Nursing Education and Research

Transcription

1 Melissa Meloche Meloche, RN RN, MSN MSN, CCRN Nursing Education and Research

2 Describe the purpose p of common clinical equipment found in the Intensive Care Unit and how this equipment could impact a patient s therapy session. Explain/Discuss how monitoring parameters and lab values could impact therapy provided to an ICU patient. Describe common medications used in the ICU and how they could impact a patient s therapy session.

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4 Feeding pumps Telemetry cables Central lines/arterial lines/sheaths Ventilators BIPAP/CPAP/VAPOTHERM Intra Aortic Balloon Pumps Continuous Dialysis Machines Ventricular Assist Devices

5 Key Points to Remember ALWAYS keep head of the bed elevated at least 30 degrees. WHY? Helps prevent aspiration REMEMBER to place REMEMBER to place therapy on HOLD when starting therapy session and RUN when finished your session.

6 Key Points to Remember e Pt. needs to be on the monitor at all times. Need a physicians order to be off tl telemetry. t Some patients are monitored in a specific lead. Important to make sure all cables are connected.

7 Typically does not interfere with therapy session. Locations Subclavian vs jugular PICC Types Triple lumen Dialysis Catheter Risks Bleeding Air embolism CLABSI

8 Key Points to Remember Purpose Hemodynamic monitoring i Risks Same as central line plus Arrhythmias Remember to ensure device is secure/locked before ambulating or repositioning

9 A direct measurement of the pressure in the right atrium. Measurement of the CVP provides information for the body s fluid status (preload) and right ventricular function. CVP is a venous pressure, expressed in a mean Normal 2-8 mmhg (mean pressure) Monitored by the distal port of a triple lumen catheter or Swan Ganz Catheter.

10 Key Points to Remember Pt positioning will impact pressures in the right atrium. The transducer must be level with the phlebostatic axis to have accurate readings. Intersection of the 4 th ICS and ½ the anterior-posterior diameter of the chest

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12 Intra-arterial arterial pressure monitoring is indicated for patients who require continuous BP monitoring or frequent blood samples for analysis. These patients are often on continuous vasoactive drugs or post-op/post-procedure that requires frequent vital signs. Arterial pressure monitoring allows for response to therapy to be easily evaluated.

13 Normal values are the same for your typical blood pressure measurements Values should be evaluated on an individual patient basis *A MAP below 60 does not allow for end organ perfusion!!!!

14 Pt positioning will impact arterial pressure monitoring as well. Arterial line transducers need to be level with the phlebostatic axis as well. Transducers that are too LOW will cause a false HIGH BP. Transducers that are too HIGH will cause a false LOW BP.

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16 Pi Primary goal lis to improve ventricular performance. Facilitates an in myocardial oxygen supply and a in myocardial oxygen demand.

17 Catheter Placement Tip of IABP catheter should be below left subclavian bl artery and base of balloon must be above the renal arteries. Assess urine output and left radial pulse as well as pulses in lower limbs.

18 What Pt s need CRRT? Elevated wastes, two that we can measure: BUN Creatinine Removal of fluid Intoxications Acid base or electrolyte disarray

19 Remember : These patients are fragile They may not tolerate sudden position changes. Each CRRT cartridge holds 170 mls of blood. PT s on CRRT can receive physical therapy but the dialysis therapy MUST be temporarily disconnected.

20 The ventilator modes determine how a breath will be delivered. M d available Modes il bl include: CMV or A/C SIMV CPAP PS

21 NEVER push SILENCE on a ventilator alarm without trouble shooting what caused the alarm in the first place.

22 Coughing Secretions / Mucous plugging Agitation Bronchspasms Biting the ET tube Kinked tubing

23 Patient disconnected Leak in ventilator circuit Blown cuff LOW Tidal Volume/LOW Minute Volume: Patient tiring out Patient s respiratory rate or tidal volume has changed Patient was sedated/paralyzed

24 Patient Disconnect If ventilator is on CPAP settings this alarm means the Pt is not BREATHING.

25 Lab results can Impact a patients level of consciousness Impact a patients energy level and ability to tolerate activity Common labs to monitor Na level regulates the amount of water in the body and the transmission of Na into and out of the cell plays a roles in critical body functions (generating electrical signals in the brain) Glucose level Ammonia level Waste product of breaking down proteins in the intestine. ti Broken down by enzymes produced d by liver or eliminated as a waste by kidneys. BUN/Creat Ratio how well kidneys are able to eliminate wastes. Hemoglobin / Hematocrit degree of anemia ABG s degree of acidosis

26 How will the medications my patient is receiving impact their ability to participate in their therapy session? Why medications are necessary to support my patients hemodynamic needs?

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