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Clinical Hub,Patient Education,Health and Nutrition Facts For You,Trauma

Trauma and Life Support Center (TLC) A Guide for Patient and Family (4310)

Trauma and Life Support Center (TLC) A Guide for Patient and Family (4310) - Clinical Hub, Patient Education, Health and Nutrition Facts For You, Trauma

4310











Trauma and Life
Support Center (TLC)
A Guide for Patient
and Family



1



Welcome to the Trauma and Life Support Center (TLC) of UW Health. TLC is an
intensive care unit (ICU) that provides care for patients who are critically ill.

TLC supports a patient and family centered approach to care. The core concepts of
patient and family centered care are dignity and respect, information sharing,
participation, and collaboration.

o We invite patients to be as involved in their own health
care as they want to be.
o We actively involve patients and families to partner with
the health care team.
o We see the patient and family as important members of
the health care team.

We value your input. Please feel free to ask questions and share your thoughts
with the nurse or any health care team member.


- TLC staff













Your health care team may have given you this information as part of your care. If so, please use it and call if you
have any questions. If this information was not given to you as part of your care, please check with your doctor. This
is not medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because each
person’s health needs are different, you should talk with your doctor or others on your health care team when using
this information. If you have an emergency, please call 911. Copyright © 12/2015 University of Wisconsin Hospitals
and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#4310

2
Table of Contents



Communication
Visiting and Patient Updates
Communication with the Interdisciplinary Team
Care Team Visits and Family Meetings
Advance Directives
Page

3
4
5
6

What to Expect in the ICU
Equipment
Procedures
Common Medicines


7
8
9

Supporting the Caregiver
Family Support and Internet Access
In the Patient Room and Journaling



11
12


Leaving the ICU
Transfer and Discharge Planning
Palliative Care
Questions
Notes
Names of Team Members


13
14
15
16
17

3
A Note to You and Your Family

Being a patient or a family member of a patient in the ICU can be an intense
experience. It is our goal to clearly share information with you while also being
careful to maintain patient privacy and confidentiality. Below are a few guidelines
that we use.

Visiting The primary support persons and family of a patient will
most often be able to visit any time during the patient’s
stay in the hospital. Visiting hours for all other guests
are from 8:00 am to 9:00 pm. In order to provide a safe
setting, people who have been granted permission to stay
after 9:00 pm will need to obtain an ID badge from the
nurse.

To ensure privacy and safety for all patients, we do ask
that all visitors call the unit each time before you enter
the patient’s room. Phones are offered in the Visitor
Lounge and on the wall of the main hallway entering
TLC.

TLC South (bed #1-12):
ξ (608) 263-8134 or
ξ Dial “3” from the hallway phones
TLC North (bed #13-24):
ξ (608) 263-8954 or
ξ Dial “4” from the hallway phones

Visitor Lounges TLC has two visitor lounges. One lounge is a space for
socializing and eating. The other lounge is a quiet area
for visitors to rest.

Patient Updates One or two people may be named as primary contacts to
receive frequent updates on the patient’s condition. This
contact is often a family member or a trusted friend.
Privacy laws limit the amount of information that
hospital staff can provide to other people.


4
The primary contacts may wish to call the unit to get
updates about the patient’s condition and plan of care.
While attempts are made to respond to every call, there
may be times when the staff is not able to come to the
phone. In these cases we will arrange for the staff to get
back to you as soon as they can.

Communication with the Interdisciplinary Team

While in the hospital you may hear the phrase “interdisciplinary team” being used.
The interdisciplinary team includes a number of people who will be directly
involved in treatment and plan of care. We see the patient and family as important
members of this team. We welcome your questions and value your input.

Interdisciplinary Team Each patient has a team of practitioners who develop
the plan of care (primary team). They will provide
direction on your treatment plan with the input of the
other care team members. The team will consist of one
attending doctor and may include nurse practitioners
and other doctors in-training, referred to as fellows and
residents.

At times, the primary team may consult specialists.
This means that the consulting team will provide the
primary team with suggestions related to their area of
specialty. For example, a cardiologist specializes in the
heart and may be consulted for concerns about the
heart.

The nurse will be your main caregiver and point of
contact.

Some other examples of interdisciplinary team
members include: respiratory, occupational, physical,
and/or speech therapists, pharmacists, clinical
nutritionists, nursing assistants, case managers, social
workers and eICU nurses and doctors.


5
Because the interdisciplinary team can consist of many
people, it may be helpful to write down the names of
the team members. Paper for this can be found at the
end of this packet.


Communication with the Interdisciplinary Team

Care Team Visits: We want to partner with you during your hospital stay
and learn what’s most important to you. One way we
achieve that is through interdisciplinary daily Care
Team Visits. The patient plan of care is discussed
during the bedside Care Team Visits. Decisions are
made about medicines, diet, activity, procedures, tests,
and the readiness to transfer to the next level of care.

