The document provides 3 case studies on different types of shock: hypovolemic shock from blood loss after surgery, cardiogenic shock following a heart attack, and septic shock from an untreated urinary tract infection. Each case study outlines the patient's presentation, relevant medical history, assessments, diagnostic findings, and shock management including fluid resuscitation and vasoactive medications. The goal is for students to apply their knowledge of shock pathophysiology and management using a case study approach.
The document provides guidance on recognizing and managing acutely ill hospitalized patients. It discusses that patients may deteriorate in the hospital and outlines a systematic approach to assessment using the ABCDE (Airway, Breathing, Circulation, Disability, Exposure) mnemonic. Certain patients are more at risk of problems, such as the elderly, those with chronic conditions, or those not responding to treatment. The assessment involves looking at, listening to, and feeling signs for each component of ABCDE. Any abnormalities should prompt seeking immediate help. Oxygen therapy and monitoring are important for treating problems found.
BCC4: Michael Parr on ICU - Surviving Trauma GuidelinesSMACC Conference
Michael Parr, director of Liverpool ICU in Australia, speaks about "Surviving Trauma Guidelines". He does so through the use of an interesting case of a patient admitted to ICU following a MVA. This educational podcast was recorded at BCC4.
The document discusses the management of polytrauma patients. It begins with definitions of polytrauma and terms like SIRS, sepsis, and MODS. It then covers the metabolic response to trauma, which occurs in two phases - the ebb phase and the flow phase. The rest of the document details the principles and philosophy of trauma management based on the ATLS approach. This includes concepts like the golden hour, damage control surgery, and the primary and secondary surveys.
Back to the Bedside: Internal Medicine Bedside Ultrasound ProgramAllina Health
David Tierney, MD. How bedside ultrasound is changing the practice of medicine and how Abbott Northwestern Hospital has become a national leader in integrating bedside ultrasound in its Internal Medicine Residency Program. "As internal medicine physicians, we are finding that everything we do with our hands, eyes and stethoscopes can be done a little better with ultrasound. That means our physical exam, which we consider our bread and butter, has more sensitivity and specificity. This gives us better diagnostic ability and results in earlier and more appropriate treatment."
The Next Generation in Managing Emergency Department Patients: Non-Invasive Cardiac Output.
Jennifer Williams, MSN, RN, ACNS-BC, CEN, Clinical Nurse Specialist, Barnes-Jewish Hospital. Emergency Services
This randomized controlled trial compared two spontaneous breathing trial (SBT) strategies: a 2-hour T-piece trial versus a 30-minute trial with pressure support ventilation (PSV) of 8 cmH2O. The Kaplan-Meier curves showed a significantly higher rate of successful extubation, defined as being free of invasive ventilation for 72 hours, in the PSV group compared to the T-piece group. Reasons for reintubation were not significantly different between groups. While the T-piece SBT was less well tolerated, the PSV SBT of 30 minutes was sufficient to assess breathing ability without increasing post-extubation respiratory failure rates.
This document discusses mass casualty management and disaster preparedness for hospitals. It provides data on road traffic accidents in Nepal and describes key aspects of managing mass casualty incidents, including establishing triage, conducting primary and secondary surveys, and activating disaster plans. The main points are:
1) Triage is crucial to prioritize patients and direct them to the appropriate level of care. The START method is described.
2) During primary survey, life threats like airway, breathing, and circulation are addressed within 2-5 minutes.
3) Secondary survey thoroughly examines all body systems to identify minor injuries.
4) Hospitals must have clear disaster plans, adequate staff and supplies, and policies to handle surges
This document provides an overview of coronary artery bypass graft (CABG) surgery. [1] It defines CABG as a procedure that grafts arteries to bypass blockages in the coronary arteries and improve blood flow to the heart. [2] It discusses the pre-operative, intra-operative, and post-operative nursing management of patients undergoing CABG, including assessment, interventions to ensure patient safety and comfort, and monitoring for complications during recovery. [3] The objectives are for students to understand the CABG procedure, indications, nursing care involved, and potential complications.
The document provides guidance on recognizing and managing acutely ill hospitalized patients. It discusses that patients may deteriorate in the hospital and outlines a systematic approach to assessment using the ABCDE (Airway, Breathing, Circulation, Disability, Exposure) mnemonic. Certain patients are more at risk of problems, such as the elderly, those with chronic conditions, or those not responding to treatment. The assessment involves looking at, listening to, and feeling signs for each component of ABCDE. Any abnormalities should prompt seeking immediate help. Oxygen therapy and monitoring are important for treating problems found.
BCC4: Michael Parr on ICU - Surviving Trauma GuidelinesSMACC Conference
Michael Parr, director of Liverpool ICU in Australia, speaks about "Surviving Trauma Guidelines". He does so through the use of an interesting case of a patient admitted to ICU following a MVA. This educational podcast was recorded at BCC4.
The document discusses the management of polytrauma patients. It begins with definitions of polytrauma and terms like SIRS, sepsis, and MODS. It then covers the metabolic response to trauma, which occurs in two phases - the ebb phase and the flow phase. The rest of the document details the principles and philosophy of trauma management based on the ATLS approach. This includes concepts like the golden hour, damage control surgery, and the primary and secondary surveys.
Back to the Bedside: Internal Medicine Bedside Ultrasound ProgramAllina Health
David Tierney, MD. How bedside ultrasound is changing the practice of medicine and how Abbott Northwestern Hospital has become a national leader in integrating bedside ultrasound in its Internal Medicine Residency Program. "As internal medicine physicians, we are finding that everything we do with our hands, eyes and stethoscopes can be done a little better with ultrasound. That means our physical exam, which we consider our bread and butter, has more sensitivity and specificity. This gives us better diagnostic ability and results in earlier and more appropriate treatment."
