Nursing Care of Patients with Life Threatening Conditions, High Acuity Situations and Multiple Organ Dysfunction Syndrome

By: ROMMEL LUIS C. ISRAEL
III
Nursing Care of Clients with
Life Threatening Conditions,
Acutely ill / Multi Organ
Problems ,
High Acuity and Emergency
Situation
BY: ROMMEL LUIS C. ISRAEL III
1

THE TERM “LIFE-
THREATENING
CONDITION” MEANS
ANY DISEASE OR
CONDITION FROM
WHICH THE
LIKELIHOOD OF
IS PROBABLE UNLESS
THE COURSE OF THE
DISEASE OR
CONDITION IS
INTERRUPTED.
• What is an appropriate
response to a life-threatening
situation?
• Stay calm, and call your local
emergency number (such as 911).
Start CPR (cardiopulmonary
resuscitation) or rescue breathing,
if necessary and if you know the
proper technique. Place a
• semiconscious or unconscious
person in the recovery position
until the ambulance arrives.
2

WHAT IS HIGH ACUITY PATIENT?
PURPOSE:
HIGH ACUITY UNITS (HAU) ARE HOSPITAL UNITS THAT
PROVIDE PATIENTS WITH MORE ACUTE CARE AND
CLOSER MONITORING THAN A GENERAL HOSPITAL
WARD BUT ARE NOT AS RESOURCE INTENSIVE AS AN
INTENSIVE CARE UNIT (ICU).
3

THE MULTIPLE ORGAN DYSFUNCTION SYNDROME (MODS) CAN BE DEFINED AS THE DEVELOPMENT OF
POTENTIALLY REVERSIBLE PHYSIOLOGIC DERANGEMENT INVOLVING TWO OR MORE ORGAN SYSTEMS
NOT INVOLVED IN THE DISORDER THAT RESULTED IN ICU ADMISSION, AND ARISING IN THE WAKE OF A
POTENTIALLY LIFE-THREATENING PHYSIOLOGIC INSULT.
• Multiple organ dysfunction syndrome (MODS) is defined as
the progressive physiological dysfunction of two or more
organ systems where homeostasis cannot be maintained
without intervention. It is initiated by illness, injury or
infection and most commonly affects the heart, lungs, liver
and kidneys.
• An Overview of Multiple Organ
Dysfunction Syndrome -
Ausmed
https://www.ausmed.com › cpd ›
articles › multiple-organ
• The fundamental cause of MODS is attributed to
the conditions such as surgery, inflammation,
accident, infection, increased metabolic rate,
metabolic activity, and decreased perfusion.
4

What would happen if your organ systems
stopped functioning properly?
AFTER ONE SYSTEM SHUTS DOWN, THE OTHERS WOULD SLOWLY START TO SHUT
DOWN AS WELL UNTIL THE BODY CAN NO LONGER MAINTAIN HOMEOSTASIS AND THE
PERSON WOULD SLOWLY DIE. 3. ALL SYSTEMS WOULD BE WORKING TOGETHER BUT THE MAIN
ONES WOULD BE MUSCULAR, NERVOUS, AND SKELETAL.
Interacting Body Systems and Homeostasis
http://sites.isdschools.org › useruploads › biology
Which organ fails
first in multi
organ failure?
Generally, the lung is the first organ to fail after injury
(failure after
3.7 +/- 2.8 days). Significant renal failure and the need for dialysis decreased to < 5%; other
signs of organ dysfunction (gastric, central nervous system) are difficult to verify.
Pattern of organ failure following severe trauma - PubMed https://pubmed.ncbi.nlm.nih.gov › ..
5

MODS CAN AFFECT ANY ORGAN, BUT THE PRIMARY PLAYERS ARE THE LUNGS, HEART,
KIDNEYS, LIVER, BRAIN, AND BLOOD. THERE ARE MANY CAUSES OF MODS, BUT THE GENERAL
CATEGORIES INCLUDE MAJOR TRAUMA, SEVERE ILLNESS, AND WIDESPREAD INFECTION.
What are signs of organ dysfunction?
• The clinical signs of tissue hypoxia are largely
non-specific.
• However, increased respiratory rate, peripheries
that are either warm and vasodilated or cold
and vasoconstricted, poor urine output, and
mental dullness may indicate organ
dysfunction and should prompt a search for
reversible causes.
• ABC of intensive care: Organ
dysfunction - PMC - NCBI
https://www.ncbi.nlm.nih.gov ›
articles › PMC1115973
6

