The purpose of this assignment is to prepare you to be in the Critical Care environment. It will assist you in understanding what is occurring with your client and will be useful to refer to during the course of your clinical day.

Student Name: _____________________________________     Clinical Site: ______________________________

Preparation for ICU clinical day document

The purpose of this assignment is to prepare you to be in the Critical Care environment. It will assist you in understanding what is occurring with your client and will be useful to refer to during the course of your clinical day.

By preparing for your critical care experience, it will provide you with a resource to refer to during your clinical day.  You need to submit your documentation via Canvas to enable your faculty member to grade the form; you need to have a paper copy with you for your clinical day. Your faculty member may provide you with a specific date that it is due prior to your first date in ICU, that may vary based on your clinical site.  

You may add to the answers in pen as you learn information throughout the day. This form needs to be with you for any other critical care days in the facility. The form is a valuable resource for your time in the critical care area.

ICU Medications   {100 points  total}

Describe what the following medications are used for. (Be prepared to know your clients’ specific meds in detail when your client is receiving them).  You can complete this assignment on the chart, or in a list; as long as you show the following information: include typical dosages, routes, mechanism of action, any pertinent side effects, any pertinent precautions, nursing considerations, client education. ***Please do not “cut & paste” information from your text- provide information that is pertinent to the ICU clients that will require the medication, what you as the RN will need to be able to ascertain & identify how the medication is helping your client, along with what they/or their family need to understand about the particular medication in relation to their health condition.  Be able to explain the medication to your client. *** For nursing considerations, be certain that you indicate what the reversal agent is. In terms of the client education, remember that the client is in ICU, so the education given needs to reflect that. Look at what the medication is, is your client going to ambulate if they are on sedation? It is important to identify what is the key piece of information is needed for the client in terms of the medication.

***You can do the meds in a narrative format or use the table above~ ***

Pain, Sedation, Paralytics Assessment {85 points total}

a)      We use a variety of pain and sedation scales in the Critical Care area.

Explain the:

i)         Richmond Agitation-Sedation Scale (RASS). Explain what each score means, including a description & definition. {20 points} Do not just copy it from your text or another resource ~

ii)      Sedation-Agitation Scale (SAS). Explain what each score means, including a description & definition. {10 points} Do not just copy it from your text or another resource ~

iii)    Critical Care Pain Observation Tool (CPOT). Explain each of the indicators, score & description in relation to the score. {15 points} Do not just copy it from your text or another resource ~

iv)    What medications are commonly used in the ICU to manage pain? Summarize pain management guidelines for ICU patients.  {15 points} Do not just copy it from your text or another resource~

v)      Explain each component of the Confusion Assessment Method for the ICU (CAM-ICU). {10 points} Explain how and why it is used in the ICU; explain the 4 features that are part of it.  Do not just copy it from your text or another resource~

b)      Neuromuscular blockading agents (NMBA): If a client is receiving a paralytic medication, what assessments need to be completed throughout the shift? What are nursing interventions that are needed for clients receiving NMBA? What are the risks and benefits of a client receiving a NMBA?  {15 points}

Lines  [46 points total]

1)     Central Line (CL/CVC) {24 points total- 4 points each}

a)      Identify where a central line is normally inserted? Why is a CL beneficial for a critical care patient?

b)      Identify each of the different ports on a double or triple lumen catheter; note what each of the ports are used for.

c)      Explain how the CL is assessed for placement?

d)     Determine and explain the nursing priorities of care for a client with a CVC?

e)      Provide details regarding each of the components of the CLABSI bundle.

f)       Explain how fluid volume status is assessed? Why would this be important in a critical care patient?

2)     Intraarterial line  {12 points total- 3 points each}

a)      What is the purpose of an intraarterial line? Provide a list of which arteries’ are used for an arterial line- list the most frequently used artery first.

b)      What is measured by an arterial line; which values are measured via the arterial line? Which values are important to provide information regarding a client’s perfusion?

c)      Provide information regarding key nursing assessments that need to be completed when a client has an arterial line in place. Why are those assessments of importance?

d)     What are potential complications that can occur with an arterial line & how are they managed?

3)     Pulmonary Artery (PA) Catheter {10 points total}

a)      Identify what a pulmonary artery catheter is utilized for? {1 point}

b)      What are the indications for a PA line? Which clients would have one?  {3 points}

c)      What are the components of nursing management of a PA line? Why are they important? {4 points}

d)     Describe what is being measured. {2 points}

Perfusion

Hemodynamic Parameters  {12 points}

1)     Define what each term means, stating the normal parameters for the following HD parameters.  Identify what abnormal values mean for each of these parameters.

