Acute care in pt

1. Acute care in pt Introduction to Patient Care

2. TOPIC OBJECTIVES • Discuss the basic guidelines for providing safe caregiver and patient environment. • Describe the ff: • Oxygen Therapy • Hemodynamic Monitoring • Intracranial Pressure Monitoring • Enumerate the general PT considerations for the different acute care behaviors mentioned above. • Enumerate the general PT considerations with medical-surgical management devices.

3. TOPIC OBJECTIVES • Familiarize with the different specialized pt care units. • In an Intensive Care Unit environment: • Enumerate the several types of equipment. • Enumerate the guidelines in treating a pt. • Enumerate the precautions to observe. • Enumerate the appropriate PT interventions.

4. ACUTE CARE/HOSPITAL SETTING • A unique environment with protocols and standards of practice and safety • Nature: to provide a 24-hour care • Patient safety is a TOP PRIORITY.

5. ACUTE CARE/HOSPITAL SETTING • Role of the PT: • strive to keep the pt safe at all times • comply with hospital initiatives • understand The Joint Commission’s annual National Patient Safety Goals.

6. Basic guidelines in providing safe environment

7. BASIC GUIDELINES • Knowledge of the facility’s policy for accidental chemical, waste, or sharps exposure, as well as emergency procedures for evacuation, fire, and natural disaster. Know how to contact the employee health service and hospital security.

8. BASIC GUIDELINES • Always following Standard Precautions. • Confirm that you are with the correct patient prior to initiating PT intervention according to the facilities policy.

9. BASIC GUIDELINES • Elevate the height of the bed as needed to ensure proper body mechanics when performing a bedside intervention (e.g. stretching or bed mobility training).

10. BASIC GUIDELINES • Leave the bed or chair in the lowest position with wheels locked. • Leave the top bed rails up for all patients. • Only use equipment that is in good working condition.

11. BASIC GUIDELINES • Keep the pt’s room as neat and as clutter free as possible to minimize risk of trips and falls. • Pick up objects on the floor • Secure electrical cords • Keep small-sized equipment used for PT • Store assistive devices when not in use • Do not block the doorway or pathway to and fro the pt’s bed.

12. BASIC GUIDELINES • Provide enough light for the patient to move about the room or read educational materials. • Always leave the pt with the call bell or other communication devices within close reach like eyeglasses and hearing aids.

13. BASIC GUIDELINES • Make recommendations to nursing for the use of bathroom equipment (e.g. tub bench or raised toilet seat) if the pt has functional limitations that may pose a safety risk.

14. BASIC GUIDELINES • Dispose of linens, dressings, and garbage according to the policies of the facility.

15. OXYGEN THERAPY

16. OXYGEN THERAPY • O2 therapy is for hypoxemia. • The goal of O2 therapy: • to treat and prevent hypoxemia, excessive work of breathing and excessive myocardial work • Variable vs Fixed performance

17. GENERAL PT CONSIDERATIONS • A green label designates the O2 supply on hospital walls. Supply of pressurized air is designated by a yellow label. • Significant supplemental O2 requirement indicates respiratory compromise which may indicate the need to modify or defer PT.

18. GENERAL PT CONSIDERATIONS • Observe pts for clinical signs of hypoxemia: SOB, use of accessory mm of breathing, confusion, pallor, or cyanosis. • Ensure all connections are intact, O2 is flowing as indicated and cannula or mask is properly positioned.

19. GENERAL PT CONSIDERATIONS • O2 system may need added humidification. • Provide extra length of O2 extension tubing if functional mobility will occur farther than 5-6ft from the bedside.

20. GENERAL PT CONSIDERATIONS • Ensure that portable O2 tanks are turned on and have sufficient levels of O2 before use. Have backup tanks available. • Observes masks for the accumulation of mucus or clogging. Clear or change the cannula or mask if needed.

21. GENERAL PT CONSIDERATIONS • Monitor the pt’s skin for potential breakdown due to pressure from the cannula or mask. Provide appropriate padding without interfering with the fit of the cannula or mask.

22. GENERAL PT CONSIDERATIONS • Document the type and amount of supplemental O2 used during PT intervention.

23. HEMODYNAMIC MONITORING

24. HEMODYNAMIC MONITORING • Provide information about the adequacy of a pt’s circulation, perfusion, and oxygenation of the tissues and organ systems. • GOAL: maintain the balance between oxygen demand and oxygen delivery • Invasive vs Noninvasive

25. HEMODYNAMIC MONITORING

26. GENERAL PT CONSIDERATIONS • Positioning: Raising the level of the phlebostatic axis relative to the transducer gives false high readings; in lowering it gives false low readings.

