ICU Flashcards
how to succeed in the ICU
approach the setting systematically
follow lines, leads, and tubes from origins to insertions
know the precautions
when in doubt, ask the ICU nurse!
the nature of the ICU/CCU/Acute Care Setting
patient family staff life-changing injury or illness environmental and psychological effects sleep pattern disturbances ICU/CCU psychosis
environmental stresses of the ICU on the patient
crowding bright lights strong odors endless activity noise touch pain
psychological stresses of the ICU on the patient
diminished dignity and self-esteem powerlessness vulnerability fear anxiety isolation spiritual distress
ICU psychosis is the result of
environmental and psychological stresses
ICU psychosis
delirium usually occurring in the 3rd to 7th day of stay (fatigue, confusions, distraction, anxiety, hallucinations) caused by: pain, drug side effects, ICU/CCU environment itself
key players in the ICU
PTs/PTAs
critical care nurses
respiratory therapists
role of PTs/PTAs in the ICU
provide services that restore function, improve mobility, relieve pain, and prevent or limit permanent physical disabilities
role of the critical care nurse
provide a high level of skilled nursing for total patient care and often facilitate communication among all the people involved in the care of the patient
role of respiratory therapists in the ICU
work with the critical care team to monitor and promote airway management of the critical care patient. this may include: oxygen therapy, mechanical ventilations management, aerosol medication therapy, cardiorespiratory monitoring, and patient and caregiver education
why do you check in with the ICU nurse before performing treatment?
saves you time
gives you up-to-the-minute status report
can look in on patient on your way to the nurse
general ICU observation skill
snapshot of the patient as you enter the room
systematic approach of taking inventory of a patient’s room
be prepared and have a plan
what are some cardiac monitoring devices?
digital monitor ECG/EKG holter monitor/telemetry external transcutaneous pacemaker transthoracic pacing left ventricular assistive device (LVAD)
LVAD
left ventricular assistive device
implanted mechanical device that helps maintain pumping ability of the heart
telemetry and monitors
usually for continuous monitoring
can sometimes be placed on standby
can view and print vital signs
blood pressure should be monitored…
before, during, and after activity
don’t take blood pressure in the arm with a
pink band
peripheral IV lines
inserted by nurse
hands, arms, or feet
changed often
may infiltrate (red and puffy)
central IV lines
inserted by physician/surgeon within large vein, usually superior or inferior vena cava neck or chest usually in place for several weeks do not infiltrate multipurpose
can an IV line be central?
yes
can a nurse put a central IV line in?
no; a central IV line is put in place by a physician/surgeon
how often does a central line get changed?
they are used for long-term use
can an IV pole serve as a gait device?
yes
how could you make treatment easier if you would like to work on mobility with a patient connected to an IV line?
ask the nursing staff to see if they can disconnect the IV prior to mobilization; making treatment easier.
central venous line red flag notes
inserted through large vein and advanced to the superior vena cava
delivers meds, fluids, blood and total parenteral nutrition
monitors central venous pressure (CVP) via transducer and monitor
allows venous blood draws
common entry sites: subclavian, internal/external jugular, femoral
complications: pneumothorax, venous air embolism
disconnection danger
CVP line
central venous pressure line
if the CVP line is disconnected for patient mobilization, it will need to be recalibrated by the nurse to monitor the patient accurately
types of central venous lines
peripherally inserted central catheter (PICC) tunneled catheter (hickman) implanted port (port-a-cath)
subclavian central line insertion precautions
may have pain with full shoulder ROM. limit to 90˚ because of long catheter extending into right atrium
jugular central line insertion precautions
may have pain with full cervical ROM limit cervical ROM as much as possible
when there is a PICC line, be sure to NOT ____ __ ____ when applying ____ ____
pull on ends; gait belt
port-a-cath
implanted line with access under the skin
needle inserted through skin and into rubber diaphragm
can stay in place for years
arterial lines (A lines)
catheter inserted into an artery (radial or femoral)
connected to pressure tubing and pressure bag: transducer and monitor
clear line that resembles an IV line but does not deliver fluid
measures arterial blood pressure, used to draw blood gases
provides constant readout of a patient’s blood pressure
provides relatively painless access to obtain blood for lab
bags of fluid are present to flush out the line to prevent clots
peripheral pulse = _____ ____ => approximation of what’s happening at the heart
pulse rate