The Next Generation in Managing Emergency Department Patients: Non-Invasive Cardiac Output.
Jennifer Williams, MSN, RN, ACNS-BC, CEN, Clinical Nurse Specialist, Barnes-Jewish Hospital. Emergency Services
This randomized controlled trial compared two spontaneous breathing trial (SBT) strategies: a 2-hour T-piece trial versus a 30-minute trial with pressure support ventilation (PSV) of 8 cmH2O. The Kaplan-Meier curves showed a significantly higher rate of successful extubation, defined as being free of invasive ventilation for 72 hours, in the PSV group compared to the T-piece group. Reasons for reintubation were not significantly different between groups. While the T-piece SBT was less well tolerated, the PSV SBT of 30 minutes was sufficient to assess breathing ability without increasing post-extubation respiratory failure rates.
This document discusses mass casualty management and disaster preparedness for hospitals. It provides data on road traffic accidents in Nepal and describes key aspects of managing mass casualty incidents, including establishing triage, conducting primary and secondary surveys, and activating disaster plans. The main points are:
1) Triage is crucial to prioritize patients and direct them to the appropriate level of care. The START method is described.
2) During primary survey, life threats like airway, breathing, and circulation are addressed within 2-5 minutes.
3) Secondary survey thoroughly examines all body systems to identify minor injuries.
4) Hospitals must have clear disaster plans, adequate staff and supplies, and policies to handle surges
This document provides an overview of coronary artery bypass graft (CABG) surgery. [1] It defines CABG as a procedure that grafts arteries to bypass blockages in the coronary arteries and improve blood flow to the heart. [2] It discusses the pre-operative, intra-operative, and post-operative nursing management of patients undergoing CABG, including assessment, interventions to ensure patient safety and comfort, and monitoring for complications during recovery. [3] The objectives are for students to understand the CABG procedure, indications, nursing care involved, and potential complications.
Stroke Nursing Certification Systems of Care.pptxStanislavNaydin
This document discusses stroke nursing certification and systems of care at a comprehensive stroke center. It begins by distinguishing between specialized stroke nurses who work in stroke units and certified stroke registered nurses (SCRNs) who have passed a certification exam. The document then outlines requirements for specialized stroke nurses, including annual education hours and skills competencies. It provides details about SCRN certification through the American Board of Neuroscience Nurses. The majority of the document focuses on the key elements covered in the certification exam, including anatomy/physiology, different phases of stroke care, diagnostic testing, and acute nursing management. It emphasizes collaboration between nurses and other providers to ensure timely and specialized care for stroke patients.
Shock is caused by inadequate systemic oxygen delivery that activates autonomic responses to maintain circulation. The main types of shock are hypovolemic, septic, cardiogenic, anaphylactic, neurogenic, and obstructive. Treatment focuses on airway control, oxygen delivery, circulation optimization through fluid resuscitation, and achieving hemodynamic goals to restore tissue perfusion. Early goal directed therapy for septic shock involving aggressive fluid administration and inotropes improves outcomes.
This document summarizes the National Institute for Health and Care Excellence (NICE) clinical guidelines for the management of femoral neck fractures. It provides background on the incidence and costs of hip fractures in the UK. It then summarizes the NICE guidelines, which include recommendations for imaging, timing of surgery, analgesia, anesthesia, surgical options, rehabilitation, and multidisciplinary management. It describes a local audit assessing adherence to the NICE guidelines and identifies opportunities to improve, such as developing nerve block skills and introducing a standardized pain assessment.
The document provides information about establishing and operating a blood transfusion service. It discusses key aspects like location, facilities, equipment, staffing, donor screening and types, blood collection procedures, storage and transportation of blood and blood products. The document also covers blood grouping systems, components of blood like packed red cells, plasma, platelets etc and their uses in transfusions. Maintaining proper standards and facilities is important for the blood transfusion service to safely and effectively meet transfusion needs.
This document provides an overview of nursing care for patients experiencing acute ischemic stroke. It discusses the nursing role in both the emergent/hyperacute phase in the first 24 hours as well as the acute phase. Key responsibilities of nurses in the emergent phase include educating emergency medical services personnel, conducting assessments upon patient arrival, monitoring patients more closely if they receive thrombolysis treatment, and notifying physicians about changes in patient status. The document emphasizes the importance of coordinated, evidence-based, multidisciplinary care to improve patient outcomes and decrease costs for stroke patients.
How to manage a case of acute exacerbation of COPD according to GOLD guidelines. Sincere thanks to Dr. Amardeep Toppo who has prepared most of this presentation.
Sepsis is a life-threatening condition that arises when the body's response to infection causes injury to its own tissues. Globally, sepsis kills about 8 million people annually. Early recognition and treatment are key to improving outcomes. The first hours after diagnosis are especially critical, as mortality increases by about 8% every hour that antibiotics are delayed. Prompt administration of broad-spectrum antibiotics and fluid resuscitation can significantly reduce mortality from sepsis.
This document provides an overview of shock, including definitions, pathophysiology, types, and treatment approaches. It defines shock as inadequate oxygen delivery to meet metabolic demands, resulting in global tissue hypoperfusion and metabolic acidosis. The main types of shock discussed are hypovolemic, septic, cardiogenic, anaphylactic, neurogenic, and obstructive shock. For each type, the document outlines signs, causes, pathophysiology, diagnostic evaluation, and initial treatment steps. Emphasis is placed on rapid fluid resuscitation and vasopressor support for hypotensive shock states.
