2.  Nutrition
 Anxiety
 Pain
 Impaired communication
 Sensory-perceptual problems
 Delirium is not “ICU Psychosis”
 Sleep problems
 Caregiver issues

4. Common Critical Care Orders:
 Hourly I/O (foley, drains, IVF)
 Continuous monitoring (Cardiac,
Sa02, hemodynamic)
 Frequent vitals
 Tube feeding
 Labs-from central line
 ABGs- from art line
 Titration of drips
Medications
(IV Push, continuous infusions,
intermittent infusions)
 Sedation
 Pain management
 Paralytics
 TPN
 Inotropic Agents
 Vasopressors
 Antihypertensive & Vasodilator Agents
 Antiarrhythmic Agents
 Antiplatelet Agents
 Nebulizers
 PPI/H2Blockers
 Insulin

5.  Invasive Hemodynamic monitoring
 Arterial pressure
 Pulmonary artery pressure
 Intraaortic Balloon pump
 Ventricular Assist devices

6. Interventions
 Positioning
 Often HOB <45deg
 Phebostatic axis
 Maintain patency of the line
 Saline flush/pressure bag
 Respond to alarms
 Check CMS
 Sterile technique
 Monitor for s/s of bleeding, infection,
etc
Complications
 Arterial- hemorrhage, clotting,
neurovascular compromise
 PA- air embolus, infection, sepsis, PA
rupture/infarction
 IABP- vascular injuries, infection,
displacement of the balloon,
mechanical complications
 VAD- bleeding, cardiac tamponade,
infection

7. o Monitor weights
o Lab values (which ones?)
o Hourly I/o
o Vitals, hemodynamics
o Temperature
o Access site
o Infection
o Bleeding

9. Types of airways
 Oral
 Nasal
 Endotracheal
 preferred
 Nasotracheal
 If positioning of head/neck can cause
injury
 Tracheotomy
Indications for artificial airways
 Upper airway obstruction
 Apnea
 Unable to maintain airway/clear
secretions
 Respiratory distress
 Need for POSITIVE PRESSURE
VENTILATION

10. Complications
 Unplanned extubation
 Aspiration
 VAP
 Barotrauma
Interventions
 Maintain tube placement
 Cuff inflation
 Monitor oxygenation/ventilation
 Tube patency
 Oral care
 Suctioning

11.  Short term (less than 3 days) versus long term
 Team approach
 Spontaneous breathing trial
 During the day
 Psychological support to patient and family
 Supplemental 02 maybe required
 Chronic mechanical ventilation