Sample Care Plan Template Page 37
ADVERTISEMENT
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51between 80-120 mm Hg; sp02
3) Place the patient on a sedation vacation to see
3) Use of continuous IV sedation infusions
>95%; pulse <110 while on
if he has recovered sufficiently from alcoholic
is associated with a longer duration of
sedation. Sedation medication was
encephalopathy, to perform neurological
mechanical ventilation (Kress et al., 2000).
titrated to maintain patient at a
assessment, and to see if the patient can
Also, a sedation vacation is needed daily
comfortable sedation level.
hemodynamically handle it so he can go off of
when a patient is on a continuous IV
the Levophed (Per MIHS MICU nursing
sedation infusing to assess clients agitation
3) It was determined that the
protocol).
and need for the medication (Kress et al.,
sedation vacation was not
2000).
successful the patient became
4) Analyze and respond to ABG’s, etCO2, and
hemodynamically unstable with
pulse ox value changes (Ackley and Ladwig,
4) Patients on ventilatory support should be
increased BP and ECG changes
2011).
continuously monitored to make sure that
PVC/PAC and a RASS of 2+. The
they are receiving adequate oxygenation
previous level of sedation was
5) Prevent unplanned extubation of patient by
and acceptable acid base balances (Ackley
resumed.
making sure ETT is secured with tape and that it
and Ladwig, 2011).
stays at correct centimeter (22) at the teeth.
4) Patients pulse ox and etC02
5) Secure taping can prevent inadvertent
remained within safe parameters the
extubation and checking the tube cm at the
whole nursing shift. The patient
teeth confirms that tubes placement in the
ABGs showed mixed results with
lungs (Takeda et al, 2003).
metabolic and respiratory acidosis.
5) The patient’s tube remained at 22
cm at the teeth during the entire
nursing shift and the nurse made
sure the tape was present securing
placement of ETT.
F:\group\MEPN\MEPN Level III\NURS610B\2013NURS 610B\610BCarePlan
12/17/2012
page 17
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Medical