Critical Care

1. Pt may be physiologically unstable.

2. Pt may be at risk for serious coplications.

3. Pt may require intensive & complicated nursing support

• a) Polypharmacy or titrating of IV meds.
• b) Advanced biotechnology

• Skin problems r/t immobility
• Hospital acquired Infections (sepsis, MODS)
• Pain
• Impaired Communication
• Artificial lighting
• Noise

High protein and high calorie diets.

Early provisions of enteral (best) or parenteral nutrition (if enteral not possible)

Enteral Nutrition-Provides structure and function of gut; frew complications; helps prevent translocation of bacteria from gut-Major cause of MODS.

Perceived or anticipated treat to physical health, actual loss of control of body functions and a foreign enviornment.

noises, lights, isolation, loss of control, pain, intensity of unit.

Characterized by appprehension and autonomic arousal.

Increased HR & BP, agitation, restlessness, verbalization of anxiety.

Include pt & family in conversation regarding care.

Encourage dialogue about concerns, questions, needs.

Assess anxiety routinely

Communication

Encourage family to bring in personal items and potos.

Alternative therapies and med if needed.

Assess routinely

Associated with anxiety and agitation

Medication; analgesia + continuous sedation.

Drug holiday are needed to neuro status

Is an acute and reversible condition characterized by:

disoreintation, Impaired short-term memory, hallucinations, abnormal thought processes, imappropriate behavior, alt. sleep-wake cycle.

Address physiological factors, reorient pt, encourage family to visit and breng personal items from home, re-establish sleep-wake cycles, med if pt is unsafe, limit noise, limit converstations in fron of pt that do not include the pt, promptly respond to alarms and silence alarms if appropriate.

Frequent monitoring, noises, procedures, medication, pain and anxiety contribute to poor sleep.

Interventions: Cluster activities, schedule rest periods, dim lights at night, open curtains during the day, nighttime comfort measures, medication if needed (last resort).

ET is passed through the mouth & vocal cords into the trachea using a laryngoscope or bronchoscope

Complication: Difficulty if head/neck movement is limited. Teeth can chipp/dislodge during insertion. Salivation in increased and swallowing is difficult. Bite block to prevent pt from biting & obstructing tube. Mouth care difficult.

• Tube is placed blindly through the nose, nasopharynx, and vocal cords.
• More stable and more difficulty to dislodge.

Complication: Contraindicated in pts with facial fx, suspected fx at the base of the skull, and post-op cranial surgies. Subject to more kinking. increased WOB r/t smaller diameter, suctioning is more difficult, increased risk for sinus infection and VAP (can lead to sepsis)

• Maintain correct tube placement:
• Monitor for placement every 2-4 hrs.
• Confirm exit mark on tube remains constant.
• Observe for symmetric chest movement.
• Ausculate for bilateral breath sounds.

• Maintain proper cuff inflation:
• To insure adequate tracheal perfusion, cuff pressure should be 20-25mmHg. Measure + record pressure
• Q8hr

Monitor Oxygenation:

• ABG (PaO₂)
• SpO₂
• SvO₂