The document discusses stress in ICU patients and their relatives. It defines stress and describes the psychological crisis ICU patients may experience due to fears, anxiety, and an unfamiliar environment. Relatives also experience stress from prolonged hospitalization, limited information and visiting hours. The document outlines causes of stress and effects on behavior, physical and emotional health. It provides strategies for meeting needs of critically ill patients including oxygenation, nutrition, mobilization and social needs. Nursing interventions are suggested to support families through the difficult time by addressing cognitive, emotional and physical needs such as providing information, support and allowing visitation.
Stress and burnout syndrome among health team memberssilla elsa soji
Stress and burnout syndrome among health team members:
“Burnout is a syndrome made up of emotional exhaustion, depersonalization, and reduced personal accomplishment"
Stress and burnout syndrome among health team memberssilla elsa soji
Stress and burnout syndrome among health team members:
“Burnout is a syndrome made up of emotional exhaustion, depersonalization, and reduced personal accomplishment"
There is a lot of confusion around Do Not Resuscitate (DNR) orders. This is a medical order that advises healthcare professionals not to attempt a cardiopulmonary resuscitation (CPR) on a person who has suffered a cardiac arrest. Healthcare workers, paramedics, and EMTs are required to attempt CPR on all people who have suffered a cardiac arrest unless a person has a DNR order. This DNR order must be available in the moment or else the assumption is that the person does not have one. This lecture will cover DNR orders and how to complete one.
Nursing tool used in a medsurg environment to detect early changes in patient conditions monitoring temperature, respirations level of consciousness and oxygen level
A "bundle" is a
group of evidence-based care components
for a given disease that, when executed together, may result in better outcomes than if implemented individually.
The retarded development of nursing and nursing profession seems to be mainly due to the fact that no serious thought has been given to this discipline.
Ventilator associated pneumonia (VAP) was defined as per the Center of Disease Control (CDC) as a pneumonia that occurs in a patient who was intubated and ventilated at the time of or within 48 h before the onset of the event. Pneumonia was identified using a combination of radiological, clinical, and laboratory criteria
Central-Line-Associated Bloodstream Infections (CLABSI) pause a major health problem in hospitalized patients. This disease is associated with people with a central line/tube inserted through the skin into the large vein, which can be used to give medicines, fluids, nutrients, or blood products to patients in critical conditions. The disease occurs when microbes enter through the central line invading the bloodstream.
There is a lot of confusion around Do Not Resuscitate (DNR) orders. This is a medical order that advises healthcare professionals not to attempt a cardiopulmonary resuscitation (CPR) on a person who has suffered a cardiac arrest. Healthcare workers, paramedics, and EMTs are required to attempt CPR on all people who have suffered a cardiac arrest unless a person has a DNR order. This DNR order must be available in the moment or else the assumption is that the person does not have one. This lecture will cover DNR orders and how to complete one.
Nursing tool used in a medsurg environment to detect early changes in patient conditions monitoring temperature, respirations level of consciousness and oxygen level
A "bundle" is a
group of evidence-based care components
for a given disease that, when executed together, may result in better outcomes than if implemented individually.
The retarded development of nursing and nursing profession seems to be mainly due to the fact that no serious thought has been given to this discipline.
Ventilator associated pneumonia (VAP) was defined as per the Center of Disease Control (CDC) as a pneumonia that occurs in a patient who was intubated and ventilated at the time of or within 48 h before the onset of the event. Pneumonia was identified using a combination of radiological, clinical, and laboratory criteria
Central-Line-Associated Bloodstream Infections (CLABSI) pause a major health problem in hospitalized patients. This disease is associated with people with a central line/tube inserted through the skin into the large vein, which can be used to give medicines, fluids, nutrients, or blood products to patients in critical conditions. The disease occurs when microbes enter through the central line invading the bloodstream.
