Any potential source of infection should be eliminated if possible. Change the dressing on all invasive line sites and surgical wounds according to protocol to keep the area free of infection

632 Multiple Organ Dysfunction Syndrome and to monitor for early signs of infection. Maintain aseptic technique with all dressing changes and manipulation of intravenous lines. Institute the measures that are necessary to prevent aspiration when patients are placed on enteral feedings. Keep the head of the bed elevated, and check for residual volume and tube placement every 4 hours.

To limit the patient's oxygen expenditure, provide frequent rest periods and create a quiet environment whenever possible. Schedule procedures and nursing care interventions so that the patient has periods of uninterrupted rest. Manage situations of increased metabolic demand— such as fever, agitation, alcohol withdrawal, and pain—promptly so that the patient conserves energy and limits oxygen consumption.

Monitor the patient's environment for sensory overload. Provide purposeful, planned stimuli and keep extraneous, constant noises to a minimum. Provide for planned, uninterrupted rest periods to avoid sleep deprivation. Monitor bony prominences and areas of high risk for skin breakdown. Note that MODS is one of the most critical illnesses that a patient can develop. Although the patient might be well sedated and unresponsive, the family or significant others are generally very anxious, upset, and frightened that the patient might not survive.

These fears are realistic, particularly if multiple organs are involved. Provide the significant others with accurate information about the patient's course and his or her prospects for recovery. Encourage the legal representative to participate in decisions about extraordinary measures to keep the patient alive if the patient cannot speak for himself or herself. Determine if the patient has a living will or has discussed his or her desire to be kept alive by technology during a potentially terminal illness. If the decision is to terminate life support, work with the significant others to provide a dignified death for the patient in an environment that allows the family to participate and grieve appropriately. Provide referrals to the chaplain, clinical nurse specialist, or grief counselor as needed.

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