post cc discharge care plan

7/28/2019 Post Cc Discharge Care Plan

1/23

The patient post critical care !


2/23

Setting the scene

Approximately 110,00 spend time in critical care

units in England and Wales every year.

Psychological and physical impact on patients is

a significant problem.

Families suffer physical and emotional health

issues and financial problems.


3/23

Escaping from critical care?


4/23

Relocation stress in ward post ITU Less secure environment.

Nursing : patient ratio

Abrupt transfer

Separation anxiety from trusted staff

Fear of deterioration not being noticed.

Physiological effects can be detrimental to health

Psychological escape behaviour, or immobility barely speaking ormoving.

Relatives experience stress too.


5/23

Weakness and fatigue

Loss of about 2% of muscle mass every 24 hrs

Some patients loss 50% of total muscle mass

Oedema may cover up evidence of muscle wasting

Amnesia may make patient not appreciate why they feel so

weak and exhausted

Amnesia may make patient have unrealistic recoveryexpectations = depression

Rebuilding profound muscle loss may take months


6/23

Weakness and fatigue

Polyneuropathies can occur (affect motor and sensory peripheral

nerves) = weakness and < sensation can be long lasting

Critical illness polyneuropathies can be severe

Can result in respiratory problems

Compressive neuropathy can occur.

Complaints of fatigue at 3 months post discharge occurs in mostpatients

Complaints of fatigue at 12 months post discharge 32- 38% of patients


7/23

Weakness and fatigue Evidence that passive limb stretching may help preserve

muscle strength and function, and maintain joint range of

movement.

Passive limb stretching helps to preserve muscle mass

Good nutrition is important and they may need help with

feeding due to arm weakness


8/23

Eating

Swallowing difficulties common

Poor appetite

Medication may < appetite

Lack of physical activity < appetite

Upper limb weakness affecting ability to feed self

Problems with dentures fitting if lost weight


9/23

Itching and hair loss May be caused by starch plasma expanders


10/23

Sleeping Fear of sleeping due to nightmares

Disturbed sleep pattern


11/23

Delirium a big problem

> length of stay in hospital / critical care

> incidence of dementia

> hospital acquired complications e.gfalls, pressure sores.

> requirement for long term care

> mortality


12/23

Delirium patient presentation

Occur within hours or days (usually 1-2 days)

Deteriorating cognitive function: e.g. worsenedconcentration, slow responses, confusion.

Abnormal perception: e.g. visual or auditoryhallucinations.

Abnormal physical function: < mobility, 75% female patients had returned to

work

12 months post-discharge 65% male patients had returned to

work.

(Eddleston et al 2000)


23/23

You can make a difference Early recognition of delirium / other psychiatric issues

Sensitive psychological support

Focus of physical rehabilitation

Assist with realistic expectations

Orientate to reality

Explain normalcy

Aid relatives to help them

Get help for them

post cc discharge care plan

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