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. Critically ill patients are any patient who is either intimated or is bed ridden. There are certain challenges faced by nurses in assessing pain, communication plays one of the important role between the nurse patient relationships as the patient is critically ill patient is unable to explain the pain scale score, it's location, intensity, type of pain and frequency. One of the most effective pain assessment is Non - verbal pain scale in critically ill patient but this again it is of no use if the patient is heavily sedated. Other factors involve staff attitude towards the patient as they are heavily sedated many a times nurses will forget to assess pain reading.

2. Nutrition plays an important role in critically ill patient, most of the time they are provided with Parenteral nutrition as TPN, they are also given food with nasogastric tube normally liquids are given such as juices. Nutrition team is required to understand the type of diet and calories to be given to the patient, the Nutrition team involves PHCP, dietitian, pharmacist, nutrition nurse specialist.

3. Acute kidney injury is a condition where there is temporary shut down of the kidney function, as  it cannot filter waste from the blood, it is a serious medical condition and requires treatment. Initiation phase is the first phase where manifestation of increased blood urea nitrogen, increase serum creatinine, Oliguria ( decreased urine output ). The treatment involves:

• Strict urine output.
  
• Limit fluid intake according to patient need.
• Vitamins and minerals supplements.
• Angiotensin concerting enzymes are also administered.
• May require haemodialyis until the kidney functions starts.

4. Hematochezia is a condition in which there is a discharge of fresh blood through the anal passage and could be found in the stool sample.  In case of peptic ulcer or cancer in the upper GI tract hematochezia can occur. However, the difference between UGI and LGI bleeding is differentiated with fresh blood and old blood melena in the stool.