PRESENTATION ON MANAGEMENT OF CRITICALLY ILL PATIENT

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PRESENTATION ON MANAGEMENT OF CRITICALLY ILL PATIENT:

PRESENTATION ON MANAGEMENT OF CRITICALLY ILL PATIENT By; M.Maloni B.Sc. Nursing, v semester, MTPG&RIHS, PUDUCHERRY.

INTRODUCTION::

INTRODUCTION: CRITICAL CARE NURSING: IT IS THE FIELD OF NURSING WITH A FOCUS ON THE UTMOST CARE OF THE CRITICALLY ILL (OR) UNSTABLE PATIENTS. CRITICALLY ILL PATIENTS : CRITICALLY ILL PATIENTS ARE THOSE WHO ARE AT RISK FOR ACTUAL (OR) POTENTIAL LIFE THREATENING HEALTH PROBLEMS.

GUIDING PRINCIPLES::

GUIDING PRINCIPLES: DELIVERY OF OPTIMAL AND APPROPRIATE CARE . RELIEF OF DISTRESS COMPASSION AND SUPPORT DIGNITY INFORMATION CARE AND SUPPORT OF RELATIVES AND CARE GIVERS.

MANAGEMENT OF CRITICALLY ILL PATIENT:

MANAGEMENT OF CRITICALLY ILL PATIENT COMPLETE MONITORING RESPIRATORY CARE CARDIO VASCULAR CARE GASTROINTESTINAL/NUTRITIONAL CARE NEURO MUSCULAR COMFORT AND REASSURANCE COMMUNICATION WITH THE PATIENT VENOUS THROMBOSIS PROPHYLAXIS

CONTINUATION::

CONTINUATION: INFECTION CONTROL SKIN CARE , GENERAL HYGIENE AND MOUTH CARE FLUID, ELECTROLYTE AND GLUCOSE BALANCE BLADDER CARE DRESSING AND WOUND CARE COMMUNICATION WITH RELATIVES

1. COMPLETE MONITORING::

1. COMPLETE MONITORING :

ASSESSMENT AND CLINICAL EXAMINATION::

ASSESSMENT AND CLINICAL EXAMINATION : A: AIRWAY B: BREATHING C: CIRCULATION D: DISABILITY E: EXPOSURE

RESPIRATORY CARE::

RESPIRATORY CARE: PROBLEMS: PATIENT MAY HAVE: ALTERED VENTILATION , POOR SECRETION CLEARANCE, ATELECTASIS(LUNG COLLAPSE) , IMPAIRED MUSCLE FUNCTION.

MANAGEMENT::

MANAGEMENT: RESPIRATORY CARE INCLUDES: ASSISTING IN COUGHING. DEEP BREATHING AND ALVEOLAR RECRUITMENT TECHNIQUES( e.g.CPAP ). CHEST PERCUSSION. POSITIONING(e.g. fowlers position) BRONCHODILATORS. SUCTIONING. TRACHEOSTOMY CARE.

CARDIO VASCULAR CARE::

CARDIO VASCULAR CARE: PROLONGED IMMOBILITY IMPAIRS AUTONOMIC VASOMOTOR RESPONSES TO SITTING AND STANDING CAUSING PROFOUND POSTURAL HYPOTENSION. TILT TABLE MAY BE BENEFICIAL PRIOR TO MOBILIZATION.

GASTRO INTESTINAL/ NUTRITIONAL CARE;:

GASTRO INTESTINAL/ NUTRITIONAL CARE; THE SUPINE POSITION PREDISPOSES TO GASTRO OESOPHAGEAL REFLUX AND ASPIRATION PNEUMONIA .PATIENTS 30 DEGREE HEAD UP PREVENTS THIS . EARLY ENTERNAL FEEDING REDUCES INFECTION, STRESS ULCERATION AND GI BLEEDING

CONTINUATION::

CONTINUATION: IMMOBILITY IS ASSOCIATED WITH GASTRIC STASIS AND CONSTIPATION, GASTRIC STIMULANTS AND LAXATIVES ARE ESSENTIAL.

NEUROMUSCULAR CARE::

NEUROMUSCULAR CARE: IMMOBILITY, PROLONGED NEURO MUSCULAR BLOCKAGE AND SEDATION PROMOTES ATROPY , JOINT CONTRACTURES AND FOOT DROPS MAY OCCUR. PHYSIOTHERAPY AND SPLINTS MAY BE REQUIRED.

