Adult Health - Adv. Med-Surg Week 1 notes
Adult Health - Adv. Med-Surg Week 1 notes NU 424
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This 3 page Class Notes was uploaded by Allison Black on Friday January 15, 2016. The Class Notes belongs to NU 424 at Jackson State University taught by in Fall 2015. Since its upload, it has received 16 views. For similar materials see Adult Health in Secondary, Tertiary, and Community Settings in Nursing and Health Sciences at Jackson State University.
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Date Created: 01/15/16
Intro to Critical Care - Resuscitation Review and Airway review▯ ▯ Resuscitation ▯ ▯ Prior to code - Early assessment is key - Approximately 50% of all patients who code exhibit warning signs up to 6 hours prior to their arrest. ▯ Watch for: ▯ ▯ ▯ Heart rate: <45 OR >125▯ ▯ ▯ Resp. rate: <10 OR >30▯ ▯ ▯ Chest Pain▯ ▯ ▯ Altered Mental Status▯ ▯ Changes can be acute or gradual, it is the nurse’s responsibility to detect trends and changes in a patient’s status. ▯ ▯ Before calling a code: Assess the patient! Look for changes in:▯ ▯ ▯ LOC▯ ▯ ▯ Vitals▯ ▯ ▯ Labs (CBC, electrolytes, esp. Potassium, Sodium, and Calcium)▯ ▯ If you believe a patient is about to code: ▯ ▯ ▯ 1) Notify the patient’s nurse / Charge Nurse / Clinical Instructor ▯ ▯ ▯ ▯ ▯ Immediately of condition changes. ▯ ▯ ▯ 2) RRT (rapid response team): Call as soon as the nurse recognizes / ▯ ▯ ▯ ▯ identiﬁes a change in patients condition.▯ ▯ ▯ 3) Reassess the patient frequently.▯ ▯ Calling the code - ▯ ▯ • Call the Facility Emergency Number▯ • Identify the type Code▯ • Give the location of the Code▯ • Note the time▯ • The patients’ primary care nurse should be present during the entire code. ▯ ▯ Before the code team arrives - ▯ ▯ • Apply PPE▯ • Start CPR▯ - Airway▯ - Breathing ▯ - Circulation ▯ - Deﬁbrillation / AED application▯ Obtain Crash Cart▯ • Remove extra furniture from room▯ • Designate a person to do the following:▯ - Page Chaplain for Family Support▯ - Call Attending MD▯ - Bring Chart to Room▯ ▯ ▯ Members of a code - Roles of a code: ▯ ▯ • Staff Nurse * Team Leader▯ • Critical Care Nurseysician: * Airway Management▯mekeeper▯ • RRT Nurse * Compressions▯ • Respiratory Therapist * Frequent femoral pulse check . to ensure good CPR▯ • House Supervisor * IV establishment/management▯ • Nursing Assistant / Tech * Medication Administration▯ • Student▯ ▯ ▯ ▯ When code team arrives: ▯ ▯ • relieve you.▯PR when code team arrives. Continue until someone is ready to • Deﬁbrillation requires electrical safety measures: No hands or clothing touching the bed, or the code team member will get shocked. ▯ ▯ What the code team needs to know: ▯ ▯ • Current Diagnosis▯ • Events Leading Up to Code▯ • Recent Meds, treatments or procedures▯ • Primary MD▯ • Code Status▯ ▯ Allergies, any other pertinent conditions.▯ ▯ ▯ ▯ Airway review▯ ▯ Oral airway (OPA): Measure against face, correct size will be the length of the corner of the mouth to the tip of the earlobe. ▯ ▯ Nasal airway (NPA): Measure against face, correct size will be the length of the tip of the nose to tip of the earlobe. ▯ ▯ ▯ Do not use in patients with basilar skull facture. ▯ Endotracheal (ET) tube: ▯ ▯ • Always check cuff prior to insertion▯ • Hyperoxygenate: ambu-bag to mask▯ • Once ETT is inserted conﬁrm placement▯ • Auscultate for bilateral breath sounds▯ • CO2 monitor ▯ • Chest X-ray▯ • Inﬂate cuff: minimal leak technique▯ • Secure Tube: Tape tube and note cm marking at the teeth line.▯ ▯ Tracheostomy: Use for long term airway management.▯ ▯ • Keep obturator at bedside at all times. ▯ • Review checkoff guidelines for trach care and suctioning.
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