Patient Care in the ICU

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Author:
Martia
ID:
255263
Filename:
Patient Care in the ICU
Updated:
2014-01-05 22:41:55
Tags:
nursing
Folders:
N303Critical Care,Test 1
Description:
nursing school
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  1. Pain Assessment: non verbal cues
    • facial expression
    • body language
    • muscle tension
    • compliance with vent (whether or not breathing against vent)
    • vital signs (increased)
  2. Pain assessment scales
    • FLACC Scale - face, legs activity, cry, consolability
    • Visual Analog Scale
  3. Pain control: Morphine
    • Opiate
    • onset: 5 min
    • duration: 4-5 hrs
    • 2-4mg IV Q4H
    • antidote: Narcan
  4. Pain Control: HYDROmorphone (Dilaudid)
    • Opiate
    • onset: 15 min
    • duration: 4-5hrs
    • 0.2-1mg IV Q2-3H
    • 7x more powerful than morphine
    • antidote: Narcan
  5. Pain Control: Fentanyl
    • synthetic opiate
    • very potent 50mcg-100mcg (0.05-0.1mg)
    • short acting - duration: .5-1hr
    • useful for procedures and surgery
  6. Pain Control: others
    • nonopioids - NSAIDs, acetaminophen (max 2g/day d/t liver tox.)
    • adjuvant therapy - antidepressants, corticosteroids, anticonvulsants
  7. sedation - Midazolam (Versed)
    • benzodiazepine
    • rapid onset
    • short duration - 4 hrs
    • dosage - weight based
    • antidote: Romazicon (flumazenil) 0.2mg every minute, max of 4 doses
  8. sedation - Lorazepam (Ativan)
    • benzodiazepine
    • slow onset: 10-20 min
    • long duration: 12 hrs
    • antidote: romazicon (flumazenil)
    • SE: seizures
  9. sedation - Propofol (Diprivan)
    • rapid onset: 2min
    • very short duration: 2-5min
    • metabolized by liver and excreted by kidneys
    • can discolor urine green
    • dissolved in lipid emulsion so can increase cholesterol
    • NO ANTIDOTE
    • propofol syndrome: cardiac failure, rhabdomyolysis, metabolic acidosis, renal failure ---don't usually give for more than 2 days b/c of SEs
  10. Sedation Assessment
    • pt. response to ventilator
    • restlessness
    • LOC
    • vital signs
    • Richmond Agitation Sedation Score (RASS)
  11. Richmond Agitation Sedation Score (RASS)
    • uses 2 scores target score (physician made) and actual score (nurse assessed)
    • positive and negative values
    • typical target and actual score should be 0 to -2
  12. Neuromuscular Block
    • creates drug induced paralysis
    • Vecuronium and Pavulon
    • paralyzes skeletal muscles only and not the brain
    • must be on ventilator and sedated
    • peripheral nerve stimulator used to monitor degree of paralysis
    • SE: tachycardia and hypertension
  13. geriatric critically ill patient
    • polypharmacy
    • comorbidities
    • decreased reserves
    • impaired immune response
    • decreased CNS - reflexes, memory
  14. delirium
    • rapid onset of difficulty with cognition, inattention, and confusion
    • can be caused by polypharmacy, infection, hyponatermia, EtOH withdrawal, hypoxia, lack of sleep, sensory overload
  15. nutrition
    • increased calories needed for healing and immune response
    • protein needed to strengthen muscles
  16. Cultural Competence
    • Consider culture
    • show respect
    • assess and affirm differences
    • show sensitivity and self awareness
    • provide care with humility

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