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•Ensures patients/family needs are being met including emotional support.
ICU Registered Nurse/ providers orders•Vital signs: Document q 5 minutes until stable; q 15 minutes x 4; q 30 minutes x 4; q 1 hour x 24 OR until de-lined and off vasoactive infusions; then q 4 hours. •Keep SBP 120-150mmHg or as ordered by MD. •Strict I+O q 1 hour. • Daily weight until discharged •Apply NIBP to non-A line arm (if not contraindicated). Release cuff after each measurement. If NIBP does not correlate with ABP within 10-15 points systolic monitor NIBP every hour.
ICU Registered Nurse/ providers orders•Maintain continuous ABP, CO/CI, CVP, SVRI, SVV monitoring (include temperature and PAP if swan present), document per vital sign order. Notify surgeon if: CI < 2.2, HR <60 or >90, RR <12 or >20, Temp >37.5 C, O2 sat < 94%, PAD <12 or > 20, CVP <5 or >15, PVCs > 6/minute. •If patient has a femoral A-line and a functional radial A-line, AND is hemodynamically stable, remove femoral A-line post extubation. •If core temperature is < 95 degrees F, use heated vent circuit and bair hugger blanket until temp is >/= 98.6 degrees F. USE FLUID WARMER FOR ALL IV FLUIDS IF TEMP < 97.0 DEGREES F. •If temp is >/= 102 degrees F and not relieved by Tylenol, apply cooling blanket and notify MD. VTE prophylaxis (possible mechanical): Apply TEDS and SCDs to all patients on arrival to CVR ONCE STABLE.
Respiratory Therapist•Goal is to wean patient off ventilator per protocol•Obtain daily ABG to ensure levels are at baseline•Obtain sputum collection for analysis of possible infection•Breathing tx Albuterol+Atrovent PRN•Suction as needed (ensure sterile technique)•Ensure patient tubes are all appropriately in place•Maintain spo2 >92%•Inform RN and MD regarding abnormal ABG values
Respiratory TherapistPost-extubation: •O2 via nasal cannula, face mask, Bipap, or high flow nasal cannula to keep O2 sat> 92%. • •CPAP q 4 hrs. X 24 hrs. Then change to incentive spirometry if patient tolerates. •Incentive spirometry q 1 hr. x 10 breaths, while awake. •RN to assist with deep breathe, cough, and turn pt q 2 hrs., as tolerated, while awake. •HHN: UDP prn wheezing. If pt is on home nebulizers, inhalers, or bipap/cpap continue if okay with MD.
Phlebotomy/ Lab DepartmentLabs/Orders: **NOTE: If A-line available get labs from A-line not venous** •CBC with diff, BMP, serum magnesium, PCXR, EKG, ABG complete. •Blood cultures x2/ wait five minutes taken on two different sites•Lactic Acid per order notify if above 2.0, reflex repeat q3h if abnormal•Coagulation Profile, including fibrinogen •Hgb/Hct q 6 hours x 2, unless bleeding, then as directed by surgeon. •Serum K+ and Mg q 6 hours x 2 (hospital protocols for CABG patient management).
Phlebotomy/ Lab DepartmentLabs/Orders: **NOTE: If A-line available get labs from A-line not venous** •Accuchecks q 2hr x 3, then q 4 hours x 24 hours (if pt not already on intensive insulin protocol). Initiate intensive insulin per protocol if glucose> 150 and place order set on chart.