Best Practices in Nursing Care for Adult ICU Patients

Introduction:

The Nursing and Midwifery council (2015) Code of conduct stated that while it comes to treat an adult patient in intense care unit (ICU), nurses, must comply with all NMC codes to assess and recognize the health needs of the patient and meet these health needs. while dealing with adult ICU patients, nursing professionals must practice in best interest of the patient to promote patient’s holistic wellbeing. For those seeking guidance in developing a comprehensive care plan, healthcare dissertation help can provide valuable insights. There are three major steps that are associated with a robust and effective care plan developed for an ICU patient such as planning, intervention and review.

NMC (2019) mentioned that while it comes to provide the high-quality care to a critically ill patient in the ICU, nurses must have the high level of expertise as well as skill in evaluating and assessing health needs of intense care patients, administering care and recognizing their complications (NMC, 2019).

The following case scenario is presented to discuss the roles and responsibilities of nursing professionals in promoting the best interest decision making while caring an adult patient in the ICU which is intubated with ASB ventilation. In nursing professional self-refection is one of the most important aspects that enables nurses to reflect on the experiences that they gather in their practice thereby assisting them to find out their professional areas if improvement and professional strengths. Here Driscoll’s Reflecting model is gong to be used in this study to reflect on the planning, intervention of care and review of the care into three steps such as What, so what and now what. Through using this model, this study will first discission the planning of care to the adult patient in ICU ventilation. Then this study will discuss the intervention that had been implemented into the care plan to provide the compassionate and person centered care to the adult patient in the ICU tom meet his holistic wellbeing, In the last segment of this reflection, now what, this study will discuss the review the entire care plan thereby determining the professional areas that nurses need to improve to provide the high quality care to the patient in ICU.

Case study:

A 45 years old gentleman was placed under the ASB (assisted spontaneous breathing) ventilation in ICU with episodic shortness of breathing and chest pain. ASB ventilation is generally used in the modern healthcare to provide the full breathing support to the patents which is unable to take the oxygen from air (Guidet et al. 2018). First a physical heath assessment has been done to check his current physical health condition. From this assessment it has been seen that the oxygen saturation is be=very low (87% in the patient) and the patient hah breathing rate the body temperature, the BP, pulse rate, circulation and heart rate are normal for the patient. The assessment of the premedical history and current health status of the patient had shown that the patient had a seven years history of COPD and lung infection

What

Planning:

During my placement in the ICU, I worked within an MDT to assist the members in developing an effectives and highly robust care plan for this patient in the ICU. During the first stage of planning the effective care plan for the patient I dis a basic physical health observation of the patient to check the range of all the biological parameters such as BP, oxygen saturation body temperature, BP, pulse and breathing rate. As mentioned by Guidet et al. (2018), planning the most important step of any diagnosis and treatment that enables health care professionals and nurses to assess the physical, behavioral and psychological health of patients and then develop relevant and effective care plan based on the health needs of the patients.As the patient suffered from COPD and lung infection he was sedated with SABA (short-acting beta-agonist) and LAMA (long-acting muscarinic antagonist) bronchodilators during the ventilation (Li et al. 2020). After extubating the patient, I performed a basic general health assessment of the patient in which I checked his breathing rate, oxygen saturation level, heart rate, pulse and body temperature,

Here I also performed the ABCDE assessment for checking airways, circulation and breathing condition of the patient. After this assessment I noticed that the patient suffered from severer health decline as his oxygen saturation became lower than that normal range, the breathing rate is higher and BP was growing up consistently. According to Murthy et al. (2020), nursing professionals must be well-competent to recognizing the signs and symptoms of sudden health decline in the critical patients that can enable them to take the immediate action to promote immediate clinical assistance to the patient to improve patient’s overall health condition. After conducting the basic physical health assessment of this patient, I was not happy with the assessment report. Therefore, I called my mentor and showed her the basic assessment report of the patients, my mentors also felt similar as me. Then my mentors call the doctors, senior nurse and the members of the MDT. As per the instruction of doctor I had again done a basic observation of the patient. This times also the health assessment report showed that BP, pulse, breathing rate and oxygen saturation level rare were not in the normal range. Doctors made the necessary adjustment in the dose of SABA a short-acting beta-agonist), LAMA (long-acting muscarinic antagonist). After 3 hours I had made another observation of patient showed that all thte biological parameters were in the normal ranges.

