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What 3 reason for ICU admission?
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
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What are the common problems of CC pt?
- Skin problems r/t immobility
- Hospital acquired Infections (sepsis, MODS)
- Pain
- Impaired Communication
- Artificial lighting
- Noise
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Impired Nutrition
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.
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Primary sources of if anxiety?
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.
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Indicators of anxiety? Reduction of anxiety?
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.
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Collaborative Management Pain?
Assess routinely
Associated with anxiety and agitation
Medication; analgesia + continuous sedation.
Drug holiday are needed to neuro status
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ICU Delirium
Is an acute and reversible condition characterized by:
disoreintation, Impaired short-term memory, hallucinations, abnormal thought processes, imappropriate behavior, alt. sleep-wake cycle.
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ICU Delirium Interventions
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.
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Alterations in Sleep
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).
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ET Oral Intubation
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.
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ET Nasal Intubation
- 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)
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ET Oral Intubation
- 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
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ET Intubation: Nursing Management
Oxygenation
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