Critical Care Nursing

1. Holistic Nursing Care
&
Unconscious Patient Care
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Prof. Dr. RS Mehta, BPKIHS

2. Care of unconscious patients.
(Unconscious, Bedridden, Critically ill, terminally ill)
• Person who has no control upon him self or his
environment.
• Is fully dependent upon others for monitoring
his/her vital functions.
Conditions of immobility: -
• Patient on traction, CVA, chronically ill,
terminally. ill, post –operative, unconscious
patients, #, accident, injury etc.
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Prof. Dr. RS Mehta, BPKIHS

3. Stages and causes of impaired
consciousness: -
Acute stage: - Caused by intra cranial diseases
and metabolic upset.
• Clouding of consciousness.
• Contusion, hyper excitability and irritability.
• Delirium.
• Illusion and hallucination,
• Delusions (persistent misperceptions).
• Stuper: aroused only by vigorous stimuli.
• Coma: Pt. totally unaware.
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Prof. Dr. RS Mehta, BPKIHS

4. Chronic stage: -
• Dementia–memory, thinking, motor loss,
cortical tissue degeneration
• Vegetative – total lack of cognitive
function, eye open-no response.
• Akinetic mutism – silent immobility.
Damage of cerebral frontal lobe.
• Locked in syndrome – Paralysis of 4
limbs and cranial nerves.
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Prof. Dr. RS Mehta, BPKIHS

5. • Complications of immobility: -
• Skin: - Pressure sore, laceration.
• Respiratory: - Hypostatic pneumonia, pull.
Embolism.
• C.V. complications: - DVT, postural
hypotension, thrombo embolsm.
• G.I. system: - Paralytic ilius, constipation,
distention.
• Urological: - UTI, stone.
• Muskulo skeleton: - Contracture, osteoporosis,
dystrophy, weakness.
• Neurological: - Foot drop.
• Psychological: - Anxiety, depression.
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Prof. Dr. RS Mehta, BPKIHS

6. Assessment of bedridden patients:
 G.C.S. (eye + verbal + moter).
• Emergency assessment: A.B.C.
• Atonic bowel: Paralytic illius, dist., N/V, pain.
• Orthostatic hypotension
• Neurogenic status: Hypotension, cold, temp.
• Skin: pressure sore, bruise, wound.
• DVT: Pain, tenderness, pulse, temp. etc.
• Psychological: Sad, depression, agitated,
anxious, critical, fear etc.
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Prof. Dr. RS Mehta, BPKIHS

7. Care of unconcious / terminally
ill or bed ridden patients.
Nsg. Aims: -
• Identify problems.
• Prevent secondry complications.
• Maximise functional recovery.
• Support patient and relatives.
• Care of psychological aspects,
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Prof. Dr. RS Mehta, BPKIHS

8. Care of unconscious Pt: -
• Emg. Management: - ABC.
• Air – way clearance: - suctioning / positioning.
• Prevention of risk of injury: -
– Altered cognitive status.
– Strain, padding and support.
– Side rails, foot splint / board.
• Maintanance of fluid volume: -
– I/O, IVF, N/G feeding, orally.
• Care of oral cavity – mouth care 4 hrly.
• Maintain tissue integrity of cornea: -
–  / abscent corneal reflex, eye care, pad.
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Prof. Dr. RS Mehta, BPKIHS

9. • Prevention from cold: -
– Damage of hypothalamic center.
– Warm clothing / protection.
• Catheter care / VS urinary care.
– Incontinence care,
– Catheterized.
– Retention care,
– Stimulation intemittat
– Catheterization, folly’s.
• Bowel care: -
• Constipation care – fluid / fiber / laxatives.
• Diarrhea – fluid / ors.
• Impaction – digital removal.
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Prof. Dr. RS Mehta, BPKIHS

10. • Prevention of pressure ulcer: -
• Back care, positioning, air / water matters etc.
• Skin care: - Positioning, bed bath, hair wash, nail.
• Nutritional care: - N/G, TPN, IVF, I/O.
• Pyrexia: - room cold, ventilation, TPR, cold.
• Promoting sensory stimulation: -
– To prevent from sensory deprivation.
Care: - Touching the Pt., communicating with Pt., avoid
negative comments near Pt., Orient Pt. about: time,
place, person ev.8 hrly. Divertional therapy: radio, music
etc.
• Monitoring and managing potential comp: -
e.g. Pneumonia, aspiration, respiratory failure.
Care: - TPR, BP, blood count, ABG, suctioning, chest
physio., C/S – blood and secretions.
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Prof. Dr. RS Mehta, BPKIHS

11. Specific needs and care: -
• Care of skin and prevention of bedsore.
• Bowel management.
• Prevention of physical detormities.
• Nutritional needs of patient.
• Care of urinary pladder.
• Different therapies to the bed-ridden Pt.
– Recreation  games, Phone, paper, pray, radio.
etc.
– Divertional  Relax. ex., meditation, touch. etc.
– Oceupational th.  Typing / phone/computer tee.
(esp. handicap).
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Prof. Dr. RS Mehta, BPKIHS

