107. Case study 1
In home care you had a patient with fever 38 c –had an
indewelling catheter ,iv canulae –how do you think according
to risk assessment rules in infection control –your
recommendations?
Care Hub orientation program
107
108. Case study 2 activity –solve this….
Care Hub orientation program
108
112. Over the last two decades, evidence has suggested that
unexpected mortality and morbidity may be prevented by
early recognition of deterioration and prompt
resuscitation of sick patients.
Observational studies from a number of authors
demonstrate that physiological parameters such as
respiratory rate and arterial pressure deteriorate before
a serious adverse clinical event. These changes are often
missed or not acted upon correctly leading to further
clinical deterioration
Resulting in unanticipated intensive care unit (ICU)
admission, increased hospital stay, or even cardiac
arrest and death.
113. What is critical care outreach?
The term Outreach is used to define the process of
extending critical care services beyond the
current or usual limits. Its purpose is to ‘break
down the walls’ of critical care, by extending
intensive care to sick patients outside of intensive
care boundaries so preventing unnecessary
morbidity and mortality in ward patients.
114. What is critical care outreach?
The term Outreach is used to define the process of
extending critical care services beyond the
current or usual limits. Its purpose is to ‘break
down the walls’ of critical care, by extending
intensive care to sick patients outside of intensive
care boundaries so preventing unnecessary
morbidity and mortality in ward patients.
122. The reporting done at the time of
conditions recognition
In these cases, the nurse have the
ability to deal with these cases and
inform the doctor of everything new
for patient conditions .
123. Fever
( acute)
Medication
s errors
Change in
laboratory
value
Wound
changes
Disturbance
level of
consciousness
High alert conditions
Blood reaction
Abdominal or chest
pain, Headache
(acute pain)
Bleeding
(acute)
hypoxia
Connective dives
obstruction
(FUC, ETT,CVC)
124. Causes of altered level of consciousness
Trauma:
(Edema ICP LOC
Vascular disease;
(direct vascular injury or cerebral
edema compression or
occlusion of blood vessels
blood flow ischemia
Infection:
(inflammation edema ICP LOC
Neoplasms:
(primary brain tumor, metastatic tumors the
pressure of the tumor on the brain or spinal
cord ... Loss of consciousness and body
tone)
a
I
125. Nursing management of DLOC
1. Maintaining the airway
2. Remove accumulated secretion to eliminate the danger of aspiration
3. Elevating the head of the bed to 30 degrees helps prevent aspiration.
4. Positioning the patient in a lateral or semiprone position to promote
drainage of secretions
5. Suctioning and oral hygiene to remove secretions
6. Chest physiotherapy and postural drainage to promote pulmonary
hygiene and Auscultate the chest sound.
126. Cont : Nursing management of DLOC
7. Elevate side rails and raised at all times to protect patient
from injury
8. Assessing GCS, intake and output, and analyzing laboratory
data.
9. Providing mouth care
10. Notify doctor (By sending a message via WhatsApp
about the patient's complaint and the nursing care that has
been provided to the patient to take the necessary action )
127. cont
Hypothermia: Cerebral metabolism is depressed ------ Lack of
oxygen to the brain--- cerebral hypoxia causes hyporeflexia,
disorders of consciousness .finally the patient is comatose with
dilated pupils
Seizures: Abnormal increased activity in fronto-parietal
association cortex and related subcortical structures is
associated with loss of consciousness in generalized seizures.
129. Conte
Systemic metabolic derangement: (diabetic ketoacidosis,
hyperglycaemic nonketotic hyperosmolar state) due to:
1-Nausea, vomiting, dehydration altered level of
consciousness
2- Cerebral edema altered level of consciousness
3- electrolyte imbalance altered level of consciousness
130. Fever indicate to:
Infection of the ear, lung ,
skin, bladder, or kidney,
Gastroenteritis, Meningitis, Sepsis,
Pneumonia, Diabetes (DFI) and
Heart disease (myocarditis,
pericarditis, endocarditis)
DVT
Hyperthyroidism
Food poisoning
Asthma
Side effect of some
medication(seizure medications
reaction due to blood transfusions(
liver disease
Cystic fibrosis
131. Nursing intervention of fever:
The nurse will assess every four hours ( Temp , B.P, HR , So2).
Apply cold compresses ( groin, under axillaries and around neck)
and avoid use of alcohol to prevent skin dryness .
Gastric lavage with cold normal saline.
Wash from FUC.
Encourage and offer oral fluid intake if patient consciouses, if
unconsciousness give patient I.V fluid .
132. Cont :
Notify doctor (By sending a message via WhatsApp
about the patient's complaint and the nursing care that has
been provided to the patient to take the necessary action )
133. Acute bleeding
Hematuria
Hematemesis and melena
Hemoptysis
Bleeding through lines(cannula ,CVC , dialysis catheter,---)
Bleeding per nose
Bleeding per stomas(tracheostomy ,gastrostomy , colostomy..)