1. Initial assessment and management of the trauma patient.pptxWalterBenites2
La primera etapa del curso ATLS (Advanced Trauma Life Support) se conoce como "Evaluación Inicial". En esta etapa, los estudiantes de medicina aprenden un enfoque sistemático y estructurado para evaluar a un paciente traumatizado de manera rápida y eficaz.
La Evaluación Inicial se centra en identificar y abordar de inmediato las lesiones que amenazan la vida del paciente.
This document contains multiple questions asking to identify medical devices, procedures, and patient scenarios. For each, the responder is asked to identify the device/procedure/scenario, indicate relevant indications or contraindications, and describe management steps or potential complications. The questions cover a wide range of topics including imaging tests, laboratory investigations, medical procedures, ventilation devices, and patient presentation.
This document discusses sepsis and septic shock. It defines sepsis as a life-threatening organ dysfunction caused by a dysregulated host response to infection. Septic shock involves circulatory and metabolic abnormalities that increase mortality risk. The document reviews signs, laboratory findings, scoring systems, management principles, and treatment approaches for sepsis and septic shock such as early antibiotics, fluid resuscitation, vasopressors, inotropes, and glycemic control. The goal of treatment is to recognize sepsis early and provide timely, targeted resuscitation to improve outcomes.
1. Neonatal surgical emergencies are common in developing countries due to factors like high birth rate, consanguinity, and infections during pregnancy.
2. Anesthetizing neonates requires special considerations due to their underdeveloped organ systems and immature physiology. Their cardiovascular, respiratory, renal and thermoregulatory systems are particularly vulnerable.
3. Close monitoring of vital signs, oxygenation, hydration and glucose levels is essential during anesthesia and in the post-operative period when apnea and cardiac arrest risks are high. Maintaining normal temperature is also critical for neonates.
This document discusses neonatal surgical emergencies and anesthetic management considerations. It covers the physiological differences of the neonatal system including the cardiovascular, respiratory, renal and thermal regulation systems. It emphasizes the importance of maintaining normothermia, oxygenation, hydration and glucose levels. The document provides guidance on optimization, monitoring, induction, intubation, maintenance and recovery for neonatal anesthesia. Special attention is needed in the postoperative period to prevent complications like apnea, laryngospasm and cardiac arrest.
1. Neonatal surgical emergencies are common in developing countries due to factors like high birth rate, consanguinity, and infections during pregnancy.
2. Anesthetizing neonates requires special considerations due to their underdeveloped organ systems and immature physiology. Their cardiovascular, respiratory, renal and thermoregulatory systems are particularly vulnerable.
3. Close monitoring of vital signs, oxygenation, hydration and glucose levels is essential during anesthesia and in the post-operative period when apnea and cardiac arrest risks are high. Maintaining normal temperature is also critical for neonates.
1. Neonatal surgical emergencies are common in developing countries due to factors like high birth rate, consanguinity, and infections during pregnancy.
2. Anesthetizing neonates requires special considerations due to their underdeveloped organ systems and immature physiology. Their cardiovascular, respiratory, renal and thermoregulatory systems are particularly vulnerable.
3. Close monitoring of vital signs, oxygenation, hydration and glucose levels is essential during anesthesia and in the post-operative period when apnea and cardiac arrest risks are high. Maintaining normal temperature is also critical for neonates.
This document discusses the fundamentals of using vasopressors. It outlines the steps to determine when to start vasopressors: 1) Is the patient's blood pressure too low? 2) Why is the blood pressure low? 3) How to raise the blood pressure? Norepinephrine is generally the first-line vasopressor. Adjuncts like vasopressin and steroids may be considered if norepinephrine dose is high. Peripheral intravenous lines can be used for vasopressors in the short term but central lines are preferable at higher doses due to risk of extravasation from peripheral lines.
This document provides guidance on general post-operative care including monitoring in the post-anesthesia care unit, vital signs, fluid and electrolyte balance, wound care, nutrition, mobilization, medications, and follow-up care. It outlines assessments of respiratory, cardiovascular, neurological and other body systems and recommendations to prevent complications and promote healing in the immediate postoperative period. Discharge criteria and the importance of communication with patients and their families is also discussed.
POST OPERATIVE CARE : MAXILLO-FACIAL SURGERYAbhishek PT
The document discusses postoperative care and complications. It covers two phases of postoperative care (Phase I requiring intensive care and Phase II progressive care), assessing the patient's vitals and airway, and complications including hemorrhage, infection, fever, fluid imbalance, and respiratory issues like atelectasis and pulmonary embolism. Prevention and treatment focus on monitoring, antibiotics, oxygen therapy, IV fluids, and early mobilization.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler Community Health Nursing A Canadian Perspective, 5th Edition TEST BANK by Stamler Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Study Guide Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Studocu Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Course Hero Community Health Nursing A Canadian Perspective, 5th Edition Answers Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Course hero Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Studocu Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Study Guide Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Ebook Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Questions Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Studocu Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Stuvia
Stroke Nursing Certification Systems of Care.pptxStanislavNaydin
This document discusses stroke nursing certification and systems of care at a comprehensive stroke center. It begins by distinguishing between specialized stroke nurses who work in stroke units and certified stroke registered nurses (SCRNs) who have passed a certification exam. The document then outlines requirements for specialized stroke nurses, including annual education hours and skills competencies. It provides details about SCRN certification through the American Board of Neuroscience Nurses. The majority of the document focuses on the key elements covered in the certification exam, including anatomy/physiology, different phases of stroke care, diagnostic testing, and acute nursing management. It emphasizes collaboration between nurses and other providers to ensure timely and specialized care for stroke patients.
