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Critical Care Exam 1

Terms in this set (35)

morals
traditions or belief about right or wrong human behavior
ethics
concerned with the basis of the action rather than whether the action is right/wrong, good/bad
ethical dilemma
a decision making problem between two possible moral imperatives, neither of which is totally acceptable or preferable (ex: execution)
moral distress
nurse knows the ethically appropriate action but feels unable to act consistently, and therefore acts unethically. also occurs when a nurse acts in a manner contrary to personal and professional values
beneficnece
preventing harm or doing good
nonmaleficene
dictates nurses prevent and minimize harm and correct harmful situations (foundation of hippocratic oath)
medical futility
especially aggressive critical care, does not meet underlying goals of care. no useful result of health care interventions
Code of ethics for nurses
provides society with a set of expectations of the profession, contains statement and directives for ethical nursing behavior
tort
civil lawsuit based on unintentional acts (can be failure to act or negligence that results in harm, or intentional acts)
a type of tort that requires the alleged wrongdoer to have special standing as a professional
malpractice and negligence
assault
threat to the patient
battery
patient is touched in unauthorized manner
two types of advanced directives
-living will
-durable power of attorney
algorithms
a guide for an "if/then" decision making process which addresses a patient's response to treatment
palliative care
begins at diagnosis and at the same time as treatment. is about symptom management and pain control, patient is still receiving treatment for their condition
hospice care
occurs after treatment for condition has stopped
drug of choice for pain control while patient is sedated
morphine
light sedation
used for anxiety and is minimal (clonidine)
moderate sedation with analgesia
utilized for procedures, is depression of patient's consciousness
deep sedation
depression of patient consciousness to where patient cannot maintain airway, used in ventilator patients
drug used for deep sedation
propofol, can only be used when patient is immediately going to be intubated or when they are already intubated
drug of choice for agitated patients
haloperidol (can cause prolonged QT segments which can lead to ventricular dysrhythmias)
preload
pressure from volume of blood in ventricles at end of diastole
when is preload increased
hypervolemia, valve regurgitation and HF
when is preload decreased
hypovolemia and dehydration
normal preload range
2-5 mm Hg (measured by CVP)
afterload
resistance left ventricles must overcome to circulate blood
what is afterload affected by
systemic vascular resistance
when is central venous pressure monitoring indicated
when a patient has a significant alteration in fluid volume
what veins are used for CVC line insertion
subclavian and internal jugular
PAOP pressure (aka pulmonary artery wedge pressure)
pressure created by the volume in the left side of the heart
normal PAOP
5-12
frank-starling law of heart
a model that indicates that the ventricle will stretch at attempt to increase cardiac output, but at some point of stretching the ventricle becomes less effective (or is over stretched), which results in decreased CO
Diagnosing HF
B-type natriuretic peptide (BNP over 100 is used to diagnosis those with HF with symptoms of SOB and fluid overload)
transesophageal echocardiography (TEE)
a less invasive way that an assessment of real time left ventricular cardiac contractility can be assessed
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