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POST CARDIAC SURGICAL MANAGEMENT OF PATIENTS

(CARE IN ICU)

PRESENTED BY

THIERRY YUNISHE

NOVEMBER 16th, 2012

BTech,ADN,HND,RNCCN,

INTENSIVE CARE NURSE.

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INTRODUCTIONPost cardiac surgery requires critical care of patients. Critical care is an exciting field with diverse and complex challenges. These challenges include identifying pathophysiology in the individual patient, integrating care providers from multiple disciplines, addressing social and psychological concerns in the sick patient, to name but a few. As a result of this complexity, care in the intensive care unit (ICU) must be guided by a thoughtful and organized approach.

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INTENSIVE CARE UNIT (ICU)

Intensive care means providing the best care for patients with resources available.Critical care is the highest level of monitoring and intensive care in a hospital of patients with life-threatening failure of single/multiple organs or body systems.

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INTENSIVE CARE UNIT

EQUIPMENTVentilatorsCardiac MonitorsDefibrillatorsSyringe/ Infusion PumpsLaryngoscopeSuction Apparatus, etc

DRUGSInotropesAnalgesicDiureticsElectrolytesAnti arhythmicsAnestheticsAntiemetic, etc.

Some of the equipment and drugs used in ICU can be found on every ward but some are specialised.

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TYPES OF PATIENTS ADMITTED INTO THE ICU

The types of patients admitted into the ICU includes:

Post cardiac-surgical patients from the operating theatre after an open/ close heart surgery.

Post diagnostic or interventional catheterization patients who are still critically ill and require intensive monitory.

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PREPARATIONS

In anticipation to receive a patient in to the ICU, the bed station is prepared as follows:

Clean and make up a post-operative bed.

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TYPES OF BEDS PRESENT IN THE ICUBABY THERM

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TYPES OF BEDS PRESENT IN THE ICU

ADULT BED

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A MONITOR IS PREPARED

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A MECHANICAL VENTILATOR IS PREPARED

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PATIENT’S TABLE IS PREPARED

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EMMERGENCY TROLLY IS PREPARED

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Prior to the end of the surgery, a theatre staff calls for the prepared bed. Five minutes before transportation of the patient from the theatre to the ICU, the theatre circulatory nurse informs the ICU staff to get set for reception.

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Transfering of patient from the operating theatre to the ICU

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Anesthetist setting the ventilator according to the required ventilation needs of the patient

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Stabilization of the patient in the ICU

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Care intra-ICU: The core concernParametry monitoring and charting.The Haemodynamic monitoringMechanical conventional ventilation and respiratory careHaemogas and blood chemistry analysis

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LABORATORY BASELINE EXAMINATION (Haemogas laboratory Exam; invasive)

HctHbpHPCO2PO2HCO3BE

SAT %NaKCLGlycaemiaCaLactateMg

When the patient is stabilized, blood chemistry and blood gas analysis is done to roll out acidosis or alkalosis of any type, and abnormalities with the chemistry

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ICU PROCEDURESAirway managementMonitoring Checking blood gas/electrolytesNeurological assessmentsNG tube/catheter insertion and careAdministration of drugsECGEchocardiographyX-Ray PhysiotherapyNutritionBasic/Advanced life support and resuscitation

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ICU PROCEDURES

Health care professionals working in the ICU provide a ‘round–the- clock’ intensive Monitoring/ management.In addition to the vitals signs that are taken, a modified aldrete score is completed on patients who are not fully conscious.The frequency of observations is also based on patient’s needs

Observations/vital signs

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ICU PROCEDURES

Separate equipmentHand washingLimit guardiansCareful aseptic techniqueWound managementLaundryClean environment

Preventing infection

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ICU PROCEDURES

Be aware the catheters are a major source of infectionTwice daily cleaning Catheters or catheter bags are not re-use.

Catheter care

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ICU PROCEDURES

Right time, right patient, right route, right medication, right dose and right documentationNew medication are given immediately when prescribedLines with particular drugs are marked and not used for other medicationsIV drips are marked (labelled) if anything is added to them.Medications are not mix unless you are sure they are compatible

Drug administration

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ICU PROCEDURES

Rationale for optimal positioning includes:Preventing pressure soresPreventing thrombo-embolismsProtecting the unconscious patientRelieving breathlessnessReducing hypotension

Positioning

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ICU PROCEDURES

All patients on IV fluids should have an up-to-date fluid balance Nurses record input and output regularly Urine output should range from 0.5-1ml/kg/hr and it should not be concentrated.

Fluid balance

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ICU PROCEDURES

Patients detailsDiagnosisSurgery doneMedicationsIV infusionsConsciousness level.Any other useful information.

Respiratory and circulatory assessmentPositioningFluid balanceNutritionDrugs againProgress

Handing over of patient

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DISCHARGE OF PATIENT FROM THE ICUThe patient is only discharged from the ICU when he/she is conscious, awake, extubated and breathing freely.When the patient is no longer on any inotropes.When there is no bleeding from the cardiotomy. When patient is haemodynamically stableGood x-ray results.Arterial/ CVP lines removed.The discharged summary form filled.Then the post operation ward is informed of the discharged patient.

DISCHARGE OF PATIENT FROM THE ICU

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CONCLUSIONThe perfect work done in the operating theatre should be accompanied by an excellent post surgical care in order to yield the outcome so desired; which is to restore health to as many people affected with heart diseases as possible.

CONCLUSION

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THIERRY YUNISHE

BTN, ADN,HND, RNINTENSIVE CARE NURSE.

St. Elizabeth Catholic General Hospital and Cardiac Centre Shisong.

ContactEmail:yunishe@yahoo.co.ukTelephone:+23774074742.