general management in icu

7/29/2019 General Management in ICU

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GENERAL

MANAGEMENT

IN ICU


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Outline Management

Nursing Care

Infection Control

Sedation and analgesia

Physiotherapy (problem of immobility)

Communication

Monitoring


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Nursing Care

BP, PR, RR, Temp, CVP, ABG, Ventilatorsettings, IO chart, Pupil size, Sedation score,IV infusion of therapeutic medication, Bloodglucose level.

Maintain ICU chart

Personal hygiene, nutrition, bowel and bladdercare

Nursing care of unconscious patient

Administration of prescribe medication

Implementation of ICU protocols

General nursing

Assist pt to orientate to time, place and person

Reassurance especially when painfulprocedure is planned

Communication withpatient

Frequent turning to prevent sores and DVT

Limb physiotherapy to prevent disuse atrophy

Chest physiotherapy

Physiotherapy


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Infection Control

Prevent ventilator associatedpneumonia by VAP preventioncontrol or ventilator bundle

protocol

Hand wash with soap or rubhand alcohol before and after

touching patient orequipments + use disposable

gown and gloves

Aseptic technique duringinserting arterial lines andcentral venous catheter to

prevent catheter related bloodstream infection

Change catheter (CBD)appropriately to prevent

catheter related UTI

Nosocomial infection


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Sedation and Analgesia

Need sedation due to artificial ventilator or other painfulprocedure ex: chest tube & to avoid post-traumatic stressdisorder

To facilitate patient ventilator synchrony and to reduce oxygen

consumption during critical period

Use of BZD such as Midazolam is commonly use; can be usealone or combine with Morphine

Other drug: Fentanyl, Propofol and Dexmedetomidine (Precedex)

Use of muscle relaxant is UNCOMMON in ICU but it is use inmx of tetanus, uncontrolled high ICP and severe ARDS

Provide adequate pain relief for patient esp in trauma andpost surgical patient.


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7 Dangerous

Agitation

Pulling at endotracheal tube (ETT), trying to remove

catheters, climbing over bedrail, striking at staff, thrashing

side-to-side.

6 Very Agitated Does not calm down despite frequent verbal reminding of

limits, requires physical restraints, biting ETT.

5 Agitated Anxious or mildly agitated, attempting to sit up, calms down

to verbal instructions.

4 Calm and

Cooperative

Calm, awakens easily, follows commands.

3 Sedated Difficult to arouse, awakens to verbal stimuli or gentleshaking but drifts off again, follows simple commands.

2 Very Sedated Arouses to physical stimuli but does not communicate or

follow commands, may move spontaneously.

1 Unarousable Minimal or no response to noxious stimuli, does not

communicate or follow commands.

Riker Sedation Scale


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Ramsay Sedation Scale

1 Patient is anxious and agitated or restless, orboth

2 Patient is co-operative, oriented, and tranquil

3 Patient responds to commands only

4 Patient exhibits brisk response to light glabellartap or loud auditory stimulus

5 Patient exhibits a sluggish response to lightglabellar tap or loud auditory stimulus

6 Patient exhibits no response


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Over sedation

Result: increased timebeing ventilated, anincreased time in the

intensive care unit, and anincreased cost of care

Complication: respiratorydepression, prolong the

weaning process

Undersedation

Result: increasedproduction of endogenous

catecholamines

increase in BP, heart rateand myocardial oxygenconsumption

general management in icu

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