Shock is caused by inadequate systemic oxygen delivery that activates autonomic responses to maintain circulation. The main types of shock are hypovolemic, septic, cardiogenic, anaphylactic, neurogenic, and obstructive. Treatment focuses on airway control, oxygen delivery, circulation optimization through fluid resuscitation, and achieving hemodynamic goals to restore tissue perfusion. Early goal directed therapy for septic shock involving aggressive fluid administration and inotropes improves outcomes.
This document summarizes the National Institute for Health and Care Excellence (NICE) clinical guidelines for the management of femoral neck fractures. It provides background on the incidence and costs of hip fractures in the UK. It then summarizes the NICE guidelines, which include recommendations for imaging, timing of surgery, analgesia, anesthesia, surgical options, rehabilitation, and multidisciplinary management. It describes a local audit assessing adherence to the NICE guidelines and identifies opportunities to improve, such as developing nerve block skills and introducing a standardized pain assessment.
The document provides information about establishing and operating a blood transfusion service. It discusses key aspects like location, facilities, equipment, staffing, donor screening and types, blood collection procedures, storage and transportation of blood and blood products. The document also covers blood grouping systems, components of blood like packed red cells, plasma, platelets etc and their uses in transfusions. Maintaining proper standards and facilities is important for the blood transfusion service to safely and effectively meet transfusion needs.
This document provides an overview of nursing care for patients experiencing acute ischemic stroke. It discusses the nursing role in both the emergent/hyperacute phase in the first 24 hours as well as the acute phase. Key responsibilities of nurses in the emergent phase include educating emergency medical services personnel, conducting assessments upon patient arrival, monitoring patients more closely if they receive thrombolysis treatment, and notifying physicians about changes in patient status. The document emphasizes the importance of coordinated, evidence-based, multidisciplinary care to improve patient outcomes and decrease costs for stroke patients.
How to manage a case of acute exacerbation of COPD according to GOLD guidelines. Sincere thanks to Dr. Amardeep Toppo who has prepared most of this presentation.
Sepsis is a life-threatening condition that arises when the body's response to infection causes injury to its own tissues. Globally, sepsis kills about 8 million people annually. Early recognition and treatment are key to improving outcomes. The first hours after diagnosis are especially critical, as mortality increases by about 8% every hour that antibiotics are delayed. Prompt administration of broad-spectrum antibiotics and fluid resuscitation can significantly reduce mortality from sepsis.
This document provides an overview of shock, including definitions, pathophysiology, types, and treatment approaches. It defines shock as inadequate oxygen delivery to meet metabolic demands, resulting in global tissue hypoperfusion and metabolic acidosis. The main types of shock discussed are hypovolemic, septic, cardiogenic, anaphylactic, neurogenic, and obstructive shock. For each type, the document outlines signs, causes, pathophysiology, diagnostic evaluation, and initial treatment steps. Emphasis is placed on rapid fluid resuscitation and vasopressor support for hypotensive shock states.
1. Initial assessment and management of the trauma patient.pptxWalterBenites2
La primera etapa del curso ATLS (Advanced Trauma Life Support) se conoce como "Evaluación Inicial". En esta etapa, los estudiantes de medicina aprenden un enfoque sistemático y estructurado para evaluar a un paciente traumatizado de manera rápida y eficaz.
La Evaluación Inicial se centra en identificar y abordar de inmediato las lesiones que amenazan la vida del paciente.
This document contains multiple questions asking to identify medical devices, procedures, and patient scenarios. For each, the responder is asked to identify the device/procedure/scenario, indicate relevant indications or contraindications, and describe management steps or potential complications. The questions cover a wide range of topics including imaging tests, laboratory investigations, medical procedures, ventilation devices, and patient presentation.
This document discusses sepsis and septic shock. It defines sepsis as a life-threatening organ dysfunction caused by a dysregulated host response to infection. Septic shock involves circulatory and metabolic abnormalities that increase mortality risk. The document reviews signs, laboratory findings, scoring systems, management principles, and treatment approaches for sepsis and septic shock such as early antibiotics, fluid resuscitation, vasopressors, inotropes, and glycemic control. The goal of treatment is to recognize sepsis early and provide timely, targeted resuscitation to improve outcomes.
1. Neonatal surgical emergencies are common in developing countries due to factors like high birth rate, consanguinity, and infections during pregnancy.
2. Anesthetizing neonates requires special considerations due to their underdeveloped organ systems and immature physiology. Their cardiovascular, respiratory, renal and thermoregulatory systems are particularly vulnerable.
3. Close monitoring of vital signs, oxygenation, hydration and glucose levels is essential during anesthesia and in the post-operative period when apnea and cardiac arrest risks are high. Maintaining normal temperature is also critical for neonates.
This document discusses neonatal surgical emergencies and anesthetic management considerations. It covers the physiological differences of the neonatal system including the cardiovascular, respiratory, renal and thermal regulation systems. It emphasizes the importance of maintaining normothermia, oxygenation, hydration and glucose levels. The document provides guidance on optimization, monitoring, induction, intubation, maintenance and recovery for neonatal anesthesia. Special attention is needed in the postoperative period to prevent complications like apnea, laryngospasm and cardiac arrest.
1. Neonatal surgical emergencies are common in developing countries due to factors like high birth rate, consanguinity, and infections during pregnancy.
2. Anesthetizing neonates requires special considerations due to their underdeveloped organ systems and immature physiology. Their cardiovascular, respiratory, renal and thermoregulatory systems are particularly vulnerable.