So what:

Intervention:

Intervention is the crucial stage of treatment process in which the effective implementation of the care plan is conducted to provide the hg quality and compassionate care to patients to meet their holistic needs (Ceniccola et al. 2018). Under this care plan an effective pharmacological intervention had been conducted. NMC (2019) mentioned that, an effective pharmacological intervention is crucial for the critically ill patients admitted in the ICU, in which nurses must ensure that proper medication regimen is followed to provide proper pharmacological assistance ICU patients (NMC, 2019). Here I played crucial roles in maintaining regular observation that whether the right dose of medicines was administered to patient’s body. Here I was assigned to check dose of different bronchodilators such as SABA (a short-acting beta-agonist), LAMA (long-acting muscarinic antagonist), theophylline and anticholinergics (Murthy et al. 2020). I also checked that whether the medicines that were administered to the patient are mentioned by doctors on the prescription. I also monitor and records patients’ physical health condition regular basis by cheeking whether all the biological parameters are in the normal range. NMC (2015) mentioned that while dealing with any intense care patients, nursing professionals, must ensure that they comply with all the four NMC codes such as preserving safety, practicing effectively, promoting professionalism and prioritise people (NMC, 2019).

Under this pharmacological intervention while maintaining effective medicine administration I ensured that the administration process, the types and dosage of medicines and the clinical tools that were used in the management of COPD in this ICU patient were highly appropriate and relevant to patient’s health needs. On the contrary Creel-Bulos et al. (2020) argued that, in case of ICU patients must develop an effective communication within the ward to ensure that there is a shared decision making between the health professionals regarding effective implementation of care plan. In the ICU, I had conducted an effectives verbal and close loop communication within the ICU which assisted all the senior nurses and the doctors to discuss the health condition, personalised health needs, lung condition and oxygen saturation level of the patient (Bassetti et al. 2017). NHS (2019) mentioned that close loop communication is highly effective communication process in which all the health care professionals, nurses and health and social care staffs in the MDT can conduct a transparent discussion on health condition of patient.

Pulmonary rehabilitation (PR) was also included under the care plan. As mentioned by Van De Veerdonk et al. (2017), pulmonary rehabilitations are highly effective program that is designed for COPD patients which are admitted in the ICU. Under this program the patient is provided with the exercise training, health care advises, healthcare education, dietary advise and breathing training. Under this PR programme I took a crucial part in providing the effective training and education to the patient regarding the how to improve the exercise tolerance, reduce risk of dyspnoea, improve the oxygen delivery to the lungs. Under NMC (2015) codes prioritising people and preserving safety, I had taken the informed consent from the patient before involving the patient into this PR program.

Appropriate dietary intake and proper nutrition are that two important aspects had been included in this care plan. After extubating the patient, he was administered with liquid diet through saline as per the direction of the doctors and nutrients. As mentioned by Sheth et al. (2021), nurses must have the enough knowledge and skill on when to give the glucose diet through saline and when to give the oral diet to the patient. NMC (2019) mentioned that student nurses must be well trained in how to make adjustment in the dose of glucose when patient is administered with liquid diet through intramuscular route.

Here I had used the MUST tool ((Malnutrition, Universal Screening Tool)) for determining whether the patient is under the risk of the severe malnutrition during the intramuscular diet as well as oral diet. NHS (2019) mentioned that MUST tool is most effective tool used by modern nursing professionals in which three physiological parameters are determined such as the weight loss in the last 6 months, the BMI of the patient and the acute illness (Barreiro, 2018). Here the MUST score for the COPD patient was 4 which had shown that the patient was at the high risk of severer of malnutrition. In this context, under the instruction of physicians I used to increase the amount of glucose solutes in the saline to provide the extra glucose to the patient.

