First scene "Handoff, ICU, Bedside"
Family involvement, patient no conscious, RN returns, turning off med, double check of med at the pump and at site, plan for the day, target RASS and Pain Score, looking at SAT, NVPS.
Second scene "SAT, SBT - one hour later"
Patient is now a RASS-1, pain evaluation, CAM evaluation - hypoactive delirium, RN RTN discussion with patient and family about SBT, RT mentions STEER, conversation with family about baseline patient status, removal of restraint.
Third scene "MD Rounds - Two Hours Later"
RN coaches family about their role in rounds, target RASS, actual RASS, CAM assessment and meds for sedation by RN, patient is on precedex & propofol & neosynephrine, RN starts rounds, MD orders to not turn propofol back on and lesser dose of precedex for SBT, Physical Therapist evaluates patient.
Last scene "Next Shift"
Patient is done with sprint and back on vent and just finished resting, secure ETT, re-do CAM med changed during the day, RN organizes lines etc as they are teaching & involving family, orthostatic BPs, patient has been OOB to chair previously, patient follows two step command, discussion, ambulate, document.
8 фев 2011