134. How to deal??!! 1) 2 Ps :Packing and pressure
2) High alert
135. Hematuria indicate to
UTI
Kidney infections (pyelonephritis).
A bladder or kidney stone or injuries
Enlarged prostate.
Cancer
Some Medications. The anti-cancer drug cyclophosphamide
and penicillin can cause urinary bleeding
136. Nursing intervention of hematuria:
Understand etiology of hematuria to assess severity, impact
and potential interventions
Continuously assess severity of bleeding and urinary tract
patency: obstruction is considered an end of life emergency
Assess of catheter related pain or discomfort, hemorrhage
bladder irrigation
137. Cont :Nursing intervention of hematuria:
Discontinuation of coagulant drugs e.g asprin, kapron.
Reassessment of urine ( color, consistency, clots)
Notify doctor (By sending a message via WhatsApp
about the patient's complaint and the nursing care that has
been provided to the patient to take the necessary action )
140. Pain indicates that:
headache
postsurgical pain
post-trauma pain
cancer lower back pain
neurogenic pain (pain caused by
nerve damage)
Intestinal obstruction
psychogenic pain (pain that isn’t
caused by disease, injury, or nerve
damage)
Gastroenteritis
Peptic ulcer
Kidney stones
Pancreatitis
141. Headache
general cases
• severe dehydration
• high blood pressure
• stroke
• head injury or concussion
• Acute hydrocephalus
• Electrolyte imbalance
Local cases
• cancer
• brain tumor
• brain aneurysm, dissection
• brain hemorrhage
• meningococcal disease (brain, spinal
cord, or blood infection)
Headaches can be a symptom of some serious illnesses or health problems, including:
general and local cases
142. Nursing Management of Headache:
1. Assess headache (severity, location, duration)
2. Monitor V/S ( B.P , Temp, So2 )
3. Keep calm ,dark and quiet environment
4. Put patient in comfort position
5. Notify doctor (By sending a message via WhatsApp
about the patient's complaint and the nursing care that
has been provided to the patient to take the necessary
action )
143. Medication error
To avoid giving the patient wrong does of medications ,
the nurse can be prevented theses cases by following 10
rights.
153. It should only be performed when a person shows no signs of
life or when they are:
1. Unconscious.
2. Unresponsive.
3. Not breathing or not breathing normally
(In cardiac arrest, some people will take occasional gasping
breaths – they still need CPR at this point.
154.
155.
156.
157.
158. If : 1- recurrent irregular breathing
2- recurrent change in saturation without provocation
(suction ,stress ---)
Suspect pulmonary embolism
159. If : 1- recurrent chest tightness
2- irregular breathing
3- cold sweating or extremities
4- persistent arm or jaw or back or epigastricpain
Suspect MI
160. If : 1- No distal pulsations
2- Cold extremities
Suspect DVT or Ischemia
Trauma: cerebral edema ,subdural and epidural hematoma
Vascular disease;
(infarction, intracerebral haemorrhage, subarachnoid haemorrhage)
Infection:
( meningitis, encephalitis, brain abscess and Hypoxic encephalopathies inflammatory process increase ICP and LOC
Cerebral ischemia occurs whenever blood flow is inadequate to meet metabolic demands of the brain.
1- kidneys (nephritis) may cause high blood pressure or kidney failure. UTI
2-Side effect of some medication:
Antibiotics , blood pressure drugs , seizure medications , pneumococcal vaccine , Steroids ,Chemotherapy ,radiation treatment
Stroke
In the United States, someone has a stroke every 40 seconds. About 87% of strokes happen because blood flow to the brain is blocked.
WHAT TO DO IF YOU SUSPECT A STROKE
Act F.A.S.T. if you or someone else may be having a stroke:
Face: Does one side of their face droop when you ask them to smile?
Arms: Can they raise both arms over their head?
Speech: Do they slur their speech or sound strange when they talk?
Time: If you see any signs of stroke, send message immediately on whatsup group for doctor . Treatment within 3 hours of having a stroke increases the chances of a better recovery.
Concussion
If you have a head injury, you may have a concussion or a mild brain injury. Get immediate medical help if you have symptoms of a concussion after a fall or a blow to the head. These include:
Headache, dizziness ,nausea or vomiting ,blurred vision or double vision ,drowsiness ,feeling sluggish , balance problems ,slowed reaction time
To provide baseline data for evaluation
5-عن طريق ارسال رسالةعبر الواتس اب بشكوي المريض و الرعاية التمريضية التي تم تقديمها للمريض لاتخاذ الاجراء اللازم
Ca 8.5 – 10
mg 1.2 – 2.1
EX
يتم استخدامة للتبليغ عن الحالات الخطرة او حالات الطوارئ التى تحتاج ألى سرعة تدخل الطبيب و يمكن استخدام
oral report فيها و ذلك لانقاذ حياة المريض