It is important to note that the timing of the Care Team
Visits may vary between services and from day to day,
however, the time is most often from 8:30-10:30.
Your Care Team Visits provide a time to:
Communicate and listen to your questions and
concerns.
Adjust the care plan to meet the health goals of the
patient.
Respect the values and beliefs of the patient and
family.
Empower you to be involved in health care decisions.

Family Meetings A family meeting is another important way to
communicate with the interdisciplinary team. You will
be able to have a family meeting with the care team by
the 3rd day of admission to TLC. During these
meetings, family members can talk with the healthcare
team about the patient’s treatment plan and goals of
care.

Patients and families often find it helpful to write down
questions and concerns that they have ahead of time.
Paper for note taking can be found at the end of this

6
packet and in the flyer that you receive upon admission
to TLC.

Communicating Patient Preferences

We make every effort to understand the wishes of the patient. Advance directives
are legal forms that allow patients to state health care wishes in the event they are
unable to do so themselves. They also allow patients to name the person(s) they
want to act as agent/spokesperson for their wishes.

Advance Directives Wisconsin and most states have two forms of advance
directives – Power of Attorney for Health Care and the
Declaration to Physicians (also known as a “Living
Will”). Federal law requires that we have a copy of any
formal advance medical directives in the patient’s
medical record. Please make sure that we have a copy
of any completed advance directives.

Some patients choose not to have advance directives or
have not yet completed one. When there is no advance
directive, doctors often turn to adult family members to
make decisions. Some questions to consider when
making these decisions might be:

o Did you ever talk about what the patient would
want if things did not go the way the patient had
hoped?
o What do you think the patient would want, and
what is best for him or her?

If you want to learn more about advance medical
directives, we can arrange for the social worker to meet
with you.

7
Equipment in the ICU

There are monitors, machines, and tubes that patients may have during a stay in the
hospital. Please ask your nurse if you have any questions about the equipment in
the ICU.

Monitor The monitor is used to measure how the heart and lungs
are doing. It tracks heartbeat, oxygen level, blood
pressure, and other body functions. The numbers and
pictures are seen in the room and at the nursing station 24
hours a day.

Nurses constantly monitor patients and respond to the
alarms. The monitors have alarms for all the patients, so
you may hear the monitor beep when the alarm is for
another patient. The purpose of this is to quickly convey
vital patient information to all nurses when they are in
patient rooms.

Pulse Oximeter A device that clips to the finger. It has a red light at the
(Pulse Ox) end of it. It measures the oxygen level in the body.

Ventilator (Vent) A machine used to help patients breathe and give higher
amounts of oxygen. Severe illness or injury can cause
too low levels of oxygen or too high levels of carbon
dioxide.

This machine is connected to the patient through a tube
in the mouth (ETT) or neck (tracheostomy or trach). A
breathing tube may be unpleasant. It can make some
people anxious. Patients can get medicines to help them
be more comfortable. The ventilator will be removed as
soon as the patient is able to breathe well on their own.







8
Equipment in the ICU

Arterial Line (A line) A tube in an artery, most often in the wrist, used to
measure blood pressure. It is also used to draw blood for
lab tests without having to use a needle.

Central Line A tube in a large vein in the neck, leg, or arm (PICC). It
is used to give certain medicines.

Bladder Catheter A tube used to collect urine into a bag. Checking the
(Foley) amount of urine helps us to know how well the kidneys
are working. Sometimes patients feel the urge to urinate
even though the catheter is in place, and this is normal.

Feeding Tube A small tube placed in the nose or mouth. It is used to
(Dobhoff) give fluids, food, and medicine to patients who cannot
take them by mouth.

Sequential Stockings Special wraps that are placed on the legs. The wraps
(SCDs) are attached to a machine that inflates and deflates in a
routine pattern. This helps blood flow and decreases
blood clots.

e-Care Camera This camera allows e-Care staff to remotely monitor
patients. E-Care includes critical care doctors and nurses
that provide further patient care support. To ensure
privacy, cameras are turned off except when needed to
check patient status or deliver care. When a camera is
off, it faces the wall. All audio and video communication
is not recorded.


Procedures in the ICU

ICU rooms are equipped to handle many procedures in the room. Some
procedures or tests may need to be done outside of the unit. The nurse and/or
doctor will always go with patients in the ICU when they leave the ICU room.



9
Common Medicines in the ICU

Pain Medicines There are many ways to manage pain. Examples of pain
medicines include morphine, hydromorphone (Dilaudid®)
and fentanyl. There are many causes of pain and nurses
often assess pain level. Please talk to the nurse if you are
concerned about managing pain or you think that the
patient looks as though he or she may be in pain.

Sedation Medicines These act in the brain to cause sedation (sleepiness,
drowsiness), decrease anxiety, and provide amnesia (help
the patient not remember much of their time in the ICU).
Examples of sedation medicines include lorazepam
(Ativan®), midazolam (Versed®), and propofol.

