Page 433 - Critical Care Nursing Demystified

418 CRITICAL CARE NURSING DeMYSTIFIED

Monitor staff and visitors for infections; you may have to teach donning of
personal protective equipment (PPE). To prevent the patient from infections in
others.
Avoid use of enemas, suppositories, and rectal temps, which can increase the
likelihood of bleeding and infection.
Provide only cooked food. Raw food, especially fruits, can contain molds or
fungi that can invade the patient’s bloodstream.
Change sources of stagnant water frequently deleting the use of fresh flowers
and plants at the bedside. Standing water such as tubing from ventilators and
IV bags can grow bacteria.

Recounting a True Story

Nursing involves using evidence-based research in order to improve patient care
and safety. Back in the day, students were taught the SASH method of maintaining
a peripheral IV site: Saline, Administer medication, Saline, and lastly Heparin. This
was a quick way to remember the order of how a piggyback or IV push medication
was delivered to prevent clotting the IV line. Clots in a capped IV line would neces- 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.
sitate a restart. This procedure was called “flushing a heparin lock.”
Research findings in the new millennium found that heparin was not needed
to keep peripheral lines open. Also, heparin-induced thrombocytopenia was
found to be caused by a second exposure to heparin and was signified by a severe
drop in platelets after repeated use of heparin.
It was easy to stop administering heparin as we know that unnecessary drugs
and procedures can increase the chance of sepsis. This also added nursing time to
do other things; most new procedures increase nursing time so “dropping the
SASH” caught on quickly. Now if we could only drop the term “heparin lock” from
our vocabulary all would be less confusing in teaching new nurses.

7 Septic Shock
What Went Wrong?
Septic shock is hypotension due to an overwhelming pathogenic infection. This
type of shock results in a decreased blood flow and an increase in blood clotting.
The decreased blood flow leads to tissue hypoxia and inadequate cellular func-
tioning. The infection-producing organism releases vasoactive substances when
the cell wall is phagocytosed, releasing cytokines that increase inflammation.
So it is the death of the causative organism releasing endotoxins that causes