Approach to internship (mbbs in bangladesh perspective)Pritom Das
Some slides are taken from different textbooks of medicine like Davidson, Kumar and Clark and Oxford, and some from other presentations made by respected tutors. These resources are free for use, and I do not claim any copyright. Hoping knowledge remains free for all, forever.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
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ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
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The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
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This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
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1. Care of patient:
Special and family needs
PATIENTS STRESS IN ICU, & THEIRRELATIVES AND
NURSES ROLE
2. WHAT IS STRESS ?
Stress is simply called
Pressure
Strain
Tension
2Prof. Dr. RS Mehta, BPKIHS
3. DEFINITION
Stress is defined as any adjustive
demand that requires an adaptive
response . It is a condition in which
the human system responds to
changes in its normal balanced state.
3Prof. Dr. RS Mehta, BPKIHS
4. PATIENTS STRESS IN ICU
A patient may experience a myriad of fears
and concerns when admitted to the
technologically sophisticated world of critical
care.
Patient enters complex setting where staff
members converge with the variety of
procedures and supportive devices in an
attempt to monitor, strengthen , or stabilize the
physiological crisis .
4Prof. Dr. RS Mehta, BPKIHS
6. …
This kind of feelings occurs as a reaction
to a threat to the person; the threat
encompasses potential physiological loss,
lifestyle changes, potential death,
invasive procedures, or concerns about
the unknown.
6Prof. Dr. RS Mehta, BPKIHS
7. Although patient may feel secure knowing
that skilled and knowledgeable health care
personnel are attending for fulfilling every
needs of critically ill patients.
At times patient may develop different
physical and behavioral manifestations
aggravated by stressors as He /She is
immediately separated from significant others
and surrounded by strangers who move about
critical care environment with familiarity and
professional experiences.
7Prof. Dr. RS Mehta, BPKIHS
8. CAUSES OF STRESS IN ICU PATIENT
• A stressor is anything that causes stress.
• It is neither positive nor negative but
rather have positive or negative effects
as the person responds to change .
• In ICU setup illness acts as a stressor.
8Prof. Dr. RS Mehta, BPKIHS
9. CAUSES…
Stressors have physical, chemical and mental responses
inside of the body . Stressor can be either:
Physical stressor.
Biological stressor.
Chemical stressor.
Environmental stressor.
Social stressor.
Psychological stressor.
9Prof. Dr. RS Mehta, BPKIHS
10. CAUSES…
Intensive care units have been considered stress
generating areas. So some of the causes of stress in
ICU patients are :
Physical aspects :
Presence of tubes in nose and mouth.
Impossibility to sleep.
Immobilization. Loss of autocontrol , decrease a
muscle tone.
Sensorial deprivation & sensory overload.
10Prof. Dr. RS Mehta, BPKIHS
11. CAUSES…
Biological aspects :
Nosocomial infection.
Chemical aspects :Certain drugs used in ICU can
causes stress :
Analgesics.
Sedatives.
Paralytics.
Anxiolytic drug.
11Prof. Dr. RS Mehta, BPKIHS
12. …
Environmental aspects :
Presence of noise of various devices.
Presence of excessive over lightening.
Unfamiliar surrounding.
Use of all kinds of machines and jargons.
12Prof. Dr. RS Mehta, BPKIHS
13. …
Social aspects :
Separation from relatives.
Lack of social network.
Security of the patient is questioned.
Ineffective communication.
13Prof. Dr. RS Mehta, BPKIHS
15. EFFECTS OF STRESS
Behavioral :
Short term : indulge in drugs , alcohol, impulsive
behavior , poor relationship with others, poor work
performance.
Long term : Marginal family social isolation.
15Prof. Dr. RS Mehta, BPKIHS
16. EFFECTS…
Physical :
Short term : headaches, backache, backache ,
insomnia , indigestion , chest pain , nausea, dizziness
, excessive sweating and trembling.
Long term :Heart disease , hypertension , ulcer,
poor general health.
