CRITICAL CARE

APPLICATIONS
KAREN DONAIRE
M A RY G E R A L I

CRITICAL CARE NURSING

specialty that deals with human responses to
life-threatening problems

CRITICAL CARE UNIT

environment geared to the monitoring and
support needs of the critically ill patient

MICROPROCESSORS
embedded in physiologic monitoring systems which permits
gathering, processing, and storage of large volumes of clinical and
financial data; facilitate downloading of data that resides in the
device to an information management system
Advantages:
Better control of patient observations

Improve assessment, intervention, and evaluation of patient care

BETTER CONTROL OF PATIENT OBSERVATIONS

IMPROVE ASSESSMENT, INTERVENTION, AND
EVALUATION OF PATIENT CARE
Major capabilities of information technology (such as physiologic monitors,
mechanical ventilators, critical care information systems):
Integrate physiologic & diagnostic info from various sources
Present deviations from preset ranges by an alarm or alert
Store patient care documentation in a lifetime clinical repository
Trend data in a graphical presentation
Comparatively evaluate patients for outcomes analysis
Present clinical data based on concept-oriented views (by patient problem or
by system)

PHYSIOLOGIC MONITORING SYSTEMS

1960s developed to oversee vital signs of astronauts
1970s replaced manual methods of gathering patient vital signs in
hospital setting
1980s became more powerful; improved overall patient
monitoring capabilities
1990s held the ability to integrate monitoring data into
information system

BASIC COMPONENTS OF PME

Sensors instrument coupled to pt and transform the physiologic signal into
an electrical signal (e.g. pressure transducer, ECG electrode)
Signal conditioners amplify and filter the display device (e.g. amplifier,
oscilloscope, paper recorder)
File ranks and orders info (e.g. storage file, alarm signal)
Computer processor analyzes data and directs reports (e.g. paper reports,
storage for graphic files, summary reports)
Evaluation/Controlling component regulates the equipment or alerts the
nurse (e.g. notice on the display screen, alarm signal)

HEMODYNAMIC MONITORS
calculate hemodynamic indices & limited data storage;
examine cardiovascular function; evaluate cardiac output&
volume status; recognize patterns (arrhythmia analysis);
assess vascular system integrity; evaluate blood gases and
electrolytes; estimate cellular oxygenation; transmit
selected data to a computerized pt database

INVASIVE
involves use of pulmonary artery catheter (measures pulmonary
artery & wedge pressures), thermistor (facilitates measurement of
CO), and fiber-optic technology (measures mixed venous oxygen
saturation). Complications: infection, hemorrhage, and embolism

NON-INVASIVE
uses oscillometric techniques (pressure measurement),
pulse oximeter (oxygentation measurement), and Doppler
(CO measurement)

CRITICAL PIECE OF HEMODYNAMIC

INFORMATION
INVOLVES
THE
AVAILABILITY OF OXYGEN TO BODILY
TISSUES.

TELEMETRY
allows for continuous monitoring of patients usually outside of the
ICU; data are sent by a transmitter to an antenna system thats
distributed around the nursing unit and displayed on the monitor
screen at the telemetry station; susceptible to signal loss due to
interrupted radio frequency signal reception by walls, furniture,
patients own body, and extraneous RF signals of the same
frequency.

MEDICAL TELEMETRY CANNOT INTERFERE

WITH LICENSED USERS SUCH AS TV AND
RADIO BROADCASTERS AND MUST ENDURE
ANY INTERFERENCE EXPERIENCED FROM
THESE LICENSED USERS. (PART 15 AND
PART
90
RULES
BY
FEDERAL
COMMUNICATIONS
COMMISSION)

COMPUTER-BASED
offers a wealth of info; nurse must learn to recognize the limitations
of manual estimation of physiologic parameters & not use that
estimation to diagnose a monitor malfunction.
Example: Manual calculation of mean arterial blood pressure is based
on discrete systolic and diastolic pressures. The hemodynamic
monitor calculates mean arterial pressure using a much larger
sample of discrete pressures. Therefore, the manually calculated mean
pressure is an estimate and the value calculated by the monitor is a
derived measurement.

ARRYTHMIA MONITORS (DETECT VENTRICULAR

FIBRILLATION AND RESPOND WITH ALARM)
System Types:
Detection surveillance- criteria for normal ECG are programmed
into the computer; store in memory the type of arrhythmia and
time of occurrence
Diagnostic/Interpretive- analyze and diagnose the ECG; generates
an analysis report thats confirmed by a cardiologist; capable of
retrieving a patients previous ECGs for comparison

CRITICAL CARE INFORMATION SYSTEMS

system designed to collect, store, organize, retrieve, and manipulate
all data related to care of the pt; focused on individual pt and the
info directly related to the pts care; should include data and info
from bedside devices, results from ancillary departments,
medications, orders, physical assessment, findings gathered from the
clinical teams; and comprehensive plans of care.
Purpose: Organization of a pts current and historical data
for use by all care providers in pt care.

COMPONENTS OF CCIS INCLUDE:

Patient management- service, length of stay, mortality, and readmit rates are
examples of data to assist in strategic planning.
Prognostic scoring system- therapeutic interventions scoring system (TISS),
acute physiology and chronic health evaluation system (APACHE), mortality
predictor model (MPM), and simplified acute physiology score (SAP)
determine the likelihood of survival.
Vital sign monitoring- data can be automatically acquired from bedside
instruments and incorporated into the clinical database; can be incorporated
into flow sheets w/ other data elements such as lab results, body system
assessment findings, and problem lists.

Diagnostic testing results- displayed in flowsheets such as lab, radiology, and

cardiology results; clinicians can access picture archival information.

 Clinical documentation- support process of physical assessment findings;

findings entered can generate problem lists based on the physical assessment
findings; alerts generated for patients at high risk for falls, pressure ulcers, and
other factors; perform calculation of physiologic indices.
Decision support- provides alerts and reminders to guide care in accordance
with evidence-based guidelines; alerts on policies thus facilitates adherence to
protocols.
Medication management- use of bar code scanning and an electronic
medication administration record; ensures rights of medication administration;
calculates IV medication dosage and total I/O.

 Interdisciplinary plans of care- allows flexibility to meet diversified

needs; helps orchestrate all of the numerous, simultaneous
processes of caring for patients by pushing tasks to individual work
lists, ensuring each tasks is completed and provides notification
when tasks fail.
Provide order entry- plays a critical role to help clinicians improve
communication, streamline processes, facilitate care; guides entire
clinical team toward common goals.

 CCISs solutions provided are usually flexible and allow for

customization of the system functionality to fit the
existing clinical practices and workflows at an individual
institution.

COORDINATION AND SCHEDULING OF

PT CARE ACTIVITIES
Critical Care Flowsheet- predominant display format for CCISs

Goal of CCIS:
Have as much information integrated into the system as
possible to obtain a comprehensive picture of patient