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Nursing in Critical Care Setting an Overview from Basic to Sensitive Outcomes Irene Comisso · Alberto Lucchini · Stefano Bambi Gian Domenico Giusti · Matteo Manici Nursing in Critical Care Setting An Overview from Basic to Sensitive Outcomes 123 Nursing in Critical Care Setting Irene Comisso • Alberto Lucchini Stefano Bambi • Gian Domenico Giusti Matteo Manici Nursing in Critical Care Setting An Overview from Basic to Sensitive Outcomes Irene Comisso Alberto Lucchini University Anesthesia and General Intensive Care Unit - San Intensive Care Unit Gerardo Hospital – ASST Monza University Hospital S. Maria della University of Milano-Bicocca Misericordia Milan, Italy Udine, Italy Gian Domenico Giusti Stefano Bambi Intensive Care Unit Emergency and Trauma ICU University Hospital of Perugia University Hospital Careggi Perugia, Italy Florence, Italy Matteo Manici Anesthesia, Intensive Care and Hub Pain Service University Hospital of Parma Parma, Italy ISBN 978-3-319-50558-9 ISBN 978-3-319-50559-6 (eBook) https://doi.org/10.1007/978-3-319-50559-6 Library of Congress Control Number: 2017964483 © Springer International Publishing AG, part of Springer Nature 2018, Corrected Publication 2018 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, repro- duction on microfilms or in any other physical way, and transmission or infor- mation storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the edi- tors give a warranty, express or implied, with respect to the material con- tained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Printed on acid-free paper This Springer imprint is published by the registered company Springer International Publishing AG part of Springer Nature The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland Dedication and Acknowledgements The Authors wish to dedicate this manuscript to their families and beloved ones, and thank them for the important support given during the editing. Thanks to all the components of our working groups. They daily collaborate with us , often providing us inspiration and precious suggestions. Also, thanks to the collaborators, who helped us in editing the manuscript. A special thought is directed to our nursing students. They are the future of our profession, and we wish them to keep working with passion and curiosity lifelong. Finally, this manuscript originated from our patients and their families. By this publication, we wish to give nurses a tool to improve patients’ care, always keeping the person we care for as the main focus of our job. The Authors’ Group Preface In May 2015, me and two co-authors were contacted by Springer’s editor, offering to travel this route. We accepted with enthusiasm, but at the same time with several perplexi- ties. We decided to enlarge the group, and started working to define essential concepts to be considered within the manu- script. Day by day, the project gathered consistency, and the path we wanted to offer to readers became clear in our minds. Nursing care in ICU is complex and requires continuos competences and knowledges update. As in other contexts, both basic and advanced competences can be found in ICU care. The book is directed to students and newly employee ICU nurses, but also to experienced ones. We aimed to under- line the importance of basic aspects in ICU nursing, in the past often disregarded in favor of more technical approaches. In our advice, today’s ICU nurse is a very complex professional. Technical, assessment, relational, team working competences are all required to face daily challenges. This is what we tried to offer within this book, together with the consciousness that it only constitutes a part of a larger view. The author’s group comes from different ICU experiences around Italy. Trying to get an advantage of it, we networked each other, giving mutual supervision to the forthcoming viii Preface contents. At the end of this travel, I think we all somehow grew up from the professional point of view, and learned more. Our wish is to give a similar feeling to our readers. Irene Comisso and the Authors’ Group Contents Part I Assessment and Monitoring in ICU 1 Monitoring Patients: What’s New in Intensive Care Setting? ................................ 3 1.1 Introduction ...................................... 3 1.2 Instrumental Monitoring ........................... 6 1.3 Monitoring and Scales .............................. 8 1.4 Bedside Monitoring: An Overview ................... 9 1.5 A New Monitoring Model .......................... 18 References ........................................... 21 2 Neurological, Pain, Sedation, and Delirium Assessment .................................. 25 2.1 Introduction ...................................... 25 2.2 Neurological Assessment ........................... 26 2.3 Pain Assessment. 31 2.4 Evaluation of Agitation and Sedation ................. 38 2.5 Delirium Assessment in ICU ........................ 43 2.5.1 Risk Factors for the Development of ICU Delirium .............................. 45 2.5.2 Detection .................................... 46 2.5.3 Prevention ................................... 50 References ........................................... 53 3 Respiratory and Ventilatory Assessment ......... 59 3.1 Introduction ...................................... 59 3.2 Basic Monitoring Tools ............................. 60 3.2.1 Pulse Oximetry ............................... 60 3.2.2 End-Tidal Carbon Dioxide (EtCO2) Monitoring ... 62 x Contents 3.3 Basic Monitoring During MV ....................... 66 3.3.1 Basic Principles. 66 3.3.2 Ventilator Waveform Monitoring ................ 66 3.4 Monitoring During Invasive Spontaneous Ventilation ... 72 3.4.1 The Weaning Process .......................... 72 3.5 Pressure and Flow Monitoring to Assess Asynchrony ... 77 3.6 Noninvasive Ventilation Monitoring and Management ... 80 3.6.1 Helmet CPAP ................................ 80 3.6.2 Monitoring During Mask-PSV .................. 88 3.7 Monitoring During Extracorporeal Membrane Oxygenation (ECMO) Support ...................... 94 3.7.1 The Need for ECMO Support .................. 94 3.7.2 Circuit Monitoring During ECMO .............. 97 References ........................................... 101 4 Cardiovascular Assessment .................... 107 4.1 Introduction ...................................... 107 4.2 General Considerations ............................ 108 4.3 Electrical Activity ................................. 109 4.4 Pump Function Effectiveness ........................ 112 4.4.1 Cardiac Output ............................... 112 4.4.2 Arterial Pressure Monitoring ................... 117 4.4.3 Pulmonary Artery Pressure .................... 123 4.5 Oxygen Transportation and Consumption ............. 123 4.6 Volemia .......................................... 125 4.6.1 Filling Pressures: Central Venous Pressure and Pulmonary Artery Occlusion Pressure ........ 125 4.6.2 Volumetric Indicators ......................... 128 References ........................................... 132 5 Early Mobility, Skin, and Pressure Ulcer Risk Assessment .................................. 137 5.1 Introduction ...................................... 137 5.2 Intensive Care Unit-Acquired Weakness (ICU-AW) .... 138 5.2.1 Prevention and Treatment of Immobility ......... 141 5.3 Skin and Pressure Ulcer Risk Assessment ............. 142 5.3.1 Definition ................................... 142 5.3.2 Epidemiology ................................ 144 5.3.3 Physiopathology and Main Risk Factors .......... 145 5.3.4 Risk Assessment .............................. 145 5.4 Conclusions ...................................... 148 References ........................................... 149 Contents xi Part II Basic Care in ICU 6 Interventional Patient Hygiene Model: New Insights in Critical Care Nursing, Starting from the Basics of Care ................ 157 6.1 Introduction ...................................... 157 6.2 From Evidence-Based Nursing to Interventional Patient Hygiene Model: The Conceptual Framework .... 158 6.3 The Priorities of Intensive Care Nursing .............. 164 6.4 Experiences About the IPHM Implementation ........ 166 6.5 Potential Developments of HPIM .................... 168 References ........................................... 172 7 Eye, Mouth, Skin Care, and Bed Bath ........... 177 7.1 Introduction ...................................... 177 7.2 The Eye Care in ICU ............................... 178 7.2.1 Main Ocular Complications in ICU .............. 179 7.2.2 Prevention and Treatment ...................... 180 7.3 Oral Care in ICU .................................. 182 7.3.1 Management of Oral Hygiene .................. 184 7.4 Body Care and Hygiene in the ICU .................
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