Podcast
Questions and Answers
What is the primary goal of monitoring patient intake and output?
What is the primary goal of monitoring patient intake and output?
Why is it recommended to record food intake in Kcal rather than cans or jars?
Why is it recommended to record food intake in Kcal rather than cans or jars?
What is a common indicator of poor nutritional status?
What is a common indicator of poor nutritional status?
What is the purpose of a care bundle in the care of critically ill patients?
What is the purpose of a care bundle in the care of critically ill patients?
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What is a key factor that predisposes patients to nosocomial infections?
What is a key factor that predisposes patients to nosocomial infections?
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Why is it essential to keep the patient clean and dry?
Why is it essential to keep the patient clean and dry?
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What is the primary goal of physical examination in the care of critically ill patients?
What is the primary goal of physical examination in the care of critically ill patients?
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What is the importance of being friendly with the patient during care?
What is the importance of being friendly with the patient during care?
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What is the primary focus of physical care in end-of-life care?
What is the primary focus of physical care in end-of-life care?
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What stage of dying involves refusal to accept the reality of the diagnosis or impending death?
What stage of dying involves refusal to accept the reality of the diagnosis or impending death?
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What is the primary benefit of providing spiritual care in end-of-life settings?
What is the primary benefit of providing spiritual care in end-of-life settings?
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What is a common characteristic of the bargaining stage of dying?
What is a common characteristic of the bargaining stage of dying?
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What is the primary goal of social support in end-of-life care?
What is the primary goal of social support in end-of-life care?
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What physiological change may occur in the cardiovascular system of a dying patient?
What physiological change may occur in the cardiovascular system of a dying patient?
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What is the primary principle of ethical decision-making in end-of-life care?
What is the primary principle of ethical decision-making in end-of-life care?
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What is a possible respiratory change in a dying patient?
What is a possible respiratory change in a dying patient?
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What is a prominent feature of the neurological system in a dying patient?
What is a prominent feature of the neurological system in a dying patient?
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What stage of dying involves expressing frustration, resentment, or rage?
What stage of dying involves expressing frustration, resentment, or rage?
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What is a characteristic of the depression stage of dying?
What is a characteristic of the depression stage of dying?
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What is the primary benefit of facilitating open communication in end-of-life care?
What is the primary benefit of facilitating open communication in end-of-life care?
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What is a key aspect of the acceptance stage of dying?
What is a key aspect of the acceptance stage of dying?
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What is the primary goal of integrating spiritual care in end-of-life settings?
What is the primary goal of integrating spiritual care in end-of-life settings?
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What is the significance of proper issuance of death certificates and performing last offices with diligence and compassion?
What is the significance of proper issuance of death certificates and performing last offices with diligence and compassion?
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What is a possible consequence of respiratory changes in a dying patient?
What is a possible consequence of respiratory changes in a dying patient?
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Study Notes
Comprehensive Care for Critically Ill Patients
- Requires a systems-based approach and integration of complex information to provide consistent high standard of care.
- Involves input from many specialties, including Microbiology, Physiotherapy, Radiology, Nutrition, Pharmacy, and Speech and Language teams.
- Implementing care bundles has been shown to improve patient outcomes.
Essential Care Components
- Monitoring of intakes and outputs, including:
- Patient intake: fluids, I.V. fluids, blood products, and liquid diets.
- Outputs: urine, faeces, vomitus, and fluid loss through body cavities.
- Comparing ins and outs to prevent overload or dehydration.
- Nutritional support:
- Recording food intake in Kcal rather than cans or jars.
- Assessing patient's energy requirements through nutritional history.
- Identifying signs of poor nutritional status, such as acute loss of lean body mass, fat, muscle wasting, or oedema.
- Meeting comfort needs:
- Assessing for pain.
- Keeping the patient clean and dry.
- Preventing urine scald and skin breakdown.
Prevention of Nosocomial Infections
- Factors that predispose patients to nosocomial infections:
- Age (geriatric and neonates).
- Immuno-compressed patients.
- Diagnostic and invasive procedures.
- Antimicrobials therapy.
- Long-term hospitalization.
- Common causes of nosocomial infections:
- Escherichia coli.
- Klebsiella.
- Salmonella.
- Canine.
- Nursing goals:
- Minimizing the risk of nosocomial infection through:
- Diligent hand washing.
- Swabbing injection ports with alcohol.
- Using disposable thermometer sheaths.
- Disinfecting patient care equipment.
- Disinfecting environmental surfaces.
- Observing aseptic techniques in catheter placement and care.
- Treating patients with nosocomial infection last during ward rounds.
- Minimizing the risk of nosocomial infection through:
Bandage and Wound Care
- Placing bandages to protect lacerations and surgical incisions.
- Performing catheter care.
Care of the Dying Patient
- Physical care is crucial for ensuring comfort, including effective pain management, maintaining hygiene, and addressing nutrition and hydration needs.
- Providing emotional support is vital throughout the dying process to address existential concerns and facilitate open communication.
Psychological Support
- Psychological support includes addressing spiritual needs for both patients and their families through spiritual counseling, religious practices, and rituals.
Social Support
- Social support is crucial for both the patient and their loved ones, involving a multidisciplinary approach with social workers, counselors, and volunteers.
- A supportive environment should be created to address practical needs and offer emotional companionship.
Ethical Considerations
- Ethical dilemmas often arise in end-of-life care, requiring consideration of autonomy, beneficence, non-maleficence, and justice principles.
- Respecting patient autonomy in treatment decisions and ensuring care aligns with their values and wishes is essential.
Kubler-Ross's Stages of Dying
- The five stages of dying are:
- Denial: refusing to accept the diagnosis or impending death
- Anger: expressing frustration, resentment, or rage towards oneself, loved ones, healthcare providers, or a higher power
- Bargaining: attempting to negotiate with oneself, others, or a higher power to delay or avoid death
- Depression: experiencing profound sadness, grief, and feelings of hopelessness
- Acceptance: coming to terms with mortality and accepting the reality of one's situation
Pathophysiology of the Dying Patient
Cardiovascular System
- Blood pressure may decrease as cardiac output diminishes
- Peripheral circulation may be compromised, leading to cool extremities and mottling of the skin
- Irregular heart rhythms, such as atrial fibrillation or bradycardia, may develop
Respiratory System
- Respiratory rate may increase or decrease, and breathing patterns may become irregular
- Secretions may accumulate in the airways, leading to "death rattle"
- Hypoxia and respiratory distress may occur as the body's ability to oxygenate tissues diminishes
Neurological System
- Neurological changes are prominent as the body approaches death
- Consciousness may fluctuate, with periods of confusion or agitation
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Description
Quiz about comprehensive care for critically ill patients, involving a systems-based approach and integration of complex information from multiple specialties.
