Chapter 10 - Special Equipment and Patient Care Environments Flashcards
Patients with Special Needs
Acutely ill and requiring extensive nursing care
May need life-supporting equipment
Advantages of early application of rehabilitation techniques
Some examples of specialized patient care units
BWICU CCU CSICU CVICU ER/ED NICU PACU PICU
Considerations before and during patient treatment in special intensive care unit
Past and present medical history and prior level of functioning
Sedation and level of alertness
Cognition and ability to learn
Patient’s active participation level
Medical stability
Activity tolerance
Adequate proximal muscle strength to participate in active mobility training
Guidelines for treating a pt in ICU
review medical record
obtain current status of pt - vital signs, physical activity level, medications, mental capacity, alertness
wash hands, apply protective garments
observe pt monitors
observe equipment and devices used by pt - ventilator, IV, O2, catheter, arterial line, supplemental nutrition, suction
ID all tubes and lines, keep them free of occlusion and tension
eval present physical and mental status
notify nurse of significant change in status, record activities and observations
Precautions in ICU
occlusion or excessive tension on all tubes, leads, lines, etc
observe and assess pt before, during and after treatment
modify or cease treatment if pt exhibits abnormal or undesired response to treatment (vital signs, breathing, pain, reduced mental awareness or alertness)
request assistance if patient support systems change in function
observe wounds, dressings, drainage, urine drainage
get help as needed
When leaving a patient in ICU after treatment…
make sure he/she is properly positioned
elevate side rails as necessary
position bedside table/personal items to be accessible to pt
make sure nurse call light is accessible to pt
progression of an ICU patient
Check vital signs and medical stability
Assess level of alertness and ability to follow commands
Assess bed mobility and supine-to-sit transfer
Sitting on edge of bed (EOB)
Establish measurable and attainable goals
Establish treatment plan
EOB activities
Transfer training
Gait training
activities to reduce development of contractures
General overall goals of treatment for pts in ICU:
minimize or prevent adverse effects of inactivity and immobility and help each person become functionally independent
pt equipment in ICU
Beds Ventilation Monitors Lab Values Nutrition Waste/Drains Traction
Types of Beds
Tilt Table Standard adjustable bed Air-fluidized bed Posttrauma mobility beds (Keane, Roto-Rest) Low air loss therapy bed
Tilt Table procedure
• Position the patient lying on his or her back on a sheet-covered tilt table
• Place a rolled towel beneath the patient’s knees, a pillow behind the patient’s head, patient’s arms at rest on either side, and feet flat on the footboard shoulder width apart
• Apply the strap restraints, one across the lower thighs just above the knees, and one across the upper chest
• Elevate the table to a position tolerated by the patient and remain here for several minutes (reassess vital signs, document the length of time spent in this position, and ask the patient how he or she is feeling)
• When the patient is stable, raise him or her to a new elevation and remain here for several minutes (reassess vital signs, document the length of time spent in this position, and ask the patient how he or she is feeling)
• Repeat this procedure as the patient becomes more acclimated to the upright position (continue to reassess vital signs, document the length of time spent in the position, and ask the patient how he or she is feeling)
***always look for signs of nausea, dizziness, sensory or color changes, and changes in vital signs that may indicate an issue. Decrease the elevation of the table if the patient is not tolerating the position or reports feeling any of these symptoms
• Conclude treatment by gradually returning the patient to a horizontal position (reassess vital signs, ask the patient how he or she is feeling, and observe the patient for any signs or symptoms of discomfort or distress)
Purpose of utilizing a tilt table
acclimate to upright / weight bearing
**guard, monitor vitals, monitor facial expressions
Components of Standard Adjustable Bed
elevate head of bed and knee flexion
“cardiac chair” position
integrated call button - within reach of pt
bed rails *only 1 side up unless doctor orders otherwise
Components of Air-Fluidized Support Bed (Clinitron)
contains 1600 lb of silicone-coated glass beads
decreased pressure against patient’s skin
difficulty with transfers
temperature can be controlled
pt must compensate for increased fluid loss
VERY expensive
For what patients is the air-fluidized bed indicated?
several infected lesions
require skin protection and position cannot be altered easily
extensive pressure ulcers
at risk of developing deterioration of skin
recent, extensive skin grafts
require prolonged immobilization
Post-Trauma Mobility Beds
maintain seriously injured pt in stable position w/ proper postural alignment
bed oscillates to reduce pressure
for improving upper respiratory tract function
environmental stimulation for neurologically impaired pts
can disorient pt
exercise may be restricted
needs sufficient space
For what patients is the post-trauma mobility bed indicated?
restricted respiratory function
advanced or multiple pressure ulcers
require stabilization and skeletal alignment after extensive trauma or as a result of severe neurological deficits
Low Air Loss Therapy Bed
individualized control of air bladders/chambers-allow limited escape of air (each individually controlled)
used for prolonged immobilization
difficult sitting at EOB
For what patients is the low air loss therapy bed indicated?
require prolonged immobilization
at high risk of developing pressure ulcers or have existing ulcers
any condition requiring frequent trunk elevation to promote proper respiratory function
obese patients
Mechanism of mechanical ventilator
Positive Pressure moves air into lungs
volume cycled: pre-determined volume used, pts who require long-term support
pressure cycled: pre-determined max pressure used, pts who require short-term support
negative pressure: rarely used
Purpose of mechanical ventilator and patient indication
Maintain adequate and appropriate air exchange when normal respiration is inhibited/can’t be actively performed by pt
diseases/conditions affecting pt’s neurological or musculoskeletal control of respiration or interfere with gas exchange in lungs
pt apnea or potential for respiratory distress/failure
ex: ARDS
Airway placement of mechanical ventilator
Oral pharyngeal, nasal pharyngeal, oral esophageal, nasal endotracheal, oral endotracheal airway
tracheostomy, laryngostomy
Definition of “intubated”
endotracheal tube is placed
Definition of “extubated”
tube is removed
Assist mode of ventilation
patient-triggered response by need, pt must develop negative pressure to trigger ventilator to provide assistance
Continuous mod
Continuous positive airway pressure (CPAP) mode of ventilation
PEEP (positive end-expiratory pressure) superimposed on patient’s spontaneous breathing pattern
used to wean pt from ventilator or help maximize gas exchange capabilities for immobile, inactive pt
Control mode - ventilation
inspiration phase begins at timed intervals based on patient’s need for gas
Assisted control mode - ventilation
combination of CPAP and control mode
Intermittent mandatory ventilation mode
ventilation cycle is established so that ventilation occurs a minimum # of times / minute
used to begin weaning pt from ventilator and develop independent respiratory pattern
Synchronized intermittent mandatory ventilation mode
ventilation cycle is coordinated with pt’s own breathing cycle
PEEP mode - ventilation
positive end-expiratory pressure
O2 is introduced into pt’s lungs by maintaining positive pressure at end of expiration –> increases alveolar surface area able to absorb gas from ventilator –> maximal alveolar ventilation
helps expand, maintain, and keep alveoli patent b/c they would normally close at end of expiration
Oxygen delivery devices
Nasal cannula: low-moderate levels O2 Oronasal mask Nasal catheter Tent: encloses pt trink and head, more frequent for children Tracheostomy mask or catheter
Common monitoring parameters for patients
Cardio-vital signs ABGs Intracranial pressure (ICP) Pulmonary artery pressure (PAP) Central venous pressure (CVP) Arterial pressure (A line)
