CRITICAL CARE NURSING PPT

CRITICAL Factors to be considered in
CARE recruiting Critical Care Nurses
NURSE
are:
1. Intra and interpersonal

factors
2. Technical Qualifications

3. Educational background

4. Clinical Experience

Prime 1.Continuous monitoring
Responsibilities 2.Keep ready emergency trolley / crash

Of A Critical Cart
Nurse 3.Efficient Individualized Care.
4.Counselling and information to family.
5.Application of policies and procedures
6.Proper records of all activities
7.Maintain infection control principles.
8.Keep update with advance information.

QUICK REFERENCE PROTOCOL FOR

MANAGING EMERGENCY IN ICU

Review Quickly review the patient - Identity, History , Physical Exam.

Be Be with the patient, ask for help.

Place Place the patient in a suitable position.

Attach Attach the cardiac monitor and call for crash cart.

Maintain Maintain ABC Along with expert team

Introduce Introduce IV, CV line

Administer Administer medication as needed.
Carry on
Maintain Carry on Investigations - ABG, ECG, Urea, Creatinine, Blood Sugar, Cardiac
enzymes.

Maintain Fluid and Electrolytes .

Record Record right things at right time rightly.

Core 1.Patient Care
Competencies 2.Medical Knowledge
3.Professionalism & Ethics
4.Interpersonal Communication Skills
5.Practice-based Learning and Improvement
6.Systems-based Practice

Family Need of the Critical Care Patient

Information – major source of anxiety and litigation (legal issues)
Reassurance – can reassure care is being given
Convenience – access to the patient

Job description

Patient care Education Research

Patient care

Multidisciplinary Bed Infection control Protocol Quality
rounds allocation/triage development control/assurance

• Residents, fellows, med Education
students, nurses, respiratory
therapists, nurse practitioners

Research

Quality assurance Clinical trials Database-driven projects
projects

General Concept, Setting and
Principle of Critical Care Nursing

•Who are critically ill patient?

Critical illness are grouped
by the system of the body;

A. Cardiac System

Acute myocardial Cardiogenic shock Complex arrhythmias Acute congestive heart
infarction with requiring close failure with respiratory
complications monitoring and failure and/or requiring
Hypertensive intervention hemodynamic support
emergencies
Unstable angina, Cardiac tamponade or Dissecting aortic
particularly with constriction with aneurysms
dysrhythmias,
hemodynamic instability, hemodynamic instability
or persistent chest pain

Complete heart block

B. Pulmonary Acute respiratory failure
System requiring ventilatory support
Pulmonary emboli with
hemodynamic instability

Massive hemoptysis

Intracranial hemorrhage

C. Neurologic Meningitis with altered mental status or respiratory
disorder compromise
Central nervous system or neuromuscular disorders
with deteriorating neurologic or pulmonary function
Status epilepticus

Severe head injured patients

D. Drug Hemodynamically unstable drug
Ingestion ingestion
and Drug
Overdose Drug ingestion with significantly
altered mental status with
inadequate airway protection
Seizures following drug ingestion

E. Gastrointestinal 1. Life threatening gastrointestinal bleeding
Disorders including hypotension, angina, continued
bleeding, or
with comorbid conditions

2. Hepatic failure

3. Severe pancreatitis

F. Endocrine Diabetic ketoacidosis complicated by hemodynamic instability,
altered mental status, respiratory insufficiency, or severe acidosis
Severe hypercalcemia with altered mental status, requiring
hemodynamic monitoring
Hypo or hypernatremia with seizures, altered mental status

Hypo or hypermagnesemia with hemodynamic compromise or
dysrhythmias
Hypo or hyperkalemia with dysrhythmias or muscular weakness

Hypophosphatemia with muscular weakness

G. Surgical 1.Post-operative patients
requiring hemodynamic
monitoring/ventilatory
support or extensive nursing
care

H. Miscellaneous 1.Septic shock with
hemodynamic instability

2.Hemodynamic monitoring
3.Environmental injuries

(lightning, near drowning,
hypo/hyperthermia)

Admission
Criteria in ICU

• The ICU admission
decision may be based
on several models
utilizing prioritization,
diagnosis, and
objective parameters
models

A.Prioritization Model

• This system defines those that
will benefit most from the ICU
(Priority 1) to those that will
not benefit at all (Priority 4)
from ICU admission.

Priority 1:

• These are critically ill, unstable patients in need of intensive
treatment and monitoring that cannot be provided outside
of the ICU. Usually, these treatments include ventilator
support, continuous vasoactive drug infusions. Examples of
these patients may include post-operative or acute
respiratory failure patients requiring mechanical ventilatory
support and shock or hemodynamically unstable patients
receiving invasive monitoring and/or vasoactive drugs

Priority 2:

•These patients require intensive monitoring
and may potentially need immediate
intervention. Examples include patients with
chronic comorbid conditions who develop
acute severe medical or surgical illness.

Priority 3:

• These unstable patients are critically ill but have
a reduced likelihood of recovery because of
underlying disease or nature of their acute
illness. Examples include patients with
metastatic malignancy complicated by infection,
cardiac tamponade, or airway obstruction.

