About Hesi Exit Critical Care Nursing

The Critical Care Nursing unit of the HESI Exit exam assesses your knowledge and understanding of caring for critically ill patients in intensive care units (ICUs). This specialized area of nursing requires advanced clinical skills, critical thinking, and a deep understanding of complex medical conditions.

Key Topics to Expect

Care of Patients in Acute or Critical Conditions  ICU Care

• Patient Assessment:
  • Comprehensive Assessment: Monitoring vital signs, level of consciousness, and physiological status.
  • Monitoring Equipment: Use of devices such as cardiac monitors, pulse oximeters, and arterial lines.
• Interventions:
  • Medications: Administering and titrating medications including vasoactive drugs, sedatives, and analgesics.
  • Nutritional Support: Implementing enteral or parenteral nutrition as needed.
• Complications Management:
  • Infection Control: Preventing and managing nosocomial infections.
  • Pressure Ulcers: Preventing and treating pressure sores with repositioning and skin care.
• Family Support:
  • Communication: Keeping families informed and involved in care planning.
  • Emotional Support: Providing emotional and psychological support to patients and families.
• Emergency Care
  • Initial Assessment:
    • Primary Survey: Conducting the ABCDE assessment (Airway, Breathing, Circulation, Disability, Exposure).
    • Secondary Survey: Performing a detailed assessment to identify additional injuries or conditions.
  • Emergency Interventions:
    • Basic Life Support (BLS): Performing CPR and basic resuscitation techniques.
    • Advanced Interventions: Administering medications, performing advanced airway management, and initiating IV access.
  • Trauma Management:
    • Trauma Protocols: Following protocols for trauma care, including immobilization and rapid assessment.
    • Stabilization: Stabilizing patients before transport to higher levels of care.

Advanced Cardiac Life Support (ACLS)

1. ACLS Protocols
   • Assessment and Recognition:
     • Cardiac Arrest Recognition: Identifying signs of cardiac arrest and initiating ACLS protocols.
     • Rhythm Interpretation: Recognizing and interpreting ECG rhythms (e.g., ventricular fibrillation, asystole).
   • Interventions:
     • CPR and Defibrillation: Performing high-quality CPR and using defibrillators to manage cardiac arrhythmias.
     • Medication Administration: Administering ACLS drugs such as epinephrine, amiodarone, and lidocaine.
   • Advanced Airway Management:
     • Intubation: Performing endotracheal intubation or using alternative airway devices.
     • Ventilation Support: Providing mechanical ventilation and monitoring airway pressures.
   • Post-Resuscitation Care:
     • Monitoring: Ongoing assessment and monitoring for complications following resuscitation.
     • Therapeutic Hypothermia: Implementing cooling protocols if indicated.
2. ACLS Algorithms:
   • Algorithm Review: Understanding and applying ACLS algorithms for various cardiac emergencies.
   • Team Dynamics: Working effectively within a team during resuscitation efforts and managing roles and communication.

Ventilator Management

1. Ventilator Settings and Modes:
   • Modes of Ventilation:
     • Assist-Control (AC): Providing full support for each breath.
     • Synchronized Intermittent Mandatory Ventilation (SIMV): Combining mandatory and spontaneous breaths.
     • Pressure Support Ventilation (PSV): Providing support based on patient’s inspiratory effort.
   • Settings:
     • Tidal Volume (VT): Adjusting the volume of air delivered with each breath.
     • Respiratory Rate (RR): Setting the number of breaths per minute.
     • Positive End-Expiratory Pressure (PEEP): Managing airway pressure at the end of expiration.
2. Ventilator Monitoring and Troubleshooting:
   • Monitoring Parameters:
     • Ventilator Settings: Regularly checking and adjusting settings based on patient needs.
     • Patient-Ventilator Synchrony: Ensuring the patient’s breathing effort is appropriately supported by the ventilator.
   • Troubleshooting:
     • Alarms: Identifying and responding to ventilator alarms (e.g., high pressure, low volume).
     • Complications: Addressing complications such as barotrauma, volutrauma, or ventilator-associated pneumonia.
3. Weaning and Extubation:
   • Weaning Protocols:
     • Gradual Reduction: Reducing ventilatory support and assessing patient readiness for extubation.
     • Spontaneous Breathing Trials: Conducting trials to assess patient’s ability to breathe independently.
   • Extubation:
     • Process: Safely removing the endotracheal tube and monitoring for respiratory distress or complications.

Hemodynamic Monitoring

1. Hemodynamic Parameters:
   • Key Measurements:
     • Blood Pressure (BP): Monitoring arterial blood pressure.
     • Heart Rate (HR): Tracking heart rate and rhythm.
     • Central Venous Pressure (CVP): Measuring pressure in the central venous system.
     • Pulmonary Artery Pressure (PAP): Monitoring pressure in the pulmonary artery.
   • Cardiac Output and Index:
     • Cardiac Output (CO): Measuring the volume of blood the heart pumps per minute.
     • Cardiac Index (CI): Adjusting cardiac output based on body surface area.
2. Invasive Monitoring:
   • Arterial Lines:
     • Insertion and Maintenance: Inserting and maintaining arterial lines for continuous blood pressure monitoring.
     • Complications: Recognizing and managing complications such as infection or thrombosis.
   • Pulmonary Artery Catheters:
     • Usage: Inserting and using pulmonary artery catheters for detailed hemodynamic measurements.
     • Interpretation: Analyzing data from pulmonary artery catheterization to guide treatment decisions.
3. Interventions Based on Monitoring:
   • Fluid Management: Adjusting fluid therapy based on hemodynamic data.
   • Vasoactive Medications: Administering medications to manage blood pressure and cardiac output.
   • Response to Changes: Adjusting treatment based on changes in hemodynamic status and patient response.

Tips for Success

1. Understand Physiology and Pathophysiology: Familiarize yourself with the physiology and pathophysiology of critical illness and organ failure.
2. Learn Monitoring and Assessment Techniques: Practice monitoring and assessing critically ill patients, including hemodynamic and respiratory monitoring.
3. Understand Interventions: Learn about common interventions used in critical care, such as mechanical ventilation, hemodynamic support, and renal replacement therapy.
4. Practice Emergency Management: Be prepared to handle critical care emergencies by practicing resuscitation techniques and recognizing signs and symptoms of common emergencies.
5. Review Ethical and Legal Issues: Study the ethical and legal considerations in critical care nursing, such as end-of-life care and informed consent.
6. Practice Case Studies: Work through case studies to apply your knowledge to real-world critical care scenarios.

By focusing on these key areas and following these tips, you can increase your chances of success on the HESI Exit Critical Care Nursing unit.