Common Critical Conditions
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“Never let what you cannot do
interfere with what you can do”
CRITICAL CONDITIONS
Sherry L. Knowles, RN, CCRN, CRNI
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OBJECTIVES1. Recognize the signs & symptoms of several
common (critical) medical conditions.
2. Describe the current treatment modalities of those common (critical) medical conditions.
3. Discuss the overall management of select (critical) medical conditions.
4. Identify the nursing interventions of several common (critical) medical conditions.
CRITICAL CONDITIONS
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Respiratory
Failure
ARDS
Acute MI
CHF
CRITICAL CONDITIONS
GI Bleed
DKA
Shock
Sepsis
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DEFINITION– A respiratory system that fails to maintain
adequate gas exchange.
– Acute loss of adequate oxygenation at the tissue level.
– PaO2 < 60 mmHg and/or PaCO2 > 50 mmHg @ 21% FiO2
In chronic hypercapnia: pH < 7.35
– Respiratory failure may be evidenced by a high or low pCO2 level.
RESPIRATORY FAILURE
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TYPES OF FAILURE
– Hypercapnic Respiratory Failure is ineffective ventilation (increased PaCO2), with normal oxygenation (normal alveolar-arterial O2 gradient).
– Hypoxemic Respiratory Failure is characterized by low PaO2, markedly elevated P(A-a)O2 gradient, and usually low PaCO2, reflecting adequate ventilation, but inadequate gas exchange.
RESPIRATORY FAILURE
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SIGNS & SYMPTOMS– Neurological
Restlessness, Agitation, Headache Disorientation, Seizures, LOC
– Cardiovascular Heart Rate, Hypertension (early),
Hypotension (late), Chest Pain , Dysrhythmias
– Respiratory Respirations, Respiratory Effort
RESPIRATORY FAILURE
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CAUSES– V/Q Mismatch
Ventilation / Perfusion Mismatch V/Q ratio = ventilation to perfusion
– Intrapulmonary ShuntPerfusion without ventilation
– Cardiac FailureMay result in pulmonary congestion
RESPIRATORY FAILURE
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SIGNS & SYMPTOMS– Renal
UOP, Edema
– Gastrointestinal Bowel Sounds, Nausea/Vomiting, Abd
Distention, Bleeding
– IntegumentaryCool, clammy, pale skin, Decreased Capillary
Refill
RESPIRATORY FAILURE
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TREATMENT
– Protect the AirwayIntubation (if needed)
Bronchodilators
Hydration (as appropriate)
Mucolytic (if appropriate)
RESPIRATORY FAILURE
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TREATMENT– Correct the Acid-Base Imbalance
ABG’sBronchodilatorsMechanical or non-invasive ventilationTreat the Cause
– Reduce sedation– Add sedation– Bring fever down
RESPIRATORY FAILURE
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TREATMENT FiO2
Ineffective with shuntingProlonged O2 > 40% may cause O2
toxicity (lung damage)Must use caution with CO2 retainers
– Chronic hypercapnia causes CO2 retainers to use hypoxic (O2) drive
– Too much O2 can depress respirations
RESPIRATORY FAILURE
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NURSING INTERVENTIONS– Monitor the Patient
Monitor ABG’s Monitor respiratory status Monitor response to therapies
– Report Changes Watch for improvement Keep respiratory status well documented
– Treat Causes Antibiotics Diuretics Mucolytics
RESPIRATORY FAILURE
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DEFINITION
– Syndrome that causes damage to the alveolar-capillary interface.
– Causes an acute lung injury that causes pulmonary capillary permeability and alveolar flooding.
– Characterized by non-cardiogenic pulmonary edema, respiratory distress, and hypoxemia.