3. Close monitoring of vital signs, oxygenation, hydration and glucose levels is essential during anesthesia and in the post-operative period when apnea and cardiac arrest risks are high. Maintaining normal temperature is also critical for neonates.
1. Neonatal surgical emergencies are common in developing countries due to factors like high birth rate, consanguinity, and infections during pregnancy.
2. Anesthetizing neonates requires special considerations due to their underdeveloped organ systems and immature physiology. Their cardiovascular, respiratory, renal and thermoregulatory systems are particularly vulnerable.
3. Close monitoring of vital signs, oxygenation, hydration and glucose levels is essential during anesthesia and in the post-operative period when apnea and cardiac arrest risks are high. Maintaining normal temperature is also critical for neonates.
This document discusses the fundamentals of using vasopressors. It outlines the steps to determine when to start vasopressors: 1) Is the patient's blood pressure too low? 2) Why is the blood pressure low? 3) How to raise the blood pressure? Norepinephrine is generally the first-line vasopressor. Adjuncts like vasopressin and steroids may be considered if norepinephrine dose is high. Peripheral intravenous lines can be used for vasopressors in the short term but central lines are preferable at higher doses due to risk of extravasation from peripheral lines.
This document provides guidance on general post-operative care including monitoring in the post-anesthesia care unit, vital signs, fluid and electrolyte balance, wound care, nutrition, mobilization, medications, and follow-up care. It outlines assessments of respiratory, cardiovascular, neurological and other body systems and recommendations to prevent complications and promote healing in the immediate postoperative period. Discharge criteria and the importance of communication with patients and their families is also discussed.
POST OPERATIVE CARE : MAXILLO-FACIAL SURGERYAbhishek PT
The document discusses postoperative care and complications. It covers two phases of postoperative care (Phase I requiring intensive care and Phase II progressive care), assessing the patient's vitals and airway, and complications including hemorrhage, infection, fever, fluid imbalance, and respiratory issues like atelectasis and pulmonary embolism. Prevention and treatment focus on monitoring, antibiotics, oxygen therapy, IV fluids, and early mobilization.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler Community Health Nursing A Canadian Perspective, 5th Edition TEST BANK by Stamler Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Study Guide Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Studocu Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Course Hero Community Health Nursing A Canadian Perspective, 5th Edition Answers Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Course hero Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Studocu Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Study Guide Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Ebook Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Questions Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Studocu Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Stuvia
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
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2. LEARNING OUTCOMES
• By the end of the class, the student will be able to:
• Apply the concepts of shock pathophysiology and
management to the care of patients with hypovolemic,
cardiogenic and septic shock using a case study approach.
• Apply concepts of quality, safety, and patient-centered care
to the care of selected patients and families in critical care
environments.
3. PATIENT #1
• You are caring for Mr. C, age 70, who was admitted to your unit
postoperatively 15 min ago following a L open thoracotomy for
removal of a malignant tumor.
• Handoff report that you receive from the PACU:
• Vital signs BP 100/88, HR 100, respirations 18, SaO2 94%
• Chest tube drainage tube totals 250 ml serosanguinous drainage at 2pm since
surgery.
• IV D5.45 at 125 ml/hr via #20 IV in the hand.
• U/O 30 ml/hr
• PMH- emphysema, HTN, (on metoprolol at home), cirrhosis
4. THINK, PAIR, SHARE
• What information in the patient’s PMH is important to note in this
post-surgical patient?
• Based on this handoff report, what are some key assessments that
you will make when the patient arrives on the unit?
5. ARRIVAL ON THE SURGICAL UNIT
• The UAP checks vital signs while you are assessing the patient.
The UAP reports
• VS BP 95/88, HR 102, RR 24.
• Mr C. is pale, skin cool. U/O via catheter 5ml in 15 min.
• You find that the chest tube has drained an additional 250 ml
in the last 15 min.
6. THINK, PAIR, SHARE
• What immediate assessments and interventions should you take? How
are you going to prioritize your actions?
• Assessments
• Interventions
• How might the patient’s prior medications affect the compensatory
response?
• How would report this change in the patient condition to the care
provider?
• SBAR
8. CONTINUED…
• Unfortunately, the resident has not returned your calls. The BP
increased somewhat with modified Trendelenburg, but you
recognize the patient needs to be seen immediately.
• You recheck the VS and find:
• BP 74/52 -118-30, shallow, 90%
• The IV insertion site looks like it might be infiltrated, and you
just learned how to insert IVs…… What should you do???
9. SOCRATIVE QUICK QUESTION
In this situation, what should the new nurse do next to advocate for this
patient?
A. Try inserting an IV ASAP
B. Use your pager phone to call the charge nurse for help starting an IV.
C. Call a rapid response.
D. Call the surgeon who performed the procedure.
10. IHI EARLY WARNING SCORING SYSTEM TO INITIATE
RAPID RESPONSE TEAM: CRITERIA
• Staff member is worried about the patient
• Acute change in heart rate <40 or >130 bpm
• Acute change in systolic BP <90 mmHg
• Acute change in RR <8 or >28 per min or threatened airway
• Acute change in saturation <90% despite O2
• Acute change in conscious state
• Acute change in UO to <50 ml in 4 hours
IHI Early Warning System and Rapid Response
12. BLOOD AND BLOOD COMPONENTS
• O negative universal
donor
• Warm fluids
• Fresh frozen plasma-
contains clotting factors.
13. THINK, PAIR, SHARE:
AACN SYNERGY MODEL
PATIENT CHARACTERISTICS
• Resiliency: In shock, what physiologic
compensatory mechanisms are in place to
help restore functioning?
