Download e-book for iPad: Critical Care Nursing Care Plan by RN, MS, CCRN, Sheree Comer
By RN, MS, CCRN, Sheree Comer
This article presents particular, special details to aid you in selecting wishes and plans of care and assist you to advance your individual particular nursing care plans for handling acutely ailing sufferers in serious care settings. prepared through physique structures, the care plans use NANDA-approved nursing diagnoses and record particular interventions and rationales.
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Additional info for Critical Care Nursing Care Plan
Auscultate heart sounds for new Arterial emboli may affect the heart and cause myocardial infarction. New murmurs may Related to: valvular vegetation emboli, plateletfibrin emboli, and immunologic responses causing allergic vasculitis; embolu Defining characteristics: petechiae, arthritis, arthralgia, myalgias, decreased peripheral pulses, Janeway’s lesions, Roth‘s spots, Osler’s nodes, lower back pain, splinter hemorrhages to subungual Due to the close proximity of aortic valve cusps to the con- CARDIOVASCULAR SYSTEM INTERVENTIONS RATIONALES or changed murmurs, pericardial friction rubs, or abnormal lung sounds (crackles, rales).
Patients who have had prosthetic valves placed and who develop endocarditis are divided into early (occurring less than two months postoperatively) and late (occurring greater than two months postoperatively) classes, and develop chills, fever, leukocytosis, and/or a new murmur. Mortality is higher in early prosthetic valve endocarditis and is a serious problem. MEDICAL CARE Antibiotics: penicillin is the treatment of choice for Streptococcus viridans, with cephalothin or vancomycin being alternate choices; penicillin plus gentamicin is the treatment of choice for Steptococcus faecalis; synthetic penicillins, such as oxacillin or nafcillin, cephalothin and/or gentamicin are used in Staphylococcus epidermidis Laboratory: a series of blood cultures is done to isolate the causative organism and sensitivity to antimicrobial agents; CBC is used to assess for anemia that may occur in up to 70% of patients, 32 to monitor leukocyte levels, and to assess platelet counts; sedimentation rates may increase; immune titers show antigen-antibody response Electrocardiography: shows alterations in conduction, dysrhythmias, ischemia Echocardiography: used to establish diagnosis, to determine underlying cardiac disease, to estimate myocardial contractility, and demonstrate early mitral valve closure and aortic insufficiency Nuclear cardiologic testing: Technetium-99 scans and gallium-67 imaging used to evaluate the extent of the infective process and to evaluate potential as a surgical candidate Surgery: valve replacement is necessary if patient develops intractable congestive heart failure with hemodynamic compromise, persistent bacteremia despite antimicrobial treatment, prosthetic valve endocarditis, major systemic emboli, gram negative or fungal infection; drainage of abscesses or empyema; repair of peripheral or cerebral mycotic aneurysms Prophylaxis: prophylactic antibiotic therapy must be prescribed prior to dental procedures, urethral or gynecological procedures, or surgery CRITICAL CARE NURSING CARE PLANS areas, hematuria, oliguria, anuria, chest pain, shortness of breath, dyspnea, confusion, weakness, convulsions, coma, hemiplegia, aphasia, hemiparesis, cardiac tamponade, pericardial friction rub, murmur, dysrhythmias, conduction defects, cold clammy skin, cyanosis, mental status changes, hypotension, tachycardia, decreased urinary output, increased BUN Outcome Criteria Patient will achieve and maintain adequate tissue perfusion to all body systems.
Activity limitation may minimize the potential for dislodgment of the dot. Elevate legs while in bed or sitting in chair. Reduces swelling and increases venous return. Some experts believe that elevation may actually enhance the release of thrombi. Observe for positive Homanb sign (pain in calf upon dorsiflexion of foot). Homan’s sign may or may not be present consistently and should not be used as a sole indicator of thrombophlebitis. Perform active or passive ROM exercises while at bedrest. Promote increased venous blood return and decrease venous stasis.
Critical Care Nursing Care Plan by RN, MS, CCRN, Sheree Comer