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Care of the critically ill patient student
1.
2.
Nutrition Anxiety
Pain Impaired communication Sensory-perceptual problems Delirium is not “ICU Psychosis” Sleep problems Caregiver issues
3.
4.
Common 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
5.
Invasive Hemodynamic
monitoring Arterial pressure Pulmonary artery pressure Intraaortic Balloon pump Ventricular Assist devices
6.
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
7.
o Monitor weights o
Lab values (which ones?) o Hourly I/o o Vitals, hemodynamics o Temperature o Access site o Infection o Bleeding
8.
9.
Types 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
10.
Complications Unplanned extubation
Aspiration VAP Barotrauma Interventions Maintain tube placement Cuff inflation Monitor oxygenation/ventilation Tube patency Oral care Suctioning
11.
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
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