6. family needs critical care

Care of patient: Special and family

needs PATIENTS STRESS IN ICU, &

THEIR RELATIVES AND NURSES ROLE

Prof. Dr. RS Mehta, BPKIHS 2

WHAT IS STRESS ?

Stress is simply called Pressure

Strain

Tension


DEFINITION

Stress is defined as any adjustive demand that requires an adaptive response . It is a condition in which the human system responds to changes in its normal balanced state.


PATIENTS STRESS IN ICU

A patient may experience a myriad of fears and concerns when admitted to the technologically sophisticated world of critical care.

Patient enters complex setting where staff members converge with the variety of procedures and supportive devices in an attempt to monitor, strengthen , or stabilize the physiological crisis .


PSYCHOLOGICAL CRISIS IN ICU PATIENTS

Anxiety.Anger.Depression.Hopelessness. Fear.Denial.Powerlessness.Spritual distress.


…

This kind of feelings occurs as a reaction to a threat to the person; the threat encompasses potential physiological loss, lifestyle changes, potential death, invasive procedures, or concerns about the unknown.


Although patient may feel secure knowing that skilled and knowledgeable health care personnel are attending for fulfilling every needs of critically ill patients.

At times patient may develop different physical and behavioral manifestations aggravated by stressors as He /She is immediately separated from significant others and surrounded by strangers who move about critical care environment with familiarity and professional experiences.


CAUSES OF STRESS IN ICU PATIENT

• A stressor is anything that causes stress. • It is neither positive nor negative but

rather have positive or negative effects as the person responds to change .

• In ICU setup illness acts as a stressor.


CAUSES…

Stressors have physical, chemical and mental responses inside of the body . Stressor can be either: Physical stressor. Biological stressor. Chemical stressor. Environmental stressor. Social stressor. Psychological stressor.


CAUSES…

Intensive care units have been considered stress generating areas. So some of the causes of stress in ICU patients are : Physical aspects :Presence of tubes in nose and mouth.Impossibility to sleep.Immobilization. Loss of autocontrol , decrease a

muscle tone.Sensorial deprivation & sensory overload.


CAUSES…

Biological aspects :Nosocomial infection.

Chemical aspects :Certain drugs used in ICU can causes stress :

Analgesics.Sedatives.Paralytics.Anxiolytic drug.


… Environmental aspects : Presence of noise of various devices.Presence of excessive over lightening.Unfamiliar surrounding.Use of all kinds of machines and jargons.


…

Social aspects :Separation from relatives.Lack of social network.Security of the patient is questioned.Ineffective communication.


… Psychological aspects :Lack of attention.Depersonalization.


EFFECTS OF STRESS

Behavioral : Short term : indulge in drugs , alcohol, impulsive

behavior , poor relationship with others, poor work performance.

Long term : Marginal family social isolation.


EFFECTS…

Physical : Short term : headaches, backache, backache ,

insomnia , indigestion , chest pain , nausea, dizziness , excessive sweating and trembling.

Long term :Heart disease , hypertension , ulcer, poor general health.


…

Emotional : Short term : Tiredness , anxiety, boredom ,

irritability , depression , lack of concentration , low self esteem.

Long terms : Depression , neurosis, nervous breakdown , suicide.


Needs of critically ill patients1. Oxygenation2. Water and fluid3. Food and nutrition4. Mobilization5. Elimination 6. Sleep and rest7. Safety and security8. Knowledge9. Social needs10.Self esteem needs


Needs of critically ill patients

1. Oxygenation:Assess• Respiratory system: tachypnea, restlessness,

confusion, resp. rate, nail beds• ABG analysis report• Auscultate lungs every 8 hour• Continuous monitoring oxygen saturation level and

inform if less than 90%.


Intervention: • Suction every 2 hour• Keep patient in semi-fowler or fowler position• Measure peak pressure & inform if necessary• Sedate the patient as needed to control ventilator

fighting• Decrease Fio2 <50% as quickly as possible to

prevent oxygen toxicity.• Promote effective secretion mobilization by using

deep breathing & coughing exercise, chest percussion& postural drainage


• Administer bronchodilators as order to promote effective airway

• Observe patient closely for increase respiratory obstruction edema in to the alveoli

• Recognize painful respiration, dyspnea and nasal congestion

• Administration of mucolytics to liquefy the secretions


2. Water and fluidAssess• Monitor vital signs • Continous monitor urine output and report if

<30 ml/hrs• Observe for sign of overload/ wt. gain, increase

output, edema, dehydration, cold &clammy skin.Intervention• Wt. daily• Maintain I/O chart hourly• Planning of fluid administration as per order• Administer frusemide as per indicated


