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MindMap Gallery 12. Functional support for critically ill patients

12. Functional support for critically ill patients

This is a mind map about functional support for twelve critically ill patients, including mechanical ventilation, analgesia and sedation, etc. Hope this helps!

Edited at 2023-11-24 17:11:58

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12. Functional support for critically ill patients

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Outline

Nursing 11 Functional Monitoring and Assessment of Critically Ill Patients
- 15
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12. Functional support for critically ill patients

Section 1 Mechanical Ventilation (MV)

Overview

concept

Mechanical ventilation (MV) is a ventilation method that uses a ventilator to establish a pressure difference between the airway opening and the alveoli to provide respiratory support to patients with respiratory insufficiency. It is a ventilation method that uses mechanical devices to replace, control or change spontaneous breathing movements. .

Principle: Establish atmosphere-alveolar pressure difference

During mechanical ventilation, the airway plateau pressure generally does not exceed 30~35cmH2O

Classification

Invasive mechanical ventilation

Concept: The ventilator is connected to the patient through an artificial airway such as oral/nasal tracheal intubation, laryngeal mask, or tracheostomy intubation.

Adaptations and taboos

Indications

As long as the patient has respiratory dysfunction, causing severe hypoxia or carbon dioxide retention, mechanical ventilation treatment is required.

Contraindications

Bullae and undrained pneumothorax

Hypovolemic shock without replenishing blood volume

severe pulmonary bleeding

tracheoesophageal fistula

EG: Severe craniocerebral trauma accompanied by skull base fracture, deep coma, and oral and nasal bleeding: Orotracheal intubation is the best choice

How to operate

Common parameter settings and precautions

Tidal volume setting: 5~12ml/kg

Common alarm causes and solutions

The focus of observation on the patient’s condition

1. respiratory function

Hypoxia: pulse and breathing increase, requiring close observation

Carbon dioxide retention: skin flushing, hyperhidrosis, and superficial venous filling

Hypoxemia: cyanosis of lips and nail beds

2. Loop function

3. consciousness

4. blood gas analysis

5. body temperature

6. other

Precautions

1. Prevent detachment

2. Prevent airway obstruction

3. Prevent airway damage

4. Observe Ventilator-Associated Pneumonia

5. Prevent ventilator-associated pneumonia

non-invasive mechanical ventilation

Overview

concept

There is no need to establish an artificial airway. The ventilator is connected to the patient through an oronasal mask, nasal mask, etc.

Disadvantages: Requires patient to be awake and cooperate

patient observations

1. ventilation effect

2. Ventilator working status

3. Air leakage compensation

4. Human-machine cooperation

5. Others: airway secretions, flatulence, reflux, aspiration

Common alarm causes and treatments: refer to Invasive

Section 4 Analgesia and Sedation

Overview

analgesia

1. Common medicines

NSAIDs: aspirin, ibuprofen

Opioid analgesics: morphine, fentanyl

Pay attention to the patient's respiratory depression

Non-opioid analgesic: Tramadol

Local anesthetic analgesics: lidocaine, bupivacaine

2. non-pharmacological intervention methods

transcutaneous electrical nerve stimulation therapy

distraction method

believe in dharma

Deep breathing and gradual relaxation

3. Route of administration

Routine administration methods: oral, intramuscular, intravenous and transdermal administration

Continuous subcutaneous injection: The analgesic is continuously injected into the patient's subcutaneous (usually abdomen) using a microinjection pump.

epidural injection

patient controlled pump

Route of administration of sedative drugs

Mainly continuous micro-pump intravenous infusion

Implementation of analgesia and sedation

Set management goals

Set reasonable analgesia and sedation goals

Patients who can express themselves: NRS (numeric rating scale) <4 points

Patients who cannot express, have good motor function, and whose behavior can be observed: BPS (Pain Assessment Scale) <5 points, CPOT (Critical Care Pain Observation Tool) <3 points

correct assessment

daily sedation interruption

drug withdrawal

Analgesia first, then sedation

Stop sedation first and then stop analgesia

Planned dose reduction of medications

Ensure patient safety

Sedation and analgesia monitoring and care

Take medication correctly as directed by your doctor

Closely observe drug effects and adverse reactions

Close monitoring and prevention of complications

1. ICU active myasthenia

2. circulatory function inhibition

3. Respiratory function depression

4. Digestive function effects

5. Other: pressure injury, deep vein thrombosis, but no intracranial hemorrhage

Delirium prevention and treatment

ESCAPE bundle strategy

1. E:early mobility exercise early mobility

2. S: sleep management, SAT, SBT sleep management, autonomous awakening test

3. C:calm choice of sedation sedation drug selection

4. A:assess pain and analgesia pain assessment, timely analgesia

5. P:psychosis evaluation mental state evaluation

6. E: emotional communication emotional communication

family members involved