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.