Class 1 (01|11|22) Patients and families experiences with life threatening and critical illness Flashcards
Definition: Stress Respons
stimulus causing disequilibrium between psychological and physiological functioning
Hormones in the stress response
- Amygdala signals hypothalamus
- Activation of hypothalamic–pituitary–adrenal axis and a release of catecholamines
- Increase in corticosteroid & aldosterone leads to a physiological response
What are some catecholamines?
E
NE
Glucocorticoids: cortisol & mineralocorticoid
The physiological response in the stress response (cortisol, E/NE, corticosteroid & aldosterone)
- Pain sensation decreases (favourable response)
- Blood flow redirected to vital organs (heart, lungs , brain)
- Cortisol inhibits insulin production to prevent glucose storage often leading to individual having hyperglycaemia and/or insulin resistance
- E/NE cause vasoconstriction to increase BP
- Results in Systemic hypoperfusion where coagulopathies can develop
- Results in increase acidosis breaking down fibrinogen (clotting agent made in liver which is not having less perfusion) leading to more coagulopathies
- Metabolic and oxygen demands of the body increase
What is Ischemia
Ischemia: injury from inadequate perfusion
Definition Coagulopathy
Coagulopathy is often broadly defined as any derangement of hemostasis resulting in either excessive bleeding or clotting, although most typically it is defined as impaired clot formation
Three needs of patient in ICU
- Need to feel safe
- Need for information
- Need minimize/eliminate stressors
What kind of psychological/emotional stress does a patient have in ICUs?
- Fear
- Anxiety
- Sleep disturbances
- Cognitive impairment
- medication: for sedation and pain
- inability to communicate:
- PTSD
Physical Assessmnet of fear & anxiety.
agitated behaviours, increase blood pressure, increase heart rate, verbalization (if able), restlessness
What can cause cognitive imparments in ICU patients
delirium, hypnotics, analgesia, sedations
Describe occurence od delirium in ICU paitent.
- very common in virtually ill patients
- combination of alterations in mentation, psychomotor behaviour, sleep wake cycle can cause delirium
- 1/3 of patient experience when intubated
Predisposed Physical conditions that increase risk factors for delirium?
Physical conditions (hemodynamic instability, hypoxemia, hypercarbia, electrolyte disturbances, and severe infections) can precipitate delirium
How to resuce/minimize Psychological Stress in ICU paitnets.
- encourage patients and caregivers to express concerns, ask questions, and state their needs
- equipment and procedures explained to them
- Patient environment should be structured to them and personalized
- Appropriate use of antianxiety drugs
Relaxation techniques - reducne Sleep disturbances: minimizing light, noise, increase comfort
- preventing Cognitive impairment: addressing fears, orientating (cues/verbally), medication, assessment of status
What kind of environmental stress does a patient have in ICUs?
- noises were an unpleasant memory
- Confusion between day and night
- Unfamiliar lights, alarms
- Frightening sights and room temp
- Unfamiliar equipment
Describe nose in ICUs
- In ICU sounds can read 80 - 90 decibels where normal sleep/rest occurs at 35 decibels causing stress
- highs cause of stress
What happens when an ICU patient does not get adequate sleep.
Disturbances in sleep can cause
- slower wound healing
- activation of SNS
- increase vasoconstriction
- hyper-arousal
- increase length of stay
- contribute to delirium
What are strategies to help promote sleep?
clustering activities, scheduling rest periods, dimming lights at night, opening currants, limiting nose and adding comfort measures
What are some strategies to reduce environmental stress?
explaining unfamiliar noises
Paper and pen when unable to communicate
Prompts for time/date
Personal items
What can cause physical stress in ICU patients?
- Pain
- Intubation & ventilation & central venous line & drains
- Endotracheal tubes
- Thirsty (most common)
- Hemodynamic instability
- Patient poor physical health: BMI, sepsis score
- Stress response
- Unable to sleep
- Discomfort VIA room temp & restricted movement
What are some strategies to reduce/minimize physical stress?
