Recommended
More Related Content
What's hot
What's hot (20)
Viewers also liked
Viewers also liked (20)
Similar to POST CARDIAC SURGICAL CARE
Similar to POST CARDIAC SURGICAL CARE (20)
POST CARDIAC SURGICAL CARE
- 1. 1 POST CARDIAC SURGICAL MANAGEMENT OF PATIENTS (CARE IN ICU) PRESENTED BY THIERRY YUNISHE NOVEMBER 16th, 2012 BTech,ADN,HND,RN CCN, INTENSIVE CARE NURSE.
- 2. 2 INTRODUCTION Post cardiac surgery requires critical care of patients. Critical care is an exciting field with diverse and complex challenges. These challenges include identifying pathophysiology in the individual patient, integrating care providers from multiple disciplines, addressing social and psychological concerns in the sick patient, to name but a few. As a result of this complexity, care in the intensive care unit (ICU) must be guided by a thoughtful and organized approach.
- 3. 3 INTENSIVE CARE UNIT (ICU) Intensive care means providing the best care for patients with resources available. Critical care is the highest level of monitoring and intensive care in a hospital of patients with life-threatening failure of single/multiple organs or body systems.
- 4. 4 INTENSIVE CARE UNIT EQUIPMENT Ventilators Cardiac Monitors Defibrillators Syringe/ Infusion Pumps Laryngoscope Suction Apparatus, etc DRUGS Inotropes Analgesic Diuretics Electrolytes Anti arhythmics Anesthetics Antiemetic, etc. Some of the equipment and drugs used in ICU can be found on every ward but some are specialised.
- 5. 5 TYPES OF PATIENTS ADMITTED INTO THE ICU The types of patients admitted into the ICU includes: Post cardiac-surgical patients from the operating theatre after an open/ close heart surgery. Post diagnostic or interventional catheterization patients who are still critically ill and require intensive monitory.
- 6. 6 PREPARATIONS In anticipation to receive a patient in to the ICU, the bed station is prepared as follows: Clean and make up a post-operative bed.
- 7. 7 TYPES OF BEDS PRESENT IN THE ICU BABY THERM
- 8. 8 TYPES OF BEDS PRESENT IN THE ICU ADULT BED
- 9. 9 A MONITOR IS PREPARED
- 10. 10 A MECHANICAL VENTILATOR IS PREPARED
- 11. 11 PATIENT’S TABLE IS PREPARED
- 12. 12 EMMERGENCY TROLLY IS PREPARED
- 13. 13 Prior to the end of the surgery, a theatre staff calls for the prepared bed. Five minutes before transportation of the patient from the theatre to the ICU, the theatre circulatory nurse informs the ICU staff to get set for reception.
- 14. 14 Transfering of patient from the operating theatre to the ICU
- 15. 15 Anesthetist setting the ventilator according to the required ventilation needs of the patient
- 16. 16 Stabilization of the patient in the ICU
- 17. 17 Care intra-ICU: The core concern Parametry monitoring and charting. The Haemodynamic monitoring Mechanical conventional ventilation and respiratory care Haemogas and blood chemistry analysis
- 18. 18 LABORATORY BASELINE EXAMINATION (Haemogas laboratory Exam; invasive) Hct Hb pH PCO2 PO2 HCO3 BE SAT % Na KCL Glycaemia Ca Lactate Mg When the patient is stabilized, blood chemistry and blood gas analysis is done to roll out acidosis or alkalosis of any type, and abnormalities with the chemistry
- 19. 19 ICU PROCEDURES Airway management Monitoring Checking blood gas/electrolytes Neurological assessments NG tube/catheter insertion and care Administration of drugs ECG Echocardiography X-Ray Physiotherapy Nutrition Basic/Advanced life support and resuscitation
- 20. 20 ICU PROCEDURES Health care professionals working in the ICU provide a ‘round–the- clock’ intensive Monitoring/ management. In addition to the vitals signs that are taken, a modified aldrete score is completed on patients who are not fully conscious. The frequency of observations is also based on patient’s needs Observations/vital signs
- 21. 21 ICU PROCEDURES Separate equipment Hand washing Limit guardians Careful aseptic technique Wound management Laundry Clean environment Preventing infection
- 22. 22 ICU PROCEDURES Be aware the catheters are a major source of infection Twice daily cleaning Catheters or catheter bags are not re-use. Catheter care
- 23. 23 ICU PROCEDURES Right time, right patient, right route, right medication, right dose and right documentation New medication are given immediately when prescribed Lines with particular drugs are marked and not used for other medications IV drips are marked (labelled) if anything is added to them. Medications are not mix unless you are sure they are compatible Drug administration
- 24. 24 ICU PROCEDURES Rationale for optimal positioning includes: Preventing pressure sores Preventing thrombo-embolisms Protecting the unconscious patient Relieving breathlessness Reducing hypotension Positioning
- 25. 25 ICU PROCEDURES All patients on IV fluids should have an up-to-date fluid balance Nurses record input and output regularly Urine output should range from 0.5-1ml/kg/hr and it should not be concentrated. Fluid balance
- 26. 26 ICU PROCEDURES Patients details Diagnosis Surgery done Medications IV infusions Consciousness level. Any other useful information. Respiratory and circulatory assessment Positioning Fluid balance Nutrition Drugs again Progress Handing over of patient
- 27. 27 DISCHARGE OF PATIENT FROM THE ICU The patient is only discharged from the ICU when he/she is conscious, awake, extubated and breathing freely. When the patient is no longer on any inotropes. When there is no bleeding from the cardiotomy. When patient is haemodynamically stable Good x-ray results. Arterial/ CVP lines removed. The discharged summary form filled. Then the post operation ward is informed of the discharged patient. DISCHARGE OF PATIENT FROM THE ICU
- 28. 28 CONCLUSION The perfect work done in the operating theatre should be accompanied by an excellent post surgical care in order to yield the outcome so desired; which is to restore health to as many people affected with heart diseases as possible. CONCLUSION
- 29. 29
- 30. 30 THIERRY YUNISHE BTN, ADN,HND, RN INTENSIVE CARE NURSE. St. Elizabeth Catholic General Hospital and Cardiac Centre Shisong. Contact Email:yunishe@yahoo.co.uk Telephone:+23774074742.