COMFORT AND REASSURANCE::

COMFORT AND REASSURANCE: ANXIETY, DISCOMFORT AND PAIN MUST BE RECOGNIZED AND RELIEVED WITH REASSURANCE, PHYSICAL MEASURES, ANALGESICS AND SEDATIVES. IN PARTICULAR, ENDOTRACHEAL OR NASOGASTRIC TUBES, BLADDER OR BOWEL DISTENSION,INFLAMED

Continuation::

Continuation: LINE SITES ,PAINFUL JOINTS AND URINARY CATHETORS OFTEN CAUSES DISCOMFORT, AND ARE OFTEN OVERLOOKED. FAN USE IS CONTROVERSIAL AS DUST-BORNE MICRO- ORGANISMS MAY BE DISSEMINATED. VISIBLE CLOCKS HELPS PATIENTS MAINTAIN CIRCADIAN RHYTHMS(i.e. day- night patterns)

Communication with the patient::

Communication with the patient: USE OF AMNESIC DRUGS MAKES REPEATED EXPLANATIONS AND REASSURANCE ESSENTIAL. ASSIST INTRACTION WITH APPROPRIATE COMMUNICATION AIDS

VENOUS THROMBOSIS PROPHYLAXIS::

VENOUS THROMBOSIS PROPHYLAXIS : TRAUMA , SEPSIS , SURGERY AND IMMOBILITY PREDISPOSES TO LOWER LIMB THROMBOSIS. MECHANICAL AND PHARMACOLOGICAL PROPHYLAXIS PREVENTS POTENTIALLY LIFE – THREATENING PULMONARY EMBOLISM.

INFECTION CONTROL::

INFECTION CONTROL: HAND WASHING IS VITAL TO PREVENT TRANSMISSION OF ORGANISMS BETWEEN PATIENTS. DISPOSABLE APRONS ARE RECOMMENDED. STERILE TECHNIQUE (e.g. gloves, masks, gowns, sterile field) IS ESSENTIAL FOR ALL INVASIVE PROCEDURES(e.g. line insertion).

CONTINUATION::

CONTINUATION: ISOLATION(+ or – ve pressure ventilation) FOR TRANSMISSIBLE INFECTIONS (e.g. tuberculosis) THOROUGH CLEANING OF BED SPACES(e.g. routinely and after patient discharge)

Skin care, general hygiene and mouth care::

Skin care, general hygiene and mouth care: CUTANEOUS PRESSURE SORES ARE DUE TO LOCAL PRESSURE(e.g. bony prominences). FRICTION MALNUTRITION OEDEMA ISCHAEMIA DAMAGED RELATED TO MOIST OR SOILED SKIN.

PRESSURE POINTS::

PRESSURE POINTS:

CONTINUATION::

CONTINUATION: TURN PATIENT EVERY 2 HOURS AND PROTECT SUSCEPTIBLE AREAS. SPECIAL BEDS RELIEVES PRESSURE AND ASSIST TURNING. MOUTH CARE AND GENERAL HYGIENE IS ESSENTIAL.

FLUID ELECTROLYTES AND GLUCOSE BALANCE::

FLUID ELECTROLYTES AND GLUCOSE BALANCE: REGULARLY ASSESS FLUID AND ELECTROLYTES BALANCE. INSULIN RESISTENCE AND HYPERGLYCAEMIA ARE COMMON BUT MAINTAINING NORMO-GLYCAEMIA IMPROVES OUTCOMES.

BLADDER CARE::

BLADDER CARE: URINARY CATHETERS CAUSES PAINFULL URETHRAL ULCERS AND MUST BE STABILIZED. EARLY REMOVAL REDUCES URINARY TRACT INFECTIONS.

DRESSING AND WOUND CARE::

DRESSING AND WOUND CARE: REPLACE WOUND DRESSINGS AS NECESSARY. CHANGE ARTERIAL AND CENTRAL VENOUS CATHETER DRESSINGS EVERY 48- 72 HOURS.

COMMUNICATION WITH RELATIVES::

COMMUNICATION WITH RELATIVES:

CONTINUATION::

CONTINUATION: FAMILY MEMBERS RECEIVE INFORMATION FROM MANY CARE GIVERS WITH DIFFERENT PERSPECTIVES AND KNOWLEDGE. CRITICAL CARE TEAMS MUST AIM TO BE CONSISTENT IN THEIR ASSESSMENTS AND HONEST ABOUT UNCERTAINTIES. ALL CONVERSATION SHOULD BE DOCUMENTED. COMPASSIONATED CARE OF RELATIVES IS ALWAYS APPRECIATED, AVOIDS ANGER AND IS ONE OF THE BEST INDICATORS OF A WELL- FUNCTIONING UNITS

CONCLUSION::

CONCLUSION: PROVIDE TOTAL CARE PREVENT COMPLICATION PROVIDE PSYCHOLOGICAL SUPPORT TO PATIENT AND THEIR FAMILY MEMBERS.

THANK YOU ……………..:

THANK YOU ……………..

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