Shock and Multiple Organ Dysfunction Syndrome
Shock is a life-threatening condition with a variety of underlying causes. It is characterized
by inadequate perfusion that,
if untreated, results in cell death. The progression of shock is neither linear nor
predictable, and shock states, especially
septic shock, comprise a current area of aggressive clinical research.
Nurses caring for patients with shock and for those at
risk for shock must understand the underlying mechanisms of shock and recognize its
subtle as well as more obvious signs.
Rapid assessment with early recognition and response to
shock states is essential to the patient’s recovery.
7

Shock can
best be
defined as a
condition in
which
widespread
perfusion to
the cells is
inadequate to
deliver oxygen
and nutrients
to support
vital organs
and cellular
function
Adequate blood flow to the tissues and cells requires
an adequate cardiac pump, effecti vasculature or
circulatory system, and sufficient blood volume.
If one of these components is impaired, perfusion to
the tissues is threatened or compromised.
Without treatment, inadequate blood flow to the cells
results in poor delivery of oxygen and nutrients,
cellular hypoxia, and cell death that progresses to
organ dysfunction and eventually death.
8

PATHOPHYSIOLOGY OF CELLULAR CHANGES
In shock, the cells lack an adequate blood supply and are deprived
of oxygen and nutrients; therefore, they must produce
energy through anaerobic metabolism. This results in low
energy yields from nutrients and an acidotic intracellular environment.
Because of these changes, normal cell function
ceases . The cell swells and the cell membrane becomes
more permeable, allowing electrolytes and fluids to
seep out of and into the cell. The sodium–potassium pump
becomes impaired; cell structures, primarily the mitochondria,
are damaged; and death of the cell results.
Glucose is the primary substrate required for
the production
of cellular energy in the form of ATP.
9

Nurses must anticipate these therapies because they need to be implemented
with speed and accuracy.
Many of the interventions required in caring for patients with shock call for
close collaboration with other members of the health care team and rapid
implementation of prescribed therapies.
Nursing care of patients with shock requires ongoing systematic assessment.
10

STAGES OF SHOCK
Shock is believed to progress along a
continuum of stages. Shock can be
identified as early or late, depending
on the
signs and symptoms and the
overall severity of organ
dysfunction.
Aconvenient way to understand
the physiologic
responses and subsequent clinical
signs and symptoms of
shock is to divide the continuum into
separate stages: compensatory
(stage 1), progressive (stage 2), and
irreversible
(stage 3).
The sympathetic nervous system and
subsequent release of
catecholamines (epinephrine and
norepinephrine). Patients
display the often-described “fight or
flight” response.
The body shunts blood from organs such
as the skin, kidneys,
and gastrointestinal tract to the brain,
heart, and
lungs to ensure adequate blood supply to
these vital organs.
As a result, the skin is cool and clammy,
bowel sounds are
hypoactive, and urine output decreases
in response to the
release of aldosterone and ADH.
11

Clinical Manifestations
Despite a normal BP, the patient shows numerous clinical
signs indicating inadequate organ perfusion.
The result of inadequate perfusion is anaerobic metabolism
and a buildup of lactic acid, producing metabolic acidosis.
The respiratory rate increases in response to metabolic acidosis.
This rapid respiratory rate facilitates removal of excess
carbon dioxide but raises the blood pH and often causes a
compensatory respiratory alkalosis. The alkalotic state
causes mental status changes, such as confusion or
combativeness,
as well as arteriolar dilation. If treatment begins in
this stage of shock, the prognosis for the patient is better
than in later stages.
12

Medical Management
Medical treatment is directed toward Identifying the cause of the shock, correcting
the underlying disorder so that shock does not progress, and supporting
those physiologic processes that thus far have responded successfully to the
threat.
Because compensation cannot be maintained indefinitely, measures such as fluid
replacement and medication therapy must be initiated to maintain an adequate
BP and reestablish and maintain adequate tissue perfusion (Otero,
et al., 2006).
13

Nursing Management
As stated earlier, intervention as soon as possible along the
continuum of shock is the key to improving the patient’s prognosis.
The nurse must systematically assess the patient at risk for shock to
recognize the subtle clinical signs of the compensatory stage before
the patient’s BP drops.
Special considerations related to recognizing early signs of shock in
the elderly patient.
14

