Intensive Care Unit (ICU
more neonatologists and assistants. alongside doctors and critical care nurses who are highly trained in caring for the most severely ill patients. and in Canada they are maintained by The Canadian Pediatric Society. such as those listed below:
1.Intensive Care Unit (ICU)
An Intensive Care Unit (ICU). Hospitals may have ICU's that cater to a specific medical specialty or patient. The term neonatal comes from neo. close monitoring and support from equipment and medication in order to maintain normal bodily functions. resident
by nurses. nurse
practitioners. Intensive Therapy Unit or Intensive Treatment Unit (ITU) is a special department of a hospital that provides intensive-care medicine. Critical Care Unit (CCU). pharmacists. Levels in the United States are designated by the guidelines published by the American Academy of Pediatrics In Britain the guidelines are issued by The British Association of Perinatal Medicine (BAPM).
and respiratory therapists. Neonatal Intensive Care Unit (NICU) is an intensive care unit specializing in the
care of ill or premature newborn infants.
. Many other ancillary disciplines and specialists are available at larger units. "new". Intensive Care Units cater to patients with the most serious injuries and illnesses. most of which are life-threatening and need constant. They have higher levels of staffing and specialist monitoring and treatment equipment. and natal. Levels of care The concept of designations for hospital facilities that care for newborn infants according to the level of complexity of care provided was first proposed in the United States in 1976. physician
physicians. "pertaining to birth or origin".
for infants with chronic lung disease needing long-term oxygen and monitoring).
Level 2: special care newborn nursery
Care of infants with a corrected gestational age of 32 weeks or greater or a weight of 1500 g or greater who are moderately ill with problems expected to resolve quickly or who are convalescing after intensive care Peripheral intravenous infusions and possibly parenteral nutrition for a limited duration Resuscitation and stabilization of ill infants before transfer to an appropriate care facility Nasal oxygen with oxygen saturation monitoring (e.. and possibly the use of umbilical central lines and percutaneous intravenous central lines. Mechanical ventilation support. total parenteral nutrition. and Phototherapy
Care for infants with corrected gestational age greater than 34 weeks or weight greater than 1800 g who have mild illness expected to resolve quickly or who are convalescing after intensive care.
. and possibly inhaled nitric oxide.Canada Level 1: Basic neonatal care
Evaluation and postnatal care of healthy newborn infants. Intravenous infusion.
Level 3: Intensive neonatal care
Level 3a: Care of infants of all gestational ages and weights. for infants with chronic lung disease needing long-term oxygen and monitoring).g..
Mechanical ventilation for brief durations (less than 24 h) or continuous positive airway pressure. Ability to initiate and maintain intravenous access and medications Nasal oxygen with oxygen saturation monitoring (e.g. for as long as required immediate access to the full range of subspecialty consultants.
or surgical repair of serious congenital cardiac malformations that require cardiopulmonary bypass. hemofiltration and hemodialysis. a nurse is assigned up to two babies. inability to maintain body
. Level 3c: Extracorporeal membrane oxygenation. stabilize and provide care for infants born at 35 to 37 weeks’ gestation who remain physiologically stable stabilize newborn infants who are ill and those born at 35 weeks’ gestation until transfer to a facility that can provide the appropriate level of neonatal care. Performance and interpretation of advanced imaging tests. including computed tomography. evaluate and provide postnatal care to healthy newborn infants. hemofiltration and hemodialysis.
Level 2 neonatal care (specialty) Special care nursery: level II units are subdivided into 2 categories on the basis of their ability to provide assisted ventilation including continuous positive airway pressure. Intensive Care (NICU) Typically in the third level of care a nurse is assigned one baby only and in some cases may be 2 nurses to 1 baby.
United Kingdom Special Care (SCBU) In a special care baby unit a nurse can be assigned up to 4 babies to care for. United States Level 1 neonatal care (basic)
Well-newborn nursery: has the capabilities to provide neonatal resuscitation at every delivery.
Level 3b: Comprehensive on-site access to subspecialty consultants. magnetic resonance imaging and cardiac echocardiography on an urgent basis Performance of major surgery on site but not extracorporeal membrane oxygenation.
Level 2A: Level 2a has the capabilities to resuscitate and stabilize preterm and/or ill infants before transfer to a facility at which newborn intensive care is provided provide care for infants born at 32 weeks’ gestation and weighing 1500 g who have physiologic immaturity such as apnea of prematurity. High Dependency (NHDU) In the second level of care. or surgical repair of serious congenital cardiac malformations that require a cardiopulmonary bypass.
