family needs

1. Care of patient:
Special and family needs
PATIENTS STRESS IN ICU, & THEIRRELATIVES AND
NURSES ROLE

2. WHAT IS STRESS ?
Stress is simply called
Pressure
Strain
Tension
2Prof. Dr. RS Mehta, BPKIHS

3. 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.
3Prof. Dr. RS Mehta, BPKIHS

4. 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 .
4Prof. Dr. RS Mehta, BPKIHS

5. PSYCHOLOGICAL CRISIS IN ICU
PATIENTS
Anxiety.
Anger.
Depression.
Hopelessness.
 Fear.
Denial.
Powerlessness.
Spritual distress.
5Prof. Dr. RS Mehta, BPKIHS

6. …
 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.
6Prof. Dr. RS Mehta, BPKIHS

7.  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.
7Prof. Dr. RS Mehta, BPKIHS

8. 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.
8Prof. Dr. RS Mehta, BPKIHS

9. 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.
9Prof. Dr. RS Mehta, BPKIHS

10. 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.
10Prof. Dr. RS Mehta, BPKIHS

11. CAUSES…
 Biological aspects :
Nosocomial infection.
 Chemical aspects :Certain drugs used in ICU can
causes stress :
Analgesics.
Sedatives.
Paralytics.
Anxiolytic drug.
11Prof. Dr. RS Mehta, BPKIHS

12. …
 Environmental aspects :
Presence of noise of various devices.
Presence of excessive over lightening.
Unfamiliar surrounding.
Use of all kinds of machines and jargons.
12Prof. Dr. RS Mehta, BPKIHS

13. …
 Social aspects :
Separation from relatives.
Lack of social network.
Security of the patient is questioned.
Ineffective communication.
13Prof. Dr. RS Mehta, BPKIHS

14. …
 Psychological aspects :
Lack of attention.
Depersonalization.
14Prof. Dr. RS Mehta, BPKIHS

15. 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.
15Prof. Dr. RS Mehta, BPKIHS

16. 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.
16Prof. Dr. RS Mehta, BPKIHS

17. …
 Emotional :
Short term : Tiredness , anxiety, boredom ,
irritability , depression , lack of concentration , low
self esteem.
Long terms : Depression , neurosis, nervous
breakdown , suicide.
17Prof. Dr. RS Mehta, BPKIHS

18. Needs of critically ill patients
1. Oxygenation
2. Water and fluid
3. Food and nutrition
4. Mobilization
5. Elimination
6. Sleep and rest
7. Safety and security
8. Knowledge
9. Social needs
10.Self esteem needs
Prof. Dr. RS Mehta, BPKIHS 18

19. 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%.
Prof. Dr. RS Mehta, BPKIHS 19

20. 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
Prof. Dr. RS Mehta, BPKIHS 20

21. • 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
Prof. Dr. RS Mehta, BPKIHS 21

22. 2. Water and fluid
Assess
• 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
Prof. Dr. RS Mehta, BPKIHS 22

23. 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
Prof. Dr. RS Mehta, BPKIHS 23

24. • 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
Prof. Dr. RS Mehta, BPKIHS 24

25. 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.
Prof. Dr. RS Mehta, BPKIHS 25

26. 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
Prof. Dr. RS Mehta, BPKIHS 26

27. 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
Prof. Dr. RS Mehta, BPKIHS 27

28. 7. Elimination and waste products
• Catheter care
• Proper cleaning, use of bed pan if possible
Prof. Dr. RS Mehta, BPKIHS 28

29. 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
Prof. Dr. RS Mehta, BPKIHS 29

30. 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
Prof. Dr. RS Mehta, BPKIHS 30

31. 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
Prof. Dr. RS Mehta, BPKIHS 31

32. 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.
32Prof. Dr. RS Mehta, BPKIHS

33. 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.
33Prof. Dr. RS Mehta, BPKIHS

34. 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.
34Prof. Dr. RS Mehta, BPKIHS

35. 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
Prof. Dr. RS Mehta, BPKIHS 35

36. 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
Prof. Dr. RS Mehta, BPKIHS 36

37. 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
Prof. Dr. RS Mehta, BPKIHS 37

38. 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
Prof. Dr. RS Mehta, BPKIHS 38

39. • 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
Prof. Dr. RS Mehta, BPKIHS 39

40. 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
Prof. Dr. RS Mehta, BPKIHS 40

41. 5. Physical needs
• Involve them in small procedure
• Allow them to visit any times and have
waiting room near the ICU
Prof. Dr. RS Mehta, BPKIHS 41

42. Thank you
Prof. Dr. RS Mehta, BPKIHS 42