• In this specific patient, what are sources of
vulnerability? (actual or potential
stressors that may affect outcome).
• Stability: Describe the patient’s stability
NURSE CHARACTERISTICS
• Clinical judgment: Integrate clinical
reasoning/clinical skills, experience, and
EBP.
• Provide an example of clinical
judgment.
• Advocacy: working to represent the
concerns of the patient and family.
• Provide an example of advocacy
14. TEST YOUR UNDERSTANDING-
SOCRATIVE QUICK QUESTION
• What is the best way to evaluate the adequacy of fluid
resuscitation in a patient with hypovolemic shock?
• A. Urine output
• B. Blood pressure
• C. IV site patency
• D. Amount of IV intake
15. FOLLOW-UP
• After receiving packed cells, fresh frozen plasma, and
crystalloid IVs, the patient stabilized, VS became normal,
and chest tube drainage gradually slowed.
• Several days later, you are assessing Mr. C’s chest tube and
note continuous bubbling in the water seal chamber.
16. THINK, PAIR, SHARE
• What is the significance of
continuous bubbling in the
water seal chamber?
• What is your next action?
Atrium.com
17. DISCHARGING MR. C
• Mr. C has progressed well, has had his chest tube removed, and is
ready for discharge.
• Prior to discharge, what are parameters to evaluate Mr. C’s safety
and readiness to be discharged to home?
• What discharge instructions would you provide to Mr. C and his
significant other?
18. SYNERGY MODEL: CONSIDERATIONS FOR
DISCHARGE PLANNING
PATIENT CHARACTERISTICS
• Resource Availability:
What are discharge planning needs?
• what resources (technical, financial, personal,
family, community) does the family bring to
the situation?
• Participation in care: engagement in care?
• Participation in decision making? How much?
Who?
NURSE CHARACTERISTICS
• Response to diversity:
• appreciate/ incorporate preferences into
provision of care.
• Facilitation of learning:
• What is the best way to provide learning, and
assess patient and family understanding of
learning?
19. MR. C’S DISCHARGE INSTRUCTIONS
1. Alternate activity with rest periods.
2. Avoid lifting > 10 lbs until cleared by surgeon (3 months expected)
3. Inspect incision and notify if redness, drainage, or separation or skin edges.
4. Stop smoking
5. Report for follow-up care to the surgeon and others. (Provide dates_____________)
6. Obtain an annual influenza vaccine, and discuss vaccination against pneumonia with
care provider.
7. Medication reconciliation
21. MANAGING CARDIOGENIC SHOCK
• Goals: adequate perfusion of end-organs
• MAP > 65
• (How do you calculate mean arterial pressure??)
• U/O > 30ml/hr
• Evidence of adequate cerebral circulation
• Cardiac index > 2.5L/min/m2
22. PUTTING IT ALL TOGETHER….
• Mr H, 65 yr old male admitted following an acute anterolateral MI. PMx: inferior
MI
• Cath lab- stents placed in LAD, L circumflex
• PA catheter placed. Initial readings:
• PA pressures elevated; PCWP 28 (nl 4-12 )
• Cardiac output 3.2 L/min, cardiac index (CI) 1.6 (nl > 2.5 L/min/m2)
• BP 80/44 mmHg MAP 56 HR 120
• SaO2 88% on 100% mask. Crackles all lobes
• Patient cold, clammy, anxious, agitated, U/O 20ml/hr
23. THINK, PAIR, SHARE
• What information suggests that the patient may be in cardiogenic shock?
• What therapies would you anticipate being prescribed?
• How could you evaluate the effectiveness of any interventions?
• What information does the PA catheter provide regarding how the patient’s heart is
pumping?
24. CARDIOGENIC SHOCK
SIGNS/SYMPTOMS
• Systolic BP <90 mmHg (cuff)
• Confusion, restlessness
• Shallow, rapid respirations, crackles
• Oliguria (< 30 ml/hr or less than 0.5
ml/kg/min)
• Cold, clammy extremities
• S3
• Tachycardia (HR > 100 bpm)
25. PULMONARY ARTERY (PA) CATHETER
• Measures pulmonary artery pressures
• Pulmonary artery diastolic pressures (PAD) and wedge
pressure reflects left ventricular preload.
• Measures cardiac output.
• Permits calculation of systemic vascular resistance (SVR) -
afterload,,
• Assess effectiveness of therapies, like vasoactive
medications or diuretics
29. PULMONARY ARTERY CATHETERS
• Cardiac Output measurements obtained either by:
• Intermittent measurements
• Continuous measurements (CCO)
• Non-invasive C.O. and Stroke volume technologies
emerging. Reliability being evaluated.
Cardiac output = HR x stroke volume
30. CARDIOGENIC SHOCK
HEMODYNAMICS
• Decreased Cardiac Output (CO), cardiac index (CI).
• Cardiac index = CO/BSA. CI- 2.5-4 L/min/m2
• Increased PA pressures= increased PRELOAD! Patient is fluid overloaded.
• Increased SVR- patient is vasoconstricted. Increased AFTERLOAD!
31. MANAGING CARDIOGENIC SHOCK
• Goals: adequate perfusion of organs- evidenced by:
• Mean arterial pressure (MAP) > 65 mmHg
• (How do you calculate mean arterial pressure??)
• Urine output greater than 0.5 ml/kg/hr
• Adequate cerebral circulation- (how would you evaluate?)
