ICU Outcomes 1. Caring for a client with multi-system failure is certainly a specialty of ICU nurses. This particular type of care requires a lot of focus and attention to details. Not only are ICU nurses treating one particular diagnosis but monitoring all other malfunctions. This includes: treating each failure, assuring no medications have negative interactions, maintaining quality of life, aiding the patient to feel as normal and “human” as possible. 2. ICU nurses play a large role in assisting clients families through these difficult and often very stressful times. This particular role is highly therapeutic and uses psycho-social interventions. This includes the following: 1. Helping family member to adjust 2. Teaching the family about what is happening to the client and ways they can help 3. Aiding them in finding their role to assist with the client in post ICU care 4.Reiterating things said by MD to avoid any confusion 5. Field questions honestly and as therapeutically as possible 6. Encourage questions and discussion 3. Adenosine Pharmacological Action: helps to correct faulty AV Node functioning enabling the heart to have a normal sinus rhythm. Side Effects: dizziness, blurred vision, SOB, chest pressure, facial flushing, transient arrhythmias Special Considerations: When given IV warm to room temperature. Assure that solution is clear (can crystallize upon refrigeration) Magnesium Sulfate Pharmacological Action: treats hypomagnesia and Torsade De Pointes arrhythmias. Side Effects: drowsiness, decreased respiratory rate, bradycardia, hypotension, diarrhea Special Consideration: Must monitor HR, BP, RR, and ECG throughout administration. Institute seizure precautions. Monitor for newborns for hypotension, respiratory depression. Monitor I + O Nitroglycerin Pharmacological Action: Reduces chest pain by acting as a vasodilator Side Effects: palpitations, syncope, hypotension, restlessness, weakness Special Considerations: Monitor for interactions with other medications such as Aspirin, Heparin, or Calcium Channel Blockers. Watch for hypotension and dizziness Vasopressin Pharmacological Action: alters the permeability of the renal tubes thus allowing for the reabsorption of water. It will also act as a vasoconstrictor Side Effects: dizziness, chest pain, abdominal cramps, diarrhea Special Considerations: Monitor EG throughout therapy and cardiopulmonary resuscitation. Assess for s/s of dehydration. Weigh patient daily and monitor I + O. Assess for edema. Watch for signs of water intoxification Sodium Bicarbonate Pharmacological Actions: Sodium Bicarbonate is an alkaline so when administered it will increase the pH of the blood and urine thus making them less acidic. Side Effects: Metabolic alkalosis, hypernatremia, hypocalcemia, water retention and edema, IV route may cause irritation at site. Special Considerations: Assess fluid balance, monitor for s/s of alkalosis, observe IV site closely to avoid extravasation, tissue irritation, or cellulitis 4. Ordered amount of drug ´ patient’s weight (kg) ´ 60 ___________________________________ Drug concentration = I.V. infusion rate (in ml/hour) While you’re working your shift on the progressive care unit, the physician phones in an order to start a patient’s I.V. dopamine infusion at 5 mcg/kg/minute. The patient weighs 73.5 kg. 5 X 73.5 X 60 ————— = 6.89 ml/hour 3200 5. Care of a client on a ventilator 1. Check ventilator settings and modes: When making assessment of patient including their vital signs, oxygen levels, lungs sounds, etc be sure to check the ventilator in order to assure that it is set at the proper levels (respiratory rate, fraction of inspired, tidal volume, peak inspiratory pressure) 2. Suction appropriately: suction only when needed. Don’t instill normal saline into the tube. Limit suctioning pressure and suction for as little time as possible. 3. Assess Pain and sedation level 4. Prevent Infection: Keep head of bed elevated to semi-fowlers. Maintain oral care. Can use prophylaxis for DVT and peptic ulcer disease.