27. GENERAL PT CONSIDERATIONS • If a waveform changes during treatment, in the absence of clinical signs, reposition the patient or limb and reassess. If the waveform does not return to baseline, notify the nurse.

28. INTRACRANIAL PRESSURE MONITORING

29. ICP MONITORING • GOALS: • For early identification of increased ICP prior to the occurrence of cerebral damage • To provide access for CSF sampling and/or drainage • To evaluate the effectiveness of medical-surgical treatment

30. GENERAL PT CONSIDERATIONS • Be aware of the ICP value and corresponding waveform on the monitor. • Sustained elevation in ICP > 5 minutes should be reported to the nurse. • Position the pt with the head of the bed at 30 degrees.

31. GENERAL PT CONSIDERATIONS • Be aware of the ff positions that can increase ICP: • Lowered head of the bed • Trendelenburg position • Lateral neck flexion • Extreme hip flexion

32. GENERAL PT CONSIDERATIONS • Be aware of the ff conditions that can increase ICP: • Valsalva maneuver • Noxious stimuli • Coughing • Pain • Stress • Frequent arousal from sleep

33. GENERAL PT CONSIDERATIONS WITH MEDICAL-SURGICAL MANAGEMENT DEVICES

34. GENERAL PT CONSIDERATIONS • Before entering a pt’s room, review the medical record, particularly new orders, recent progress notes, and test results. Review graphic sheets for vital signs, noting trends or variations from the norms.

35. GENERAL PT CONSIDERATIONS • Note whether any particular precautions protecting the patient or the caregiver from specific pathogens are in place.

36. GENERAL PT CONSIDERATIONS • Practice standard precautions. The likelihood of encountering bodily fluids is increased in the acute care setting especially in ICU.

37. GENERAL PT CONSIDERATIONS • Discuss your planned intervention with the nurse. Scheduled procedures may take precedence over this intervention, or it may coordinate well with another planned procedure.

38. GENERAL PT CONSIDERATIONS • On entering the pt’s room, take inventory. • Observe the pt’s appearance and position. • Systematically observe the pt, and verify the presence of all documented lines.

39. GENERAL PT CONSIDERATIONS • On entering the pt’s room, take inventory. • Develop a consistent method of surveying the room: left to right, top of bed to bottom of bed: to ensure that all lines and equipment are observed and considered in your treatment plan. • Take note of all the readings on the monitor before intervention.

40. GENERAL PT CONSIDERATIONS • Anticipate how your intervention may change the pt’s vital signs and how this will likely appear on the monitors. Be aware of which readings may change artificially owing to relative position change.

41. GENERAL PT CONSIDERATIONS • Using appropriate precautions, gently trace each line from the pt to its course. Ask for assistance, if needed, to untangle any lines or to free any lines that might be under the pt.

42. GENERAL PT CONSIDERATIONS • Ensure that there is no tension on each line before attempting to move the pt. • Never attempt to free a line that cannot be completely visualized! • Ask for appropriate assistance when mobilizing the pt.

43. GENERAL PT CONSIDERATIONS • Discuss with the nurse whether any lines can be removed or temporarily disconnected from the pt before your treatment.

44. GENERAL PT CONSIDERATIONS • Most invasive monitoring systems have two alarm controls: one to silence or discontinue the alarm for a few minutes, and another to disable or turn off the alarm. Do not silence an alarm without permission from the nurse! It is not recommended that the PT disable an alarm.

45. GENERAL PT CONSIDERATIONS • If available and appropriate , use a portable telemetry monitor when mobilizing a pt away from the bedside to maintain the continuity of the ECG.

46. GENERAL PT CONSIDERATIONS • On completion of your treatment, ensure that all appropriate alarms are turned on and that the pt is positioned with the appropriate safety and communication measures in place. Notify the nurse of any change in the pt’s status.

47. SPECIALIZED PATIENT CARE UNITS • CCU: Coronary/Cardiac Care Unit/ Critical Care Unit • ER/ED: Emergency Room/ Emergency Department • ICU: Intensive Care Unit/ Intermediate Care Unit • MICU: Medical Intensive Care Unit

48. SPECIALIZED PATIENT CARE UNITS • NICU: Neurologic Intensive Care Unit/ Neonatal Intensive Care Unit • OHRU: Open Heart Recovery Unit • PACU: Post Anesthesia Care Unit • SICU: Surgical Intensive Care Unit

49. INTENSIVE CARE UNIT

50. INTENSIVE CARE UNIT A typical pt cubicle in an ICU is likely to have several types of equipment to: • monitor the physiologic state • ventilate the pt • provide intravenous therapy • deliver oxygen • remove fluids from the pt