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Navigating the ICU

A Guide for Patients and Families
Edition: 1
9781975191382
ISBN/ISSN:
9781975191382
Publication Date:
August 25, 2022
2022-08-25
9781975191382
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Written in a straightforward, readable, and highly informative style, Navigating the ICU: A Guide for Patients and Families is a ...
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  • Written in a straightforward, readable, and highly informative style, Navigating the ICU: A Guide for Patients and Families is a compact, affordable guide to today’s intensive care unit. This unique, patient-focused handbook is designed to help patients and their families navigate the complexities of the ICU—from the role of each member of staff, to common procedures, medications, and laboratory tests, to what to expect after the hospital stay. Author and ICU nurse Alex Gottsch concisely explains the ICU experience and provides accessible answers to common questions asked by patients and families. 

    • Provides a single, accessible resource for patients and families in the high-stress setting of the ICU, where life-changing decisions often need to be made rapidly in an unfamiliar and intimidating environment 

    • Improves communication between patients, families, and health care providers by educating families about how the ICU works, what questions to ask, and how to advocate for themselves and family members 

    • Guides you through the ins and outs of the ICU experience with an intuitive, easy-to-use table of contents 

    • Answers questions you may not have known you had, such as “What is the most important part of the day for me to be present?” and “What Medical Care Would I Want If I Could Not Choose?” 

    • Addresses a wide range of post-ICU possibilities including Post-Intensive Care Syndrome (PICS), what to expect from skilled nursing facilities and long-term acute care facilities, and end-of-life issues 

    • Includes a Foreword by Patricia M. Davidson, Dean of The Johns Hopkins School of Nursing 

    • Enrich Your eBook Reading Experience

    • Read directly on your preferred device(s), such as computer, tablet, or smartphone.

    • Easily convert to audiobook, powering your content with natural language text-to-speech.