16Prof. Dr. RS Mehta, BPKIHS
18. Needs of critically ill patients
1. Oxygenation
2. Water and fluid
3. Food and nutrition
4. Mobilization
5. Elimination
6. Sleep and rest
7. Safety and security
8. Knowledge
9. Social needs
10.Self esteem needs
Prof. Dr. RS Mehta, BPKIHS 18
19. Needs of critically ill patients
1. Oxygenation:
Assess
• Respiratory system: tachypnea, restlessness,
confusion, resp. rate, nail beds
• ABG analysis report
• Auscultate lungs every 8 hour
• Continuous monitoring oxygen saturation level and
inform if less than 90%.
Prof. Dr. RS Mehta, BPKIHS 19
20. Intervention:
• Suction every 2 hour
• Keep patient in semi-fowler or fowler position
• Measure peak pressure & inform if necessary
• Sedate the patient as needed to control ventilator
fighting
• Decrease Fio2 <50% as quickly as possible to
prevent oxygen toxicity.
• Promote effective secretion mobilization by using
deep breathing & coughing exercise, chest
percussion& postural drainage
Prof. Dr. RS Mehta, BPKIHS 20
21. • Administer bronchodilators as order to promote
effective airway
• Observe patient closely for increase respiratory
obstruction edema in to the alveoli
• Recognize painful respiration, dyspnea and nasal
congestion
• Administration of mucolytics to liquefy the
secretions
Prof. Dr. RS Mehta, BPKIHS 21
22. 2. Water and fluid
Assess
• Monitor vital signs
• Continous monitor urine output and report if
<30 ml/hrs
• Observe for sign of overload/ wt. gain, increase
output, edema, dehydration, cold &clammy skin.
Intervention
• Wt. daily
• Maintain I/O chart hourly
• Planning of fluid administration as per order
• Administer frusemide as per indicated
Prof. Dr. RS Mehta, BPKIHS 22
23. 3. Food and nutrition
• Obtain nutritional consultation for all ventilator
dependent patients
• Monitor serum albumin level to determine
malnutrition.
• Weight daily
• Start total parental nutrition if patient is unable
to tolerate enteral feeding
• Perform calories counts to ensure adequate
nutrition
• Suggest family bring food from home if patient
does not like hospital food
Prof. Dr. RS Mehta, BPKIHS 23
24. • Avoid too much carbohydrate feeds as it
may increase co2 production and may cause
hypercapnia
• Keep head of bed elevated if patient is in
naso-gastric feeding to decrease potential
aspiration
• Auscultate for the presence of bowel sound
and medicate to prevent constipation
Prof. Dr. RS Mehta, BPKIHS 24
25. 4. Mobilization
• Assess for GI problems:
• Preventive measures include antacids or H2
receptor antagonist therapy, adequate sleep
cycles
• Observe skin integrity for pressure ulcers
• Turn patient at least every 2 hour
• Back care
• Use pressure relief mattress if indicated
• Maintain muscle strength with active/ active
assistive/ passive ROM exercises and prevent
contractures with use of splints.
