Critical Care Nursing Prepared by: Ms. Elizabeth D. Cruz, R.N., M.A.N.

CRITICAL CARE UNIT

Is a hospital area in which an increased concentration of specialty trained staff and monitoring equipment allow more detailed and frequent monitoring and more frequent intervention in seriously ill patients

CRITICAL CARE

Is defined as the care of seriously ill patients from point of injury or illness until discharge from Intensive Care This encompasses ambulatory services, disaster medicine, emergency medicine and preventive medicine

PERSONNEL IN ICU

Involves medical, nursing and allied health CRITICAL CARE NURSE - is a licensed professional nurse who is responsible for ensuring that acutely and critically ill patients and their families receive optimal care

ROLES OF A CRITICAL CARE NURSE

Bedside clinicians Nurse educators Nurse researchers Nurse managers Clinical nurse specialist Nurse practitioners

CRITICALLY ILL PATIENTS

Are defined as those patients who are at high risk for actual or potential lifethreatening health problems More critically ill patient, the more likely he or she is to be highly vulnerable, unstable and complex, thus require intense and vigilant nursing care.

ROLES OF CCN FOR CRITICALLY ILL PATIENT

Respect & support the right of the patient or patients designated surrogate to autonomous informed decision-making Intervene when the best interest of the patients in question Help patient obtain necessary care Respect the values,beliefs & rights of the patient Support the decision of the patient or designated surrogate, or transfer care to an equally qualified critical care nurse Intercede for patient who cannot speak for themselves in situation that require immediate action Monitor & safeguard the quality of care the patient recieves Acts as a liaison between the patient, the patients family & other healthcare professionals

3 PHYSICALLY DISTINCT ICU AREAS

NICU (NEONATAL CARE UNIT)

= will care for premature babies, low-weight babies,full term infants born with critical care condition or babies with severe congenital malformation, = will acquire care skills to care for all babies needing surgical interventions posy-op care, thus limiting necessary transfer between ICUs NICU (NEONATAL CARE UNIT) defined as needing continuous ventilatory support, ongoing invasive monitoring, close clinical supervision, and corrective therapies to reverse potentially lifethreatening conditions.

PICU (PEDIATRIC INTENSIVE CARE UNIT) Will be a multidisciplinary intensive care unit offering all critical care services to infants, children, and adolescents Will develop & implement tertiary services & remain on the leading edge of advanced therapies and procedures Will also provide consultation resources to the emergency department, the in patient wards and other referring centers

ADULT INTENSIVE CARE UNIT Will be defined as those needing continuous ventilatory and hemodynamic support, ongoing invasive monitoring, close supervision and corrective therapies to prevent or reverse potentially & immediately life-threatening conditions Will care for all critical care patients within the same physical environment and will include a mix of medical, surgical, trauma and neuro/neurosurgery patients

ICU EQUIPMENT Hemodynamic & cardiac monitoring systems Mechanical ventilator therapy Intra-aortic balloon pump (IABP) Ventricular assist devices Continuous renal replacement equipment Extracorporeal mechanical oxygenation circuits

INTRA-AORTIC BALLOON PUMP

VENTRICULAR ASSIST DEVICES

CONTINUOUS RENAL REPLACEMENT EQUIPMENT

EXTRA CORPOREAL MECHANICAL OXYGENATION CIRCUITS

MONITORING EQUIPMENT IN ICU: - CARDIAC or HEART MONITORS = are used to monitor the electrical activity of the heart = looks like a computer screen with lines, or tracings, moving across the screen = the monitor has electrodes that are attached to the chest of the patient with sticky pads

- PULSE OXIMETER = allows the critical care team to monitor the saturation of oxygen in the blood = looks like a clothespin and is attached to a patients finger, or it may be smaller & clipped onto the earlobe

- SWAN-GANZ CATHETER =or PULMONARY ARTERY CATHETER = used to measure the amount of fluid filling the heart as well as to determine how the heat is functioning. = is inserted through the large vessels of the neck or upper chest & threaded into the heart

- ARTERIAL LINES (a-lines) = are used for continuous monitoring of blood pressure = catheter are inserted into an artery, usually in the wrist or, less often in the bend of the elbow or groin. = arterial lines produce a tracing on a monitor that is similar to that of a heart monitor but with a different wave form

TUBES & CATHETERS IN ICU - CENTRAL VENOUS CATHETER(CVC) = is a soft, pliable tube that is inserted into a large vessel(vein) in the neck, the upper chest, or in the groin area = can carry some risk of bloodstream infection & thrombosis CENTRAL VENOUS CATHETER

USE OF CENTRAL VENOUS CATHETER To administer frequent or continuous medication To administer large amounts of fluid, including blood & nutrition, that would damage smaller vessels such as those in arms - To measures central venous pressure(amount of fluid in the vessels) - INTRAVENOUS(IV) = Is a plastic catheter (tube) that is inserted into the veins (peripheral IV) or a larger size catheter inserted into large veins of the neck = Fluids, medications, nutrition preparations, & blood products are administered through IV catheters. = patients in ICU often have multiple IVs

INTRAVENOUS LINE

- CHEST TUBES = Are inserted through the chest wall into the space around the lung to drain fluid or air that has accumulated & prevent the lung from being able to expand

- URINARY CATHETER =Referred to as Foley catheters, are inserted through the urethra into the bladder = continuous drain the bladder and allow for accurate measurement of urinary output, which is extremely important in fluid management and is assessing kidney function

- ENDOTRACHEAL TUBES = are used when mechanical ventilation is necessary = a plastic tube is inserted either through the nose or mouth between the vocal cords & into the trachea = a small soft balloon at the end of the tube in trachea is inflated to prevent air from escaping, thus allowing adequate ventilation by a respirator.

LIFE SUPPORT DEVICES - VENTILATOR or RESPIRATOR = is a breathing machine that helps patients breathe when they are too ill to breathe on their own. = patient is connected to the ventilator by an endotracheal tube as patient;s lungs recover, the amount of ventilator support is gradually de creased until it is felt a patient can breathe on his or her own

MECHANICAL VENTILATOR

- NUTRITION = is very important for critically ill for healing process = nutritional solutions can be administered through feeding tubes inserted through either the nose or the mouth into the stomach or through central venous catheters = special nutritional preparations are available to provide the nutritional needs of the critically & are calculated & monitored PARENTERAL NUTRITION

INFORMED CONSENT Prior to initiating any procedure in the ICU, physicians must secure informed consent from the patient Except in emergency situations, physicians obtain consent directly from patient ADVANCE DIRECTIVE = contains instructions regarding care decisions DO NOT RESUSCITATE (DNR) = is a patients instructions not to re start a failed heart beat or respiration

CARE OF PATIENT Physically Psychologically considering:

1. Attitude of patient towards disease 2. Attitude of patient towards treatments 3. Attitude of patient towards patient 4. Attitude of relatives towards patient 5. Attitude of patient towards death OBJECTIVES OF CARE Maintenance of life support system Prevention of complications