Ventilator Management and Care
HoB elevated 30 degrees, regular mouth care, proper hand hygiene, and a daily "sedation vacation" for a ventilated patient, are all efforts to prevent what?
Ventilator-associated pneumonia - VAP
The integration of care is comprised of 3 fundamental needs, what are they?
Psychosocial, relational, and physical
Open communication, answering any questions the family has, and respecting the families values/ beliefs
Name two assessments specific to neurological function, that are vital to monitor when performing a head-to-toe assessment on a patient with a severe TBI.
PERLA (pupillary response)
GCS (Glasgow coma scale for level of consciousness)
Understanding the management of a mechanically ventilated patient and the mechanism of actions of vasopressors is a demonstration of which of the ways of knowing?
Empirical
With a mechanically ventilated patient, when should suctioning be performed?
When oxygen saturation levels drop because of increased respiratory secretions
Regularly repositioning, performing mouth care, eye care, and hygiene, addresses which domain of the circle of care?
The patient's dad is in the room telling you how difficult it is to see his son this way and how he feels helpless. What is one thing you can do as a nurse to help this parent?
Assess the dad's willingness to be involved in providing care, if so ask the dad if he is comfortable being involved in simple cares (i.e., repositioning, eye/skin care, etc.), and give him a responsibility.
A patient with a TBI opens their eyes to pain, makes incomprehensible sounds, and withdraws to painful stimuli, what is their GCS score?
GCS = 8
Providing the family with all necessary information regarding Dan's brain death diagnosis and allowing them to make an informed decision to withdraw care, demonstrates which way of knowing?
Personal
Dan is ventilated on AC (assist control), what does this mean?
(hint: level of support)
Full machine control
(typically used after CPR or on life-support)
Actively listening and engaging with the family members of this patient is part of fulfilling which domain of the integration of care circle?
Relational
What is one of the main benefits to ensuring family-centered care (FCC) is provided in the ICU setting?
(recall the pre-readings)
Family members are essential for communicating the patient's thoughts and preferences to the team, advocating on behalf of the patient's thoughts and preferences to the team, advocating on behalf of the patient, and serving as a surrogate decision-makers
The use of vasopressors for patients who have suffered a TBI is paramount for what purpose?
To maintain cerebral perfusion and prevent ischemia
Providing the family with all necessary information regarding Dan's brain death diagnosis and allowing them to make an informed decision to withdraw care, demonstrates which way of knowing?
Ethical
Dan's most recent ABG results indicate what imbalance:
pH: 7.25
pCO2: 35
Bicarb: 13
Metabolic acidosis with partial compensation of respiratory alkalosis
By assessing the families, values, beliefs, and religious or spiritual preferences, this addresses which domain of the integration of care circle?
The holistic model of patient-centered care emphasizes what 3 things?
1. An empathetic respectful relationship between the team and patient
2. Ongoing bidirectional communication
3. Collaborative decision-making regarding care planning.
Cerebral perfusion pressure (CPP) is determined by what two measured values? (hint: equation)
CPP = MAP (mean arterial pressure) - ICP (intracranial pressure)
The nurse has developed a therapeutic relationship with the patient's family and the family is now sharing stories about the patient with the nurse. The nurse feels empathetic and gains an understanding of the family's relationship. Which of the ways of knowing is this nurse partaking in?
Aesthetic
As the nurse, you notice that your intubated patient is desating to the low 70s, what are your top 3 priority nursing interventions at this time?
1. 100% O2 boost
2. Call RT
3. Assess and suction the patient
What is the purpose of the ILC fundamentals of care framework?
To ensure that the patient's fundamental care needs are met and no fundamental care needs are neglected
How does family-centered care benefit the healthcare providers (3 ways)?
1. Enhances job performance
2. Sense of self-efficacy and well-being
3. Lower levels of burnout
What is the purpose of using a hypertonic solution such as 3% NS when treating increased ICP for severe cerebral edema?
To shift the excess fluid back into the intravascular space so it can circulate out of the brain, with the goal of increasing cerebral perfusion pressure.
The patient's dad is in the room and telling you how hard it is to see his son this way and how helpless he feels. As the nurse, you ask about his willingness to participate in care and delegate simple tasks such as providing eye and mouth care. Which way of knowing does this demonstrate?
Emancipatory