3. Food and nutrition• Obtain nutritional consultation for all ventilator

dependent patients• Monitor serum albumin level to determine

malnutrition.• Weight daily• Start total parental nutrition if patient is unable

to tolerate enteral feeding• Perform calories counts to ensure adequate

nutrition • Suggest family bring food from home if patient

does not like hospital food


• Avoid too much carbohydrate feeds as it may increase co2 production and may cause hypercapnia

• Keep head of bed elevated if patient is in naso-gastric feeding to decrease potential aspiration

• Auscultate for the presence of bowel sound and medicate to prevent constipation


4. Mobilization• Assess for GI problems:• Preventive measures include antacids or H2

receptor antagonist therapy, adequate sleep cycles• Observe skin integrity for pressure ulcers• Turn patient at least every 2 hour• Back care• Use pressure relief mattress if indicated• Maintain muscle strength with active/ active

assistive/ passive ROM exercises and prevent contractures with use of splints.


5. Adequate knowledge• Explain purpose, mode and all treatments• Explain alarms• Explain about disease, progress• Encourage patient to relax and breathe with

the ventilator• Provide alternate method of communication ;

keep call bell within reach


6. Safety and security needs• Freedom from harm• Person must feel safe & secure physically, mentally

& emotionally• Use proper hand washing technique• Prevent from infection by using sterile technique• Explain before the procedure• Maintain warm adequate body temperature• Put side rails• Open visiting or release visiting hours for critically

patients


7. Elimination and waste products• Catheter care• Proper cleaning, use of bed pan if possible


8. . Sleep and rest:• Assess the patient sleep pattern • Decrease noise level if possible• Decrease conversation level at bed side• Turn monitor alarm down if possible• Provide soft music if possible• Use dim light if possible• Cover patient eyes with clean guaze


9. Social needs:• Love and affection begin with bonding at birth must

be continous through out the life• Encourage visitor card and phone call• Provide verbal clues before touching patient• Use of signals, signs, nodding, palm writing, lip

reading• Provide paper & pencil, magic slate• Allow patient to respond and repeat explanations• Respect their dignity


10. Self esteem needs• Positive self esteem, senses of personal worth• Nurse always assist patient regarding positive self

esteem by encouraging independent, rewarding for progress


STRESS OF FAMILY AND RELATIVES IN ICU

When an individual undergoes a physiologic crisis and is admitted to an intensive care unit (ICU); the other family members undergo a psychological crisis, shock , and disbelief may be the first emotional experienced by the family.


CAUSES OF STRESS IN RELATIVES IN ICU

Prolonged hospitalization.Inadequate knowledge.Financial burden.Impaired communication.Fear of losing.Limited visiting hours .Lack trust with health care workers.


FAMILY NEEDS

The major needs of families are : Relief of anxiety.Assurance that care is competent.Access to the patient.Information about the patient.Emotional support.


Family needs of critically ill patient

• Need to be with critically ill patient• Need to help to the critically ill person• Need for assurance of comfort of critically ill patient• Need to be informed of impending death• Need to ventilate emotions/ feeling• Need for comfort & support of the family members• Need for acceptance, support comfort health


Parents, children, sibling needs

• To feel there is hope• To feel that hospital personnel doing well• To know the prognosis of patient’s condition• To receive the information about the patient once a

day• To see the patient frequently• To have explanation about his/her condition


Nursing intervention to meet family needs

1. Cognitive needs:• To know specific factors about patient progress• Avoid using generalization. E.g. he is much better• Use simple term to discuss prognosis of patient• Relate the prognosis to illness as you have

described initially • All nurses must use the same terminology


2. To know the probable outcomes• Be realistic as possible but be aware families coping

mechanism• If patient prognosis is poor allow to adequate time to

spend with the family • To inform what is being done for the patient, how the

patient is being treated medically & why things are being done for the patient

• Briefly describe each line, & or monitoring device including urinary catheter, NG tube, oxygen devices


• Encourage them to question.• Remember that explanation may not be enough • Anxiety is barrier in learning• Use simple terminology such as breathing tube,

cardiogram & ET tube• Promote continuity of care through the nursing

care plan


3. To have questions answers honestly• Be specific, discuss are issues as they relate to

the patient as a unique individual• Maintain good communication with physician so

that we will be aware of what they have told to family

4. Emotional needs• To ensure that best possible care is being given

to the patient• To be called at home about changes in the

patient’s condition to release information once a day


5. Physical needs• Involve them in small procedure• Allow them to visit any times and have

waiting room near the ICU


Thank you

6. family needs critical care

Health & Medicine