Professional Documents
Culture Documents
NURSING
1
CRITICAL
Crucial
Crisis
Emergency
Serious
Requiring immediate action
Thorough and constant observation
Total dependent
(Oxford Dictionary)
Prof. Dr. R S Mehta, BPKIHS 2
CRITICAL CARE NURSING
CRITICAL CARE :
CRITICAL CARE IS A TERM USED
TO DESCRIBE AS THE CARE OF
PATIENTS WHO ARE EXTREMELY
ILL AND WHOSE CLINICAL
CONDITION IS UNSTABLE OR
POTENTIALLY UNSTABLE.
Prof. Dr. R S Mehta, BPKIHS 7
CRITICAL CARE UNIT :
IT IS DEFINED AS THE UNIT IN
WHICH COMPREHENSIVE CARE
OF A CRITICALLY ILL PATIENT
WHICH IS DEEMED TO
RECOVERABLE STAGE IS
CARRIED OUT.
17
ICU’s also treat the dying
Isaac Asimov:
“Life is pleasant.
Death is peaceful.
It is the transition
that is difficult”
Open
Closed
transitional
A team:
doctors, nurses, R/T, pharmacists
• led by full time intensivists
critical care trained
available in a timely fashion (24hr/day)
no competiting clinical responsibilities
during duty
• closed units, if resources allow
Prof. Dr. R S Mehta, BPKIHS 29
What are the conditions
considered as Critical?
1. ANY PERSON WITH LIFE
THREATENING CONDITION
2. PATIENTS WITH :
ARF
AMI
CARDIAC TAMPONATE
SEVERE SHOCK
Prof. Dr. R S Mehta, BPKIHS 30
HEART BLOCK
ACUTE RENAL FAILURE
POLY TRAUMA, MULTIPLE
ORGAN FAILURE AND ORGAN
DYSFUNCTION
SEVERE BURNS
DESIGN OF ICU :
1. Should be at a geographically distinct area
within the hospital, with controlled access.
2. There should be a single entry and exit.
However, it is required to have emergency exit
points in case of emergency and disaster.
3. There should not be any through traffic of
goods or hospital staff. Supply and professional
traffic should be separated from public/visitor
traffic. Prof. Dr. R S Mehta, BPKIHS 53
4. Safe, easy, fast transport of a critically sick pt
should be a priority in planning its location.
Therefore, the ICU should be located in close
proximity or ER, OT, trauma ward etc.
5. Corridors, lifts and ramps should be spacious
enough to provide easy movement of bed/trolley
of a critically sick patient.
6. Close, easy proximity is also desirable to
diagnostic facilities, blood bank, pharmacy etc.
BED STRENGTH:
1. It is recommended that total bed strength in ICU
should be between 8-12 and not less than 6 or
not more than 24 in any case.
Prof. Dr. R S Mehta, BPKIHS 54
2. 3-5 beds per 100 hospital beds for a Level III ICU
or 2 to 20% of the total no of hospital beds.
3. 1 isolation bed for every ICU beds.
Patient Care
Medical Knowledge
Professionalism & Ethics
Interpersonal Communication Skills
Practice-based Learning and
Improvement
Systems-based Practice
Prof. Dr. R S Mehta, BPKIHS 63
Evaluation of ACCP Board
Procedure Log Books
Monthly Evaluations
In Training Exams
Review Lectures
Error Reporting
QI PROJECTS
Tauma MAn
FCCS
THCI
Patient Care X X X X X X X X
Medical Knowledge X X X X X X X
Professionalism X X X X
Systems-Based Practice X X X X
C. Neurologic disorder
1. Intracranial hemorrhage
2. Meningitis with altered mental status or respiratory
compromise
3. Central nervous system or neuromuscular disorders
with deteriorating neurologic or pulmonary function
4. Status epilepticus
5. Severe head injured patients
E. Gastrointestinal Disorders
1. Life threatening gastrointestinal bleeding including
hypotension, angina, continued bleeding, or with
comorbid conditions
2. Hepatic failure
3. Severe pancreatitis
H. Miscellaneous
1. Septic shock with hemodynamic instability
2. Hemodynamic monitoring
3. Environmental injuries (lightning, near
drowning, hypo/hyperthermia)
Prof. Dr. R S Mehta, BPKIHS 73
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.
Electrocardiogram
Myocardial infarction with complex arrhythmias,
hemodynamic instability or congestive heart failure
Sustained ventricular tachycardia or ventricular
fibrillation
Complete heart block with hemodynamic instability
84
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.
Pastoral Care
Chaplains are available to minister to the spiritual needs of patients and
families.
Manager
Nurse Managers are nurses with additional experience and education, who
are responsible for the day to day operations of the ICU. In addition to
managing the ICU nursing staff, the ICU Nurse Manager is responsible for
the ICU budget and nursing practices. Nurse Managers are responsible for
ensuring that the care in the ICU is safe. She/he hires ICU nurses and
ensures that all nursing staff members meet the standards established for
their performance. She is also there to assist family members with their
needs.
It includes
Enteral feeding
o Oro - gastric and Naso - gastric feeding
o Churn diet
o Dairy and poultry products (Milk, egg,
youghort)
o High protein liquid diet
o Medications
Prof. Dr. R S Mehta, BPKIHS 89
Oral feeding
o Hospital diet
o Bland diet
o Normal diet
o Liquid intake
Fentanyl
o It works 600 times more effectively than
Morphine and reduces the pain and
increases the pain threshold
o Used in moderate and severe pain
o In ICU 50 – 100 µg per Kg
o Antidote Naloxone 0.05 mg/ Kg
Benzodiazepines
1. Midazolam
oShort acting sedatives and hypnotics
oIn intubated patients
oDose 0.01- 0.05 mg/Kg for several hours
2. Diazepam
• Adult dose = 0.2 – 0.5 mg/ Kg
• Not given in MI patients
Dopamine
Dobutamine
Nor- adrenaline
RBS as prescribed
Insulin therapy
Careful monitoring of signs of
Hypoglycemia
(trembling, clammy skin, palpitations,
anxiety, sweating, hunger, and irritability)
Aspirin
Clopidogrel
Nitroglycerine
Atorvastatins
LMWX
Morphine