Download - Critical Care Nursing A Holistic Approach Part 3

Critical Care Nursing A Holistic Approach

Part 3

The Critically Ill Pediatric Patient

Chapter 11

Copyright © 2005 Lippincott Williams & Wilkins. Instructor's Resource CD-ROM to Accompany Critical Care Nursing: A Holistic Approach, eighth edition.

Pediatric Patients Pediatric Patients

Children are not small adults.


Vital SignsVital 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


NeurologicalNeurological

• Needs to be age appropriate

• Reflexes

• Fontanels

• Mental status

– Interaction with the environment

– Knows Mom and Dad

– Awake, looking around


CardiovascularCardiovascular

• 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


RespiratoryRespiratory

• 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


RenalRenal

• 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

The Critically Ill Pregnant Woman

Chapter 12


Critical Care Complications of PregnancyCritical 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 DiagnosesNursing 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 AdultPhysiologic 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 AdultMedications in the Older Adult

Start Low and Go SlowStart 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 PatientProblems in the Postanesthesia Patient

• AIRWAY! AIRWAY! AIRWAY! AIRWAY!

• Hypoxemia

• Hypotension

• Hypertension

• Cardiac dysrhythmias

• Hypothermia


Malignant HyperthermiaMalignant 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 CarePostoperative 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 TransportMode 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


EMTALAEmergency Medical Transfer Active Labor Act EMTALAEmergency 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

Download - Critical Care Nursing A Holistic Approach Part 3

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