UNDERSTANDING THE BASICS OF ICU/CCU CARE VOLUME 2

Contents:

  • Monitoring sedation
  • Stay far, far away from Respiratory!!!!
  • A Standardized Shift Handover Protocol: Improving Nurses’ Safe Practice in Intensive Care Units
  • A Standardized Shift Handover Protocol: Improving Nurses’ Safe Practice in Intensive Care Units
  • Top Cities for Respiratory Therapist Jobs
  • Recent Respiratory Therapist Jobs

    • This technique is mostly used to monitor depth of surgical anaesthesia in the operating theatre; it provides a quantitative value between 0 and A BIS value of 0 equals EEG silence, near is the expected value in a fully awake adult, and between 40 and 60 indicates a level recommended for general anaesthesia. BIS has also been investigated in critical care, and several studies have shown a good correlation between BIS and Ramsay scoring for a Ramsay Score of 1—5.

    Ensuring patient comfort requires a multidisciplinary approach in addition to pharmacotherapy. This includes frequent communication and explanation to the patient by all staff directly involved in their care, both nursing and medical, and relatives. Physiotherapy plays an important role as prolonged immobility may be painful and this can be reduced by daily assessment and treatment.

    Basic needs such as feeding and hydration require addressing regularly to prevent the symptoms of hunger and thirst. The class of medication used needs to match the underlying cause of discomfort.

    Monitoring sedation

    In a ventilated patient, this is often multifactorial, and thus a combination of pharmacotherapy may be required. When considering combinations of drugs, knowledge of their context sensitive half-times is essential. Propofol is extensively used in the intensive care setting as a sedative. It has been shown to be more effective compared with midazolam with respect to quality of sedation, and shortening of time between termination of sedation and extubation.

    In some studies, this has equated to a shorter ICU stay; 3 however, in others, the duration of stay was the same.

    Stay far, far away from Respiratory!!!!

    Propofol has a high clearance, and metabolism is mainly dependent on hepatic degradation to glucoronide metabolites, which are subsequently excreted into the urine. Significant accumulation of propofol does not occur after bolus doses or a continuous infusion. Infusion should be titrated to response range 0. Problems with propofol sedation include bradycardia, myocardial depression, reduced systemic vascular resistance, and green coloured urine. This consists of severe metabolic acidosis and muscle necrosis, probably due to impairment of oxidation of fatty acid chains and inhibition of oxidative phosphorylation in the mitochondria.

    Hypertriglyceridaemia after propofol use has also been shown to produce artifactual reductions of in vitro arterial and mixed venous oxygen saturations. Thiopental is now only administered by continuous infusion in the management of refractory status epilepticus. It has a low clearance and, when given as an infusion, its metabolism may become linear zero order due to saturation of hepatic enzymes; 5 thus accumulation is a serious concern, and may lead to myocardial depression and immunosupression. Its use as a sedative in ICU has been shown to increase mortality. Ketamine is a phencyclidine derivative that antagonizes the excitatory neurotransmitter glutamate at NMDA receptors.

    It produces a state of dissociative anaesthesia, profound analgesia, and amnesia. It is also a potent bronchodilator. Ketamine is not commonly used as a sedative infusion due to sympathetic nervous system stimulation resulting in increased cardiac work and a rise in cerebral metabolic oxygen consumption. Hallucinations, delirium, nausea and vomiting frequently follow its use, 5 but it still has a role in the management of status asthmaticus. Haloperidol is an anti-psychotic that produces a state of neurolepsis via central dopaminergic D 2 blockade.

    This state is characterized by diminished motor activity, anxiolysis, and indifference to the external environment. It is commonly administered by i. Cardiac monitoring is recommended as it may cause Q-T prolongation and an increased incidence of arrhythmias. Chlorpromazine has similar indications and mechanism of action as haloperidol. Thus, chlorpromazine has a much wider profile of possible adverse effects. It is less sedative than haloperidol with a greater incidence of respiratory depression, and is rarely administered in ICU. Benzodiazepines produce sedation and hypnosis by modulating the effects of GABA, the main inhibitory neurotransmitter within the central nervous system.

    Benzodiazepines may be administered as bolus doses or by continuous infusion. They cause less haemodynamic compromise than i.

    Concerns with their use include dependence and withdrawal agitation. Midazolam is metabolized in the liver to active compounds. It has the highest clearance of the benzodiazepines rendering it most suitable as an infusion 0. It is often used as a bolus method of producing sedation 1—4 mg p. Diazepam is metabolized in the liver to active compounds.

