CARING FOR THE HIGH-ACUITY PATIENT p.2-77
Objectives: At the completion of this class, the student will be able to:
1. Identify ways the nurse can help high-acuity patients and their families and themselves
cope effectively with the patient’s illness;
Complementary & alternative therapies
Reduce stress (p.8)
2. Discuss the educational needs of these patients and families;
Current information about pt. progress
Informed decision making
Acknowledgement of past
Optimal learning environment
Orientation to routines and care
3. Discuss end of life issues to be considered in caring for these patients;
P.19 sources of conflict
4. Describe effective pain management for high-acuity patients; (module 2 p.26)
Multidimensional: Education- splinting (p.36)
Meds: tordol, dilauded, opioids
5. Discuss fluid and electrolyte imbalances in terms of assessment and management;
(Module 3 p.55)
Most are dehydrated= ↓BP (do orthostatic BP check); meds- AHTN, polypharmacy;
LOC, lung/bowel sounds, urine output, mucous membranes
Labs: increased specific gravity (1.010-1.030), hematocrit (35-51%), BUN(9-
Assessment p.63; values p.66
6. Discuss care of the elderly high-acuity patient.
P.4 patient care: priorities
1. Ms W is a 78 yo female with ESRD (end stage renal disease), CHF (congestive heart
failure), DM, and severe edema LUE. What physiological and psychological needs does
she have? What about her daughter who she lives with? What stressors affect the nurses
caring for her?
2. Mr. McClure is a 55 yo with anemia, secondary to a retroperitoneal bleed and renal mass.
He is also HIV positive, unknown origin. What needs does he have? His wife and
children? His nurses? He has 10/10 left flank pain.
I. PATIENT AND FAMILY CONSIDERATIONS
A. High-acuity patients: who are they?
B. Families of these patients: what do they need and want?
C. Coping with high-acuity illness: How?
D. Educational needs of families: What are they?
A. To the patient: physical and psychological
B. To the family: physical and psychological
C. To the nurse: physical and psychological
III. PAIN MANAGEMENT
A. Physiology of pain
B. Assessment: How?
D. Effective management: How?
IV. FLUID AND ELECTROLYTE BALANCE
A. Body fluid: where is it and why?
B. Fluid regulation: how?
C. Fluid imbalance:
1. edema: what is it?
2. third spacing: what causes it?
3. fluid volume deficit: examples
4. fluid volume excess: examples
5. assessment: how?
6. management: how?
1. sodium:hypo and hyper
2. potassium: hypo and hyper
3. chloride: hypo and hyper
4. calcium: hypo and hyper
5. magnesium: hypo and hyper
6. phosphate: hypo and hyper
V. SPECIAL CONSIDERATIONS OF THE ELDERLY HIGH –ACUITY PATIENT