Special Environments - Intensive Care Unit - Student Copy(3) - Tagged 2

Chapter 3: Special Environments

Intensive Care Unit (ICU)

  • Purpose:

    • Provides medical assistance to critically ill patients.

    • May specialize in specific types of care: cardiopulmonary, neurological, trauma, or neonatal.

  • Mobility Tasks:

    • Essential for patient recovery but poses challenges due to:

      • Positioning

      • Bed mobility

      • Transfers

      • Ambulation

Psychological Impact of ICU

  • Family Interaction:

    • Limited opportunities for patients to be around family and friends.

  • Environmental Stressors:

    • Bright lights, unfamiliar noises, restricted mobility, isolation, and disrupted sleep can negatively affect psychological status.

  • ICU Syndrome/Delirium:

    • Extreme confusion resulting from environmental stresses.

  • ICU-Acquired Weakness (ICUAW):

    • State of weakness developing during extended ICU stays, impacting recovery.

  • Importance of Mobility:

    • Early mobility may enhance patient survival rates and recovery.

Early Mobility in Critical Care Units

  • Benefits:

    • Early progressive mobility reduces effects of ICU delirium and ICUAW.

  • Interdisciplinary Team Approach:

    • Mobility goals are set collaboratively, considering scheduled procedures and medications.

  • Mobility Progression:

    • Follows a structured pathway: from passive to active, and supine to standing, then stationary to mobile.

Systemic Approach to Early Mobility

  • Key Components:

    • Focus on necessary work despite challenges in space, patient status, and equipment presence.

    • Participation in interdisciplinary care.

    • Establish patient goals and coordinate mobility activities with nutritional and therapeutic interventions.

    • Create and document a comprehensive mobility plan.

Communication and Preparation

  • Check with Nursing Staff:

    • Gather recent patient status updates and notify them of planned activities.

  • Patient Communication:

    • Inform patients of what to expect during activities and ensure their comfort and safety.

  • Environmental Scanning:

    • Assess surroundings for potential hazards posed by equipment, lines, and tubes prior to mobility activities.

  • Aspects to Monitor Before Activities:

    • Vital signs and ventilator settings.

Equipment Check and Modification

  • Lines and Tubes:

    • Inspect and manage tubing to ensure safe mobility.

    • Avoid pulling or kinking lines; never modify equipment without nursing assistance.

  • Plan Mobility Activities:

    • Anticipate how equipment will need to be adjusted for patient mobilization (e.g., moving IV poles).

Patient Engagement and Safety

  • Using a Gait Belt:

    • Apply as necessary without interfering with medical lines or tubes.

  • Group Lines/Tubes Together:

    • Hold them in one hand for easier management during mobility.

  • Monitoring Patient Tolerance:

    • Observe patient response during mobility and adjust as needed.

  • Completion Protocols:

    • Ensure safe return of patient to bed and check all equipment before notifying nursing staff of activity completion.

Feeding Devices

  • Types:

    • Nasogastric (NG) Tube

    • Gastric (G) Tube

    • Jejunostomy (J) Tube

  • Usage:

    • Provide liquid nutrition, medications, and manage stomach contents.

    • Each device varies by placement location.

  • Precautions:

    • Feeding can usually be disconnected for mobility, but patient should be positioned upright for a period before returning to supine position.

Waste Excretion Devices

  • Types:

    • Urinary catheters (indwelling, condom, external female, suprapubic)

    • Colostomy and urostomy systems

  • Indwelling Urinary Catheter:

    • Continuously drains urine via bladder through urethra, secured by a balloon and can be temporarily taped to prevent movement.

    • Must keep collection bag below bladder level, and drain before mobility.

Cardiovascular System Devices

  • Types:

    • Tunneled central venous catheters, PICC lines, arterial lines.

    • PACs (Swan-Ganz catheters), which monitor cardiac output.

  • Precautions for Use:

    • Monitor for displacements, ensure no pressure alterations, avoid certain shoulder and head movements based on catheter insertion sites.

Respiratory System Devices

  • Techniques:

    • Use of tracheostomy masks, nasal cannulas, and ventilators.

    • Various oxygen delivery methods based on patient needs.

    • Monitor connection integrity and adjust aiding mobility based on patient capability.

Neural System Devices

  • Intracranial Pressure Monitors (ICP):

    • Monitor pressure within the skull with sensors placed surgically.

    • Awareness of activities that affect ICP is necessary.

Patient Positioning Techniques

  • Common Positions:

    • Reverse Trendelenburg, Fowler Position, and Semi-Fowler.

  • Adjustments in Positioning:

    • Important to align head and neck appropriately, as well as adjust bed heights for monitoring and therapy sessions.

Lab Values in Patient Care

  • Importance:

    • Review of significant lab findings and trends is essential for determining an appropriate plan of care.

  • Key Values and Interpretation:

    • Hemoglobin, Hematocrit, Platelets, Sodium, Potassium, Calcium, BUN, Creatinine, and Glucose levels can affect patient's tolerances and treatment approaches.

Summary of Common Lab Value Ranges and Clinical Implications

  • Hemoglobin Levels:

    • Males: 14-17 g/dL, Females: 12-15 g/dL.

    • Implications of high and low levels on activities and patient safety.

  • Electrolyte Levels:

    • Sodium (135-148), Potassium (3.5-5.2), Calcium (8.5-10.5), significant consequences for mobility and cardiac function.

Conclusion

  • Utilize collaborative approaches in critical care environments while maintaining vigilance regarding equipment management and patient safety throughout mobility activities.