1
Q
why are hospital color codes used
A
- to denote to staff various kinds of emergency situations.
- to convey essential information quickly and with a minimum of misunderstanding.
- to minimize stress and prevent panic among patients and visitors to the hospital.
2
Q
What is code pink
A
Pediatric emergency
3
Q
what is code yellow
A
missing resident/patient
4
Q
what is code amber
A
missing/abducted child/infant
5
Q
what is code white
A
aggression/violence
6
Q
what is code red
A
fire
7
Q
what is code grey
A
system failure
8
Q
what is code green
A
evacuation
9
Q
what is code brown
A
hazardous spills
10
Q
what is code black
A
bomb threat
11
Q
what is code orange
A
mass casualty/disaster
12
Q
what is code silver
A
active attacker
13
Q
what are the principles of code silver protocol
A
RUN-HIDE-FIGHT
14
Q
what rate should chest compressions be given
A
100-120 min
15
Q
what depth should chest compressions be given at
A
atleast 2 inches (5 cm for adults, 1/3 of the anteroposterior diameter of the chest for child and infants)
16
Q
what should be allowed when giving chest compressions
A
full recoil of the chest
17
Q
how should ventilation be given between chest compressions
A
2 breaths after 30 compressions, each breath delivered over 1 second
18
Q
if an advanced airway is in place, how should ventilation be given during chest compressions
A
1 breath every 6 seconds (10 breaths/min)
19
Q
What are two shockable rhythms
A
VF: ventricular fibulation
pVT: pulseless ventricular tachycardia
20
Q
when a HCP is assisting someone who is having a Opioid-associated emergency, how long should they check for a pulse if the person is not breathing
A
less than or equal too 10 seconds
- If they have pulse: start ventilation and give naxolone.
- if no pulse start CPR w/ AED and consider naxolone.
21
Q
When do you call a CODE BLUE
A
1) when your patient has a respiratory or cardiac arrest
2) when your assessment deems necessary - (warning signs)
3) when directed to do so
22
Q
What are the 5 rights of clincial reasoning?
A
1) right cues
2) right patient
3) right time
4) right action
5) right reason
23
Q
when considering the 5 rights of clinical reasoning, what does “right cues” refer too?
A
- physiological or pyschosocial changes
24
Q
when considering the 5 rights of clinical reasoning, what does “right patient” refer too?
A
at risk of critical illness and/ or serious adverse event
25
when considering the 5 rights of clinical reasoning, what does "right time" refer too?
identifying clinically at risk patients in a timely manner and undertaking nursing interventions at the right time and in the right sequence
26
when considering the 5 rights of clinical reasoning, what does "right action" refer too?
- what is the priority;
- who should perform the action;
- which policy/procedure are involved;
- who should be notified and when.
27
What is failure to rescue
the inability of clinicians to save a patient's life by timely diagnosis and treatment when a complication develops
28
when considering the 5 rights of clinical reasoning, what does "right reason" refer too?
- right reasoning processes;
- reasoning is ethical, legal, and professional;
- and just and compatible with the beliefs of the person who is the recipient of care
29
what does research say in regards to the signs patients display of impending arrest
they occur as early as 72 hours
30
what are four activities to prevent failure to rescue
1) Surveillance/assessment.
2) Timely identification of complications.
3) Taking action.
4) Activating a team response.
31
what are the 8 plots of the neurological bell curve in detecting failure to rescue
1. restlessness
2. anxious
3. irritable
4. agitated
5. confused
6. combative
7. lethargic
8. unresponsive
32
What are the 6 points on the respiratory bell curve to detect failure to rescue
--> 20
--> 24
--> 30
--> Increasing 40s
--> 4-10
--> Apnea
33
what is the major cause of instability
Compensation for hypoxia and/or hypo-perfusion (can be from other causes too)
34
what are the 3 cues of a pathological change
Neuro: bell curve progression
Respiratory: RR increase to 20.
Cardiac: ventricles are accurate indicator.
35
What are 4 main elements that maintain ventricular stability and function efficiently
a) oxygenation
b) perfusion
c) electrolytes
d) acid/base imbalance
36
what are the clincial signs and symptoms of *early* hypoxia
restlessness
change in mental status
anxiety
headache
fatigue
tachycardia
dysrhythmia
37
what are the clinical signs and symptoms of *intermediate* hypoxia?
- Increased confusion.
- Agitation.
- Increase O2 requirements.
- Decreased O2 saturation.
- Lethargy.
38
what are the clinical signs and symptoms of *late* hypoxia?
- Cyanosis
- Diaphoresis
- Unresponsive
- Respiratory arrest
39
What % of Oxygen can NC/NP deliver at 1-6L/min
24-44%
40
What % of oxygen can a simple mask deliver at 6-10L/min
35-55%
41
What % of oxygen can a non-rebreather mask deliver ar 10-15L/min
60-80%
42
What medications can be given to manage acute respiratory failure
bronchodilators, steroids, analgesics, sedatives, antibiotics (to treat underlying cause if needed)
43
in order to improve ventilation and promte adequate gas exchange, what could be used
- positive end-expiratory pressure (BiPaP)
- endotracheal intubation
44
what signs determine cardiac instability
- change in heart rhythm (palpate pulse).
- (+) one of the following signs:
= HypoTN
= dizziness
= chest pain
= SOB
= new or worsening HF
45
What are lethal rhythms:
- 3rd degree atrial ventricular (AV) block.
- Ventricular tachycardia.
- Ventricular fibrillation.
46
What is a pulseness electrical activity (PEA)
There is an ECG rhythm, but the heart is not pumping.