    It has the lowest clearance of the benzodiazepines and its half-life is greatly increased by use as an infusion. It is not commonly used in ICU for sedative purposes. It can be given orally 2 mg three times daily or i. Opioids are commonly used to provide analgesia, narcosis, and anxiolysis. Side-effects include respiratory depression, bradycardia, and hypotension secondary to histamine release.

    They stimulate the chemoreceptor trigger zone and may cause nausea and vomiting via 5HT 3 and dopamine receptors. Content relating to Edwards Lifesciences devices is intended for healthcare professionals.

    A Standardized Shift Handover Protocol: Improving Nurses’ Safe Practice in Intensive Care Units

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    Flotrac System The clarity to consistently maintain patients in the optimal volume range. An integrated hemodynamic monitoring system The FloTrac sensor integrates with the Edwards EV clinical platform to show patient status at a glance, for visual clinical support and increased clarity in volume administration during moderate-high-risk surgical procedures. The value of advanced hemodynamic parameters. Stroke volume variation optimization SVV 13 For control-ventilated patients, SVV has proved to be a highly sensitive and specific indicator for preload responsiveness, serving as an accurate marker of patient status on the Frank-Starling curve.

    Request a copy close. Hemodynamic education for sustained clinical advancement With a long-term commitment to improving the quality of care for surgical and critical care patients through education, Edwards Clinical Education meets you no matter where you are in the learning process — with a continuum of resources and tools that continuously support you as you solve the clinical challenges facing you today, and in the future.

    A Standardized Shift Handover Protocol: Improving Nurses’ Safe Practice in Intensive Care Units

    Compatible monitoring platform EV clinical platform EV setup guide. Contact a sales representative. Accordingly, we practically educated each individual nurse the handover protocol in three half-hour sessions held in three successive days. The practical education sessions held at the time of inter-shift handover. Accordingly, he encourages the group members to follow the learned behaviors and prevents them from the re-adopting the old ones. Data analysis We employed the version Open in a separate window.

    Conflict of interest The authors declare no conflict of interest in this study. Acknowledgments We would like to gratefully thank the managers and lecturers of Mashhad Faculty of Nursing and Midwifery as well as head-nurses and staff nurses who helped us conducting this study. Nine Patient Safety Solutions [cited Apr 05]. An introduction to patient safety.

    1. Principles of sedation?
    2. Introduction;
    3. Mechanical ventilation: past lessons and the near future.
    4. La Mosaïque humaine : Entretiens sur les révolutions de la médecine et le devenir de lhomme (Documents, Actualités, Société) (French Edition)?
    5. .
    6. .
    7. .

    Journal of Medical Imaging and Radiation Sciences. Cullen DJ, Bates D. Prevention of adverse drug events: The Journal of Arthroscopic and Related Surgery. An analysis of variance in nursing-sensitive patient safety indicators related to magnet status, nurse staffing, and other hospital characteristics fairfax. George Mason University; A Systematic Review of the Literature. American Journal of Nursing. An investigation into the functions of nurses' communication at the inter-shift handover.

    Communication skills and error in the intensive care unit. Curr Opin Crit Care.

    Top Cities for Respiratory Therapist Jobs

    Today's practice and a look to the future' symposium. Author information Article notes Copyright and License information Disclaimer. Get hooked up with a traveling temp agency. Cullen DJ, Bates D. Find articles by Javad Malekzadeh.

    A case study of the implementation of bedside reporting: Doctor Of Nursing Program Coordinator; Improving patient safety by implementing a standardized and consistent approach to hand-off communication. Donahue K, vanOstenberg P. Joint Commission International accreditation: Int J Qual Health Care.

    Strople B, Ottani P. Can technology improve intershift report?

    Recent Respiratory Therapist Jobs

    What the research reveals. Medication errors in critical care: Kurt Lewin and complexity theories: Journal of Change Management. Scales K, Pilsworth J. The importance of fluid balance in clinical practice. Fluid balance in critically ill patients. Should we really rely on it? Aspiration risks and enteral feeding: Clinical use of gastric residual volumes as a monitor for patients on enteral tube feeding.

    A review of the nursing care of enteral feeding tubes in critically ill adults: Intensive Crit Care Nurs. Preventable adverse drugevents in hospitalized patients: A comparative study of intensive care and general care units. Preventable adverse drug events in hospitalized patients: Crit Care Med ; 25 8: Patient safety in the intensive care unit. San Diego Patient Safety Council. Support Center Support Center. Please review our privacy policy.

    Assessment of the level of consciousness using the Glasgow Coma Score. Routine eye care once a shift. Routine mouth wash once a shift. Assessment of fluid balance in the last six hours.

    Inspection of the potential pressure ulcer areas. Intervention for promoting defecation during the first three days after the patient complaint. Care for areas under pressure. Routine hand wash before each procedure.