Studied by 8 peoplewhat is the earliest warning sign og physiological instability
change in mental status
what does the neurological bell curve focus on
decreased LOC
what does the respiratory bell curve focus on
respiratory rate
what does the cardiac bell curve focus on
worsening EKG strip
what happens to LOC as the patient progresses along the neurological bell curve
restless to combative to unresponsive
what happens to the RR as the patient progresses along to respiratory bell curve
respirations increase until it leads to apnea
what components make up the MEWS score
RR, HR, BP, temp, urinary output
when using the mews score what trend is a warning score
a high or increasing score
what is the role of the rapid response team
brings critical care to the patients bedside
when should you call the rapid response team
physiologic or lab value changes, “gut feeling”, high MEWS score
what steps can be taken to prevent failure to rescue
high RN-to-patient ratios, more BSN, recognize S/S, prepare emergency supplies, collaboration and autonomy,, high-tech, RRT
which patients are the most vulnerable to failure to rescue
trauma and surgical
what potential complications can place the patient at risk for failure to rescue
cardiopulmonary arrest, pneumonia, upper GI bleed, VTE, sepsis
define failure to rescue
inability to save a patients life by timely diagnosis and treatment when a complication occurs, or the inability to save a hospitalized patients life when they experience a complication
when do S/S of impending arrest begin
up tp 72 hours before
which is more important during CPR compressions or breaths
compressions
what is the goal of CPR
preserve brain function
how should pulse checks during CPR be managed
complete full 2 minute cycles with minimal interruptions and pulse checks, use ETCO2 and monitor ROSC over BP and pulse checks
what style of communication should be used during codes
closed feedback
after a patient is shocked what is the immediate next step
resume CPR, don’t do a pulse check first
what factors can influence the decision to terminate a code
no consistent perfusion for more than 30 min, initial rhythm of systole, length of time between cardiac arrest and start of CPR
nursing care post-code
O2, correct hypotension, EEG if patient is comatose
what is a reperfusion injury
as oxygen is introduced back into brain cells they begin to die as they carried back inflammatory agents
how does the cold hypothermic setting benefit the brain
brain cells lasted longer since the cerebral metabolism was decreased (lower O2 demands), decreased excitatory neurotransmitters, decreased permeability (less cerebral edema)
how cold should a patient in induced hypothermia be kept at and for how long
32-34 degrees for 12-24 hours (cool as quickly as possible after ROSC)
what are the outcomes of induced hypothermia post-code
better neurologic function and decreased mortality
how should a patient in induced hypothermia be rewarmed
0.5 degrees per hour
what are the side effects/complications of induced hypothermia
decreased electrolytes and insulin sensitivity, hypovolemia (cooling causes increased UO), risk for infection and bleeding, bradycardia
what does the nursing care look like for a patient in induced hypothermia
analgesics, sedation (reduced shivering), paralytics (alleviate muscle movement), keep MAP > 70
why is meperidine (demerol) given to induced hypothermia patients
decreases shivering threshold
why are sedatives such as propanol and fentanyl given to induced hypothermia patients
decreases shivering but no the threshold
what are the goals for cardiac rehabilitation
reduce risk for future MI and rehospitilization, lessen chest pain and need for meds, control risk factors
what are the components of cardiac rehabilitation
exercise, healthy diet, reduce stress, stop smoking, meds
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