Special Considerations: the Intensive Care Unit (ICU) Flashcards
What are special considerations for acute care?
- Medical history
- Current illness (precautions and/ or contraindications)
- Medical stability
- Sedation/ level of alertness (ability to actively participate)
- Cognition
- Prior level of function (PLOF)
- Activity tolerance to perform mobility and activities of daily living (ADLs)
- Strength to perform mobility and participate in ADLs
What should you use to find current information about the patient’s physiologic status?
Observe the equipment or devices that monitor the patient
Make sure you observe the _____ and _____ of all equipment or devices as well as all tubes, monitor lead connections, intravenous connections and insertion sites.
type and location
Maintain all tubes and leads free of ____ and ____.
Occlusion and tension
Before starting treatment and during treatment make sure you are evaluating and determining the patients present _____ and _____ status
physical and mental
Observe the patient and be monitoring device frequently to determine the response to _____ and identify significant changes in the patient condition or physiologic status.
treatment
Who should you notify if there is a significant change in the patients condition or physiologic status?
Nursing and document and record your activities and observations
Review the two charts in the ppt
What are some commonly monitored physiological functions?
Cardiac and vital signs
What helps monitor intracranial pressure (ICP)?
Intracranial pressure monitor
What are additional monitoring systems weve been introduced to?
- Arterial pressure (A line)
- Central venous pressure (CVP)
- Indwelling right arterial catheter (Hickman catheter)
- Pulmonary artery catheter (PAC): aka a Swan-Ganz
What are some precautions and considerations when working with someone with various lines (IV, arterial line, PICC line)?
- Shortest line is priority
- Do not pull anything out
What does mechanical ventilation do?
- Sends a controlled flow of oxygen into a patients lungs
- Rate, pattern, and duration of gas exchange can all be adjusted
What are the three types of mechanical ventilation?
- Assist-control
- Synchronized intermittent mandatory ventilation
- Pressure support ventilation
What is the difference between noninvasive and invasive mechanical ventilation?
- Noninvasive: NC, face mask, and continuous positive airway pressure (CPAP)
- Invasive: endotracheal tube (ETT), nasotracheal, or tracheostomy
Supplemental oxygen is indicated when…
Concentrations of inspired oxygen are insufficent for respiration and patients are at risk for hypoxia and hypoxemia (<90%)
What are the modes of delivery of oxygen?
- Nasal cannula
- Face mask
- Nonrebreather
- Tracheostomy
- CPAP
- Bilevel positive airway pressure (BiPAP)
What are some precautions and considerations when working with someone on a mechanical ventilation?
Don’t let it come unplugged?
What are abdominal precautions (for things like post-surgical drain and wound vacuum systems)?
What is an ostomy?
Opening in the abdomen to allow for elimination
What are the 3 types of collecting devices for ostomys?
- Colostomy
- Ileostomy
- Urostomy
What is the difference between a nephrostomy and urostomy?
- Nephrostomy is attached to the kidneys on the posterior side of the body
- Urostomy is at the stomach area by the ureters on the anterior side
What are chest tubes used for?
Used to remove air, blood, or other undesirable matter from the patients chest or pleural cavity
Where are chest tubes placed?
- Anterior or lateral chest wall to remove air
- Posterior and inferior chest wall to remove fluids and blood