47
How do you know a rhythm is a pulseless electrical activity (PEA)
ECG monitor shows a rhythm, but there is NO PULSE on palpation
48
What are signs and symptoms of arrhythmias
palpitations
anxiety
lethargy
fatigue
weak pulse
diaphoresis
cyanosis
chest discomfort
nausea
dizziness
lightheadedness
SOB
unresponsiveness
49
What diagnostic test can be done to determine arrhythmias
ECG, troponin
50
Why call the rapid response team (CCOT)
early recognition of signs and symptoms of pre-arrest indicator can have a significant outcome reducing patient mortality
50
what is the treatment for arrhythmias
pacemaker, ICD, rhythm control medications, shock, cardioversion
51
What are examples of the early warning signs
- RR > 25 or < 8.
- SBP < 90 or a drop more than 30 mmhg.
- HR > 120 or < than 50.
- change in LOC or GCS of less than 10.
- Spo2 < 90% w/ supp oxygen > than 0.5 fi02
- Urine output < 80 ml over 4 hours.
- skin= pale, diaphoretic or mottling.
- bleeding
- seizures (new or prolonged)
- chest pain unrelieved by nitro.
- failure to respont to tmt
- signs of sepsis
52
When should the MRP/CCOT/RRT be called
-client is still responsive but there is sudden deterioration in patient status.
-respiratory distress
-oxygen sat, BP, HR, is dropping below norm
53
When should a code blue be called
- Client is unresponsive
- No respiration
- No pulse
54
What process should be taken before calling a code.
- perform a thorough assessment
- is code a "no code"
- Be prepared to use SBAR
- notify MRP (if possible)
- notify CCOT
55
How often should the ward emergency cart be checked?
weekly
56
what supplies should the emergency cart contain?
- Back board
- Bag valve mask with ambu bag
- Oral airways
- Intubation supplies
- Suction supplies
- Intravenous solution & tubing
- Check lists and resuscitation records
- Orange cone
- Code charting
57
One of your clients on the medical floor is unresponsive. You quickly assess that there are no respirations and no pulse. What will you do?
call code blue
58
What is important to remember NOT TO DO when a code is initated
do not cancel the code button until all members of the team arrive
59
In a code, what is the role of the primary nurse (nurse 1)
patient (assessment, call for help, initiate CPR)
60
In a code, what is the role of nurse 2
To Assist (call code/bring emergency equipment to scene, orange cone, suction, backboard; assist with CPR
61
In a code, what is the role of nurse 3?
environment (bring patient chart to bedside, start IV, remove headboard)
62
what is the role of the team lead (ICU/ER physician) during a code
lead and direct the code
63
what is the role of the critical care unit
- attach/interpret monitor
- defibrillate/initiate IV
- administer medications
- documentation on cardiac arrest record
64
what is the role of the primary/unit RN during a code
- Provide pt information to code team
- notify MRP/airway if not RT
- document on patient progress notes
65
respiratory therapist
airway/ventilation
66
What is the role of the PCC or charge nurse during a code
coordinate possible transfer to ICU and communication
67
During a code, what is the responsibility of nurse 1, 2 and 3?
Nurse 1: remain on scene and document
Nurse 2: remain on scene and run errands
Nurse 3: direct traffic and resume ward duties caring for nurse 1 and 2 patients
68
What does AVPU stand for and when is it relevant
A= alert
V= respond to verbal stimuli
P= responds to painful stimuli
U= Unresponsive
This is related to primary surveying during a code and identifying level of responsiveness (disability)
69
what is consisted in a primary survey during a code
- rapid assessment of the patient+ environment
- Airway
- breathing
- circulation (pulse?)
- disability (level of response)
70
what is consisted in a secondary survey during a code?
Detect potentially life-threatening conditions and provide care and initate life-support interventions.
A) advanced airway management
B) confirm airway placement, provide supp O2, assess ventilation
C) IV, cardiac monitor
D) Find differential diagnosis
E) Exposure/ evaluate effectiveness or interventions
F) Facilitate family presence
71
What are the 5 H's when referrring to reversible causes of arrest
- Hypovolemia
- Hypoxia
- Hydrogen ions (acidosis)
- Hypo/Hyperkalemia
- Hypothermia
72
What are the 5 T's when referrring to reversible causes of arrest
- Tension pneumothorax
- Tamponade, cardiac
- Toxins
- Thrombosis, (pulmonary)
- Thrombosis, (coronary)
73
should the nurse rely on the ECG or the patient/pulse?
do not rely on an pulse, always check the patient pulse
74
When does post-resuscitation care take place
period of time between spontaneous circulation and the transfer to intensive care
75
what is the emphasis of post-resuscitation care
maintain optimal tissue oxygenation and perfusion, aswell as identify the cause of the arrest and to initiate treatment
76
during post-resuscitation care, what should the nurse do
go to ICU with patient
- Restart IV.
- Insert foley, nasal, or gastric tube and monitor intake and output.
- Temperature regulation,
77
What is the role of nurse number 1 following a code?
Complete charting: ensure family is notified and transfer patient
78
What is the role of nurse 2 following a code?
Assist nurse 1
79
What is the role nurse 3 following a code?
Continue to care for nurse 1 and 2 patients
80
Elements of effective resuscitation team dynamic
- effective communication
- clear message
- clear roles and responsbility
- knowing ones limitations
- share knowledge
- constructive intervention
- re-evaluate and summarize
- mutual respect
81
Why is family presence during resuscitation
- usually is helpful and comforting for loved ones
- helps family comprehend the seriousness of the patient's condition
- may ease grieving
82
NRSG 301
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Decks in class (5)
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