Critical Care Nursing A Holistic Approach Part 3

1. Critical Care Nursing A Holistic ApproachPart 3

2. The Critically Ill Pediatric Patient Chapter 11

3. Pediatric Patients Children are not small adults.

4. Vital Signs • Normals change with age • Blood pressure is the last vital sign to change in a child with shock • Bradycardia is not well tolerated in young children and can be precipitated by hypoxia • Tachycardia can be a nonspecific response to many conditions • Tachypnea might indicate respiratory distress • Bradypnea may indicate respiratory arrest

5. Neurological • Needs to be age appropriate • Reflexes • Fontanels • Mental status • Interaction with the environment • Knows Mom and Dad • Awake, looking around

6. Cardiovascular • Skin color • Peripheral cyanosis normal for newborn only • Central cyanosis always abnormal • Mottling – take into consideration room temperature • Capillary refill time is less then 2 seconds

7. Respiratory • Infants under 6 months are obligatory nose breathers • Smaller airway in diameter and length, easily occlude • Watch for retractions • Abdominal breathing • Seesaw breathing • Listen for sounds • Grunting • Stridor • Wheezing

9. Renal • Normal urine output • Infants: 2mL/kg/hour • Decreased ability to concentrate urine • Children: 1mL/kg/hour • Increased risk of dehydration • Dry mucous membranes • Poor skin turgor • Sunken fontanels

10. The Critically Ill Pregnant Woman Chapter 12

11. Critical Care Complications of Pregnancy • Severe preeclampsia • HELLP – Hemolysis, elevated liver enzymes and low platelets • DIC – Disseminated intravascular coagulation • Amniotic fluid embolus • ARDS – Acute respiratory distress syndrome

12. Nursing Diagnoses • Anxiety, Stress related to poor/uncertain pregnancy outcomes • Anticipatory Grieving related to threat to self • Fear related to fetal well-being • Potential Injury related to infection • Alterations in Family coping related to hospitalization • Impaired Fetal Oxygen Transport related to maternal position, blood loss, or placental trauma

13. The Critically Ill Older Patient Chapter 13

14. Physiologic Changes of the Older Adult • Many changes occur in every system • Table 13-1 is a summary of these changes • The most troublesome changes are: • Loss of sight • Loss of hearing • Decrease in quality sleep • Cognitive changes

15. Medications in the Older Adult Start Low and Go Slow • Altered Drug Absorption • Altered Drug Distribution • Altered Drug Metabolism • Altered Drug Excretion

16. The Postanesthesia Patient Chapter 14

17. Problems in the Postanesthesia Patient AIRWAY! AIRWAY! AIRWAY! AIRWAY! Hypoxemia Hypotension Hypertension Cardiac dysrhythmias Hypothermia

20. Malignant Hyperthermia • Rare, autosomal dominant disorder • Assess for family history • Increase in temperature – as high as 46˚C • Unexplained tachycardia, sweating, labile BP • Treatment • Dantrolene • Cooling of the patient • 100% oxygen

21. Postoperative Nursing Care • Patient able to maintain airway • Patient’s mental status is assessed frequently until he or she is easily aroused and back to baseline • Pain control • Management of postoperative nausea and vomiting

22. Interfacility Transport of the Critically Ill Patient Chapter 15

23. Mode of Transport • Physician must order type of transport – The level of transport should be the same as the level of care the patient is already receiving. • Ambulances • BLS • ACLS • Air transport – All ACLS • Helicopter • Fixed wing

24. EMTALAEmergency Medical Transfer Active Labor Act • Hospitals must provide screening exam • Patient should be stabilized prior to transport • Medical certification that benefits outweigh risks • Receiving facility has accepted care of the patient • Physician to physician report • Nurse to nurse report • Transport personnel have the required training and equipment for a safe transport