Assessment of the Critically Ill Patient. Learning outcomes:. Identify the correct sequence of priorities in assessing the critically ill patient. State why it is important to have a systematic approach to assessment and care, with rational for each step.
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Learning outcomes: • Identify the correct sequence of priorities in assessing the critically ill patient. • State why it is important to have a systematic approach to assessment and care, with rational for each step. • Identify clinical situations in which a patient’s condition may become compromised. • Demonstrate safe and effective assessment and care of the critically ill patient using a systematic approach.
Introduction Healthcare workers should be competent in undertaking a systematic and comprehensive approach to patient assessment to enable early recognition of potential or actual deterioration in the patient’s condition. (DOH, 2001)
Facts • Patients admitted from the wards to ICU when compared to those admitted from A&E have a higher percentage mortality (Goldhill, 2001). • Nearly 80% of hospital inpatients who experience a cardiorespiratory arrest have documented observations of deterioration in the 8hours before the arrest (Bristow et al 2000)
The 3 key stages of recognition and treatment of a critically ill patient: • Understanding that an emergency exists • Identifying and prioritising problems. • Action and evaluation
Assessment • Assessment is the first step in caring for a patient, and assessing the critically ill patient is an essential part of their care. • Careful assessment is fundamental in order to recognise when a patient is becoming compromised. • The nurse acts as patient advocate, monitoring, anticipating potential problems, planning, implementing and constantly evaluating care, and communicating with other MDT staff involved in the patient care.
Patient Assessment Systems • Basic Life support (BLS) • Advanced Life Support (ALS) • Acute Life-threatening Events, Recognition and Treatment (ALERT) • The Advanced Trauma Life Support (ATLS)
All of these assessment systems use a systematic approach in a strict order: • A: airway (with C-spine protection in trauma) • B: breathing • C: circulation • D: deficits in neurological status • E: environment (exposure)
Airway How do we assess airway and why?
Breathing Why do we assess breathing and how do we carry out a comprehensive respiratory assessment?
Circulation What is the significance of circulation and how do we assess the patient?
Central Venous Pressure • Involves insertion of a line to a major vein e.g. subclavian, internal jugular under full aseptic technique. • Patient is placed in supine or Trendelenburg position – promotes venous filling,aids catheter placement and reduces risk of air embolism. • Following insertion a check x-ray is required to confirm position and absence of pneumothorax.
CVP (contd.) • It is a direct measurement of pressure within the right atrium. • Readings should not be used in isolation, but as part of full haemodynamic assessment. • Used as a guide in fluid replacement. • Used to establish deficits in blood volume. • Used for drug administration, maintaining nutrition (TPN)
CVP (contd.) • What is the nursing management of CVP lines?
Deficits in neurological status & environment (exposure) How will you assess neurological status and environment?
Current practice in critical care services • Development of outreach services from critical care specialists to support ward staff in managing patients at risk. • Improved patient monitoring through the use of early warning scores (EWS) or modified early warning scores (MEWS)
QUIZ • What do you now know?