By Burns, Suzanne M.; Chulay, Marianne
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The ICU environment itself can contain safety issues. Consider that inappropriate use of medical gas equipment, electrical safety with invasive lines, certain types of restraints, bedside rails, and cords and tubings lying on the ﬂoor can all be hazardous to the acutely ill patient. In addition, with so many health-care providers involved in the care of each patient, it is imperative that communication remain accurate and timely. Use of a standardized handoff communication tool is one step in preventing inaccurate and unnecessary errors.
It is important for the nurse to use critical thinking skills throughout the provision of care to accurately analyze patient changes. After each assessment, the data obtained should be looked at in totality as they relate to the status of the patient. When an assessment changes in one body system, rarely does it remain an isolated issue, but rather it frequently either impacts or is a result of changes in other systems. Only by analyzing the entire patient assessment can the nurse see what is truly happening with the patient and anticipate interventions and responses.
Skin Breakdown Skin breakdown is a major risk with critically ill patients due to immobility, poor nutrition, invasive lines, surgical sites, poor circulation, edema, and incontinence issues. Skin can become very fragile and easily tear. Pressure ulcers can start to occur in as little as 2 hours. Healthy people constantly reposition themselves, even in their sleep, to relieve areas of pressure. Critically ill patients who cannot reposition themselves rely on caregivers to assist them. Pay particular attention to pressure points that are most prone to developing breakdown, namely, heels, elbows, coccyx, and occiput.