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CARE OF THE CRITICALLY ILL PATIENT

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Page 1: Care of the critically ill patient student

CARE OF THE CRITICALLY ILL

PATIENT

Page 2: Care of the critically ill patient student

COMMON PROBLEMS Nutrition

Anxiety

Pain

Impaired communication

Sensory-perceptual problems Delirium is not “ICU Psychosis”

Sleep problems

Caregiver issues

Page 3: Care of the critically ill patient student

ABDCE

Page 4: Care of the critically ill patient student

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

Page 5: Care of the critically ill patient student

CRITICAL CARE INTERVENTIONS Invasive Hemodynamic monitoring

Arterial pressure Pulmonary artery pressure

Intraaortic Balloon pump

Ventricular Assist devices

Page 6: Care of the critically ill patient student

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

Page 7: Care of the critically ill patient student

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

Page 8: Care of the critically ill patient student

AIRWAY MANAGEMENT

OF THE CRITICALLY ILL

PATIENT

Page 9: Care of the critically ill patient student

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

Page 10: Care of the critically ill patient student

NURSING CAREComplications

Unplanned extubation

Aspiration

VAP

Barotrauma

Interventions

Maintain tube placement

Cuff inflation

Monitor oxygenation/ventilation

Tube patency

Oral care

Suctioning

Page 11: Care of the critically ill patient student

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


(Running Header) CARE PLAN FOR A CRITICALLY ILL PATIENT 1

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