12. The components of basic nursing care for bed
ridden patients are: -
14 principles of V. hendersons
• Respiration, eating and drinking,
elimination, maintain desirable posture,
rest and sleep, dressing and undressing,
maintain body temperature, keep body
clean and well groomed, avoid dangers of
environment, communicate effectively,
practice his religion, work or productive
occupation, recreational activity and to
learn.
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Prof. Dr. RS Mehta, BPKIHS

13. Specific needs and care:
Care of skin and prevention of bed-sore:
– Position change 2 hrly.
– Back care.
– Air/water mattress. (if need).
– Care of pressure points.
– Avoid friction.
– Nutrition diet.
– Family teaching.
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Prof. Dr. RS Mehta, BPKIHS

14. Bowel management: -
Complication: - Constipation, impaction, diarrhea, atonic
dysreffexia (SCI), etc.
• Bowel history: - Frequency, consistency and stimulus.
• Physical stat us: - reason, activity, age, G.I. pre.
• Privacy: - Sound, smell, cartons, commod.
• Positioning: - upright with pillows, SCI-no bed pan.
• Intra abdominal pressure: - Massage, deep breathing.
• Oral medications: - laxative, sedatives ,
– Suppositories.
– Diet/fluid/exercise.
• Digital stimulation: - Index finger (1/2” – 2”) (nerve
stimulatory.
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Prof. Dr. RS Mehta, BPKIHS

15. Prevention of physical deformities: -
• Wrist drop: - Quadriplegia, disuse syndrome.
– Due to pressare on radial nerve.
• Care: - Soft ball on hand, use of splint, slab,
exercise, skin care.
• Foot drop: j- Para plegia, Quadriplegia.
– Due to peroneal nerve damage.
• Care: - Position change 2 hrly, Rom = 1-2 hrly,
use of splint, foot board, sand bag.
• Use of bed cradal: -  pressure on tre.
• External rotation of hip: -
• of folled towel unaer buttock to knee.
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Prof. Dr. RS Mehta, BPKIHS

16. Nutritional needs of patient: -
• Assess nutritional needs of patients: - food habit,
preference, appetite, bowel sound, flatus, constipation,
HB%, serum protein, Wt.,
• Consultation with dietician  mean planning.
• Develop rapport with patients.
• Plenty of fluid 2-3 cit/24 hrs.
• Diet: - protein , iron rich, vitamins, minerals, fiber, low
calcium diet etc.
• Avoid gas forming food: - onion, radish, cabbage.
• Avoid spicy foods.
• Care of environment: j- clean, foul smell , quit, free from
distractions.
• Meal secure: - small quantity, digestible tasty, low fat,
delicious.
• Maintain I/O, Wt. vitals.
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Prof. Dr. RS Mehta, BPKIHS

17. Care of urinary bladder: -
• Assess urinary status: - retention, incontinence,
UTI, calculi etc.
• Adequete fluid intake: - 2-3 lit/day.
• Indewling catheter – SOS.
• Maintain – I/O, fluid balance.
• Skin care.
• Pelvic muscle exercise.
• Supra pubic stimulation. etc.
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Prof. Dr. RS Mehta, BPKIHS

18. Different therapies to the bed ridden Pt.
Recreational therapy: - as per need.
• games, phone, paper, pray, radio etc as per hobby.
Divertional therapy: - Relaxation exercise, meditation,
therapeutic touch, wheel chair use. etc.
• Occopational therapies: -
– Help in physical, mental and social development.
– Therapy: - according to intrest and skill of Pt.
– Help – from other govt. or training insti.
• E.g.: - computer work, typing, telephone, teaching.
• Preparation of family: -
• Family is backbone of Pt’s support.
• Family: - type, income, education, IPR etc.
• Be non-Judgmental and realistic.
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Prof. Dr. RS Mehta, BPKIHS

19. Points to remember: -
• Put air way if Pt. is unconscious.
• Tracheostomy – if air way obstruction.
• Suction equipment available.
• Assess breath sound 1-2 hrly.
• Never give fluid / food to shallow.
• Lateral position.
• Perineal care.
• Examine abdomen for distention.
• Involve family in care (general wards).
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Prof. Dr. RS Mehta, BPKIHS

20. Nursing Care of Bed Ridden Patients
( Summary)
1.Regular change of position.
2.Care of skin and pressure sore,
3.Bladder management.
4.Care of bowel.
5.Management of diet.
6.Chest physiotherapy.
7.Rehabilitation & physiotherapy.
8.Recreational and Divertional therapy.
9.Occupational therapy.

21. Discharge teaching:
• Discharge Pt. only after sure that there is no
neurological or circulatory interferences with
plaster.
• Date and time of next visit/follow up.
• Report hospital immediately if: Swelling, feel
tight, cold, blue, numb, pain. Etc., plaster cracks.
• Plaster lcup dry. No F.B. put inside eg. Coins.
• Exercise all joints except immobilized.
• Elevate the plaster limp.

22. Answer all the queries of Pt.
and their relatives before
sending home.
Thank you