Under this care plan I used to provide proper health education, dietary advise and health information to the COPD patients. In this training session I provide different healthcare information to the patients regarding following a proper medication regimen, follow a systematic and healthy lifestyle, eat healthy and seasonal foods, no skipping of meals, take regular inhalers, regular exercise and monthly check-ups (Halacli et al. 2020). I also provide the health advise to the patient regarding how to improve the oxygen supply to the lung alveoli by informing the patient about different important breathing techniques. Such as deep breathing, pursed lips breathing and diaphragmatic breathing. Under instruction of physicians and mentors, I also provide the clear information regarding the vaccination to the patients by informing him regarding the name and types of influenza vaccine, the times of vaccination and duration of two vaccine

Now what:

Review:

An effective review of care is important to evaluate the usefulness of the implemented care plan thereby determining the areas of improvement in the treatment process (Bassetti et al. 2017). Under this review of care, I could determine my own strength and weakness that enabled me to develop an effective action plan to provide high quality care to the patents. throughout this review, I had learned to how to make a follow up treatment to check whether all the treatment had been implemented into the care plan are effective to meet patient’s holistic needs or not. Here I also learned how to work within multidisciplinary team to maintain an effective early recognition and response system in ICU to provides the adult patient with the immediate clinical support during the review of care is any health decline is noticed in the patient. .I also had gathered in-depth understanding on medicine administration and medicine management. A mentioned by Creel-Bulos et al. (2020), nursing professionals must have good and clear knowledge on safe medicine administration to ensure patients’ safety. Throughout the practices I had gathered good understanding on effective health assessment of intense care patients by using the relevant assessment tools such as ABCDE and APIE tools. Throughout the practices I had gone through several ups and down that although sometimes made me feel nervous, but also assisted me to learn from each experience. I had learned the importance of task prioritization in nursing practices while working in ICU (Bassetti et al. 2017). NMC (2019) mentioned that task prioritization is crucial for nursing staffs to conduct for assuring the they divide each task on time. Working closely with mentors and physicians in the ICU, I had learned how to work collaboratively with team members to develop effective care plan for patients, in this context, I had also learned the importance and process of conducting early recognition and response to the health declines of ICU patients to provide them immediate clinical support. Moreover, this practice assisted me to develop good skill in maintaining effective and transparent information delivery system in the ICU to maintain an effective close loop communication.

Conclusion:

From the overall discussion it can be concluded that, while treating ICU patients, nurses must be well trained in assessing and evaluating the health needs of the patients, nurses are obliged to comply with all the NMC codes of conducts to ensure patients’ safety and promote their professional values into practices.

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Reference list:

Lee, J.S., Kang, J.E., Park, S.H., Jin, H.K., Jang, S.M., Kim, S.A. and Rhie, S.J., 2018. Nutrition and clinical outcomes of nutrition support in multidisciplinary team for critically ill patients. Nutrition in Clinical Practice, 33(5), pp.633-639.

Li, L., Li, R., Wu, Z., Yang, X., Zhao, M., Liu, J. and Chen, D., 2020. Therapeutic strategies for critically ill patients with COVID-19. Annals of intensive care, 10(1), pp.1-9.

Shang, Y., Pan, C., Yang, X., Zhong, M., Shang, X., Wu, Z., Yu, Z., Zhang, W., Zhong, Q., Zheng, X. and Sang, L., 2020. Management of critically ill patients with COVID-19 in ICU: statement from front-line intensive care experts in Wuhan, China. Annals of intensive care, 10(1), pp.1-24.

Bhatraju, P.K., Ghassemieh, B.J., Nichols, M., Kim, R., Jerome, K.R., Nalla, A.K., Greninger, A.L., Pipavath, S., Wurfel, M.M., Evans, L. and Kritek, P.A., 2020. Covid-19 in critically ill patients in the Seattle region—case series. New England Journal of Medicine, 382(21), pp.2012-2022./p>

Guidet, B., Vallet, H., Boddaert, J., de Lange, D.W., Morandi, A., Leblanc, G., Artigas, A. and Flaatten, H., 2018. Caring for the critically ill patients over 80: a narrative review. Annals of intensive care, 8(1), pp.1-15.