Vasopressors These medicines are used when a patient’s blood
“Pressors” pressure is too low. They work in the heart and blood
vessels to increase blood pressure. Examples of
vasopressors include norepinephrine (norepi),
vasopressin, and dopamine. Nurses may make frequent
changes to the medicines to keep a patient’s blood
pressure within a certain range.

Antihypertensives These medicines are used when a patient’s blood
pressure is too high. They work in the heart and blood
vessels to decrease blood pressure. Examples of
antihypertensives include nitroglycerin, labetalol, and
esmolol.

Insulin This medicine is used when a patient’s blood sugar is too
high. The stress of critical illness and/or medicines can
cause a patient’s blood sugar to increase. Just because a
patient needs insulin in the ICU does not mean he will
always need it. A small blood sample from the finger is
used to check the blood sugar level often.



10

Ventilator
e-Care Camera
Central Line
Bladder Catheter
(foley) Chest Drain

11
Supporting the Caregiver

Having a family member in the ICU can be a very stressful time. Stress can affect
the body and mind. It is important to take care of yourself. Remember basic
needs, stay well-hydrated, eat regular meals, and try to get plenty of rest.

Family Support There are resources available for support. Please ask
the nurse if you would like to speak with a social
worker, case manager, or chaplain.

Worship services are held in the chapel on the main
floor of the American Family Children’s Hospital. The
schedule for worship services may change. For the
most recent schedule call (608) 263-8574 or go to
www.uwhealth.org and click on “Patients and Visitors”
link to find the UW Hospital Visitor Guide.

Resources in the
Hospital In the TLC Visitor Lounge there are “Finding Your
Way” brochures. This brochure provides Hospital
maps and information on services such as the cafeteria,
pharmacy and gift shop. If you need help, please don’t
hesitate to ask for help from any hospital employee.

Internet Access & The hospital offers free Wi-Fi wireless internet access
Web Resources from your own wireless device throughout the hospital.

There are also public computers in the TLC Visitor
Lounge and the Surgical Waiting Area in the B module
on the 2nd floor.

A hospital visitor guide can also be found on
www.uwhealth.org. Click on “Patients and Visitors”
link to find the UW Hospital Visitor Guide.







12
Supporting the Caregiver


Ideas For When You’re Let the patient know that you are there. A well-known
In the Patient Room voice and a gentle touch can provide comfort. Consider
reading aloud or talking about daily events. You should
speak in a calm voice.

Keep in mind that the patient might not be able to
respond to you, either because there is a breathing tube
in place that does not allow the patient to speak, or
because of medicines or altered awareness.

Be yourself. There may be moments when you may
feel like laughing or crying with the patient.

Talk with the nurse about helping with personal cares,
if you would like. Examples may include: applying lip
balm, giving a hand and/or foot massage, helping in
passive range of motion exercises.




Supporting the Caregiver


Journaling Putting your thoughts and feelings on paper may help
reduce stress. Writing may also help you keep track of
daily events. Paper is provided in this packet for you.

Going over notes from the ICU stay can also help
patient recovery. A better understanding of the time in
the ICU may reduce further stress and anxiety. This is
very helpful for patients who are unable to recall
portions of the ICU stay.

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Leaving the ICU

Patients are ready to move from the ICU when their care needs change. The unit
that the patient is transferred to depends upon the patient’s needs. Transfer plans
will be discussed with the patient and family as soon as possible.

Transfers When a patient is ready to move from the ICU to another
unit in the hospital or to another facility, they may be
moved to an “IMC” – intermediate care or “to the floor”
– general care unit. This depends on their care needs.
Most often, moving from the ICU also means that
patients are getting closer to being discharged from the
hospital. Hospital staff makes every effort to predict
when the transfer will happen and to tell the family about
the move as soon as they can.

The new unit will most likely include new nurses and
doctors, different medical equipment and different
structure (visiting hours, time for rounds). Staff on the
new unit will be happy to answer questions and explain
what to expect during your stay with them.

Discharge Planning Discharge planning begins at admission. It includes input
from the care team and most importantly from patients
and their families. Case management staff (nurses and
social workers) will begin talking about and exploring
possible needs for when a patient is ready to leave the
hospital. Not all patients require more support or
medical care after the hospital. There are different types
of care available for those who do. This may include
home health services, long term acute care hospitals,
skilled nursing facilities and inpatient rehabilitation units.



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Leaving the ICU

Palliative Care Sometimes, in spite of our treatments and hopes, a patient
cannot recover or return to a desired quality of life.
There are some cases where the patient does not want
further treatment.

Palliative care is focused on giving patients relief from
the symptoms, pain, and stresses of a serious illness,
whatever the diagnosis. The goal is to improve quality of
life for both the patient and the family. Palliative care is
offered in a number of settings, which includes the ICU.
The hospital also has a palliative care unit and a specialty
team available if needed.

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Questions

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Notes

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Names of Team Members

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