Pediatric surgical specialists and pediatric anesthesiologists on site or at a closely related institution to perform major surgery such as ligation of patent ductus arteriosus and repair of abdominal wall defects. child life specialists. including computed tomography. or inability to take oral feedings or who are moderately ill with problems that are anticipated to resolve rapidly and are not anticipated to need subspecialty services on an urgent basis. perforation. social workers. magnetic resonance imaging. necrotizing fistula enterocolitis with bowel atresia. and/or esophageal
Level 3C: Level 3c has the capabilities of a level IIIB NICU and also is located within an institution that has the capability to provide ECMO and surgical repair of complex congenital cardiac malformations that require cardiopulmonary bypass. with interpretation on an urgent basis.temperature. physiotherapists. They also provide care for infants who are convalescing after intensive care
Level 2B: Level 2B has the capabilities of a level IIA nursery and the additional capability to provide mechanical ventilation for brief durations (24 hours) or continuous positive airway pressure
NICU: level 3 (advanced specialty)
Level 3A: Level 3a has the capabilities to provide comprehensive care for infants born at 28 weeks’ gestation and weighing 1000g provide sustained life support limited to conventional mechanical ventilation perform minor surgical procedures such as placement of central venous catheter or inguinal hernia repair Level 3B: Level 3b has the capabilities to provide comprehensive care for extremely low birth weight infants (1000g and 28 weeks’ gestation) advanced respiratory support such as high-frequency ventilation and inhaled nitric oxide for as long as required. tracheoesophageal and myelomeningocele. and teenagers. and respiratory
specially trained and experienced in pediatric intensive care.
2. physician assistants. and echocardiography. Advanced imaging. A PICU is typically staffed directed by one or more pediatric intensivists or therapists who are PICU consultants and by doctors. nurses. The unit may also have nurse practitioners. Pediatric Intensive Care Unit (PICU) is an area within a hospital specializing in
the care of critically ill infants. Prompt and on-site access to a full range of pediatric medical subspecialists.
e.and clerks on staff although this varies widely depending on geographic location. Complex technology and equipment is often in use. The ratio of professionals to patients is generally higher than in other areas of the hospital. Consequently..
. Nurse-to-patient ratios range from 2 nurses to 1 patient to 1 nurse to 3 patients.e. entry and exit is controlled by the nursing staff) and staffing levels are higher than on a normal acute admission ward.
These wards are always locked (i. The patient's length of stay is normally short (a few weeks) rather than prolonged as the patient should be treated and returned to the unlocked ward as soon as their mental state is stable. Levels of care United States Level 1 Level I PICUs are variable in size. Registered respiratory therapists are required to be assigned primarily to the Level I PICU in-house 24 hours per day. PICUs have a larger operating budget than many other departments within the hospital. Many PICUs have a seclusion room. and equipment and that they differ in the types of specialized care (i.
3. personnel. care following transplantation or cardiac surgery) that they provide. Psychiatric Intensive Care Unit (PICU) is a type of psychiatric in-patient ward. Level 2 Level II PICUs are smaller than level I PICUs and are able to care for less critical patients. PICUs are designed to take patients that cannot be managed on the open (unlocked) wards due to the level of risk the patient poses to themselves or to others. some have two seclusion rooms. Clinical assessment of the risks posed by to the patient to themselves and to others should be included in any decision to transfer a patient to a PICU. physical characteristics. The role of a PICU does not encompass either of these two functions and patients should not be sent to a PICU solely as a 'punishment' for their behavior. There is a common misconception amongst the public and some patients that a PICU is a type of "punishment ward" or "segregation unit" (as found in UK prisons). particularly mechanical ventilators and patient monitoring systems. reflecting the acuity of PICU patients and the risk of life-threatening complications.
Patients are usually held in such facilities for a limited amount of time. discharge.
Common activities The PACU staff. hematoma. Managing post-operative pain. These essential activities include:
Monitoring vital signs (heart rate. and owing to the bed management cycle. redness. or Recovery Room. swelling. temperature and respiratory rate). and must meet a set of physiological criteria before transfer back to a ward with a qualified nurse escort takes place. Due to high patient flow in Recovery Units. generally composed of highly trained nurses. They are charged with many vital tasks for the care of post-anesthesia and post-operative patients. Post Anesthesia Care Unit (PACU) . Windows have restricted opening widths. Access to areas such as the unit's kitchen and secure external area (such as a garden) are controlled and risk assessed for each patient. Visitors have their bags searched on entry. blood pressure. the PACU provides immediate post-op observation and stabilization of patients following surgical operations and anesthesia. etc.
.Environment PICUs typically have the following environmental components:
Higher than normal staff to patient ratios. and dangerous (or "risk") items are removed. All exit/entry doors are locked. if a patient breaches a time frame and is too unstable to be transferred back to a ward.Also known as the Post-Operative
4. they are normally transferred to a High Dependency Unit (HDU) or Post-Operative Critical Care Unit (POCCU) for closer observation. Treating symptoms of postoperative nausea and vomiting (or PONV) Treating postanesthetic shivering Monitoring surgical site(s) for excessive bleeding.
progressive and intermediate care units and are utilized until a patient's conditions stabilizes enough to qualify them for discharge to a general ward. treatment and nursing care that cannot be provided on a general ward.These common activities may often need supplementing with more intensive care or treatment. These units are also called step-down. ventriculostomies. but whose care is not at a critical enough level to warrant an ICU bed. central venous lines. epidural or perineural infusions Preparation and establishment of invasive monitoring such as arterial lines. High Dependency Unit (HDU)
Many hospitals have a transitional High Dependency (HDU) facility for patients who require close observation.
. This may require:
Preparation and education for the use of Patient Controlled Analgesia (PCA) units Preparation and establishment of IV. etc.
INTENSIVE CARE UNIT (ICU)
Submitted to: Lucille C. Quidilla. RN
Submitted by: Dianne B. BSN IV
June 16. 2012