Page 287 - Critical Care Nursing Demystified

272 CRITICAL CARE NURSING DeMYSTIFIED

Medication Action Nursing Actions
Morphine Used in pain control for 1. Assess the patientʼs
sulfate major burns respiratory status for
hypoventilation
2. Assess the patientʼs BP; do
not give if BP is <100 mm Hg
systolic
Tetanus toxoid Used to prevent tetanus 1. Assess the last date of last
prophylaxis if from “dirty wounds” tetanus toxoid
needed 2. Check if patient is on steroids
or is immunocompromised
3. Observe for drug reaction
Vasopressors See Chapter 3

Fluid Volume Replacement (FVR)

6 One of the most frequent challenges a critical care nurse implements in the
care of a traumatized patient is in the area of FVR. Replacement of body fluid
with IVs and blood are the first-line treatments in hemorrhagic shock for almost Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
all severely traumatized patients. The goal of FVR is to ensure that the tissues
get oxygen and nutrients. Without FVR, the patient would quickly succumb to
multiorgan failure.

Sites of FVR

IV access is of utmost importance, and multiple access with several different
sites many be needed in severe fluid loss. Sites are accessed with the largest
gauge needle possible (#14 and #16). Table 6–2 lists common IV access sites
for FVR. The central venous site is most preferable.
To administer fluid quickly, a rapid infuser may be used. This piece of equip-
ment warms a solution and can administer a liter over 2 minutes.

Preferred Solutions

There are many solutions that can be used for FVR in the traumatized patient.
In deciding which solution to use, the cause of the volume loss and blood com-
ponents that need to be replaced are two decisions that need to be made. The
three main types of solutions are crystalloid, colloid, and blood products.