CRITICAL CARE NURSING Susan M Clark, LVT, VTS(ECC) Anesthetist Radiology Tech Dental Tech Surgical Assistant Laboratory Tech Nurse Veterinary Technician Nursing Care Compassion for patients and owners. Patient comfort. Patient advocate. Monitoring for changes in medical status. Communication with doctors and staff. Client education and counseling. Critical Care Nursing Critical care nursing is the field of nursing with a focus on the utmost care of the critically ill or unstable patient. (Wikipedia) Patient Doctor Client/Owner RESPONSIBILITIES to.. 1
Triage Recognize patients who need immediate care. Whether working in an emergency setting, ICU, or in general practice, all technicians are capable of providing care for the critical patient. Mentation Vital signs Painful Trauma Recent toxin ingestion Seizure Hx of illness Assessment & Monitoring Temperature (T) Pulse Rate (PR) Pulse Quality (PQ) Heart Rate (HR) & Rhythm Respiratory Rate (RR) Respiratory Effort (RE) Mucous Membrane Color (MM) Capillary Refill Time (CRT) Blood Pressure (BP) Pain Assessment Temperature Hyperthermia (fever, heat stroke, pain) Hypothermia (shock, cardiac disease, exposure, dehydration) Pulse Rate Should match heart rate. Tachycardia (pain, shock, v-tach, toxins) Bradycardia (heart block, hyperkalemia, hypoglycemia) Arrhythmia (+/- pulse deficits) Pulse Quality (Strong, Fair, Weak, Bounding) Rough assessment of BP Heart Rate & Rhythm Should match pulse rate. Tachycardia (pain, shock, v-tach, toxins) Bradycardia (heart block, hyperkalemia, hypoglycemia) Arrhythmia (cardiac dz, metabolic dz) Respiratory Rate Tachypnea (pain, pulmonary dz, cardiac dz, metabolic dz) *Differentiate from panting or purring. Bradypnea (eminent pulmonary arrest, metabolic dz) Respiratory Effort Flared nostrils, Abdominal and/or open-mouthed breathing Stridor (laryngeal paralysis, upper airway obstruction) Stertor (brachycephalic syndrome) Orthopnea (pulmonary/cardiac dz) 2
Mucous Membrane Color anemia, hypovolemia, endotoxemia, hypoxia, icterus Capillary Refill Time <1 sec (endotoxemia, hypertension, fluid overload) >2 sec (hypovolemia, shock, dehydration) Blood Pressure Systolic <90 mmhg = hypotension Mean Arterial Pressure <60 mmhg = no renal perfusion Systolic >180 mmhg Hypertension (cardiac dz, renal dz, hyperthyroidism, pain) Pain Assessment Trauma, intervertebral disc disease, acute abdominal disease, cancer, arthritis. Preparing for the Critical Patient O2 Supplementation ready. Prep for IV catheter placement. (Have catheter, scrub, tape, clippers, fluids ready. Start warming if warranted. Anticipate doctor s orders. Ready for CPR if cardiopulmonary arrest seems imminent. Think of critical care monitoring as serial triage assessments. A critical patient s status can change quickly; within hours, or even minutes. Good nursing requires that we anticipate what may happen, and prepare accordingly. Frequent monitoring is often necessary. Technician monitoring does not require a doctor s order. 3
Attending veterinarian should be alerted when negative changes in patient status are noted. Oxygen Delivery Proper supportive care can be initiated by the technician. Oxygen, patient warming, recheck of vital signs, ECG, SpO2, BP.all information that can be collected while waiting for the doctor. Nutrition Hypoproteinemia Hypoglycemia Hyperglycemia Pancreatitis Hepatic Lipidosis Promote healing Protect GI tract Troubleshooting changes in status. Recheck vital signs whenever necessary. Some patients may need constant supervision. Look for signs of sepsis; check catheters, tubes, etc. Don t be afraid to make suggestions to attending veterinarian. Critical Patient Check List Frequent monitoring Control Pain Patient Comfort Fluid Support O2 Supplementation Heat Support Nutritional Support 4
Intensive Care Doctor Technician Staff Client Communication The responsibility of receiving and delivering information between doctor and client is often that of the technician s. Clients will sometimes give to, or ask for information from a staff member instead of the doctor. In order to provide the best care possible, doctors, technicians and staff must be able to communicate with each other. Ask your veterinarian to discuss protocols in your hospital for dealing with critical patients. Share concerns, and be willing to listen to constructive comments. Gaining a client s trust is an important part of successful patient care. Without client approval, no treatment may be initiated. Sometimes clients make decisions that are different than what we might decide for our own pet. Clients should to be educated as to why certain diagnostics or procedures need to be performed, and are in the best interest of their pet. As professionals, we must respect that decision, knowing that their pet is in your care because it is loved. 5
WE MAKE A DIFFERENCE! There will be times when your most important role is helping someone say goodbye to a beloved pet. AVECCT.ORG 6