Critical Care Nursing
A Holistic Approach
Part 3
The Critically Ill Pediatric Patient
Chapter 11
Pediatric Patients
Children are not small adults.
Copyright © 2005 Lippincott Williams & Wilkins. Instructor's Resource CD-ROM to Accompany Critical Care Nursing: A Holistic Approach, eighth edition.
Vital Signs
• Normals change with age
• Blood pressure is the last vital sign to change in a child
with shock
• Bradycardia is not well tolerated in young children and
can be precipitated by hypoxia
• Tachycardia can be a nonspecific response to many
conditions
• Tachypnea might indicate respiratory distress
• Bradypnea may indicate respiratory arrest
Copyright © 2005 Lippincott Williams & Wilkins. Instructor's Resource CD-ROM to Accompany Critical Care Nursing: A Holistic Approach, eighth edition.
Neurological
• Needs to be age appropriate
• Reflexes
• Fontanels
• Mental status
– Interaction with the environment
– Knows Mom and Dad
– Awake, looking around
Copyright © 2005 Lippincott Williams & Wilkins. Instructor's Resource CD-ROM to Accompany Critical Care Nursing: A Holistic Approach, eighth edition.
Cardiovascular
• Skin color
– Peripheral cyanosis normal for newborn only
– Central cyanosis always abnormal
– Mottling – take into consideration room temperature
• Capillary refill time is less then 2 seconds
Copyright © 2005 Lippincott Williams & Wilkins. Instructor's Resource CD-ROM to Accompany Critical Care Nursing: A Holistic Approach, eighth edition.
Respiratory
• Infants under 6 months are obligatory nose breathers
• Smaller airway in diameter and length, easily occlude
• Watch for retractions
– Abdominal breathing
– Seesaw breathing
• Listen for sounds
– Grunting
– Stridor
– Wheezing
Copyright © 2005 Lippincott Williams & Wilkins. Instructor's Resource CD-ROM to Accompany Critical Care Nursing: A Holistic Approach, eighth edition.
Copyright © 2005 Lippincott Williams & Wilkins. Instructor's Resource CD-ROM to Accompany Critical Care Nursing: A Holistic Approach, eighth edition.
Renal
• Normal urine output
– Infants: 2mL/kg/hour
• Decreased ability to concentrate urine
– Children: 1mL/kg/hour
• Increased risk of dehydration
– Dry mucous membranes
– Poor skin turgor
– Sunken fontanels
Copyright © 2005 Lippincott Williams & Wilkins. Instructor's Resource CD-ROM to Accompany Critical Care Nursing: A Holistic Approach, eighth edition.
The Critically Ill Pregnant Woman
Chapter 12
Critical Care Complications of Pregnancy
• Severe preeclampsia
• HELLP – Hemolysis, elevated liver enzymes and low
platelets
• DIC – Disseminated intravascular coagulation
• Amniotic fluid embolus
• ARDS – Acute respiratory distress syndrome
Copyright © 2005 Lippincott Williams & Wilkins. Instructor's Resource CD-ROM to Accompany Critical Care Nursing: A Holistic Approach, eighth edition.
Nursing Diagnoses
• Anxiety, Stress related to poor/uncertain pregnancy
outcomes
• Anticipatory Grieving related to threat to self
• Fear related to fetal well-being
• Potential Injury related to infection
• Alterations in Family coping related to hospitalization
• Impaired Fetal Oxygen Transport related to maternal
position, blood loss, or placental trauma
Copyright © 2005 Lippincott Williams & Wilkins. Instructor's Resource CD-ROM to Accompany Critical Care Nursing: A Holistic Approach, eighth edition.
The Critically Ill Older Patient
Chapter 13
Physiologic Changes of the Older Adult
• Many changes occur in every system
• Table 13-1 is a summary of these changes
• The most troublesome changes are:
– Loss of sight
– Loss of hearing
– Decrease in quality sleep
– Cognitive changes
Copyright © 2005 Lippincott Williams & Wilkins. Instructor's Resource CD-ROM to Accompany Critical Care Nursing: A Holistic Approach, eighth edition.
Medications in the Older Adult
Start Low and Go Slow
• Altered Drug Absorption
• Altered Drug Distribution
• Altered Drug Metabolism
• Altered Drug Excretion
Copyright © 2005 Lippincott Williams & Wilkins. Instructor's Resource CD-ROM to Accompany Critical Care Nursing: A Holistic Approach, eighth edition.
The Postanesthesia Patient
Chapter 14
Problems in the Postanesthesia Patient
• AIRWAY! AIRWAY! AIRWAY! AIRWAY!
• Hypoxemia
• Hypotension
• Hypertension
• Cardiac dysrhythmias
• Hypothermia
Copyright © 2005 Lippincott Williams & Wilkins. Instructor's Resource CD-ROM to Accompany Critical Care Nursing: A Holistic Approach, eighth edition.
Copyright © 2005 Lippincott Williams & Wilkins. Instructor's Resource CD-ROM to Accompany Critical Care Nursing: A Holistic Approach, eighth edition.
Copyright © 2005 Lippincott Williams & Wilkins. Instructor's Resource CD-ROM to Accompany Critical Care Nursing: A Holistic Approach, eighth edition.
Malignant Hyperthermia
• Rare, autosomal dominant disorder
– Assess for family history
– Increase in temperature – as high as 46˚C
– Unexplained tachycardia, sweating, labile BP
• Treatment
– Dantrolene
– Cooling of the patient
– 100% oxygen
Copyright © 2005 Lippincott Williams & Wilkins. Instructor's Resource CD-ROM to Accompany Critical Care Nursing: A Holistic Approach, eighth edition.
Postoperative Nursing Care
• Patient able to maintain airway
• Patient’s mental status is assessed frequently until he or
she is easily aroused and back to baseline
• Pain control
• Management of postoperative nausea and vomiting
Copyright © 2005 Lippincott Williams & Wilkins. Instructor's Resource CD-ROM to Accompany Critical Care Nursing: A Holistic Approach, eighth edition.
Interfacility Transport of the
Critically Ill Patient
Chapter 15
Mode of Transport
• Physician must order type of transport – The level of
transport should be the same as the level of care the
patient is already receiving.
• Ambulances
– BLS
– ACLS
• Air transport – All ACLS
– Helicopter
– Fixed wing
Copyright © 2005 Lippincott Williams & Wilkins. Instructor's Resource CD-ROM to Accompany Critical Care Nursing: A Holistic Approach, eighth edition.
EMTALA
Emergency Medical Transfer Active Labor Act
• Hospitals must provide screening exam
• Patient should be stabilized prior to transport
– Medical certification that benefits outweigh risks
• Receiving facility has accepted care of the patient
– Physician to physician report
– Nurse to nurse report
• Transport personnel have the required training and
equipment for a safe transport
Copyright © 2005 Lippincott Williams & Wilkins. Instructor's Resource CD-ROM to Accompany Critical Care Nursing: A Holistic Approach, eighth edition.
Copyright © 2005 Lippincott Williams & Wilkins. Instructor's Resource CD-ROM to Accompany Critical Care Nursing: A Holistic Approach, eighth edition.