Priority 4:

• These are patients who are generally not appropriate
for ICU admission. Admission of these patients should
be on an individual basis, under unusual
circumstances and at the discretion of the ICU
Director. These patients can be placed in the following
categories:

B. Diagnosis
Model

• This model uses specific
conditions or diseases to
determine appropriateness of
ICU admission. (described above
in critically ill patient)

C. Objective • Pulse < 40 or > 150 beats/minute
Parameters • Systolic arterial pressure < 80 mm Hg or 20 mm
Model: Vital Hg below the patient's usual pressure
Signs • Mean arterial pressure < 60 mm Hg
• Diastolic arterial pressure > 120 mm Hg
• Respiratory rate > 35 breaths/minute

C. Objective • Serum sodium < 110 mEq/L or > 170 mEq/L
Parameters • Serum potassium < 2.0 mEq/L or > 7.0 mEq/L
Model: • PaO2 < 50 mm Hg pH < 7.1 or > 7.7
Laboratory • Serum glucose > 800 mg/dl
Values (newly • Serum calcium > 15 mg/dl
discovered) • Toxic level of drug or other chemical substance in a
hemodynamically or neurologically compromised patient

C. Objective Parameters Model : Cerebral vascular hemorrhage, contusion
Radiography/Ultrasonography/Tomography or subarachnoid hemorrhage with altered
(newly discovered) mental status or focal neurological signs
Ruptured viscera, bladder, liver,
esophageal varices or uterus with
hemodynamic instability

Dissecting aortic aneurysm

C. Objective Myocardial infarction with complex
Parameters arrhythmias, hemodynamic
Model : instability or congestive heart failure
Electrocardiogram Sustained ventricular tachycardia or
ventricular fibrillation
Complete heart block with
hemodynamic instability

Physical Unequal pupils in an unconscious patient
Findings Burns covering > 10% BSA
(acute Anuria
onset) Airway obstruction
Coma
Continuous seizures
Cyanosis
Cardiac tamponade

Team of Critical The Most Responsible
Care Unit : Physician (MRP) is the
Physicians. physician in charge of the
patient’s care during the
current hospitalization. He or
she communicates with other
members of the team on a
daily basis

Team of • Intensive Care nurses are the
Critical minute-to-minute critical care
Care Unit providers. They not only help to
:Nurses provide, but also coordinate
most aspects of care delivery.
They have received specialized
training in caring for critically ill
patients.

Team of • Intensive Care nurses are the minute-
Critical Care to-minute critical care providers. They
Unit : Nurses not only help to provide, but also
coordinate most aspects of care
delivery. They have received specialized
training in caring for critically ill
patients.

Team of Critical Care Unit :
Respiratory Therapists

Respiratory therapists have special training and
experience in caring for patients with breathing
problems. They work closely with the physician to
develop a plan to support a patient’s breathing. They
set up, monitor and maintain the breathing machines
(mechanical ventilators), and they adjust these
machines minute by minute and hour by hour to best
meet the patient's needs.

Team of Critical Care Unit :Pharmacists

Pharmacists consult with the physician in selecting the
right medicines at the correct dose for patients and also
in monitoring drug levels in the body. Pharmacists also
help to decrease medication side effects and provide
valuable information to the team members.

Team of Critical Care Unit:
Physical Therapist

• They help prevent disabilities and facilitate
rehabilitation as soon as possible.

Team of Critical Care Unit :
Dieticians

Dieticians calculate the nutritional needs of the
critically ill patient and consult with the physician
to provide the patient with the best possible diet,
whether orally or through a feeding tube.

Team of Critical Care Unit :

Medical Radiation Technologist
Medical Laboratory Technologist

Team of Critical Care Unit :
Trauma Coordinator

The Trauma Coordinator reviews the plan of care for each
trauma patient and in consultation with the ICU Care Team,
makes suggestions regarding patient needs. She also works
closely with the patient and family, and provides teaching
and information to the patient and family about the patient’s
progress and expected outcomes.

Team of Critical Care Unit :
Social Worker

Social workers provide professional assistance with the
needs of patients and families. They can help to assess
and determine what resources patients and families
might be lacking, providing them with information on
agencies to assist with various needs and generally
assisting with other family difficulties.

Team of Critical Care Unit :
Clinical Educator

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Team of Critical Care Unit :
Ward Clerk

ICU Ward Clerks help with communication by answering
the phones, processing physician orders and
coordinating some of the patient activities in the ICU.

Team of Critical Care Unit :
Pastoral Care

Chaplains are available to minister to the spiritual needs
of patients and families.

Team of Critical Care Unit :
Manager

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ICU & CCU Service

Nursing Care and Protocols

Critical Care F = Feeding/fluid
Considerations A = Analgesics
S = Sedation
T = Thrombolytic agents
H = Head elevation
U = Ulcer – bed sore
G = Glucose monitoring

Feeding and Fluids : • Oro - gastric and Naso - gastric
Enteral feeding feeding

• Churn diet
• Dairy and poultry products

(Milk, egg, youghort)
• High protein liquid diet
• Medications

Feeding and 1.Hospital diet
Fluids : 2.Bland diet
Oral 3.Normal diet
feeding 4.Liquid intake

Feeding and Fluids :Transparenteral diet

1.Oliclinomel • KCl
Includes:-
❑MgCl2
• Amino acid solution with electrolyte ❑Sodium
(5.5%) volume 800 ml ❑Magnesium
• Amino acid 44 gram ❑PO4
• Na acetate ❑Acetate
• Na glycerophosphate ❑Chloride
❑Glucose 20% solution with

CaCl2