Monitoring Tissue Perfusion
The nurse observes for changes in level of consciousness, vital signs
(including pulse pressure), urinary output, skin, and laboratory values
(eg, base deficit and lactic acid levels).
In the compensatory stage of shock, serum sodium and blood glucose
levels are elevated in response to the release of aldosterone and
catecholamines
15

Monitoring Tissue Perfusion
The nurse should monitor the patient’s hemodynamic status
and promptly report deviations to the physician, assist in
identifying and treating the underlying disorder by continuous
in-depth assessment of the patient, administer prescribed
fluids and medications, and promote patient safety. Vital
signs are key indicators of hemodynamic status and BP is
an indirect measure of tissue
hypoxia.
The nurse should report a systolic BP lower than 90 mm Hg or a
drop in systolic BP of 40 mm Hg from baseline.
16

Pulse pressure correlates well with stroke
volume. Pulse pressure is calculated by
subtracting the diastolic measurement from the
systolic measurement; the difference is the
pulse pressure (Cottingham, 2006).
Normally, the pulse pressure is 30 to 40 mm Hg.
Narrowing or decreased pulse pressure is an
earlier indicator of shock than a drop in systolic
BP.
17

Decreased or narrowing pulse pressure, an early
indication of decreased stroke volume, is illustrated in the
followingexample:
Systolic BP Diastolic BP Pulse pressure
Normal pulse pressure:
120 mgHg 80 mm Hg 40 mm Hg
Narrowing of pulse pressure:
90 mm Hg 70 mm Hg 20 mm Hg
stroke volume, BP, and overall cardiac output.
18

Elevation of the diastolic BP with release of
catecholamines and attempts to increase venous return
through vasoconstriction is an early compensatory
mechanism in response to decreased stroke volume,
BP, and overall cardiac output.
19

Promoting Safety
The nurse must be vigilant for potential threats to the patient’s
safety, because a high anxiety level and altered mental
status impair judgment.
In this stage of shock, patients who were previously
cooperative and followed instructions may now disrupt IV
lines and catheters and complicate their condition.
Therefore, close monitoring and frequent reorientation
interventions are essential.
20

NURSING ALERT
By the time BP drops, damage has already been occurring
at the cellular and tissue levels.
Therefore, the patient at risk for shock must be assessed
and monitored closely before the BP falls.
21

• Continuous central venous oximetry (Scv–O2)
monitoring may be used to evaluate mixed venous
blood oxygen saturation and the severity of tissue
hypoperfusion states.
• A central catheter is introduced into the superior vena
cava (SVC), and a sensor on the catheter measures the
oxygen saturation of the blood in the SVC as blood
returns to the heart and pulmonary system for
reoxygenation.
• A normal Scc–O2 value is 70%.
• Body tissues use approximately 25% of the oxygen delivered to
them during normal metabolism.
• During states of stress, such as shock, more oxygen
is consumed and the Scv–O2 saturation is lower,
indicating that the tissues are consuming more
oxygen.
22

Monitoring tissue oxygen consumption with
Scv–O2 is a minimally invasive measure to more
accurately assess tissue oxygenation in the
compensatory stage of shock before changes in vital
signs detect altered tissue perfusion (Dellinger, et al.,
2008; Goodrich, 2006; Otero,
et al., 2006).
New technologies allow clinicians to detect changes in
tissue perfusion before changes in classic signs (BP,
heart rate, and urine output) indicative of
hypoperfusion occur.
23

Clinical Manifestations
Chances of survival depend on the patient’s
general health before the shock state as well
as the amount of time it takes
to restore tissue perfusion.
As shock progresses, organ systems
decompensate.
24

1. Respiratory Effects
25

• The lungs, which become compromised
early in shock, are affected at this stage.
• Subsequent decompensation of the lungs
increases the likelihood that mechanical
ventilation will be needed.
• Respirations are rapid and shallow.
• Crackles are heard over the lung fields.
26

• Decreased pulmonary blood flow causes
arterial oxygen levels to decrease and carbon
dioxide levels to increase.
• Hypoxemia and biochemical mediators cause
an intense inflammatory response and
pulmonary vasoconstriction, perpetuating
pulmonary capillary hypoperfusion and
hypoxemia.
27

