PERSONAL AND PROFESSIONAL DEVELOPMENT IN CRITICAL CARE b.

Any violation of Nursing Law 9173

c. Not renewed for more than 3 years
A. Continuing Professional Development in Critical Care Nursing d. Violations in the Standards of IV Therapy
1. Intravenous Training
 RA 7164 (Philippine Nursing Act of 1991) Section 27 (a) Article V which provides that IV Therapy Program
IV injection is within the scope of nursing; and that in the administration of IV  Has concepts in IV therapy and skills demonstrations
injection, special training shall be required  Has a 24-hour lecture, practicum with the following pre & post-tests, completion of
 IV Nursing Standards of Practice developed by Association or Nursing Service required actual number of cases.
Administrators of the Philippines (ANSAP) should be used o Initiating and maintaining peripheral IV
 In IV injections, nurses should follow the policies of their agencies o Administering IV drugs
 BON Resolution #08, Sec 30 series of 1994 or in RA 7164 Art V Sec 28 states that any o Administering & maintaining blood & blood components
RN is prohibited from administering IV injections… unless undergone special
training. Duties & Responsibilities of IV Therapists
 Violation of such leads to criminal (Art VII Sec 39) or administrative (Art VII Sec 21)
sanctions or both. 1. Interpret and carry out the physician’s prescriptions for IVT.
 RA 9173, Art 6 Sec. 28. Scope of Nursing (a) Provide nursing care through utilization 2. Prepare, initiate, and terminate IV therapy.
of the nursing process. Nursing care includes, but not limited to… administration of 3. Perform peripheral venipuncture (Except central lines and cut downs).
written presentation for treatment, therapies, oral, topical, and parenteral 4. Determine solution and medication incompatibilities.
medications. 5. Administering blood and blood components (prescribed by physician) and computing
 That in the practice of nursing in all settings, the nurse is duty-bound to observe the flow rates.
Code of Ethics for Nurses and uphold the standards of safe nursing practice. 6. Assess all adverse reactions related to IV therapy and initiate appropriate nursing
interventions.
Standards of IV Therapy requirements to Become and IV Therapist 7. Establish nursing care plan related to IV therapy.
1. Entrance Requirements 8. Adhere to established infection control practices.
a. BSN graduate, RN 9. Maintain proper care of IV equipment.
b. Behavioral characteristics 10. Document relevant data in the preparation, administration, and termination of all
c. Demonstrates communication and technical skills forms of IV therapy.
2. Completion Requirements
a. 3 days Basic IV Therapy Training program Nursing Documentation
3. Renewal/Revalidation of an IV Therapy Card Proper documentation provides:
a. Every 3 years  Accurate description of care
b. 24 units  Mechanism for recording and retrieving information
4. Loss of IV Therapy Card  Record for healthcare insurers of equipment and supplies used
a. Affidavit of loss
b. Certificate of Training IV therapy may be documented on:
c. Photocopy of official list of participants  Progress notes
5. Cancellation of IV Card  Special IV therapy sheet or flow sheet
a. PR License is not renewed  NCP on patient’s chart
  Intake and output sheet Core Principles (according to WHO)
 Medication sheet  Symptom Management
 Common symptoms:
Documenting IV Therapy Maintenance o Pain
What to check?  Most prevalent symptom in CC
 Condition of the site  Sources: diseases, procedures, and interventions
 Site care provided  Pharmacologic/nonpharmacologic interventions should be
 Dressing changes incorporated in every patient’s NCP
 Tubing and solution changes o Dyspnea
 Teachings done and evidence of client understanding  Causes: underlying disease pathology, anxiety, and family,
 Time and date spiritual, or social issues
 Reason for discontinuing therapy  Pharmacologic interventions: oxygen, opioid, anxiolytics
 Assessment of venipuncture site before and after removal of venous access device  Nonpharmacologic interventions: reducing room temp (but
 Complications, client reactions, and nursing interventions not chilling the patient), reducing visitors, unobstructive line
 Integrity of venous access device upon removal of sight bet. patient and environment, fan blow gently
 Follow-up actions (ex: restarting the IV infusion in another extremity) across the face
 Amount of IVF infused before discontinuing therapy o Anxiety and agitation
 Common