- Increase comfort: warm blanket, Repositioning
- Oral care
- Changing dressing
- Watching for irritation (swellings, pressure wounds, infection, redness)
- Hygiene
How do assess ICU patient for pain when they are in deep sedation?
- implementing a scheduled interruption of sedation, or “drug holiday,”
- sedative interruption allows the patient to awaken and the health care provider to conduct a neurological examination and assess readiness for weaning from the mechanical ventilator
What does supporting the family’s need curate?
- Better patient outcomes
- Better patient and family satisfaction
- Better healthcare outcomes: staff have better job satisfaction
- fewer issues with patient safety
What are the three needs of family members?
- need for information
- need for reassurance
- need to be near the patient
Describe the need for information for families.
- explain the particularities of the care setting to the family by underlining elements that lead to questions or incomprehension
- Determine if additional info/resources are required
- Honesty with information and status of loved one
- Adapt information to family’s level of stress and ability to understand
Describe the need for reassurence in families.
- DO NOT GIVE FALSE HOPE
- Giving reassurance to caregiver for care and decision being done
- Giving interventions and why
Describe the need to be near the patient for families
Touch, sees, hold
- Favour the development of their involvement patient care or decision making
Encourage talking to patients
- Favour family presence at bedside and develop visitation habits to respect availability and support rest periods
- Flexible visits Horus for family
- Give the options to be present at bedside for procedures
Why is it important to give the options to be present at bedside for procedures?
: being present helped caregivers remove doubts about the patient’s condition, decreased their anxiety and fear, facilitated the need to be together and to support their loved one, and facilitated the grief process when death occurred
What are some emotional/psycholigcal impacts critical illness have on families.
- stress: normal response, not concerned with own well-being (safety, eat, sleep)
- Disorganized: don’t know where to starts
- Helplessness: environments aren’t inviting or hopeful
- Anxiety: may not have experience with critical illness, worry about the impacts on family
What is General Adaptations Syndrome?
General adaptation syndrome (GAS) is a term that describes the physiological changes the body automatically goes through when it responds to stress
What is the stress response in families with patients in the ICU? Describe the three stages.
- alarm stage
- Flight or fight response: physiological and psychological
- Initial awareness of critically ill member
- Body is hyper aroused - States of resistance
- body begins to repair itself (calmer but still highly aware)
- Often occurs when seen loved one in unit being to feel “better” - Stage of Exhaustion
- do not always reach this stage
- Often seen with families with long periods of stress or coping mechanisms are unhealthy for not there
- Mentally, physical and emotional resources suffer
- Their own health becomes depleted and challenging to the loved on in critical care
What are some barriers to well-being that a patient may have with their family?
- Missing close family
- not being able to fulfill family obligations
- Inability to communicate with family
- Seeing close family worry about their illness
What can cause a patient admitted to the ICU for a hypermetabolic state?
burns, trauma, sepsis
Describe a catabolic state
What can cause a patient admitted to the ICU for a Catabolic states state?
- When you’re in a catabolic state, you’re breaking down or losing overall mass, both fat and muscle. You may be able to manipulate your body weight by understanding these processes and your overall metabolism. Both the anabolic and catabolic process lead to fat loss over time
- acute kidney injury
What can cause a patient admitted to the ICU for a Malnourished state?
chronic heart, pulmonary or liver disease
Describe Internal nutrition.
What are the benefits?
- delivery of calories via the gastrointestinal [GI] tract
- preserves the structure and function of the gut mucosa and prevents the movement of gut bacteria across the intestinal wall and into the bloodstream
- fewer complications and shorter hospital stays and is less expensive than parenteral nutrition
Describe Parenteral nutrition
When may you used Parenteral nutrition
- delivery of calories intravenously
- Used when the enteral route cannot provide adequate nutrition or is contraindicated
- Examples of these conditions include paralytic ileus, diffuse peritonitis, intestinal obstruction, pancreatitis, GI ischemia, intractable vomiting, and severe diarrhea