2. GASTROINTESTINAL EFFECTS
28

• Gastrointestinal (GI) ischemia can cause
stress ulcers in the stomach, putting the
patient at risk for GI bleeding.
• In the small intestine, the mucosa can
become necrotic and slough off, causing
bloody diarrhea.
• Beyond the local effects of impaired
perfusion, GI ischemia leads to bacterial toxin
translocation, in which bacterial toxins enter
the bloodstream through the lymphatic
system.
29

• In addition to causing infection, bacterial
toxins can cause cardiac depression,
vasodilation, increased capillary permeability,
and an intense inflammatory response with
activation of additional biochemical mediators.
• The net result is interference with healthy
cellular functioning and their ability to
metabolize nutrients (Stapleton, Jones &
Heyland, 2007).
30

3. HEMATOLOGIC EFFECTS
31

The combination of
hypotension, sluggish blood
flow, metabolic acidosis,
coagulation system imbalance,
and generalized hypoxemia can
interfere with normal
hemostatic mechanisms.
In shock states, the
inflammatory cytokines activate
the clotting cascade, causing
deposition of microthrombi in
multiple areas of the body and
consumption of clotting
factors.
32

The alterations of the hematologic system, including imbalance of the clotting cascade,
are linked to the overactivation of the inflammatory response of injury.
Disseminated intravascular coagulation (DIC) may occur either as a cause or as a
complication of shock.
In this condition, widespread clotting and bleeding occur simultaneously.
Bruises (ecchymoses) and bleeding (petechiae) may appear in the skin. Coagulation times
(eg, prothrombin time [PT], activated partial thromboplastin time are prolonged.
Clotting factors and platelets are consumed and require replacement therapy to achieve
hemostasis.
33

Medical Management
Specific medical management in the progressive stage of shock
depends on the type of shock and its underlying cause.
It is also based on the degree of decompensation in
the organ systems. Medical management specific to each type of
shock is discussed later in this chapter.
Although there are several differences in medical management by
type of shock, some medical interventions are common to all types.
34

Medical Management
These include the use of appropriate IV fluids and
medications to restore tissue perfusion by the
following methods:
• Supporting the respiratory system
• Optimizing intravascular volume
• Supporting the pumping action of the heart
• Improving the competence of the vascular system
Other aspects of management may include early enteral
nutritional support, aggressive hyperglycemic control
with IV insulin (Hafidh, Reuter, Chassels, et al., 2007;
Vanhorebeek, Langouche & Van den Berghe, 2007),
• and use of antacids, histamine-2 (H2) blockers, or
antipeptic agents to reduce the risk of GI ulceration and
bleeding.
35

Subjective nursing assessment is an
individualized, qualitative approach that does
not use objective, measurements, tools or
equipment.
Rather, it is based on individualized clinical
observation relating to the physical, emotional
and behavioural characteristics of the child and
family.
36

What objective data does the nurse collect during a physical
assessment?
OBJECTIVE DATA IN NURSING IS DATA THAT IS MEASURED OR OBSERVED BY THE 5 SENSES.
EXAMPLES INCLUDE BLOOD PRESSURE, TEMPERATURE, SKIN COLOR AND TEXTURE, AND
HEART SOUNDS.
What is objective data in nursing assessment?
Objective data in nursing refers to information that can be measured
through physical examination, observation, or diagnostic testing.
Examples of objective data include, but
are not limited to, physical findings or patient behaviors observed by the
nurse, laboratory test results, and vital signs.
37

SUBJECTIVE NURSING
DATA Objective Nursing Data
Subjective nursing data are collected
from sources other than the nurse's
observations. This type of data
represents the patient's perceptions,
feelings, or concerns as obtained
through the nursing interview. The
patient is considered the primary source
of subjective data. Other sources,
including the patient's family or
caregivers, and other members of the
healthcare team, are called secondary
sources.
Objective data in nursing refers to
information that can be measured
through physical examination,
observation, or diagnostic testing.
Examples of objective data include,
but are not limited to, physical
findings or patient behaviors
observed by the nurse, laboratory
test results, and vital signs.
38

