Page 239 - Critical Care Notes

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■ MAP >65% mm Hg
■ Svo 2 saturation 65%
■ Urine output >0.5 mL/kg/hr
■ Lactate level within normal limits
■ Administer hydrocortisone IV only if hemodynamic instability persists.
Administer 200 mg/day by continuous flow. Taper drug when vasopressors
are no longer required. Avoid ACTH stimulation test.
■ Transfuse patient with RBCs only when Hgb ≤7.0 g/dL. Target Hgb level is
7.0–9.0 g/dL in adults. Erythropoietin and fresh frozen plasma are not
recommended.
■ Administer platelets if platelet count is <10,000/mm 3 .
■ Antithrombin administration is not recommended.
■ Selenium IV and IVIGs are not recommended.
■ Start glucose control protocol if two consecutive blood glucose levels are
>180 mg/dL. Target glucose level is <180 mg/dL.
■ Provide low-calorie oral or enteral feeding recommended and advance as
tolerated. Consider IV glucose and enteral nutrition rather than solely TPN
in the first 7 days after diagnosis.
■ Remove intravascular devices if deemed a source of infection.
■ Administer O 2 via nasal cannula, mask, or mechanical ventilation. Use
minimum positive end-respiratory pressure to achieve tidal volume and
end-inspiratory plateau pressure goals.
■ Follow protocols for mechanically ventilated patients; prevent ventilator-
associated pneumonia (VAP). Refer to Basics and Respiratory Tabs.
■ Maintain a median inspiratory plateau pressure of ≤30 cm H 2 O for mechani-
cally ventilated patients.
■ Use PEEP as needed.
■ Avoid sodium bicarbonate for hypoperfusion-induced lactic academia
pH ≥7.15.
■ Institute stress ulcer and DVT prophylaxis.
■ Sedate patient as necessary, but limit or avoid sedation when possible.
Consider train-of-four monitoring.
■ Consider CRRT and hemodialysis as needed.
■ Discuss goals of care and treatment with patient and family within 72 hr of
ICU admission.
■ Use palliative care protocols where appropriate.
■ Refer to the reference section in the Tools Tab for complete guide.
Other Nursing Care
■ Assess vital signs and monitor mean arterial pressure.
■ Assess hemodynamic status. Refer to the previously noted target
guidelines.
■ Assess cardiac, respiratory, neurological, and GI status.
■ Monitor ABGs and note ↓ pH, ↓ PaO 2 , and ↑ PaCO 2 . Monitor for ARDS.
Refer to the Respiratory tab.
MULTISYS