Critical Care Nursing A Holistic Approach Part 3

The Critically Ill Pediatric Patient Chapter 11

Children are not small adults. Pediatric Patients Children are not small adults.

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

Neurological Needs to be age appropriate Reflexes Fontanels Mental status Interaction with the environment Knows Mom and Dad Awake, looking around

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

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

Renal Normal urine output Increased risk of dehydration 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

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

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

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

Medications in the Older Adult Start Low and Go Slow Altered Drug Absorption Altered Drug Distribution Altered Drug Metabolism Altered Drug Excretion

The Postanesthesia Patient Chapter 14

Problems in the Postanesthesia Patient AIRWAY! AIRWAY! AIRWAY! AIRWAY! Hypoxemia Hypotension Hypertension Cardiac dysrhythmias Hypothermia

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

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

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

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