This document outlines common orders, interventions, complications, and care considerations for critically ill patients requiring intensive care. It discusses orders like frequent monitoring, labs, medications, and procedures. Complications of lines, tubes, and devices are covered. Artificial airways like endotracheal and tracheostomy tubes are described along with indications, complications, and interventions. Weaning from ventilation is briefly addressed.

2.  Nutrition
 Anxiety
 Pain
 Impaired communication
 Sensory-perceptual problems
 Delirium is not “ICU Psychosis”
 Sleep problems
 Caregiver issues

4. Common Critical Care Orders:
 Hourly I/O (foley, drains, IVF)
 Continuous monitoring (Cardiac,
Sa02, hemodynamic)
 Frequent vitals
 Tube feeding
 Labs-from central line
 ABGs- from art line
 Titration of drips
Medications
(IV Push, continuous infusions,
intermittent infusions)
 Sedation
 Pain management
 Paralytics
 TPN
 Inotropic Agents
 Vasopressors
 Antihypertensive & Vasodilator Agents
 Antiarrhythmic Agents
 Antiplatelet Agents
 Nebulizers
 PPI/H2Blockers
 Insulin

5.  Invasive Hemodynamic monitoring
 Arterial pressure
 Pulmonary artery pressure
 Intraaortic Balloon pump
 Ventricular Assist devices

6. Interventions
 Positioning
 Often HOB <45deg
 Phebostatic axis
 Maintain patency of the line
 Saline flush/pressure bag
 Respond to alarms
 Check CMS
 Sterile technique
 Monitor for s/s of bleeding, infection,
etc
Complications
 Arterial- hemorrhage, clotting,
neurovascular compromise
 PA- air embolus, infection, sepsis, PA
rupture/infarction
 IABP- vascular injuries, infection,
displacement of the balloon,
mechanical complications
 VAD- bleeding, cardiac tamponade,
infection

7. o Monitor weights
o Lab values (which ones?)
o Hourly I/o
o Vitals, hemodynamics
o Temperature
o Access site
o Infection
o Bleeding

9. Types of airways
 Oral
 Nasal
 Endotracheal
 preferred
 Nasotracheal
 If positioning of head/neck can cause
injury
 Tracheotomy
Indications for artificial airways
 Upper airway obstruction
 Apnea
 Unable to maintain airway/clear
secretions
 Respiratory distress
 Need for POSITIVE PRESSURE
VENTILATION

10. Complications
 Unplanned extubation
 Aspiration
 VAP
 Barotrauma
Interventions
 Maintain tube placement
 Cuff inflation
 Monitor oxygenation/ventilation
 Tube patency
 Oral care
 Suctioning

11.  Short term (less than 3 days) versus long term
 Team approach
 Spontaneous breathing trial
 During the day
 Psychological support to patient and family
 Supplemental 02 maybe required
 Chronic mechanical ventilation