Page 148 - ACCCN's Critical Care Nursing

Essential Nursing Care of the Critically Ill Patient 125

prophylaxis and pressure injury prevention, along with a
Practice tip thorough assessment of physical care needs and a subse-
quent plan of management. Consideration of factors
If ceasing nutrition during the patient transport, make sure that such as limb function, which may ultimately reduce the
the patient is not at risk of hypoglycaemia from concurrent deficits in physical function often experienced at least
insulin therapy. transiently by critically ill patients, is another component
of essential nursing care of the critically ill patient. Recov-
ery for patients to normal functioning after a critical
illness is dependent upon a multitude of factors, and is
a dynamic process over time, however, much of the essen-
The need for monitoring relates to both the patient and tial nursing care given to critically ill patients assists in
equipment, and is identified in Table 6.16. 158 Some moni- both reducing deficits associated with their episode of
toring should be continuous, such as cardiac, oxygen illness and reducing the time taken to achieve normal
saturation, capnography if the patient is intubated, and functioning.
arterial, pulmonary artery and intracranial monitoring if
the respective devices are in situ. Intermittent monitoring Good personal hygiene is at the heart of essential nursing
of central venous pressure CVP, non-invasive blood pres- care, and many other aspects of essential care (e.g. eye
sure and respiratory rate should be undertaken as indi- care and oral care) are closely related. Personal hygiene
cated by the patient’s condition. 158,166 is often attended to when patients are repositioned, and
whenever they are moved the nurse has an opportunity
A complete record should be kept of all details of the to assess patients, particularly their dependent pressure
patient’s condition, personnel involved, clinical events, areas.
observations and therapy given during transport. The
transporting team should hand over directly to the receiv- Bowel and urinary catheter care are vital but often
ing team providing continuing care for the patient, 163,167 neglected areas of care. When patients are critically ill, the
or should remain during the intervention/procedure to development of preventable complications such as con-
manage the patient’s care. stipation and urinary tract infection may have significant
consequences for them.
SUMMARY All critically ill patients are at risk of infection, and essen-
tial nursing care requires effective application of surveil-
In the management of critically ill patients there is always
an initial focus on assessing and treating the patient’s lance, prevention and control measures that should be
most life-threatening and immediate problems. Early applied equally to all patients. This principle is embed-
attention should then be given to the implementation of ded in the recommended use of standard precautions.
preventative therapies such as venous thromboembolism Critically ill patients are often transferred to other depart-
ments for further investigation or specific interventions.
All transfers pose a potential risk to patients, particularly
if they are unstable. Essential nursing care of patients
during transfer is based on thorough assessment and
TABLE 6.16 Monitoring during transport preparation in an attempt to anticipate their every need
so that adverse events do not occur.
Clinical patient
monitoring Equipment monitoring This chapter has provided a comprehensive overview of
the general but essential nursing care of critically ill
● Circulation ● Pulse oximeter and capnography
● Respiration ● Breathing system alarms patients. It offers a guideline for nurses, which is relevant
● Oxygenation ● Electrocardiograph for most patients, most of the time. As with all other
● Neurological ● Physiological pressures aspects of nursing practice, nursing care and intervention
● Pain score ● Other clinically indicated equipment should be based on a thorough assessment of each indi-
● Patient comfort (e.g. blood gas analysis)
vidual patient.

Case study

Day 1 On examination Kevin was found to have:
Initial presentation ● difficulty breathing and respiratory rate of nearly 60
Kevin is a 45-year-old male who presented to his local country ● sore throat
hospital with increasing shortness of breath and a 4 day history of ● fever with body temperature of 38.1°C
flu-like symptoms, of fatigue, muscular discomfort, cough and ● decreased air entry and vocal resonance right chest
‘chills’. Kevin is obese and has a past medical history of chronic back ● heart rate @ 120
pain. Kevin lives with his wife and children and works for a local ● SpO 2 71–75% on air with central cyanosis
real estate company. ● blood pressure 96/34