ARDS
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CAUSES– Aspiration Injuries– Sepsis– Multiple Blood Transfusions– DIC– Shock States– Severe Pancreatitis– Embolism
ARDS
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SIGNS & SYMPTOMS– Dyspnea
– Low PaO2
– Intrapulmonary ShuntingLow PaO2 despite high FiO2
– Pulmonary Crackles– Diffuse bilateral alveolar infiltrates – Low or normal PAWP
ARDS
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SIGNS & SYMPTOMS– Early
Irritability, confusion, hyperventilation, tachypnea, dyspnea, tachycardia
– Late Increasing respiratory insufficiency,
pulmonary compliance ( pulmonary vascular resistance), PCO2 retention, frothy sputum, pulmonary crackles
ARDS
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COMPLICATIONS– Barotrauma– Pulmonary Fibrosis– Pulmonary Emboli Cardiac Output– Renal Failure– Nosocomial Pneumonia– Sepsis– DIC
ARDS
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TREATMENT– Maintain Oxygenation
BiPAP, CPAP Intubation PEEP ABG Monitoring
– Maintain Vascular Volume IVF Fluid Restriction
– Treat the Cause Antibiotics
ARDS
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DEFINITION
– Infarction occurs due to mechanical obstruction of a coronary artery (or branch) caused by a thrombus, plaque rupture, coronary spasm and/or dissection.
ACUTE MI
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SIGNS & SYMPTOMS
– Complains vary and may include crushing chest pain (which may or may not radiate), back, neck, jaw, teeth and/or epigastric pain, nausea/vomiting and dizziness.
– ST elevations on ECG
– Elevated cardiac enzymes
ACUTE MI
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SIGNS & SYMPTOMS
PAWP, CO, SVR, dysrhythmias, S4,
cardiac failure, cardiogenic shock
– Diaphoresis, pallor, referred pains
– Diabetics and women often present abnormal symptoms
ACUTE MI
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COMPLICATIONS
– Dysrhythmias, heart failure, pericarditis,
ventricular aneurysms, ventricular thrombus,
VSD, mitral regurgitation, papillary muscle (or
chordae tendineae) rupture, pericardial
effusions, pericarditis
ACUTE MI
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TREATMENT
– Time Is Heart Muscle
– The goal of treatment for an AMI is to relieve pain, limit the size of the infarction and to prevent complications, primarily lethal dysrhythmias
– Prompt ECG
ACUTE MI
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TREATMENT
– Usual medications include O2, NTG, MSO4, aspirin, heparin, beta-blockers, and ace inhibitors. May also include thrombolytics or Gp2a3b inhibitors
– Cardiac Catheterization (with angioplasty, atherectomy and/or stent)
– IABP, CABG, Education
ACUTE MI
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TREATMENT– IWMI
Fluids InotropicsAfterload reducing medications
– AWMIDiuretics InotropicsAfterload reducing medications
ACUTE MI
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NURSING INTERVENTIONS– O2
– Bedrest– Serial ECG’s– Serial cardiac enzymes
– Keep pain free (NTG. MSO4)– Aspirin, heparin, beta-blockers, ace inhibitors,
Gp2a3b inhibitors, thrombolytics, PTCA, IABP, CABG
ACUTE MI
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DEFINITION
– CHF
A condition in which the heart cannot pump sufficient blood to meet the metabolic needs of the body.
Pulmonary (LVF) and/or systemic (RVF) congestion is present.
CHF
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DEFINITION
– Pulmonary EdemaFluid in the alveolus that impairs gas
exchange by altering the diffusion between alveolus and capillary; acute left ventricular failure causes cardiogenic pulmonary edema.
Non-cardiogenic pulmonary edema is a synonym for Adult Respiratory Distress Syndrome (ARDS).
CHF
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SIGNS & SYMPTOMS– Sympaththetic nervous system stimulation
TachycardiaVasoconstriction and increased SVR
– Renin-angiotensin-aldosterone system activationHypo perfusion to the kidneys (rennin)Vasoconstriction (angiotension)Sodium and water retention (kidneys)Ventricular dilation
– See Handout
CHF
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FUNCTIONAL CLASSIFICATIONS
– Class I
– Class II
– Class III
– Class IV
CHF
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COMPLICATIONS– Respiratory Failure
– Dysrhythmias
– Hypotension
– Progressive Deterioration
– Acute Renal Failure
– Fluid & Electrolyte Imbalances
CHF
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TREATMENT– Improve Oxygenation
– Decrease Myocardial Oxygen Demand
– Decrease Preload
– Decrease Afterload
– Increase Contractility
– Manage Dysrhythmias
CHF
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CAUSES– PUD
– Stress Ulcers
– Esophageal Varicies
– Portal Hypertension
– Mallory Weiss Syndrome
GI BLEED
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SIGNS & SYMPTOMS– Hematemesis– Hematochezia BP H & H BUN– Weakness– Dizziness– Syncope
GI BLEED
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TREATMENT– Hemodynamic Stabilization
Blood, IVF, NGT, antacids, H2 blockers, antibiotics, serial H & H’s and clotting factors
– Vasopressin (Pitressin)– Sengstaken-Blakemore or Minnesota Tube– Sclerotherapy– Laser Electorcautery– Surgery
GI BLEED
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NURSING INTERVENTIONS– Large Bore IV’s– Type & Cross Match Blood– Serial H & H’s (q4hr)– Monitor Clotting Factors– Watch for Complications
ARF, ARDS, DIC– Maintain Tubes
NG, Blakemore or Minnesota Tube
GI BLEED
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DEFINITION
– Serious or life-threatening complication usually from diabetes mellitus type I.