• Cardiac index > 2.5L/min/m2
32. CARDIAC OUTPUT VS CARDIAC INDEX
• Cardiac Output varies with
age, size, and metabolic
demands
• To compare “normal” CO
between people of different
sizes, we use “cardiac
index”. (CI)
• CO/Body surface area
(BSA)= cardiac index (CI)
33. PHARMACOLOGIC THERAPY
• Vasoactive medications-aim is to increase cardiac output without
increasing afterload
• Common IV vasoactive medications include dopamine,
dobutamine, milrinone (phosphodiesterase inhibitor),
norepinephrine, epinephrine. Action depends on medication and
dose.
• Treat arrhythmias appropriately (KCl, MgSO4, amiodarone)
• Diuretics if pulmonary edema present.
35. PATIENT MANAGEMENT ON VASOACTIVE
MEDICATIONS
• VS frequently; q 15 min while titrating vasoactive meds or while unstable
• Dosage titrated to patient response.
• Titrated to BP or cardiac index goal
• Administer via central line if possible
• Extravasation may cause tissue damage
• Use arterial line for monitoring BP.
36. INVASIVE ARTERIAL BP MONITORING
• Indwelling catheter in artery.
• Radial, brachial, femoral
arteries most frequently
utilized
• Pressure tubing to transducer
• Converts pressure to electronic
waveforms
(youtube.com)
Youtube.com
37. ARTERIAL LINE MONITORING
• Advantages-
• Continuous monitoring
• Invasive- more accurate in
shock states
• Access for blood draws
including arterial ABGs
• Disadvantages
• Risk for bacteremia
• Risk for loss of arterial pulse
(Learnpicu.com)
38. ARTERIAL MONITORING- PREVENT COMPLICATIONS
• Strict asepsis
• Strict line protocols
• Allen test prior to radial A-line insertion (or
ultrasonography)
• Close monitoring of circulation distal to line-
pulses, pallor, temp, pain-
• AT LEAST HOURLY CIRCULATION CHECK!!
(McHale
2011)
39. INTRA-AORTIC BALLOON PUMP
• Inflates at the beginning of diastole to “augment”
coronary perfusion. (Increase myocardial blood
supply).
• Deflates just prior to systole to reduce afterload.
(Decrease myocardial oxygen demand)
• Vascular complications!-
• check pulses!!
• Check groin
• Keep leg straight
McHale (2011)
Cacvi.org
40. PUTTING IT TOGETHER (CONT.)
• IABP inserted
• Patient intubated after BiPAP failed
• Transferred to CCU
• Dobutamine drip started and titrated to achieve CI >2.5 L/min/m2
• Heparin drip at 12 units/kg/hr
• Furosemide (Lasix) 60mg IV administered
• Labs drawn-Comprehensive metabolic panel (CMP), cardiac enzymes, PTT, CBC, ABGs,
serum lactate.
41. FOLLOW-UP IN THE CCU
• Describe the nursing care required when caring for a patient receiving
dobutamine?
• Medication-related
• Interventions related to central line
• You are ordered to start dobutamine at 4 mcg/kg/min. The drip is mixed
500 mg in 250 ml D5W. The pt weighs 75 kg. How many ml do you set on
the pump? _______
• List nursing priority assessments and interventions when the patient has an
IABP?
42. SAO2 INTERPRETATION
• On the monitor, this is the plesmograph SpO2 waveform that is seen. What is the
first action you, as the nurse should take?
43. SOCRATIVE QUICK QUESTION
1. Assess level of consciousness, skin temperature, and color
2. Disconnect pulse oximeter device from the client and restart it
3. Preoxygenate with 100% oxygen and perform endotracheal suction
4. Reset the high and low alarm parameters on the pulse oximeter device
44. PUTTING IT ALL TOGETHER
• Twelve hours later:
• ABGs: 7.41- 37-82- 22- 94% on mechanical ventilator (PRVC
TV 700 rate 10 FIO2 .4)
• PA readings 36/16
• CO 5.2 CI 2.6 with dobutamine@ 5 mcg/kg/min
• U/O 50-70 ml/hr
• Alert, less anxious. Skin warm, dry. All pulses present with
doppler.
45. CARDIOGENIC SHOCK, CONT.
• IABP weaned and d/c within 48 hrs.
• Dobutamine weaned to off.
• Over the next week, Mr. H participated in in-patient
cardiac rehabilitation. He was discharged to home within
10 days. Post discharge, he participated in an outpatient
cardiac rehab.
46. CASE #3
• Mrs. J., a normally healthy and ambulatory 75 year old
female patient has recently become lethargic, less active,
and anorexic over the past week. She complains only of
nonspecific lower abdominal pain unrelated to food or
bowel movements.
• She is diagnosed with a UTI by her DNP and is prescribed
TMP-SMX (Bactrim) for 7 days.
47. CASE STUDY, CONT.
The pills make her nauseous, so Mrs. J does not finish them. Three
days later, she is admitted to the ED.
• Shaking chills, fever 101.5.
• PMH DM type II, HTN
• VS: HR 110, respirations 28, BP 90/42(58) SaO2 94%
• ABGs 7.51-24-74-21- 93%
• Admitted to general medical unit
• D5 1/2 75 ml/hr
• U/A, urine C&S, BMP.
• Dx UTI. Admit to medical unit.
48. MEANWHILE, ON THE MEDICAL UNIT…..
• The UAP takes VS on your new admission….
• T 102.5 118 28 BP 84/40 (54)!!!
• What do you do next?
49. THINK, PAIR AND SHARE
1. What signs and symptoms are concerning to you?
2. What information in the patient’s history makes the
patient’s presentation more concerning?
3. What should the nurse do?
50. SEPTIC SHOCK: SIGNS AND SYMPTOMS
• Anxiety, restlessness, confusion, disorientation
• Flushed, warm, dry skin. Elderly- pale, cool, mottled.