Prof. Dr. RS Mehta, BPKIHS 25
26. 5. Adequate knowledge
• Explain purpose, mode and all treatments
• Explain alarms
• Explain about disease, progress
• Encourage patient to relax and breathe with
the ventilator
• Provide alternate method of communication ;
keep call bell within reach
Prof. Dr. RS Mehta, BPKIHS 26
27. 6. Safety and security needs
• Freedom from harm
• Person must feel safe & secure physically, mentally
& emotionally
• Use proper hand washing technique
• Prevent from infection by using sterile technique
• Explain before the procedure
• Maintain warm adequate body temperature
• Put side rails
• Open visiting or release visiting hours for critically
patients
Prof. Dr. RS Mehta, BPKIHS 27
28. 7. Elimination and waste products
• Catheter care
• Proper cleaning, use of bed pan if possible
Prof. Dr. RS Mehta, BPKIHS 28
29. 8. . Sleep and rest:
• Assess the patient sleep pattern
• Decrease noise level if possible
• Decrease conversation level at bed side
• Turn monitor alarm down if possible
• Provide soft music if possible
• Use dim light if possible
• Cover patient eyes with clean guaze
Prof. Dr. RS Mehta, BPKIHS 29
30. 9. Social needs:
• Love and affection begin with bonding at birth must
be continous through out the life
• Encourage visitor card and phone call
• Provide verbal clues before touching patient
• Use of signals, signs, nodding, palm writing, lip
reading
• Provide paper & pencil, magic slate
• Allow patient to respond and repeat explanations
• Respect their dignity
Prof. Dr. RS Mehta, BPKIHS 30
31. 10. Self esteem needs
• Positive self esteem, senses of personal worth
• Nurse always assist patient regarding positive self
esteem by encouraging independent, rewarding for
progress
Prof. Dr. RS Mehta, BPKIHS 31
32. STRESS OF FAMILY AND RELATIVES IN
ICU
When an individual undergoes a physiologic
crisis and is admitted to an intensive care unit
(ICU); the other family members undergo a
psychological crisis, shock , and disbelief may
be the first emotional experienced by the
family.
32Prof. Dr. RS Mehta, BPKIHS
33. CAUSES OF STRESS IN RELATIVES IN ICU
Prolonged hospitalization.
Inadequate knowledge.
Financial burden.
Impaired communication.
Fear of losing.
Limited visiting hours .
Lack trust with health care workers.
33Prof. Dr. RS Mehta, BPKIHS
34. FAMILY NEEDS
The major needs of families are :
Relief of anxiety.
Assurance that care is competent.
Access to the patient.
Information about the patient.
Emotional support.
34Prof. Dr. RS Mehta, BPKIHS
35. Family needs of critically ill patient
• Need to be with critically ill patient
• Need to help to the critically ill person
• Need for assurance of comfort of critically ill patient
• Need to be informed of impending death
• Need to ventilate emotions/ feeling
• Need for comfort & support of the family members
• Need for acceptance, support comfort health
Prof. Dr. RS Mehta, BPKIHS 35
36. Parents, children, sibling needs
• To feel there is hope
• To feel that hospital personnel doing well
• To know the prognosis of patient’s condition
• To receive the information about the patient once a
day
• To see the patient frequently
• To have explanation about his/her condition
Prof. Dr. RS Mehta, BPKIHS 36
37. Nursing intervention to meet family
needs
1. Cognitive needs:
• To know specific factors about patient progress
• Avoid using generalization. E.g. he is much better
• Use simple term to discuss prognosis of patient
• Relate the prognosis to illness as you have
described initially
• All nurses must use the same terminology
Prof. Dr. RS Mehta, BPKIHS 37
38. 2. To know the probable outcomes
• Be realistic as possible but be aware families coping
mechanism
• If patient prognosis is poor allow to adequate time to
spend with the family
• To inform what is being done for the patient, how
the patient is being treated medically & why things
are being done for the patient
• Briefly describe each line, & or monitoring device
including urinary catheter, NG tube, oxygen devices
Prof. Dr. RS Mehta, BPKIHS 38
39. • Encourage them to question.
• Remember that explanation may not be enough
• Anxiety is barrier in learning
• Use simple terminology such as breathing tube,
cardiogram & ET tube
• Promote continuity of care through the nursing
care plan
Prof. Dr. RS Mehta, BPKIHS 39
40. 3. To have questions answers honestly
• Be specific, discuss are issues as they relate to
the patient as a unique individual
• Maintain good communication with physician so
that we will be aware of what they have told to
family
4. Emotional needs
• To ensure that best possible care is being given
to the patient
• To be called at home about changes in the
patient’s condition to release information once
a day
Prof. Dr. RS Mehta, BPKIHS 40
41. 5. Physical needs
• Involve them in small procedure
• Allow them to visit any times and have
waiting room near the ICU
Prof. Dr. RS Mehta, BPKIHS 41