Examples Of Subjective Data In
Nursing
EXAMPLES OF OBJECTIVE DATA IN
NURSING
Chills
Congestion or Runny Nose
Constipation
Coughing
Diarrhea
Vomiting
Sweating
Sore throat
Dizzines
s
Exhaustion and Fatigue
Feeling Sleepy or Dizzy
Itching
Level of Consciousness
Loss of Appetite
Loss of Taste or Smell
Muscle or Body Aches
Nausea
Numbness
Pain
Shortness of Breath
Ambulation
Bleeding
Blood Urea and Creatinine Levels
Blood Pressure
Body Temperature
Demeanor
Full Blood Count
Heart Rate
Height and Weight
Overall Appearance
Respiratory Rate
Wound Appearance
X-Ray or Computed Tomography (CT)
Scans
39

SUBJECTIVE DATA IS
IMPORTANT IN NURSING
Objective Data is Important In
Nursing
Because the patient is the primary source of
subjective data in nursing, this data can paint a
more thorough picture of what the patient is
experiencing, making it an essential part of care
plan development. Subjective data may signal
possible issues with the patient's psychological,
physiological, and sociological wellness.
Subjective data signals the nurse about things
that may be problematic for the patient and can
also indicate specific patient strengths that could
be useful when communicating with and caring for
patients.
Objective nursing data is an essential
part of patient assessments. Objective
data is the view of the patient's status
through the eyes of the assessing nurse.
While a patient may state, "My stomach
hurts," the nurse may observe changes in
his vital signs or abnormal lab results that
signal abnormal changes in the patient's
body and give practitioners an idea of
where to start the diagnosis process.
40

OBJECTIVE PHYSICAL ASSESSMENT
EXAMPLES OF OBJECTIVE ASSESSMENT INCLUDE:
OBSERVING A CLIENT'S GAIT
PHYSICALLY FEELING A LUMP ON CLIENT'S LEG,
LISTENING TO A CLIENT'S HEART
TAPPING ON THE BODY TO ELICIT SOUNDS
AS WELL AS COLLECTING OR REVIEWING LABORATORY AND DIAGNOSTIC
TESTS SUCH AS BLOOD TESTS, URINE TESTS, X-RAY ETC.
Objective Assessment – Physical Examination Techniques: ANurse's ...
https://pressbooks.library.torontomu.ca › ippa › chapter-1
41

Objective data includes:
observations of nonverbal indications of pain,
such as restlessness, facial grimacing and wincing,
moaning, and rubbing or guarding painful areas.
11.5Applying the Nursing Process – Nursing Fundamentals
https://wtcs.pressbooks.pub › chapter › 11-5-applying-the
42

ANALYSIS/NURSING DIAGNOSIS OF MULTI ORGAN
FAILURE
Multi-Organ Failure syndrome (MOF) is a reason for admission
to intensive care or can occur during hospitalization.
It is characterized by associated failures of several organs
(heart, lungs, liver, kidneys, brain).
The prognosis is all the more gloomy as the number of affected
organs is high. It is due to an alteration of the microcirculation
responsible for an acute and lasting cellular hypoperfusion, encountered
during an aggression (trauma, pancreatitis, burns, states of cardiogenic
or hypovolemic septic shock) requiring substitutive treatments, artificial
ventilation, renal replacement therapy, hemodynamic support and
appropriate nutritional intake.
43

Analysis/Nursing Diagnosis of multi Organ Failure
Objectives of Nursing Care
The therapeutic nursing objective is to anticipate clinical changes, notify the resuscitator
as soon as possible, in order to limit the aggravation of failures by the rapid introduction
of specific therapies.
This patient care involves close collaboration between the doctor and the
paramedical team. Clinical monitoring and monitoring are the main axes, associated
with the monitoring of specific treatments.
First time surveillance: The management of patients with MOF requires increased
nursing supervision, requiring theoretical and technical knowledge.
44

Objectives of Nursing Care
Cardio-Circulatory Failure: Cardiocirculatory failure is characterized by persistent
arterial hypotension despite adequate vascular filling. The objective is to assess the
impact of this failure on perfusion and therefore on tissue oxygenation.
Clinical monitoring: Involves mottling (signs of impaired peripheral circulation),
cyanosis, pinkish foaming bronchial secretions, and swollen jugular joints (signs of
heart failure). Biological monitoring is carried out on medical prescription by a dosage
of lactates (signs of cellular suffering), an arterial gas, a blood count, a blood ionogram,
a liver and kidney test.
45

objectives
provided
recorded
to be achieved. The parameters
by these different
on a monitoring sheet or in
techniques are
a
computerized memory of patient parameters.
Non-Invasive Monitoring Includes
One cardioscope per patient connected to a central
monitoring unit: heart rate monitoring and alarm settings allow
rapid identification of any rhythmic change, type of atrial
fibrillation, extrasystoles,tachycardia or bradycardia, justifying
medical intervention to nitiate appropriate therapy; Taking
blood pressure in the cuff every 15 minutes with recording
of systolic, diastolic and mean blood pressure. The alarms are
set according to the therapeutic
46

