NCM 118 Critical Care

NCM 118 – Critical Care Concept: P a i n , D e a t h a n d D y i n g , A s s e s s m e n t T o o l s u s e d i n C r i t i c a l Care, Patient Handover , and Medical Abbreviat ions. Instructors: Qvimrej A. Dimabogte, RM, RN /Manuel O. Arines MAN /Jeffrey A. Borromeo,MAN /Ralph Kevin B....

NCM 118 – Critical Care Concept: P a i n , D e a t h a n d D y i n g , A s s e s s m e n t T o o l s u s e d i n C r i t i c a l Care, Patient Handover , and Medical Abbreviat ions. Instructors: Qvimrej A. Dimabogte, RM, RN /Manuel O. Arines MAN /Jeffrey A. Borromeo,MAN /Ralph Kevin B. Araňa, MAN BSN 4: 1st Semester SY 2024-2025 4. Obstructive Shock: Caused by physical obstruction TABLE OF CONTENTS to blood flow. I. Pain 1. Examples: Pulmonary embolism, cardiac tamponade. II. Shock and Types od Shock III. SIRS, SEPSIS, and SEVERE SEPSIS Management: IV. Dying and Death  Identify and Treat Underlying Cause: Fluid resuscitation, medications, or surgical intervention. V. Assessment Tools Used in Critical Care  Supportive Care: Maintaining airway, breathing, and circulation (ABCs). VI. Patient Handover III. SIRS, Sepsis, and Severe Sepsis VII. Medical Abbreviations commonly Used Systemic Inflammatory Response Syndrome (SIRS): VIII. Advnace Directive  A systemic inflammatory response to various insults, I. Pain including infection, trauma, or pancreatitis. Criteria include fever, hypothermia, tachycardia, tachypnea, Pain is an unpleasant sensory and emotional experience and leukocytosis or leukopenia. associated with actual or potential tissue damage. It serves as a crucial protective mechanism, signaling the body to avoid or Sepsis: respond to harm. Types of Pain:  A severe infection causing systemic inflammation and potentially leading to organ dysfunction. It is 1. Acute Pain:· Short-term pain that arises suddenly and is usually characterized by SIRS criteria plus a confirmed or linked to a specific injury or condition, often resolving with suspected infection. treatment. 2. Chronic Pain: Persistent pain lasting beyond the expected Severe Sepsis: healing time, often due to conditions like arthritis or neuropathy. It may not always have a clear cause.  Sepsis with associated organ dysfunction or hypoperfusion. Symptoms may include altered Management: mental status, decreased urine output, and lactic acidosis.  Pharmacological: Use of analgesics, such as acetaminophen, NSAIDs, or opioids, depending on the Management: severity.  Non-Pharmacological: Techniques like physical therapy, cognitive-behavioral therapy, and acupuncture can  Early Recognition and Treatment: Administer complement pain relief strategies. antibiotics, fluids, and vasopressors as needed.  Supportive Care: Monitor vital signs, organ function, and provide supportive measures like oxygen and II. Shock and Types of Shock ventilation. Definition: Shock is a critical condition where the body's organs IV. Dying and Death and tissues are not receiving adequate blood flow, leading to insufficient oxygen and nutrient delivery. Concepts of Dying: Types of Shock:  Dying: The process of approaching death, often characterized by physical, emotional, and 1. Hypovolemic Shock: Caused by significant loss of blood psychological changes. or fluids, leading to decreased blood volume.  Death: The cessation of all biological functions 1. Examples: Hemorrhage, severe dehydration. sustaining life. 2. Cardiogenic Shock: Results from the heart's inability to pump blood effectively. Care Approaches: 1. Examples: Myocardial infarction, congestive  Palliative Care: Focuses on relieving symptoms and heart failure. improving quality of life, rather than curative treatment. 3. Distributive Shock: Characterized by widespread  Hospice Care: Specialized care for individuals in the vasodilation and impaired blood flow. final stages of life, emphasizing comfort and support for both patients and families. Emotional and Ethical Considerations: 1. Examples: Septic shock, anaphylactic shock. NCM 118 – Critical Care Concept: Pa t i e n t Sa f e t y Instructors: Qvimrej A. Dimabogte, RM, RN /Manuel O. Arines MAN /Jeffrey Borromeo, MAN/ Ralph Kevin B. Araňa, MAN BSN 4: 1st Semester SY 2024-2025  Emotional Support: Providing comfort and addressing  To assess organ dysfunction and failure in critically emotional needs of patients and families. ill patients, especially in sepsis.  Advance Directives: Legal documents outlining a patient’s wishes regarding medical treatment if they Components: become unable to communicate.  Respiratory System: Assesses oxygenation and Understanding pain, shock, SIRS, sepsis, and the process of dying respiratory support. is fundamental in providing comprehensive patient care. Effective  Coagulation: Evaluates platelet count and management involves recognizing symptoms, diagnosing coagulation abnormalities. conditions, and delivering appropriate interventions to improve  Liver Function: Measures bilirubin levels. patient outcomes and ensure dignity in end-of-life care.  