1. Critical Care Nursing A Holistic Approach Part 3

2. The Critically Ill Pediatric Patient
Chapter 11

3. Children are not small adults.
Pediatric Patients
Children are not small adults.

4. Vital 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

5. Neurological Needs to be age appropriate Reflexes Fontanels
Mental status
Interaction with the environment
Knows Mom and Dad
Awake, looking around

6. Cardiovascular 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

7. Respiratory 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

9. Renal Normal urine output Increased risk of dehydration
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

10. The Critically Ill Pregnant Woman
Chapter 12

11. Critical 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

12. Nursing 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

13. The Critically Ill Older Patient
Chapter 13

14. Physiologic 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

15. Medications in the Older Adult
Start Low and Go Slow
Altered Drug Absorption
Altered Drug Distribution
Altered Drug Metabolism
Altered Drug Excretion

16. The Postanesthesia Patient
Chapter 14

17. Problems in the Postanesthesia Patient
AIRWAY! AIRWAY! AIRWAY! AIRWAY!
Hypoxemia
Hypotension
Hypertension
Cardiac dysrhythmias
Hypothermia

20. Malignant 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

21. Postoperative 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

22. Interfacility Transport of the Critically Ill Patient
Chapter 15

23. Mode 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

24. EMTALA Emergency 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