– Results from relative or absolute insulin deficiency.
DKA
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CAUSES– Type I DM– Insufficient Insulin Dosing– Poor Compliance– Malfunctioning Insulin Pump– Phenytoin (Dilantin)– Thiazide/Sulfonamide Diuretics– Stress– New Onset DM
DKA
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SIGNS & SYMPTOMS – Sudden Onset (hours)
– Serum Glucose 300-800
– Ketones Strongly Positive
– Serum pH < 7.3 (Ketoacidosis)
– Fruity Acetone Breath (Ketones)
– Kussmaul Respirations
– Serum Osmolarity < 350
DKA
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SIGNS & SYMPTOMS – Thirst (polydipsia)
– Dry Mouth
– Dry Skin
– Weakness
– Kussmaul Respirations
– Polyuria
DKA
– Hypotension
– Tachycardia
– Mental confusion
– Changes in LOC
– Mental confusion– Changes in LOC
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TREATMENT
1. Reverse Dehydration Rapid IVF Replacement
– NS, then ½ NS
– Continue NS If Needed
Prevent Hypoglycemia
– D5½ NS when Glu 250
DKA
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TREATMENT
2. Restore Normal Glucose Levels
Give Rapid Acting Insulin
Frequent Glu Monitoring (q ½ - 1 hr)
Monitor Serum and Urine Ketones
DKA
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TREATMENT
3. Replenish Electrolytes
Watch for Dilution
Monitor Electrolytes Frequently
Insulin Lowers Serum K
DKA
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ADDITIONAL INTERVENTIONS
– Monitor Frequent Accuchecks (q1hr)
– Monitor Serial Serum Glucose (q4hr)
– Monitor Serial Electrolytes (4hr)
– Monitor Anion Gap (q4hr)
– Monitor Serum & Urine Ketones
DKA
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DEFINITION
– Inadequate perfusion to the body tissues
– Low blood pressure with impaired perfusion to the end organs
– May result in multiple organ dysfunction
SHOCK
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TYPES OF SHOCK
– Hypovolemic Shock
– Cardiogenic Shock
– Distributive Shock
– Obstructive Shock
SHOCK
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SIGNS & SYMPTOMSThe body attempts to compensate for shock:
1. Tachycardia Attempts to deliver more blood to the tissues
2. Vasoconstriction Attempts to maintain adequate BP in order to
adequately perfuse the body tissues3. Increased ADH Secretion
ADH makes the body hold onto water in an effort to maintain volume and thus enough blood pressure to perfuse the body tissues
SHOCK
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SIGNS & SYMPTOMS– Hypovolemic Shock:
Low BP , tachycardia, orthostatic hypotension,
restlessness, confusion, agitation (or listless),
thirst, pallor, cool, clammy skin, resp. rate,
UOP, CO, PAWP, CVP, SVR,
lactate levels
SHOCK
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SIGNS & SYMPTOMS– Cardiogenic Shock:
Low BP , tachycardia, restlessness, confusion,
agitation (or listless), thirst, pallor, cool,
clammy skin, resp. rate, UOP, CO,
PAWP (low with RVF), CVP, SVR,
JVD, peripheral edema, ventricular gallop,
dyspnea, pulmonary crackles, lactate levels
SHOCK
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SIGNS & SYMPTOMS– Anaphylactic Shock:
Low BP , tachycardia, orthostatic hypotension,
restlessness, confusion, agitation (or listless),
thirst, pallor, warm feeling, pruritus, hives,
angioedema, bronchoconstriction, wheezing,
laryngoedema, dyspnea, cool, clammy skin,
UOP, CO, PAWP, CVP, SVR, lactate levels
SHOCK
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SIGNS & SYMPTOMS– Obstructive Shock:
Low BP, tachycardia, restlessness,
confusion, agitation (or listless), pallor,
cool, clammy skin, UOP, CO,
symptoms related to cause
SHOCK
