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    Add as Friendacute biological crisis

    by: michael

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    1 : Acute Biologic Crisis Prepared by: Michael Magpantay
    2 : CRITICAL CARE NURSING nurse licensed professional who provides careto meet the patient s individualized needs in response to potentially life-threatening conditions in an environment supportive of highly technological, collaborative and holistic care.
    3 : Common Problems Seen in Critical Care Setting 1. Anxiety 2. Impaired communication 3. Sleep deprivation 4. ICU psychosis Common procedures 1. Hemodynamic monitoring 2. Circulatory assist device * IABP 3. Airway maintenance adjuncts
    4 : Complications 1. Sepsis 2. MOSF Multiple Organ System Failure 3. Shock
    5 : Nursing Interventions Anxiety related to fear of death, unknown patients and significant others; ineffective coping mechanism . Tx: Family participation, biobehavioral intervention 2. Impaired communication related to barriers : ET , newTT, or trauma Tx : Acknowledge patient’s concern ; reassurance ; alleviate common difficulties; family feedback
    6 : 3. Sleep deprivation : lack of consistent REM and NREM Tx: Meds ;Family visits ; rest periods; decreased environmental stimulation ; biobehavioral intervention 4. ICU psychosis -acute confusional state sec.to CNS stimulants, narcotics, depressants, steroids/ sleep deprivation, sensory overload, F/E imbalance, dec. Oxygen, infection, head trauma, brain disorders
    7 : Hemodynamic Monitoring Cardiac Output – volume of blood that is ejected from the heart in 1 minute. - determined by the HR x SV expelled per heart beat. - NV- 4-8L/min. 2. Pre-load – amount of stretch in the LV just before ventricular contraction at the end of diastole. 3. Afterload – tension the ventricle must overcome to eject the blood into the arterial systems (pulmonary and aortic); measured by the systemic vascular resistance. 4. Cardiac index – is the CO by the BSA - better indicator of the body’s ability to perfuse the tissues effectively than CO. - NV- 2.5 – 4.0 L/min/m 2
    8 : PCWP-BP in the most distal peripheral capillariesof the PA. (Left Atrial Pressure) PAP-pressure exerted on the PA walls being pumped out of the RV MAP-average of S &D BP- DBP+2SBP ----------------- 3 CVP- blood within the heart & great vesselsof the thorax
    9 : Types of Hemodynamic Monitoring Arterial lines – provides a direct, intra-arterial measurement of BP; assist in the continuous measurement of SBP, DBP and MAP. Method : a 20 g arterial catheter inserted into the radial, brachial or femoral artery connected to high pressure tubing leading to a pressure transducer and amplifier.
    10 : Nursing Management : Same mechanics in CVP reading Drawing a – blood sample – flush A line with valve flush device to allow return of sharp arterial waveform thru a 3 way stopcock. 2. Change dressings 24-48 hrs., IV solutions and IV tubings per hosp. policy 48-72 hrs. 3. Watch out for complications : bleeding from insertion site , hemorrhage, infection- systemic , air embolus, thrombosis, occlusion of circulation with loss circulation distal to insertion site. 4. Perform Allen Test prior to radial artery insertion and freq. monitor distal pulses to decrease A/E.
    11 : 2. Swan-Ganz Catheter – Pulmonary Artery Balloon Flow provide indirect measurement of LV function for detection and treatment of CP changes. Method : a 5 lumen, balloon tipped , flow directed catheter connected to a pressure transducer and pressurized heparin flush system is inserted thru a percutaneous or cutdown venous site and directed into the RA. Site : subclavian vein most common
    12 : Indications : a. a need to monitor PAP and or PCWP- indirectly reflect LV function. b. provide information about CO, tissue perfusion and BV. c. Obtain venous blood specimens d. Proximal orts used for continuous fluid or medication infusion.
    13 : Nursing Management : Level and secure transducer at the phlebostatic axis – 4th ICS, MAL – serves as a reference point for the RA. 2. Taking readings – record PA Systolic and Diastolic Pressures to obtain a PCWP or LVEDP , then inflate the catheter balloon slowly, watch for waveform changes-dampening indicates wedging. 3. After reading has been recorded, allow the balloon to deflate passively and lock it out tp prevent accidental wedging- take all reading at the end of expiration.
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