Invasive Monitoring Includes
Sterile placement of catheters by the doctor according to department
protocols. The nurse prepares the necessary material and serves the
operator sterilely. Changes of tubing and dressings are redone in
accordance with the protocol of the service. There are several
catheter devices: Arterial catheterization is an invasive device
allowing the continuous monitoring of blood pressure, the realization
of iterative blood samples, the monitoring of the repulsed pressure
delta (Delta PP), measurement of the systolic-diastolic differential
during a respiratory cycle in the patient who is intubated, ventilated,
adapted to the ventilator and in sinus rhythm. It informs us about the
need for a filling (›13% = signs of hypovolaemia)
ANALYSIS/NURSING DIAGNOSIS OF MULTI ORGAN
FAILURE
47

•Pulse Pressure = Systolic Blood Pressure – Diastolic Blood
Pressure
The systolic blood pressure is defined as the maximum
pressure experienced in the aorta when the heart contracts and ejects
blood into the aorta from the left ventricle (approximately 120
mmHg).
The diastolic blood pressure is the minimum pressure
experienced in the aorta when the heart is relaxing before ejecting
blood into the aorta from the left ventricle (approximately 80
mmHg).
Normal pulse pressure is, therefore, approximately 40 mmHg.
Achange in pulse pressure (delta Pp) is proportional to volume change
(delta-V) but inversely proportional to arterial compliance.
48

How do you manage multiple
organ failure?
The management of MODS requires a
multidisciplinary approach that includes
antibiotics for sepsis control,
microcirculatory and respiratory support
for reperfusion, organ-targeted drugs,
and the correction of coagulation
abnormalities, acid-base imbalance;
metabolic issues, and electrolyte
imbalance.
Multiple organ dysfunction syndrome: Contemporary
insights ...
https://www.ncbi.nlm.nih.gov › articles ›
PMC7884906
Planning
1. PLANNING FOR HEALTH
PROMOTION
The multiple organ dysfunction syndrome is both
a syndrome and a form of clinical shorthand for
the approach to patient care that is exemplified by
contemporary ICU practice.As a syndrome, it is
intimately linked to the adaptive host response to
injury or infection, and it is to be expected that
interventions that can modulate the expression of
this response will ultimately prove effective in
improving clinical outcome. As a clinical
shorthand, it categorizes the range of
interventions available to support critically ill
patients, and underlines the prime importance of
recognizing the potential for iatrogenic harm
implicit in the increasingly complex and
technological repertoire we use to care for them.
49

2. Planning for Health Restoration and Maintenance
PLANNING
MODS is difficult to treat, escalates quickly and is often fatal. Therefore, early
detection is crucial in preventing its progression (Wang et al. 2017).
Positive patient outcomes rely on immediate recognition, ICU admission
and invasive organ support.
Management and treatment may include:
•Identifying and treating the underlying causes, comorbidities or
complications;
•Fluid resuscitation to increase perfusion
•Support care and monitoring:
• Multi-organ support;
• Mechanical or non-invasive ventilation;
• Maintaining fluid homeostasis; and
• Renal replacement therapy
50

Implementation of Care of Clients
1.INDEPENDENT NURSING CARE
a. Physiologic Care
b. Psychosocial Care
c. Spiritual Care
2. Independent Care
a. Pharmacological Therapeutics
b. Complementary and alternative Therapies
c. Nutritional and Diet Therapy
d. Surgical Intervention
e. Immunologic Therapy
51