• Tachypnea, dyspnea
• Tachycardia (HR > 90 bpm)
• BP < 90 systolic or fall of 40 mmHg from baseline
• Temp > 100.4 or < 96.8, chills.
• Hemodynamics:
• Cardiac index > 3.5 L/min/m2 (hyperdynamic)
• SVR < 900 (low)- vasodilated
• PA pressures low
51. MEANWHILE IN THE ICU…..
RECEIVING HANDOFF REPORT
An ICU nurse is preparing to receive Mrs J.
• What information is important to receive from the providing nurse in this
patient in order to help plan care?
• (ie- What are priorities of care for patients with septic shock; What
questions should the nurse ask to support a safe transition of care to the
ICU?)
• 2. What equipment should the nurse anticipate needing?
52. SEPSIS RESUSCITATION BUNDLE: INITIATE
WITHIN THE FIRST HOUR
• Multidisciplinary EBP from “Surviving Sepsis Campaign”:
• Measure serum lactate. > 2mmol/L indicates tissue hypoperfusion.
• Blood cultures prior to abx administration for sx of fever, chills,
hypothermia, leukocytosis, L shift.
• Admin. broad spectrum abx
• Fluid resuscitation- initial minimum 30ml/kg crystalloid
• Additional fluids as needed
53. SEPSIS RESUSCITATION BUNDLE(CONT.)
• Vasopressors- for hypotension and/or lactate > 4 not responding to
initial fluid bolus. Maintain MAP > 65 mmHg.
• Use invasive arterial line to monitor BP.
• Norepinephrine (levophed) preferred vasopressor. Strong alpha
agonist, some beta agonist activity. (1-30 mcg/min)
54. PATIENT PARAMETERS 4 HRS POST ADMISSION TO
ICU
• Patient has received total 1.5 L .9NSS (Patient weighs 80 kg)
• Norepinephrine (Levophed) infusing @ 8mcg/min via subclavian
central line triple lumen catheter.
• VS q 15 min: T 101.1 110 28 90/46 (61) on 40% ventimask
• U/O 20 ml/hr
• Blood cultures x 2 drawn and abx started within 1 hr of ICU
admission
• ABGs 7.21-35-80-12-94% Lactate 6 mmol/L
55. THINK, PAIR, SHARE
1. What are your thoughts about the patient’s tissue perfusion?
Adequate or inadequate? What evidence supports your
conclusions?
2. What therapies would you recommend in an SBAR format with
the interprofessional team? Why?
3. What procedure may be imminent for which you must prepare?
56. THINK, PAIR SHARE
Mr. H., the husband, is very concerned about his wife and
wants to remain with her in the ICU after 7pm. The visiting
hours in the ICU are 15 min an hour, ending at 7pm.
What is the evidence concerning family visiting and patient
safety and patient/family satisfaction in the ICU?
57. SYNERGY MODEL
PATIENT FAMILY CHARACTERISTICS
• Participation in
care/Participation in decision
making:
• Assess to what extent family
participates in care and decision
making?
NURSE CHARACTERISTICS
• Advocacy- working to represent
the concerns of the patients and
family. Caring practices-
responsiveness of caregivers to
patient and family individualized
needs.
58. AACN PRACTICE ALERT: RECOMMENDATIONS
• Facilitate unrestricted access to a chosen support person
24 hrs/day unless contraindicated (other’s safety or rights,
therapeutically or medically contraindicated).
• Develop policies that allow support person to be at the
bedside, according to the patient’s wishes.
• Policies should prohibit discrimination of all kinds.
AACN (2016) doi:http://dx.doi.org/10.4037/ccn2016677
59. THREE DAYS LATER…
• Patient extubated following implementation of awake and breathing trials.
(ABCDE Bundle)
• Pressors weaned off.
• MAP 65-90 mmHg, U/O 50 ml/hr, Serum lactate 1.6 mmol/L
• Continuing antibiotics to complete course.
• Patient received aggressive inpatient rehabilitation prior to D/C.
• Patient eventually d/c to home with home care, home PT/OT.
• Discharge instructions include prevention of UTIs, when to call PCP,
complete all antibiotics.
60. REFERENCES
AACN Practice Alert (2016). Family visitation in the Adult intensive care unit. Critical Care Nursing 36(1),
doi:http://dx.doi.org/10.4037/ccn2016677
Dellinger RP, Levy MM, Rhodes A, et al.(2013) Surviving Sepsis Campaign: International guidelines for
management of severe sepsis and septic shock: 2012. Critical Care Medicine;41(2):580-637.
Hinkle J, Cheever, K. (2018). Brunner & Suddarth’s Textbook of Medical-Surgical Nursing (14th ed.) Philadelphia, PA.
Wolters Kluwer.
Levy M., Evans L., Rhodes A (2018). The surviving sepsis campaign bundle: 2018 update. Intensive Care Medicine 44,
925-928.
McHale-Weigand DL (2011). AACN Procedure Manual for Critical Care. St. Louis, MO. Elsevier.
Qureshi, S. H., et al. (2016). Meta-analysis of colloids versus crystalloids in critically ill, trauma, and surgical patients.
British Journal of Surgery, 103(1), 14–26.
Society of Critical Care Medicine, European Society of Critical Care Medicine (2018). Surviving Sepsis Campaign One
hour bundle. www.survingsepsis.org
Yarema, T. Yost, Spencer (2011) “Low-Dose Corticosteroids to Treat Septic Shock: A Critical Literature Review.” Critical
Care Nurse. 31(6) 16-26.