Q Checks

Question 1

Vital: Resp, SpO2, mode of O2 delivery and amount

Answer 1

Q1h

Question 2

HR and BP for vasoactive infusions (Titrating)

Answer 2

Q15min

Question 3

Vitals during procedures

Answer 3

q5min

Question 4

I/Os

Answer 4

Q1h

Question 5

Temp

Answer 5

Q4h

Question 6

Pain assessment (verbal, NVPS (non-verbal pt), or CPOT (critical care pain observation tool)

Answer 6

When pain meds are given

Question 7

Head to toe complete assessment

Answer 7

Q4h

Question 8

Monitoring Strips (6 sec strips) ECG waveform

Answer 8

Once a shift, place strip in chart

Question 9

Hemodynamics parameters

Answer 9

CO/CI q1h

SVV/SVR/SVRI/TPR/TPRI q4h

Question 10

Zeroing-calibrated

Answer 10

Q4h or as needed for repositioning and PRN

Question 11

HR parameters

Answer 11

50-140 BPM

Question 12

Systolic BP parameters

Answer 12

90-160 mmHg

Question 13

Diastolic BP parameters

Answer 13

50-90 mmHg

Question 14

Respiratory Rate parameters

Answer 14

8-30 BPM

Question 15

Pulse Oximetry

Answer 15

94-100%

Question 16

Restraints orders

Answer 16

Need face to face assessment within 1 hour
18 yr< q4h
9-17 yr q2h

Question 17

Restraint assessment

Answer 17

Each shift

Question 18

Restraint monitoring and plan of care

Answer 18

Non-violent- q2h
Violent- q15min
Plan of care- Each shift

Question 19

Room Set-Up

Answer 19

IV pole/pump
Cables/Modules for bed side monitoring
Ambu bag
Suction + Tubing
Yankauer 
Electrodes 
Zeroed bed 
Sheets, Slip sheet, Pillow case, Gown, Towels

Question 20

Patient Family Education

Answer 20

Every shift

Question 21

Daily Weight

Answer 21

On admission

Question 22

Bathing/Linen

Answer 22

Every day & PRN

Question 23

Tracheostomy Care

Answer 23

Every shift

Question 24

Critical labs and test

Answer 24

Report to Physician within 30min of results

Question 25

Patient Transporting

Answer 25

Orders Portable monitor ICU RN

Question 26

Discharge Procedures

Answer 26

Print discharge instructions Have pt sign valuables and belongings sheet Provide med education on discharge meds

Question 27

Death Pronouncement

Answer 27

Obtain bereavement packet for instructions on process for death (front desk) Death pronounced by physician within 60-90 min Leave all ID bands on pt Remove lines, drains, tubes Place in body bag Call transport

Question 28

Risk for suicide

Answer 28

``` Red gown Sitter 24/7 Special observation check list q15min Eval by mental health professional Strip pt room of items that could be weapons ```

Question 29

Surgical drains

Answer 29

Assess q4h | Dressing change daily or PRN

Question 30

Chest Tubes

Answer 30

Assess q4h | Change dressing daily & PRN

Question 31

Feeding Tube

Answer 31

If residual 150< notify stop feeds and notify MD | HOB >30 degrees for feeding and for 60 min after

Question 32

Naso/Oral Gastric Tubes

Answer 32

Placement assessment w/ air bolus auscultation q4h | Residual q4h

Question 33

Post-Pyloric Tubes (J tubes) Placement and Assessment

Answer 33

KUB | Do not check residuals

Question 34

Surgically placed Tubes (PEG, G) Assessment

Answer 34

Q4h | Residual q4h

Question 35

Tube Feeding changes

Answer 35

Document type of feeding Bottle change q48h Bag change q24h Label with date, time, and initials

Question 36

Tubing change

Answer 36

q96h, Sunday and Wednesday | Propofol tubing change q12h

Question 37

Peripheral Intravenous (PIV) Catheter Assessment

Answer 37

Q4h

Question 38

Peripherally inserted Central Catheter (PICC) Assessment/Dressing change

Answer 38

Assess- q4h | Change- q7days or PRN

Question 39

Swan-Ganz

Answer 39

``` Document length of catheter at hub TKO infusion running at all times (white port) Blue port- proximal Yellow port- distal tip White port- proximal infusion ```

Question 40

Hemodialysis Catheters dressing change

Answer 40

q7days `

Question 41

Epidural

Answer 41

Must have dedicated single channel pump that is labeled “EPIDURAL” Assess every shift for complications (numbness above nipple line) Dressing change with oder from anesthesiologist