Mathews, K.S., Durst, M., Vargas-Torres, C., Olson, A.D., Mazumdar, M. and Richardson, L.D., 2018. Effect of Emergency Department and Intensive Care Unit occupancy on admission decisions and outcomes for critically ill patients. Critical care medicine, 46(5), p.720.

Piva, S., Filippini, M., Turla, F., Cattaneo, S., Margola, A., De Fulviis, S., Nardiello, I., Beretta, A., Ferrari, L., Trotta, R. and Erbici, G., 2020. Clinical presentation and initial management critically ill patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in Brescia, Italy. Journal of critical care, 58, pp.29-33.

Ceniccola, G.D., Holanda, T.P., Pequeno, R.S.F., Mendonca, V.S., Oliveira, A.B.M., Carvalho, L.S.F., de Brito-Ashurst, I. and Araújo, W.M.C., 2018. Relevance of AND-ASPEN criteria of malnutrition to predict hospital mortality in critically ill patients: A prospective study. Journal of critical care, 44, pp.398-403.

Bassetti, M., Scudeller, L., Giacobbe, D.R., Lamoth, F., Righi, E., Zuccaro, V., Grecchi, C., Rebuffi, C., Akova, M., Alastruey‐Izquierdo, A. and Arikan‐Akdagli, S., 2019. Developing definitions for invasive fungal diseases in critically ill adult patients in intensive care units. Protocol of the FUN gal infections Definitions in ICU patients (FUNDICU) project. Mycoses, 62(4), pp.310-319.

Martindale, R., Patel, J.J., Taylor, B., Arabi, Y.M., Warren, M. and McClave, S.A., 2020. Nutrition therapy in critically ill patients with coronavirus disease 2019. Journal of Parenteral and Enteral Nutrition, 44(7), pp.1174-1184.

Murthy, S., Gomersall, C.D. and Fowler, R.A., 2020. Care for critically ill patients with COVID-19. Jama, 323(15), pp.1499-1500.

Creel-Bulos, C., Hockstein, M., Amin, N., Melhem, S., Truong, A. and Sharifpour, M., 2020. Acute cor pulmonale in critically ill patients with Covid-19. New England Journal of Medicine, 382(21), p.e70.

Bassetti, M., Garnacho-Montero, J., Calandra, T., Kullberg, B., Dimopoulos, G., Azoulay, E., Chakrabarti, A., Kett, D., Leon, C., Ostrosky-Zeichner, L. and Sanguinetti, M., 2017. Intensive care medicine research agenda on invasive fungal infection in critically ill patients. Intensive care medicine, 43(9), pp.1225-1238.

Van De Veerdonk, F.L., Kolwijck, E., Lestrade, P.P., Hodiamont, C.J., Rijnders, B.J., Van Paassen, J., Haas, P.J., Oliveira Dos Santos, C., Kampinga, G.A., Bergmans, D.C. and Van Dijk, K., 2017. Influenza-associated aspergillosis in critically ill patients. American journal of respiratory and critical care medicine, 196(4), pp.524-527.

Halacli, B., Kaya, A. and İSKİT, A.T., 2020. Critically ill COVID-19 patient. Turkish Journal of medical sciences, 50(SI-1), pp.585-591.

Sheth, K.N., Mazurek, M.H., Yuen, M.M., Cahn, B.A., Shah, J.T., Ward, A., Kim, J.A., Gilmore, E.J., Falcone, G.J., Petersen, N. and Gobeske, K.T., 2021. Assessment of brain injury using portable, low-field magnetic resonance imaging at the bedside of critically ill patients. JAMA neurology, 78(1), pp.41-47.

Thompson, K., Taylor, C., Jan, S., Li, Q., Hammond, N., Myburgh, J., Saxena, M., Venkatesh, B. and Finfer, S., 2018. Health-related outcomes of critically ill patients with and without sepsis. Intensive care medicine, 44(8), pp.1249-1257.

Barreiro, E., 2018. Models of disuse muscle atrophy: therapeutic implications in critically ill patients. Annals of translational medicine, 6(2).