  • Edition
    1
    ISBN/ISSN
    9781975191382
    Product Format
    Paperback Book
    Trim Size
    5 x 8
    Pages
    216
    Table
    20
    Edition
    1
    Publication Date
    August 25, 2022
  • Alex Gottsch MHS, MSN, RN
  • Introduction vi
    How This Book Helps Patients and Families ix
    How to Use This Book x
    1 The Staff . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
    The Nurses 1
    The Doctors 2
    The Nurse Practitioners and Physician Assistants 4
    The Respiratory Therapists 4
    The Pharmacists 5
    The Physical and Occupational Therapists 5
    The Speech- Language Pathologists 5
    The Social Workers and Case Managers 6
    The Ethics Committee/Ethicists 6
    The Nurse Aides 6
    Other Vital Staff Who May Be Regularly Seen in the ICU 7
    2 A Typical Day . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
    The Most Important Part of the Day to Be at the Bedside 8
    The Schedule for the Day 9
    The Staff Shift Change 10
    3 The Basics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
    Why the ICU 11
    Admission Into the ICU 12
    Monitoring the Patient 13
    Intravenous Access 14
    Medication Pumps 16
    Computers and Electronic Medical Records 17
    Prefer Another Language 17
    Visiting the Patient 17
    Preventing Infection 18
    Transfer Out of the ICU 20
    4 Common Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
    Informed Consent—Explaining All the Options 21
    Questions to Ask for Informed Consent 22
    Capacity—Can the Patient Make Their Own Decisions 23
    Arterial Line 25
    Blood Transfusion 26
    Bronchoscopy 28
    Central Line 29
    Chest Tube 31
    Esophagogastroduodenoscopy (EGD) 32
    Feeding Tube for the Short Term—Nasogastric (NG), Orogastric (OG), and
    Nasoduodenal (ND) Tubes 34
    Feeding Tube for the Long Term—Percutaneous Endoscopic Gastrostomy (PEG)
    and Gastrostomy/Jejunostomy (G/J) Tubes 36
    ContentsPeripherally Inserted Central Catheter (PICC) 38
    Pulmonary Artery Catheter 39
    Swallow Test 41
    Tracheostomy 42
    Urinary Catheter 44
    Sterile Precautions 46
    5 Medications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
    Medication Timing 48
    Pain 49
    Managing Pain Without Medicine 51
    Pain Medicine 52
    Patient- Controlled Analgesia: Patient- Controlled Pain Medicine 54
    Vasoactive Medications: Controlling Blood Pressure 55
    Sedation: Calming the Patient 56
    Mild Sedation: Reducing Anxiety 56
    Moderate Sedation: Relaxing the Patient During a Procedure 57
    Deep Sedation: Relaxation During Extended Therapy 57
    Paralytic: Preventing Patients From Working Against Themselves 59
    6 Lab Tests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
    What the Labs Can Tell About the Patient 62
    Illnesses and Their Labs 62
    Bleeding 62
    Infection 63
    Kidney Injury 64
    Liver Injury 64
    Heart Injury 64
    Diabetes 65
    Other Labs 65
    7 Possible Side Effects of the ICU . . . . . . . . . . . . . . . . . . . . . . . . 66
    Delirium: When the Patient Becomes Confused 66
    Restraints: Restraining Movement for Safety 69
    Pressure Injuries: Skin Breakdown From Pressure 72
    8 Therapies for Common Issues . . . . . . . . . . . . . . . . . . . . . . . . . 74
    Cooling the Patient 74
    Warming the Patient 75
    Hemodialysis and Continuous Renal Replacement Therapy 75
    Basics About Breathing 78
    First Steps to Improve Breathing 79
    A Non-Rebreather Mask: Quick Increase in Oxygen Levels 80
    Continuous Positive Airway Pressure (CPAP) and Bilevel Positive Airway
    Pressure (BiPAP): Aid for Sleep Apnea or High-Level Help for
    Breathing Difficulty 81
    High-Flow Nasal Cannula: High-Level Help for Breathing Difficulty 83
    The Ventilator: Total Help Breathing 84
    Respiratory Distress and Respiratory Failure: When Trouble Breathing
    Turns Into Needing a Breathing Tube 86
    Intubation: Inserting the Breathing Tube 86
    9 Essentials for the ICU Patient . . . . . . . . . . . . . . . . . . . . . . . . . 89
    Feeding: Providing Nutrition to Help Recovery 90Sedation: Relaxation During Extended Therapy 92
    Thromboembolic Prevention: Preventing Blood Clots 93
    Head of Bed Elevation: Preventing Lung Infections 95
    Ulcer Prevention: Preventing Stomach Damage 96
    Glucose Control: Managing Blood Sugar 96
    Spontaneous Breathing Trial: Testing if the Breathing Tube Can Be Removed 97
    Bowel Regimen: Promoting Bowel Movements 97
    Indwelling Catheter Removal: Preventing Infection of Lines 98
    De-escalation of Antibiotics: Targeting the Infection 98
    The “Get to Know Me” Board: Helping Everyone Know the Patient 98
    ICU Journal: Better Insight for Now and Later 99
    Extubation: Removing the Breathing Tube 100
    Early Mobility: Exercising ASAP 100
    10 How to Help the Patient During Downtime . . . . . . . . . . . . . . 102
    1 1 How to Prepare Now for a Better Life After Hospitalization . . . 105
    Preventing and Overcoming Post- Intensive Care Syndrome 108
    1 2 Where the Patient Recovers After the Hospital . . . . . . . . . . . 112
    Long-Term Acute Care Hospital 113
    Inpatient Rehabilitation Facility 113
    Skilled Nursing Facility 113
    Home Health 113
    Outpatient Rehabilitation 113
    Questions to Ask the ICU Team About Leaving the Hospital 114
    1 3 Common Concerns and Helpful Tips . . . . . . . . . . . . . . . . . . . 116
    What to Bring to the Hospital and What to Leave at Home 116
    How to Make the ICU Stay More Comfortable 117
    How to Communicate With the ICU Team 118
    Not Allowed to Eat or Drink—Nil Per Os (NPO) 120
    Unable to Visit the Patient 120
    Strategies for Reducing the Costs of Treatment 122
    Questions to Ask When Making a Decision 123
    Second Opinion 125
    Full Code and Do Not Attempt Resuscitation 126
    What Happens if the Heart Stops for a Full Code Patient (Code Blue) 127
    What Happens After Surviving a Code Blue 128
    What Happens if a Patient May Be Having a Stroke (Code Stroke) 129
    The Most Serious Types of Brain Injury 131
    A Quick Guide to Organ Donation 133
    1 4 Critical Questions That Determine the Right Care . . . . . . . . . 135
    Goals of Care 135
    Advance Care Planning 136
    Durable Power of Attorney 137
    Responsibilities When Making Decisions for the Patient 138
    Living Will 139
    Goal of Living Until Death 142
    A Story of the Importance of Advance Care Planning 144
    Physician Orders for Life- Sustaining Treatment (POLST or Medical OLST) 146
    Helpful Online Resources to Organize Thoughts 146
    If the Patient Cannot Respond, and the Family Does Not Know 1 5 Important Topics When Discussing
    the End of the Patient’s Life . . . . . . . . . . . . . . . . . . . . . . . . . 149
    If More Time Is Needed to Decide About the Right Path for the Patient 151
    Comfort Care: A Focus on Patient Comfort as Death Nears 152
    Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155
    Appendix 1 – Helpful Tool for Organizing Patient Details
    or to Use During Rounds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
    Appendix 2 – Journal Outline . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177
    Appendix 3 – Get to Know Me Board . . . . . . . . . . . . . . . . . . . . . . 184
    Appendix 4 – Questions to Ask When Making a Decision
    About Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185
    Figure Credits 186
    Index 189
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