bradycardia often indicate in a deteriorating patient
What is impending cardiac arrest?
Name one type of data Epic DI uses
What are vitals, labs, nursing documentation, or patient history?
True or False: You should wait for provider orders before calling RRT
What is False?
A patient has stable vitals but becomes suddenly restless and states they feel “off.” What is the priority nursing action?
What is perform a focused reassessment and consider early escalation
A patient on 4L nasal cannula has SpO₂ of 95% but is tachypneic with increased work of breathing. Why is this concerning?
What is the patient is compensating and at risk for respiratory failure despite normal oxygen saturation?
A patient becomes acutely confused with a normal blood pressure. What does this most likely indicate?
What is early hypoxia or decreased cerebral perfusion?
A patient’s Epic DI score rises from 35 to 70 over 3 hours, but vital signs are only mildly abnormal. What is the best nursing action?
What is reassess the patient and escalate care based on rising risk trends?
A nurse is unsure whether a patient meets strict RRT criteria but feels the patient is declining. What is the most appropriate action?
What is activate the rapid response team based on clinical concern?