8.

11 - Introduction to Critical Care with human responses to life-threatening

1. The Set-Up
Critical Care Unit / Intensive Care Unit
• A hospital unit where 24-hour medical care is
rendered to patients with life-threatening injuries
and illnesses
5. The CCU Nurse
• A distinct organizational & geographic section
for clinical activity & care, operating in
coordination with other departments integrated
in a hospital
2. The Functions
Critical Care Unit / Intensive Care Unit:
• To monitor & support threatened or failing vital
functions in critically ill patients,
 with illnesses that can endanger life, &
 that adequate diagnostic measures &
medical or surgical therapies are
performed to improve their outcome
problems.
• These problems deal dynamically with
human responses to actual or potential
life-threatening illnesses”
(CCNAPI, 2014)
 A licensed professional nurse who is responsible
for ensuring that all acutely and critically ill
patients receive optimal care
 Basic to the provision of optimal care is
individual professional accountability through:
 Adherence to the standards of nursing
care of acutely ill and critically ill
patients
 Commitment to act in accordance with
ethical principles
 Essential Elements of CCN:
 Nursing expertise
 Ability to observe patients
 Appropriate nursing intensity

3. The Men and Women 6. The CCU Patients:

Critical Care Unit / Intensive Care Unit Acutely and Critically Ill Patients

• A team of specially-trained health care providers • Patients who are at high risk for
are involved in rendering specialized treatments mortality due to present health problems
with the use of machines to constantly monitor (AACN, 2015)
vital signs • At high risk of actual or life-threatening
• With dedicated medical, nursing, & allied health health problems (Aitken, Chaboyer,
staff that operates with defined policies & Elliot, 2019)
procedures, with its own quality improvement,
continuing education, & research programs
4. CCU Nursing Discipling
Acute and Critical Care Nursing
• The specialty within nursing that
specifically deals with human responses
to actual or potential life-threatening
Development of Critical Care Units (CCU)
health symptoms and diagnosis (AACN,
2015)
• Assisting, supporting, and restoring the
patient toward health, or to ease the
patient’s pain, or to prepare them for
dignified death (World Federation of
Critical Nurses)
• “Critical care nursing is the specialty
within nursing that deals specifically
History of Critical Care
• 1800 - Florence Nightingale :
 advantages of separating recovering
surgical patients
 needs of acute, life-threatening illness
or injury could be better met if the
patients were organized in distinct areas
of the hospital
• WW2 – shock wards were set to care for
critically injured patients
• 1900 – John Hopkins Hospital
• 3-bed post-op neurosurgical CC
(Baltimore)
• premature infants unit (Chicago)
• 1950s – mechanical ventilation was introduced –
establishing the first ICU (respiratory)
• 1970s – the Society of Critical Care Medicine
(SCCM) was established and became the driving
force behind:
• critical care guidelines
• education
• interdisciplinary collaborative
initiatives
• WW2 :
 provided for the impetus for
specialized MS Nursing care in the
civilian setting.
 the most critically ill patients were
segregated in areas where they can be
cared for by nurses with specialized
knowledge.
 Organized as a specialty less than 60 years ago
(1960s)
• 1960s
 physicians depended on nurses to assess
for critical changes in
their patients
 nurses would initiate emergency
medical treatment
 nurses began consolidating their
knowledge & practice into focused areas
(coronary care, nephrology, intensive
care)
 nurses assumed many functions &
responsibilities formerly reserved for
physicians, & assumed a new authority
by virtue of their knowledge & expertise
Contemporary Critical Care
• Provided by a multidisciplinary
(multiprofessionals) team of health care
professionals equipped with an extensive
education & expertise in the specialty field of
critical care
 physicians intensivist / specialty
physicians
 nurses (advanced practice nurses –
APNs)
 pharmacists
 respiratory therapists / other specialized
therapists
 social workers
 clergy / other religious sect
 Critical care is provided in specialized units,
with emphasis on the continuum of care, with an
efficient & seamless transition of care from one
setting to another
 Settings:
 adult / pediatric / neonatal
 step-down / telemetry / progressive or
transitional care units
 intentional radiology departments
 post-op recovery units
Scope of Practice
 Describers the; Who, What, Where, When,
Why & How the nurse functions when caring
for acutely & critically ill patients
 Should allow for an exchange, expansion, and
flexibility of the profession to meet the changing
needs of patients, organizations, and society
 Boundaries of the practitioner’s license:
 procedures
 nursing actions
 processes
 For which the practitioner has received:
 education
 training
 licensure
 certification
Scope of Critical Care Practice
• Activities that the CCN is permitted to perform
• Scope of practice is established by the ACT of
the specific practitioner's board, and the rules
adopted pursuant to the act (AACN, 2015)
Critical Illness:
• Any disease process which causes physiological
INSTABILITY leading to:
 disability or death within minutes or
hours
  Disturbance of these systems generally has the
most immediate life-threatening effects
 neurological
 respiratory
 cardiovascular
Critical Illness: Common Observations
• Hypotension
• Tachycardia
• Tachypnea
• Reduced level of urine output
• Altered consciousness
NOTE: The presence of 2 or more of these signs
strongly suggests that the patient is critically ill and at
risk of death