This paper presents the care to a patient during one shift in the Intensive Care Unit (ICU). Tony*, a 79 year old,was admitted to ICU with suspected anoxic brain injury;post Out of Hospital Cardiac Arrest; and Head Injury. Cardiopulmonary Resuscitation was initiated by his son. When the EMTambulance arrived Tony was pulseless, cardiac monitoring showed Ventricular fibrillation – he was cardioverted twice at the scene. Inthe Emergency Department (ED) he developed Ventricular tachycardia and required a further cardioversion. CT brain showed subdural brain haemorrhage. Therapeutic Hypothermia (TH) wascommenced in ED.As Tony was without CPR for 20-25 minutes at home, his prognosis was uncertain and his family were informed of this. He had a history of hypertension. Day 1 nursing care and diagnosis for Tonyand 2 concepts from the Careful Nursing Model(Meehan 2012a) will be discussed. Psycho-Spiritual Reality
Tony’s psycho-spiritual reality was assessed through touch as Tony was sedated. I sat at his bedside and introduced myself. While talking to Tony he did not display any emotional effects of distress or pain. His face was relaxed and calm. I assessed Tony through his family, as they sat with him and spoke to me about him. They told me he was a peaceful man, and contented with life. They denied he ever had low moods or stress – although he did become animated during soccer matches! He was happily married for nearly 60 years and his wife was in good health. They had 2 sons and 1 daughter. One son lived in Australia. His other children were married and lived close by. He had 3 grandchildren which he adored. His son in Australia was making arrangements to return to Ireland. The Therapeutic Milieu
The therapeutic milieu of the environment Tony was cared in was assessed using the five dimensions defined by Meehan, (2012a). The environment had an awareness of caritas. Caritas allows nurses to care for patients with kindness, compassion, tenderness and an empathetic nature (Meehan, 2012a). The unit was calm; interventions were carried out with composure and without haste to encompass contagious calmness. Great tenderness in all things was achieved by maintaining dignity and privacy while attending Tony’s physical needs,while considering his and his family’s psychological and emotional needs. Nurses’ care for selves and one another; all nurses in the unit respected each other’s opinions in relation to patient care. Relief was provided in a timely manner to allow for breaks. As I am new to ICU, assistance was provided whenever needed and senior staffare approachable with questions. Intellectual engagement is obvious in the ICU where Tony was cared for, as most staff have a higher diploma in Critical Care or a hospital based ICU course. Best research guides nursing practise. Creation of a restorative environment; bedspaces are maintained at the highest possible standard. Continuous monitoring of vital signs and ABGs were carried out. The therapeutic milieu of the unit was given a numerical scoreof 79. The ICU scored its highest marks with evidence of contagious calmness, intellectual engagement and a safe and restorative environment. However, on assessment of my own therapeutic milieu, my scores were lower than the overall ICU. As I am relatively new to ICU and to maintain a safe and restorative environment, I am scheduled to work on shifts with good support from senior nurses. This also can be considered nurse’s care for themselves and others. Bio-physical assessment
Monitor and ventilator alarm limits were checked and set to within 10% of Tony’s parameters. All emergency equipment was present and checked. Neurological:Tony scored 3/15 on Glasgow Coma Scale;pupils reacting to light but were unequal R>L. He had previously had cataract surgery and developed a torn iris. The GCS is considered the most reliable tool for measuring a patient’s level of consciousness. (Mavin, 2008). He was on infusions of opiod...
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