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SIGNS & SYMPTOMS– Septic Shock:
Early Stage (Hyper-dynamic, Warm Phase)
Normal BP, tachycardia, confusion, agitation (or listless), resp. rate, temp, normal color, normal or UOP, CO, normal PAWP, CO, SVR,
SHOCK
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SIGNS & SYMPTOMS– Septic Shock:
Late Stage (Hypo-dynamic, Cold Phase)
Low BP, tachycardia, orthostatic hypotension, restlessness, confusion, agitation (or listless), thirst, pallor, cool, clammy skin, UOP, CO, PAWP, CVP, SVR, lactate levels
SHOCK
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TREATMENTS– Hypovolemic Shock:
Volume (IVF, Blood)
– Cardiogenic Shock: CO Preload & Afterload Myocardial Demand
SHOCK
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TREATMENTS– Anaphylactic Shock:
Epinephrine IVF Vasoconstrictors Support/Maintain Airway
– Obstructive Shock: Treat the Cause
SHOCK
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TREATMENTS– Septic Shock:
IVF (150cc/hr or wide open)
Treat Cause (pan culture, antibiotics)
Vasoconstrictors in warm phase
Treat temp if needed
SHOCK
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DEFINITION– SIRS
Systemic Inflammatory ResponseManifested by two or more of the following:
– Temp > 38C or < 36C, HR > 90/min, RR > 20/min, CO2 < 32 mmHg, WBC > 12,000 or < 4,000 or > 10% (immature) bands
– Sepsis Inadequate perfusion to the body tissues due
to bacteremia.
SEPSIS
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DEFINITION– Severe Sepsis
Sepsis associated with organ dysfunction, hypo-perfusion or hypotension.
– Septic ShockSystemic response to infection.
SEPSIS
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SIGNS & SYMPTOMS– Early Stage (Hyper-dynamic, Warm Phase)
Normal BP, tachycardia, confusion, agitation (or listless), resp. rate, temp, normal color, normal or UOP, CO, normal PAWP, CO, SVR,
SEPSIS
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SIGNS & SYMPTOMS– Late Stage (Hypo-dynamic, Cold Phase)
Low BP, tachycardia, orthostatic hypotension, restlessness, confusion, agitation (or listless), thirst, pallor, cool, clammy skin, UOP, CO, PAWP, CVP, SVR, lactate levels
SEPSIS
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COMPLICATIONS
– Acute Renal Failure
– Multiple Organ Failure
– Disseminated Intravascular Coagulation
– Death
SEPSIS
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TREATMENT
1. Give IVF (150cc/hr or wide open)
2. Treat the Cause (Pan culture, antibiotics,)
3. Give Vasoconstrictors in warm phase (vasoconstrictors are contraindicated in cold phase).
4. Treat Temperature as needed
5. Consider Protein Activated C (Xigris)
SEPSIS
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THE END
CRITICAL CONDITIONS
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THANK YOU
CRITICAL CONDITIONS
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REFERENCES
1.Johanson WG and Peters JI. "Respiratory Failure." IN: Textbook of Respiratory Medicine, Murray and Nadel, eds.; 1988. 2.Morris AH. "Acute Respiratory Failure." IN: Therapeutic Strategies in Current Therapy in Critical Care Medicine, JE Parrillo, ed.; 1987. 3.Pontoppidan H, Geffin B and Lowenstein E. Acute respiratory failure in the adult, Parts I-III. N Engl J Med 287:690-698, 743-752, 799-806, 1972. 4.Pingleton SK. Complications of acute respiratory failure. Am Rev Respir Dis 137:1463-1493, 1988. 5.Heffner JE. Tracheal intubation in mechanically ventilated patients. Clin Chest Med 9:23-35, 1988. 6.Stauffer JL. Medical Management of the Airway. Clin Chest Med 12:449-482. 7.Bone RC. Symposium on Respiratory Failure. Med Clinics of N Amer 67:551-750, 1983.