Why are these measures important with critical care clients? {12 points total- 2 points each}

a)      CVP (central venous pressure)

b)      MAP (mean arterial pressure) – how is the MAP calculated- include the formula for calculation.

c)      PAP (pulmonary artery pressure)

d)     CO & CI (cardiac output & cardiac index) –Define each term & identify how it is calculated~

Cardiac Procedures 

1) Cardiopulmonary bypass surgery/OHS {30 points total} Be thorough.

a. What are the particular problems that occur that require a client to have OHS? Explain why and when coronary artery bypass surgery (CABG) is done.  What is off-pump coronary bypass graft surgery? {10 points}

b. Identify where we get the grafts that are used to bypass the coronary artery occlusions. Identify complications that can occur post-bypass surgery, including possible complications post harvesting the graft. {6 points}

c. Explain why a patient may have an arterial line, a pulmonary artery catheter, be on a ventilator, have chest tubes in place, and possibly have epicardial pacer wires post-CABG surgery.  {4 points}

d. Why does a patient (even those that are not diabetic) require hourly glucose monitoring and the infusion of an insulin drip after CABG surgery?  {2 point}

e.  What are at least 8 nursing interventions for clients that have this procedure done postoperatively?  {8 points}

2)     Transcatheter Aortic Valve Replacement (TAVR)  {5 points total}

a)      Explain what a TAVR is. {2 points}

b)      What are the preoperative signs/symptoms that may require a client to have a TAVR?  Why does a TAVR need to be done?  {2 point}

c)      What criteria makes a patient eligible to have this procedure done?  {1 point}

3)     Briefly explain extracorporeal membrane oxygenation (ECMO) – why is it used, what is important to assess & monitor with the client that is on ECMO; are there any precautions that need to be implemented?  {5 points}

4)     a) Explain the purpose of an intra-aortic balloon pump (IABP).  {3 points}

b) What should be assessed and monitored.  {3 points}

c)      What complications should the nurse assess the client for? {3 points}*

2)     Impella: why is it used; what is important to assess & monitor with the client that is on impella; are there any precautions that need to be implemented?  {5 points}

Oxygenation [50 points total]

1)     Explain at least 5 indications for intubation and explain why intubation is required for each indication- provide details as to how it will benefit the client. {10 points}

2)     Normally an endotracheal tube is placed for a client that has difficulty with airway maintenance. {4 points total}

i)        Explain the meaning of the numbered markings on the ET device.

ii)      What is the preferred method of verifying placement of the ET tube?

3)     a) What is a closed tracheal suction system? {2 points}

b)      How is it beneficial to use with a client that is intubated?  {2 points}

4)     What is the standard of care & procedure for oral care for a client who is intubated? Explain how the standards of care facilitate improved management of the intubated client?  {5 points}

5)     What are at least 3 complications associated with mechanical ventilation?  {3 points)

6)     VAP: {5 points total}

a.       What is Ventilator-Associated Pneumonia (VAP) {1.5 points}

b.       Define strategies to prevent VAP. {3.5 points}

7)     Explain the following components of mechanical ventilation: {4 points- 1 point each}

a.       PEEP (setting)- why is it used? Which client benefits from PEEP? What does PEEP do?

b.       Tidal Volume (setting)

c.        CPAP v. BiPAP- what are the differences between them?

d.       FiO₂

8)     What is the ABCDEF bundle? Provide information on how each component of the bundle is implemented in the ICU setting and why it is used. {6 points- 1 point each}   *this can be made as a table* Do not copy & paste from the text!*

9)     What are the benefits of positioning therapy, including the different positions that may be used. Include any precautions that may be needed (ABCDEFG of positioning), including any specific nursing care that may be needed. {5 points}

10)  Removing mechanical ventilation: {4 points- 1 points each}

a)      What is a spontaneous awakening trial- what makes a client a candidate for it?

b)      What is the process that leads to the spontaneous breathing trial?

c)      Why are the trials important to be done?

d)     What are the key factors that need to be considered if we are planning to remove mechanical ventilation?

Renal management   {8 points total- 2 points each}

a.       What is CRRT (Continuous Renal Replacement Therapy)?; Why is it used?

b.       What are the indications for CRRT?

c.        What are the safety measures to consider when using CRRT?

d.       What is SLED? What qualifies a patient for SLED versus CRRT or HD?

Infusion titration paper: You need to review the facility’s titration policy for medications in the ICU; what is the facility’s policy on how to titrate a medication for an ICU client, what medications is this used for, how does the RN know what to do? Did you need to titrate an infusion for your client during the clinical day? Why? How did it affect your client? There is a separate form that provides full details in regards to what is required. This is due by the next clinical day; it is worth 15 points. It needs to be typed & submitted via canvas.

Faculty member: _______________________________________                                                    Date: __________________

Grade:  _        ______/350                  

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