Cardiovascular System: Assesses blood pressure and need for vasopressors. V. Assessment Tools Used in Critical Care  Renal Function: Measures serum creatinine and urine output. 1. Glasgow Coma Scale (GCS)  Neurological Status: Assesses Glasgow Coma Scale. Purpose: Score Interpretation:  To assess the level of consciousness and neurological  Scores range from 0 to 24, with higher scores function in patients with head injuries or altered mental indicating more severe organ dysfunction. status. Components: 4. MAP (Mean Arterial Pressure) Monitoring  Eye Opening: Scores from 1 (no response) to 4 (spontaneous opening). Purpose:  Verbal Response: Scores from 1 (no response) to 5 (oriented).  To assess overall blood flow and perfusion status.  Motor Response: Scores from 1 (no response) to 6 (obeys commands). Calculation: Total Score:  MAP = (SBP + 2*DBP) / 3  Ranges from 3 (deep coma) to 15 (fully alert). Lower o SBP: Systolic Blood Pressure scores indicate a more severe level of impaired o DBP: Diastolic Blood Pressure consciousness. Target Range:  A MAP of 60-70 mmHg is generally aimed for to 2. APACHE II (Acute Physiology and Chronic Health Evaluation) ensure adequate organ perfusion. Purpose:  To estimate the severity of illness and predict outcomes 5. Hourly Urine Output Monitoring in critically ill patients. Purpose: Components:  To evaluate kidney function and fluid balance.  Physiological Measurements: Includes temperature, blood pressure, heart rate, respiratory rate, and more. Normal Range:  Chronic Health Conditions: Accounts for pre-existing conditions like chronic liver disease or diabetes.  0.5 to 1.5 mL/kg/hr is considered normal.  Age: Affects overall score and prognosis. Decreased output can indicate renal impairment or fluid imbalance. Score Interpretation: Importance:  Higher scores correlate with increased risk of mortality and severity of illness.  Helps in early detection of kidney failure and fluid status monitoring, crucial for adjusting fluid therapy. 3. SOFA (Sequential Organ Failure Assessment) Score 6. Cardiac Output Monitoring Purpose: Purpose: NCM 118 – Critical Care Concept: Pa t i e n t Sa f e t y Instructors: Qvimrej A. Dimabogte, RM, RN /Manuel O. Arines MAN /Jeffrey Borromeo, MAN/ Ralph Kevin B. Araňa, MAN BSN 4: 1st Semester SY 2024-2025  To measure the amount of blood the heart pumps per Understanding and utilizing these assessment tools is crucial minute, reflecting heart function and perfusion. for providing effective and timely care in critical care settings. Each tool provides specific insights into the patient's Techniques: condition, guiding interventions and monitoring responses to treatment.  Pulmonary Artery Catheter (PAC): Measures cardiac output directly. VI.Patient Handover  Echocardiography: Non-invasive method to estimate cardiac output. Definition: Importance:  Patient handover is the process of transferring responsibility and information about a patient from  Essential for managing patients with heart failure, shock, one healthcare provider to another. It ensures and other critical conditions. continuity of care and safety. Importance: 7. Ventilator Settings and Monitoring  Safety: Prevents errors and omissions.  Continuity: Ensures that all relevant information is Purpose: communicated for ongoing care.  Efficiency: Enhances team coordination and patient  To assess and adjust mechanical ventilation in patients outcomes. with respiratory failure. Key Components of Effective Handover Parameters: 1. Identification: o Patient Details: Name, age, and medical =olume (VT): Volume of air delivered with each breath. record number. o Location: Current unit/bed.  Respiratory Rate (RR): Number of breaths per minute.  PEEP (Positive End-Expiratory Pressure): Maintains 2. Clinical Status: alveoli open and improves oxygenation.  FiO2 (Fraction of Inspired Oxygen): Oxygen o Chief Complaint: Main reason for concentration delivered. admission or current issue. o Diagnosis: Confirmed or suspected medical Monitoring: conditions. o Vital Signs: Recent measurements and any  Regularly check arterial blood gases (ABGs) to guide abnormalities. adjustments in ventilator settings. 3. Treatment Plan: o Current Orders: Medications, treatments, 8. ABG (Arterial Blood Gas) Analysis and interventions. o Pending Tests/Procedures: Upcoming diagnostic tests or planned procedures. Purpose: 4. Recent Changes:  To assess respiratory and metabolic function, including oxygenation, ventilation, and acid-base balance. o Significant Updates: Changes in condition or treatment. Components: o Responses to Treatment: How the patient is reacting to interventions.  