care of the critically ill patient student

CARE OF THE CRITICALLY ILL

PATIENT

COMMON PROBLEMS Nutrition

Anxiety

Pain

Impaired communication

Sensory-perceptual problems Delirium is not “ICU Psychosis”

Sleep problems

Caregiver issues

ABDCE

CARE OF THE CRITICALLY ILL PATIENTCommon Critical Care Orders:

Hourly I/O (foley, drains, IVF)

Continuous monitoring (Cardiac, Sa02, hemodynamic)

Frequent vitals

Tube feeding

Labs-from central line

ABGs- from art line

Titration of drips

Medications

(IV Push, continuous infusions, intermittent infusions)

Sedation Pain management Paralytics TPN Inotropic Agents Vasopressors Antihypertensive & Vasodilator Agents Antiarrhythmic Agents Antiplatelet Agents Nebulizers PPI/H2Blockers Insulin

CRITICAL CARE INTERVENTIONS Invasive Hemodynamic monitoring

Arterial pressure Pulmonary artery pressure

Intraaortic Balloon pump

Ventricular Assist devices

NURSING CARE Interventions

Positioning Often HOB <45deg Phebostatic axis

Maintain patency of the line Saline flush/pressure bag

Respond to alarms

Check CMS

Sterile technique

Monitor for s/s of bleeding, infection, etc

Complications

Arterial- hemorrhage, clotting, neurovascular compromise

PA- air embolus, infection, sepsis, PA rupture/infarction

IABP- vascular injuries, infection, displacement of the balloon, mechanical complications

VAD- bleeding, cardiac tamponade, infection

CARE OF THE PATIENT RECEIVING CONTINUOUS RENAL REPLACEMENT

THERAPYo Monitor weights

o Lab values (which ones?)

o Hourly I/o

o Vitals, hemodynamics

o Temperature

o Access siteo Infectiono Bleeding

AIRWAY MANAGEMENT

OF THE CRITICALLY ILL

PATIENT

TYPES OF AIRWAYSTypes of airways

Oral

Nasal

Endotracheal preferred

Nasotracheal If positioning of head/neck can

cause injury

Tracheotomy

Indications for artificial airways

Upper airway obstruction

Apnea

Unable to maintain airway/clear secretions

Respiratory distress

Need for POSITIVE PRESSURE VENTILATION

NURSING CAREComplications

Unplanned extubation

Aspiration

VAP

Barotrauma

Interventions

Maintain tube placement

Cuff inflation

Monitor oxygenation/ventilation

Tube patency

Oral care

Suctioning

WEANING Short term (less than 3 days) versus long

term

Team approach

Spontaneous breathing trial

During the day

Psychological support to patient and family

Supplemental 02 maybe required

Chronic mechanical ventilation