IMPLEMENTATION OF CARE OF
CLIENTS
1.Independent Nursing Care
Independent nursing interventions are the tasks that a nurse can perform
without input from another discipline, particularly without a physician's order. These
interventions include many basic comfort care actions such as providing water,
repositioning a patient, providing toileting assistance, and bathing.Nursing
Intervention Examples & Classification -
Study.com
https://study.com › ... › The Profession of Nursing
Common nursing interventions include:
•Bedside care and assistance.
•Administration of medication.
•Postpartum support.
•Feeding assistance.
•Monitoring of vitals and recovery progress.
52

a. Physiologic Care
•Physiological Adaptation - managing and providing care for clients
with acute, chronic or life threatening physical health conditions.
• Related content includes but is not limited to:
• Alterations in Body Systems
• Medical Emergencies
• Fluid and Electrolyte Imbalances
• Pathophysiology
• Hemodynamics
• Unexpected Response to Therapies
• Illness Management
53

a. Physiologic Care
How do you prepare a patient physiologically for surgery?
Preparing for Surgery
1.Stop drinking and eating for a certain period of time before the
time of surgery.
2.Bathe or clean, and possibly shave the area to be operated on.
3.Undergo various blood tests, X-rays, electrocardiograms, or
other procedures necessary for surgery.
54

IMPLEMENTATION OF CARE OF
CLIENTS
b. Psychosocial Care
Psychosocial interventions include such strategies as stress management, self-coping
skills, relapse prevention, and psychoeducation. They also include psychological therapies,
such as cognitive behavioral strategies or motivational interviewing techniques.
Psychosocial Treatments
The term psychosocial refers to an individual’s psychological development in and interaction with
their social environment. Psychosocial treatments (interventions) include structured counseling,
motivational enhancement, case management, care-coordination, psychotherapy and
relapse prevention
55

IMPLEMENTATION OF CARE OF CLIENTS
c. Spiritual Care
Spiritual care is an important component of holistic nursing care. To implement spiritual care, the
nurse must assess, diagnose, and respond to the needs of each patient and her or his significant
others. Meeting the spiritual care needs of the patient can lead to physical healing, reduction of
pain, and personal growth. Nurses providing spiritual care experience lower stress and less
burnout.
THE ROLE OF THE NURSE IN SPIRITUAL CARE
To provide spiritual care, the nurse needs to be able to conduct a spiritual assessment;
recognize the difference between religious and spiritual needs; identify appropriate spiritual care
interventions; and determine when it is appropriate to deliver spiritual care.
The Essence of Spiritual Care | Springer Publishing
https://connect.springerpub.com › entity_view › node › ful
56

2. INDEPENDENT CARE
a. Pharmacological Therapeutics
Nursing responsibilities in drug therapy
The 7 responsibilities are: (1) Management of therapeutic
and adverse effects of medication; (2) Management of
medication adherence; (3) Management of patient
medication self-management; (4) Management of patient
education and information; (5) Prescription management;
(6) Medication safety management.
Nurses' responsibilities and tasks in pharmaceutical care: A scoping ...
https://onlinelibrary.wiley.com › doi › full › nop2
57

The nurse’s responsibilities
Drug therapy plays a major part in the treatment of patients. Traditionally,
medicines have been prescribed by doctors and the nurse’s responsibility has been to
ensure safe and reliable administration and to monitor side-effects. However, in 1994 the
law was changed to allow district nurses and health visitors employed in pilot sites
throughout England to prescribe from a limited formulary. Many of the preparations
they were initially able to prescribe were for over-the-counter preparations. In 1998 it
became possible for all appropriately qualified community nurses to prescribe
from a limited nursing formulary. From 2003, any registered nurse could undertake training
to enable them to become a nurse prescriber and prescribe from a broader Nurse
Prescribers’ Extended Formulary. In 2006 the law changed again, enabling nurses who
had undergone the requisite training to prescribe from the full range of drugs in the
British National Formulary (with the exception of most controlled drugs) provided this was
in their sphere of competence.
IMPLEMENTATION OF CARE OF CLIENTS
58

accurately,
recording that the drug has been given and observing the patient’s response.
Prior to administration the nurse must know the reason for, action and usual
dosage of the drug; this should enable him or her to recognize and question
mistakes in prescribing. When in doubt about a prescription, advice should be
sought and, if necessary, the doctor should be consulted. Observations should be
made for therapeutic and adverse effects. The nurse should realize that the patient’s
condition may alter the effect of a drug and that there may be interactions with
concurrent treatment. The nurse is greatly assisted in these circumstances by the
pharmacist, with whom a good working relationship will enhance the safety of patient
care.
2. Independent Care
Nursing aspects of administration
The nurse is responsible for interpreting the prescription
59

Nursing Care of Patients with Life Threatening Conditions, High Acuity Situations and Multiple Organ Dysfunction Syndrome

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