pH: Measures acidity/alkalinity.  PaO2 (Partial Pressure of Oxygen): Indicates oxygenation 5. Patient Needs: status.  PaCO2 (Partial Pressure of Carbon Dioxide): Reflects ventilation efficiency. o Immediate Concerns: Any urgent issues or needs.  HCO3- (Bicarbonate): Assesses metabolic component of o Long-Term Goals: Ongoing care objectives acid-base balance. and discharge plans. Importance: 6. Safety Information:  Guides treatment decisions, including ventilation o Allergies: Known allergies and reactions. adjustments and fluid therapy. o Special Precautions: Any additional safety measures or concerns. NCM 118 – Critical Care Concept: Pa t i e n t Sa f e t y Instructors: Qvimrej A. Dimabogte, RM, RN /Manuel O. Arines MAN /Jeffrey Borromeo, MAN/ Ralph Kevin B. Araňa, MAN BSN 4: 1st Semester SY 2024-2025 Best Practices for Handover 1. Structured Format: o Use standardized tools or frameworks (e.g., SBAR: Situation, Background, Assessment, Recommendation). 2. Clarity and Conciseness: o Provide clear, relevant information without unnecessary detail. 3. Verification: o Confirm understanding by summarizing key points and asking for questions. 4. Documentation: o Ensure all information is recorded accurately in the patient’s records. 5. Communication: o Use direct, respectful, and professional language. Be attentive and engaged during the handover process. Example Handover Situation: "Mr. John Smith, 65 years old, in Room 301." Background: "Admitted 2 days ago with community-acquired pneumonia. History of COPD and diabetes." Assessment: "Vital signs stable: BP 130/85, HR 85 bpm, RR 18, Temp 98.6°F. Improved from yesterday but still on IV antibiotics." Recommendation: "Continue current antibiotic regimen. Monitor for any changes in respiratory status. Plan for chest X-ray tomorrow morning. Keep an eye on blood glucose levels due to diabetes." Patient handover is a critical component of safe and effective healthcare delivery. Adhering to a structured approach ensures all essential information is communicated, fostering continuity and quality of patient care. VII.Medical Abbreviation Commonly Used. NCM 118 – Critical Care Concept: Pa t i e n t Sa f e t y Instructors: Qvimrej A. Dimabogte, RM, RN /Manuel O. Arines MAN /Jeffrey Borromeo, MAN/ Ralph Kevin B. Araňa, MAN BSN 4: 1st Semester SY 2024-2025 VIII.Advance Directive 4.Practical Application: An advance directive is a legal document that outlines a patient’s  Documentation: Ensure advance directives preferences for medical treatment if they become unable to are properly documented and accessible in communicate their wishes due to illness or injury. the patient’s medical record.  Interdisciplinary Team: Collaborate with Types of Advance Directives: the entire care team, including physicians, social workers, and ethicists, to honor the 1. Living Will: directives effectively.  Purpose: Specifies the types of medical Advance directives are essential tools in the ICU for guiding treatments the patient wants or does not want in treatment decisions according to the patient’s wishes, situations where they are terminally ill or in a ensuring respect for their autonomy, and aiding in ethical persistent vegetative state. and legal decision-making. Nurses play a key role in  Example: Preferences regarding mechanical understanding, communicating, and implementing these ventilation, tube feeding, or resuscitation. directives in critical care settings. 2. Durable Power of Attorney for Healthcare (Healthcare ` Proxy):  Purpose: Designates a person (the healthcare agent) to make medical decisions on behalf of the patient if they are unable to make decisions themselves.  Example: The agent might make decisions about end-of-life care or specific treatments based on the patient’s known wishes. Importance in the Intensive Care Unit (ICU): 1. Decision-Making:  Clarifies Patient Wishes: Advance directives guide the healthcare team in making decisions that align with the patient’s preferences, especially in critical situations.  Prevents Confusion: Reduces uncertainty and stress for family members by clearly outlining the patient’s treatment preferences. 2. Ethical Considerations:  Respect for Autonomy: Ensures that patient autonomy is respected even when they cannot communicate their wishes directly.  Legal Compliance: Helps avoid potential legal conflicts by adhering to the patient’s documented preferences. 3.Communication:  Discuss Early: Encourages early discussions with patients and families about treatment preferences and end-of-life care, ideally before admission to the ICU.  Review Regularly: It is crucial to review and update advance directives regularly, particularly if there are significant changes in the patient’s health status.