B. ICU Nurse as a Patient’s Advocate  Complex assessment
1. Palliative Care for Critically Ill  Pharmacologic interventions (if needed): benzodiazepines,
 Originated from hospice care atypical antidepressants
 Designed to improve quality of death and dying for patients and their families  Nonpharmacologic interventions: counseling, taking care of
 Care that are unrelated to disease-specific treatments, cure, or rehabilitation practical matters, arranging for spiritual concerns to be
 Studies have shown that this improves management of symptoms addressed
o Depression
3 Levels of Palliative Care: Von Gunten and Lupu  Natural feelings present for only a short time
1) Primary palliative care – basic understanding of interventions to relieve suffering  Treatment: supportive psychotherapy, cognitive behavioral
and improve the quality of life therapy, and antidepressants
o Responsibility of all nurses o Delirium
2) Secondary palliative care – provided by specialists in hospital or hospice consult  Acute change in awareness or cognitive status that may
services or hospice programs manifest as agitation, withdrawal, or confusion
o Assists providers of primary palliative care  Terminal delirium: common with dying patients
3) Tertiary palliative care – found in academic medical centers that conduct research  Common
to discover new knowledge (disseminated through educational programs)  Management: symptom control and relief of distress
 Pharmacologic interventions: benzodiazepines or
neuroleptics (haloperidol)
o Nausea and vomiting
 Very common with advanced diseases
  Exhausting, debilitating, frustrating o Establishing treatment goas and priorities
 Causes: physiological factors (GI, metabolic, CNS, emotional, o Ensuring interdisciplinary communication
treatment-related, vestibular disturbances) o Delivering bad news
 Pharmacologic interventions: serotonin receptor antagonist,  Awareness of ethical issues
anticholinergics, antihistamine, phenothiazines, steroids,  Caring for the caregiver
prokinetic agents, butyrophenones, benzodiazepines
o End-of-life sedation 2. Advocacy: Access to Social Care Services
 AKA terminal sedation  PhilHealth
 Consultation of pain or palliative care specialist to verify o Aims to ensure the best healthcare benefit for the Filipinos
that all therapies had been attempted without success o Tied with MALASAKIT program
 Used when patient is: (1) experiencing unbearable pain and  DOH (Department of Health)
other symptoms; (2) approaching last hours or days of their o Tasked to operationalize health programs geared towards the health of the
life; (3) or when all possible treatments are ineffective/have family
failed o Responsible for creation, implementation, and evaluation of health family
 Goal: to relieve suffering without hastening death programs
 Advanced Care Planning  DSWD (Department of Social Welfare and Development)
 Deciding how a patient would like to be treated in the event that they o Geared towards promoting the rights and welfare of the poor and
become unable to make decisions for themselves marginalized for an important quality of life
 CC nurse must communicate with primary care provider o Target beneficiaries: older adults, persons with disabilities, women in
o Advance Directives (living wills, healthcare proxies) special or difficult circumstances (e.g., disadvantaged and marginalized
o Do-Not-Resuscitate (DNR) and Do-Not-Attempt-Resuscitation women, victims of illegal recruitment, involuntary prostitution, victims of
(DNAR) orders abuse/battery, children and in need of special protection)
 Family-centered Care o Provides financial support for those with:
Four core issues form the basis for family-centered care at the patient’s end-of-life:  Hospital bills
 Family presence during resuscitation  Medicines
 Visitation  Laboratories and diagnostic procedures
 Family conference  Assistive devices
 Bereavement care  Need for burial assistance
 Emotional, psychological, social, and spiritual care  PAGCOR (Philippine Amusement and Gaming Corporation)
 Patients nearing the end of their lives may experience emotional, o Affiliated with PSCO
psychological, social, and spiritual crises o Community service
 Interdisciplinary team is needed  PCSO (Philippine Charity Sweepstakes Office)
 At times, these crises can manifest physical symptoms (refer to symptom o Can give ₱25,000
management)
 Facilitating communication
 Most important aspect of caregiving in critical care
 Facilitates healing environment
 Three (3) significant issues: