care of the critically ill patient student
TRANSCRIPT
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