NSG 128 Nursing Care of Clients PDF

NSG 128 Nursing Care of Clients with Life-Threatening Condition, Acutely Ill and Multi-Organ Problems Prepared by: AMM Prof. Abolbashar M. Mangontawar 1 WHAT IS C...

NSG 128 Nursing Care of Clients with Life-Threatening Condition, Acutely Ill and Multi-Organ Problems Prepared by: AMM Prof. Abolbashar M. Mangontawar 1 WHAT IS CRITICAL CARE? Administering immediate and continuous care to clients/patients having: actual or potentially life-threatening health conditions potentially recoverable condition requirement of advanced respiratory support established organ failure Early referral is a MUST! AMM 2 Reason for ICU Admission physiologically unstable patients risk of serious complications complicated nursing support: IV Polypharmacy Advanced Biotechnology (ECMO, CRRT, IABP, etc.) AMM 3 Reason for ICU Admission Advanced respiratory support: (MechVent, ETT) (CPAP, BiPAP, HFNC) AMM 4 Reason for ICU Admission Circulatory Support Need for vasoactive drugs to support arterial pressure or cardiac output: Vasopressors; Inotropes; Mixed agent, Vasodilators AMM 5 Reason for ICU Admission Circulatory Support Unresponsive to modest volume replacement Patients resuscitated after cardiac arrest Intra-aortic balloon pumping AMM 6 Reason for ICU Admission Neurologic Monitoring Support Central nervous system depression Invasive neurological monitoring ICP Monitoring, EEG, Brain Tissue Oxygenation Monitoring, SjO2, Invasive BP monitoring AMM 7 Reason for ICU Admission Renal Support acute renal replacement therapy: Hemodialysis (HD), Hemofiltartion (HF), Hemodiafiltration (HDF) CRRT AMM 8 Consider the following: Diagnosis Age and Physiological reserve Severity of illness Coexisting disease / Comorbidities Prognosis Availability and utilization of suitable treatment Treatment response Associated Quality of Life Patient’s and Family decisions AMM 9 Common Problems of Critical Care Patients 1. Nutrition Increased Nutritional Requirement Impaired Gastrointestinal Function Malabsorption and Digestive Issues Hyperglycemia Protein-Energy Malnutrition Fluid and Electrolyte Imbalance Delayed Gastric Emptying Nutrient Deficiencies Feeding Tube Complications AMM 10 Common Problems of Critical Care Patients Primary goal: correct nutritional deficiency Alternative routes for nutrition: Enteral Nutrition (EN): aka tube feeding, is a way of sending nutrition right to the stomach or small intestine. Nasogastric (NG) Tube Orogastric (OG) Tube Percutaneous Endoscopic Gastrotomy (PEG) Jejunostomy Tube (J-Tube) Nasojejunal (NJ) Tube * Collaborate to dietician and physician to determine how to meet the nutritional need of ICU px AMM 11 Common Problems of Critical Care Patients PARENTERAL NUTRITION feeding intravenously Total Parental Nutrition (TPN) or CPN carbohydrates proteins, fats, vitamins, minerals, and electrolytes. via a central venous catheter or PICC long-term nutrition Partial Parenteral Nutrition (PPN) carbohydrates, proteins, and sometimes fats. Less concentrated through a peripheral vein ; shorter-term Cannot provide complete nutritional AMM 12 Common Problems of Critical Care Patients 2. ANXIETY ✓Common problem in ICU ✓Primary sources: anticipated threat to physical health, actual loss of control of body functions and environment ✓Encourage px and S.O. to express concerns, ask questions and state their needs AMM 13 Common Problems of Critical Care Patients 3. PAIN ✓As many as 70% of ICU patient ✓ Psychological Stress have moderate-severe ✓ Pain Management issues unrelieved pain *Pain management both medication ✓Maybe due to: and non-pharmacological ✓ Serious condition approaches, along with regular ✓ Invasive procedure adjustments to treatment plans ✓ Post-Surgery should be implemented ✓ Medical Devices ✓ Trauma ✓ Immobilization ✓ Medication side effects AMM 14 Common Problems of Critical Care Patients 3. IMPAIRED COMMUNICATION ✓sedatives, ETT ✓Patients can communicate through gestures, sign language, writing or incomprehensible words. ✓use of devices such as picture boards, note pads ✓Non-verbal communication ✓Comforting touch AMM 15 Common Problems of Critical Care Patients 3. IMPAIRED COMMUNICATION ✓sedatives, ETT ✓Patients can communicate through gestures, sign language, writing or incomprehensible words. ✓use of devices such as picture boards, note pads ✓Non-verbal communication ✓Comforting touch AMM 16 Common Problems of Critical Care Patients 4. SENSORY-PERCEPTUAL PROBLEMS ▪ Visual Disturbance ▪ Blurry vision, hallucinations or confusion, Light Sensitivity ▪ Auditory Disturbance ▪ Noisy ICU environment, Hearing impairment, Auditory hallucination ▪ Tactile Sensory Issues ▪ Pressure sores, sensory overlaod, Touch sensitivity AMM 17 Common Problems of Critical Care Patients 4. SENSORY-PERCEPTUAL PROBLEMS ▪ Olfactory and Gustatory Problems ▪ Altered taste, Altered smell, odor sensitivity ▪ Cognitive and Perceptual Issues ▪ Delirium, Disorientation, Hallucination, sleep disturbances * Communication aids, Comfort measures, Snesory stimulation, Monitoring and support. AMM 18 to be continued.. AMM 19