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Von Jerold Buendia

on 10 June 2015

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Transcript of project1

2015 CCNAPI Annual Convention
Ebola virus disease (EVD) or Ebola hemorrhagic fever (Ebola HF)
is the human disease caused by the Ebola virus-one of numerous Viral Hemorrhagic Fevers. It is a severe, often fatal disease in humans and nonhuman primates such as monkeys, gorillas, and chimpanzees.
researchers believe that the virus is animal-borne with bats, particularly fruit bats, being considered the most likely natural reservoir of the Ebola virus (EBOV).

Ebola viruses are highly transmissible by:
>Direct contact with infected blood, secretions, tissues, organs or other bodily fluids of dead or living infected persons.
>Through broken skin or mucus membranes.
>Contact with contaminated medical equipment, particularly needles and syringes.
>Sexual intercourse with a male since semen is infectious in survivors for up to 7 weeks.
>Oral exposure and exposure to conjunctival secretions since these have been confirmed in non-human primates.
>Appropriate protective clothing including masks, goggles, face shields, gowns and gloves have not been worn.
>Needles and syringes have been reused without being appropriately sterilized.
>Improper sterilization of instruments before being used again occurred.
>There is a lack of use of universal precautions
Bundles of care for Pressure Ulcers
• Surveillance for Patients who are at High Risk of Pressure Injury.
• Proper Assessment & Re-Assessment.
• Determining the different factors that may cause the pressure injury.
• Proper prevention and care.

– ensure patient is on the right mattress, cushion, there are no creases or wrinkles
Keep moving
- encourage self movement, reposition patient and inspect skin
- meet patient’s toileting or continence needs
– keep well hydrated, meet patient’s nutritional needs
DAY 2 (FEB 27, 2015)
Buendia, Von Jerold

• Remember that a seated patient is also at risk of developing pressure injury.
• Turning and repositioning of the patient every 2 hours is a good preventive measure.
• use of mechanical and assistive devices should be advised for patient that are high risk for developing pressure injury.
• Always be updated on the different modern dressings and managements on pressure injury, it is best to know your wound dressings well.
• A good assessment and documentation for better communication between the wound care team.
• Always consider to treat patients with wounds in a multi disciplinary team approach.
 Wound Classification/Staging
 Knowing the Anatomic location and origin of the redness.
 Measuring the non-blanchable (reddish area) or Wound Area
 Pain scale assessment
 Capturing an image of the affected area for documentation if with patients consent (Do not forget to include a measuring guide when capturing the image).
A pressure ulcer is a localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear.
Pressure ulcer remains to be a common problem encountered in ICU. This happens when patients stay longer in the hospital, when they are nutritionally compromised, or when caregivers fail to incorporate meticulous skin care and management to avoid its occurrence.
• When using support surfaces to prevent heel pressure injury, ensure that heels are free of the surface of the bed.
• Nutritional status should be assessed for all individuals with pressure injury initially, with a change in condition, and when the injury is not showing signs of healing.
• Avoid using hot water, cleansers that are too strong that may dry the skin, use moisturizers for patients with dry skin to prevent skin breakdown.
• Attend to incontinence episodes ASAP!!!
Frequent, careful repositioning of the patient. Use rule of 30 (raise head in 30 degrees and avoid raising the bed more than 30 degrees to prevent the build up of shearing pressure, Turning the patient in a lateral line through his hips in a 30 degree angle.)
• Do not massage bony prominences for it may lead to deep tissue injury and trauma.
• DO NOT USE LATEX GLOVES with WATER as an off loading device for it contributes friction, heat, and shear.
• Maintain skin integrity to the extent possible.
• Apply skin emollients per manufacturer’s directions to maintain adequate skin moisture and prevent dryness.
• Minimize the potential adverse effects of incontinence on skin
• Clean the pressure injury and surrounding skin at the time of each dressing change.
Always assess your patients for presence of Pressure Ulcers specially for those who are bed bound and wheel chair bound patients.
• Do not use the pressure ulcer classification or staging system in describing other types of wounds other than pressure ulcer.
• Make sure that your staffs are well educated, well trained, and reliable in classifying pressure ulcers to other types of wounds.
Goal of outbreak control:
>Interrupt direct human-to-human transmission through the early identification and systematic isolation of cases.
>Timely contact-tracing, proper personal protection.
>Safely conducted burials
>Improved community awareness about Ebola infection and individual protective measures.
>Quarantine infected patients
Preventive approaches for healthcare workers:
• Full compliance to vaccinations (notably yellow fever) and malaria prophylaxis as recommended for the target region (including documentation as a vaccination record);
• sensitisation for viral hemorrhagic fever symptoms before working in endemic countries; and
• strict implementation of barrier management, use of personal protective equipment, and disinfection procedures, as per specific guidelines
For critical care to be effective, as system must be in place to quickly identify the deteriorating patient on the floors/wards. Rapid response teams are a team of especially trained clinical providers who are summoned to the bedside to immediately assess and treat the patient with the end goal of preventing intensive care unit transfer, cardiac arrest, or death. In contrast to the “Code Blue” team that is activated only after cardiopulmonary arrest occurs, the rapid response team are designed to prevent to prevent further deterioration, thus improving the patient’s survival rate.
Sepsis is a serious illness that can develop when the body’s normal reaction to fight an infection goes awry and can quickly become life-threatening. The body’s immune system releases chemicals into the blood to fight infections but sometimes those chemicals can cause inflammation, which can lead to blood clots and organ damage. In severe cases, sepsis can weaken the heart, shut down other organs, and may lead to death. Early recognition of patients with possible sepsis is critical for preventing severe outcomes
Objectives for World Sepsis Day
1. RECOGNIZE risk factors, signs and symptoms of sepsis.
2. RESUSCITATE with rapid intravenous fluids and antibiotics within the first hour of recognition of sepsis.
3. REFER to senior clinicians and specialty teams, including retrieval as required
Aspects of Palliative Care
• Providing information
– Health status
– Needs and requirements

Symptom management
– Impeccable assessment
– Efficient and timely management

Supporting patients and families
– Presencing
What dying patients want
• Connectivity with care providers
• Being independent while accepting support, comfort and care from health care providers
• Preservation of integrity and dignity
Important aspects of a peaceful death
– The presence of family support, acceptance of the burden of the patient
– The belief in God and dying as a time to surrender self.
Deficiencies in ICU Palliative Care
• Untreated pain and other symptoms
• Unmet needs for family care
• Inadequate communications
• Conflict among clinicians/patients/family
• Divergence of treatment goals from patient/family preferences
• Inefficient resource utilization
• Clinician “moral distress” and burnout
Critical Care Challenges
• Pain and other symptoms cause distress and present special challenges
• Many patients may not be able to self-report
• Diagnostic and treatment interventions are themselves common sources of symptom distress
• Routine and non-invasive aspects of patient care such as turning can contribute to symptom distress
• Family needs are sometimes overlooked
Quality Stories in ICU
Drug Calculations
Sample Questions
answer: 12.4ml/hr
answer: 12 mcg/min
Full transcript