Question

Why is pain assessment more challenging in critically ill patients?

-Which team members would the nurse consult to assist with the nutritional support of critically ill patients?

-What actions and treatments can reverse AKI at the initiation phase?

-When would hematochezia occur secondary to upper GI bleeding?

-Why are bowel sounds often hyperactive in GI bleeding?

Answer 1

1. Pain Assessment in Critically ill patients

Pain Assessment is one of the primary measure for medical and nursing management to know the severity of pain. Pain Assessment is really challenging for critically ill patients as they may have difficulty in communicating or some may be unconscious or subconscious or drowsy. Communication is a primary method for assessing the pain. Example of critically ill patients are ICU patients, post operative, terminally ill patients, severe trauma or accident , Heart attack etc.

2. Nutritional support of Critically ill patients:

Meeting the Nutritional needs of critically ill patients are an important task of ICU nurses. Health team members can help the Nurses to meet the patien's need. Nurses can consult:

* Dietition : The critical care dietition is the main professional who can direct the Nurse in meeting the Nutritional needs.

* Physician: Along with the dietition,  physician's order also help the  nurse to   plan for the Nutritional support for the critically ill patients.

3. Actions and treatment to reverse AKI

AKI is Acute Kidney Injury. In the initiation phase AKI can be reversed by various treatment and measures such as:

* Bicarbonate administration for correcting severe acidosis.

* Furosemide for reducing the fluid overload.

* Hyperkalemia , as a result of AKI , can be treated by decreasing potassium intake in diet, by the usre of potassium- binding resins or by dialysis.

* Avoid all Nephrotoxic agents such as NSAIDs, certain antibiotics and heavy metal preparations.

* Dietary modification: Restriction of salt and fluid.

4. Hematochezia  and Upper stomach bleeding.

Hematochezia is the presence of fresh blood in stools, often due to lower GI bleeding. Sometimes Hematochezia occur as secondary to upper GI bleeding. Upper GI bleeding may manifest as melena or Hematemesis. Considerable blood loss may leads to Orthostatic hypotension. Hematochezia often may be due to associated rectal lesions.  

5 . Bowel sounds and GI beeding:

Hyperactive Bowel sound may occur  due to various factors. One of the reason is Gastrointestinal bleeding in the patient. Any disturbances in GI system may affect the bowel movement. GI bleeding may occur due to various reasons, from moderate  to severe condition of Peptic ulcer, Inflammatory bowel disease , tumours, hemarrohoids etc. These disorders may cause  disturbances in the intestine, thus leads to hyperactive bowel movements.