Special Considerations in the ICU Flashcards
What are considerations for acute care?
- medical history
- current illness
- medical stability (vitals)
- sedation/level of alertness
- cognition
- prior level of function (PLOF)
- Cognition
- Activity tolerance to perform mobility and ADLs
- strength to perform mobility and participate in ADLs
What are guideline for treating in the ICU concerning equipment?
Observe the type and location of the equipment or devices being used by the patient
What should we identify concerning the tubes in the ICU?
- the location of all tubes, monitor lead connections, IV line connections, and insertion sites
What should all tubes and lead be free from?
Occlusion and tension
What should we observe during our treatment in the ICU?
The patient and be monitoring devices frequently; determine the response to the treatment; identify significant change in the patients condition or physiologic status
What should we notify nursing of when treating in the ICU?
Significant change in the patient’s condition or physiologic status
What are some examples of equipment we may see when treating in the ICU?
- ventilator
-IV line - oxygen
- urinary catheter
- arterial line
- supplemental nutrition
- suction
What does the physiological monitoring system tell us?
The cardiac and vital signs
What does an arterial pressure (A line) monitor?
blood pressure constantly
What are some monitoring systems that are looking at cardiac pressure?
- central venous pressure (CVP)
- Indwelling right atrial catheter (Hickman catheter)
What does an IV line provide?
Medication, fluids
What type of patient will need an arterial line?
patients with consistent blood draws
What is a PICC line?
Peripheral Inserted Central Catheter - prolonged IV antibiotics
What type of patient commonly has a central venous catheter?
Chemotherapy patients
What does mechanical ventilation do?
Sends a controlled flow of oxygen into a patient’s lungs
What can be adjusted with mechanical ventilation?
- rate
- pattern
- duration of gas exchange
What are the 3 types of mechanical ventilation?
- assist control
- synchronized intermittent mandatory ventilation
- pressure support ventilation
What are some examples of a noninvasive mechanical ventilation?
- NC
- Face mask
- CPAP (continuous positive airway pressure)
What are some invasive mechanical ventilation methods?
Endotracheal tube (ETT)
nasotracheal
tracheostomy
What is an oxygen therapy system?
Supplemental oxygen is indicated when concentrations of inspired oxygen are insufficient for respiration- patients are at risk for hypoxia and hypoxemia (<90%)
What are modes of delivery for oxygen therapy?
- nasal canula
- face mask
- nonrebreather
- tracheostomy
- CPAP
- Bilevel positive airway pressure (BiPAP)
What are some precautions and considerations when working with someone on mechanical ventilation?
- positioning of tubes, lengths
- energy level
- maintaining open tubing, preventing occlusion
- not stepping over lines
- keeping lines above everything else
What type of precautions would someone with a postsurgical drain have (usually)?
Abdominal precautions
What is an ostomy device?
Opening in abdomen to allow elimination
What are the 3 types of ostomies?
- colostomy
- ileostomy
- Urostomy
What are chest drainage systems used for?
To remove air, blood, or other undesirable matter from the patient’s chest or pleural cavity
Where are tubes for an air chest drainage system positioned?
Anterior or lateral chest wall to remove air
Where are tubes for fluid chest drainage positioned?
Posterior and inferior chest wall to remove fluids and blood
What are urinary catheters used for?
To alleviate urinary retention, rebuild bladder muscle tone, collect urine output and cultures, and manage bladder conditions
What are the two types of urinary catheters for males?
- indwelling (foley) catheter through the urethra
- condom catheter
What are some of the different types of feeding devices?
- nasogastric tube (NG tube)
- Gastrostomy tube (G - tube)
- total parenteral nutrition (TPN)
How do we monitor intracranial pressure (ICP)?
Monitor screwed into skull between the arachnoid membrane and cerebral cortex to measure ICP
What is normal ICP?
5 to 10-15 mmHG
What medical interventions are there for ICP?
- external ventricular drain (EVD)
- Ventriculoperitoneal shunt (VP)
Where is an EVD placed?
In the lateral ventricle to relieve ICP, hydrocephalus or CSF
When is an EVD used?
After a hemorrhage
What do we do with the EVD before patient mobility?
Clamp it!
What is a swan-ganz catheter?
Placed in the pulmonary artery for cardiac function monitoring
What does a swan Ganz catheter monitor?
pulmonary artery pressure, right atrium pressure, pulmonary wedge pressure, etc.
What do we do if we have uncertianty about equipment?
Check with nursing or a more experienced therapist for guidance
When do we check a patient’s status?
EACH TIME we see them - conditions can change hour by hour
Research indicates that early mobilization leads to …
Better outcomes!!
