NCM 118/L

Care of clients with life-threatening conditions, acutely

ill/multi-organ problems, high acuity and emergency situation.

EMEemergency situation

Regina Katherine Joyce Q. Mandigma,

RN
 Unit Learning 1
Expectation:

Explain and introduce the concepts of Critical Care Nursing, Emergency

Nursing, Trauma Nursing, and care of clients with Respiratory Emergencies.
 Activity #1

Type your answer on the padlet link provided at the

chat messaging
Critical Care Nursing

is the field of nursing with a focus on the utmost care of

the critically ill or unstable patients following extensive
injury, surgery or life-threatening diseases.
Critical care nurses can be found working in a wide variety of
environments and specialties, such as general intensive care units,
medical intensive care units, surgical intensive care units, trauma
intensive care units, coronary care units, cardiothoracic intensive care
units, burns unit, paediatrics and some trauma centre emergency
departments.
These specialists generally take care of critically ill patients who require
mechanical ventilation by way of endotracheal intubation and/or
titratable vasoactive intravenous medication.
Critical Care Nurses can work in variety of areas:
1. General ICU
2. Medical ICU
3. Surgical ICU
4. Cardiovascular ICU
5. Neuro-Trauma ICU
6. Burn ICU
7. Coronary Care Unit
8. Emergency Department
9. Neonatal ICU
10. Pediatric ICU
11.High Dependency Unit
Critical Care Nurses Roles and Responsibilities

- provide direct, hands-on care for critically ill or injured patients

in pre-and postoperative medical settings
- tasked with assessing the risks and benefits of proposed medical
interventions, rendering life-saving treatment in emergency
situations, and nursing patients back to health.
- responsible for highly technical patient assessments,
implementing complex patient care plans, and the administration
of extensive medication protocols. Duties such as tracking life
support equipment, providing supplemental oxygen, administering
IV medications, monitoring cardiac and renal status, catheter care,
and dressing changes are a common part of a critical care nurse’s
job description.
 Responsibilities of a Critical Care Nurse:

1. Coordinate with health care team members to evaluate, plan, and implement
patient care plans
2.Prepare and administer (orally, subcutaneously, through an IV) prescribed
medications
3. Provide basic bedside care including dressing changes, catheter care, assisting the
patient with moving, and taking vital signs
4. Monitor patients for subtle or sudden changes in ventilation, renal, and cardiac
status
5. Report adverse reactions to treatments or medication
6. Order, interpret and evaluate diagnostic tests to assess a patient’s condition
7.Quickly identify when a patient decompensates and alert the rest of the
critical care team
8. Initiate corrective action when a patient displays adverse symptoms
9. Monitor and adjust specialized electronic equipment such as cardiac
monitors, respirators, ventilators, and oxygen pumpsAct as a patient
advocate, by respecting the basic rights, beliefs, and values of the patient
10. Communicate essential and appropriate information about a patients’
condition to family
 Emergency Nursing

is a specialty within the field of professional nursing focusing on the care of patients who
require prompt medical attention to avoid long-term disability or death. In addition to
addressing "true emergencies," emergency nurses increasingly care for people who are
unwilling or unable to get primary medical care elsewhere and come to emergency
departments for help. In fact, only a small percentage of emergency department (ED)
patients have emergency conditions such as a stroke, heart attack or major trauma.
Emergency nurses also tend to patients with acute alcohol and/or drug intoxication,
psychiatric and behavioral problems and those who have been raped.
 Character of an emergency nurse:

- must be able to sit, stand, walk, reach, squat and lift throughout their eight- or twelve-hour
shift.
- must have good manual dexterity, hearing and vision.
- must understand principles of human development, anatomy, physiology, and pharmacology.
- must also have a working knowledge of the many legal issues impacting health care such as
consent, handling of evidence, mandatory reporting of child and elder abuse, and involuntary
psychiatric holds.
- must be adept and comfortable working with patients of many different backgrounds, cultures,
religions, ages and types of disabilities.
- must be calm and professional at all times, especially when dealing with situations which are
difficult, emotional or disgusting.

Emergency nurses must also know how to care for themselves physically and emotionally.
Role of the emergency nurse:

- to evaluate and monitor patients and to manage their care in the emergency
department.
- to supervise licensed practical nurses and unlicensed assistive personnel
("nurse aides" or "care partners")
Some ED nurse functions are common to other nursing specialties, while others
are specific to emergency nursing. These can be divided into
1.) assessment,
2.) planning and managing care,
3.) tasks,
4.) communication, and
5.) teaching.
 Role of the ED Charge Nurse or the Team leader

responsible for the overall "flow" of the department. He or she

assigns nurses to patients, assures patients are being transported to
and from tests outside the ED, addresses patient complaints and
concerns, communicates with the house supervisor, takes phone
calls, and assures nurses get their breaks.
Trauma Nursing

- the content and process of all the various roles nurses assume
when caring for a trauma patient.
 Trauma Nurse

-a nurse who specializes in the care of patients who suffer an acute injury or
illness, whether it is accidental or intentional.
- a nurse skilled in caring for patients of all ages—from newborn to the elderly.
Examples of cases that trauma nurses may be involved in are:
a. Motor vehicle accidents
b. Assault
c. Gunshot wounds
d. Stab wounds
e. Environmental injuries such as a crush or penetrating injury
f.Head injuries
g. Physical or emotional abuse/neglect
- need to be able to function in a high-stress, chaotic environment
while maintaining an outwardly calm demeanor.
- must also be able to think and intervene quickly as trauma
patients often arrive without easily identifiable diagnoses.
- trauma patients can be critically unstable, so nurses in this
specialty need to be able to intervene as rapidly as possible.
- Effective communication is also essential in trauma nursing.
Nurses must be able to multitask, often performing life-saving care
while reporting to physicians and other members of the medical
team.
- Communication is crucial in preventing errors during
emergencies.
 Perioperative Nurse

- registered nurses who work directly with patients who are

undergoing operations or other invasive procedures.
- These nurses work closely alongside surgeons, nurse anesthetists,
anesthesiologists, surgical technologists, and nurse practitioners to
provide pre- and post-op education as well as preoperative,
intraoperative, and postoperative care in the operating room, recovery
room, and other locations within medical surgical units.
- Within the broad field of perioperative nursing, nurses can choose
to focus on surgical sub-specialties like cardiac surgery,
neurosurgery, oncology, urology, plastic or reconstructive, transplant,
general and more.
Circulating nurse - supervises nursing care and ensures surgical rooms
are safe, secure, and sterile
RN First Assistant - perform suture cuts, manage and monitor
bleeding, and carry out other complex tasks.
Scrub Nurse - sterilizing tools and providing tools to surgeons as they
require them throughout a procedure, assisting surgeon to perform
simple tasks throughout surgery
Post-Surgery Recovery Nurse - provides immediate patient care post-
surgery
Stroke Specialist Nurse

- work closely with the medical team to work out what tests,
treatments and care you need.
- Their role also includes offering support and education to you
and your family.
- works closely with the rest of the team in coordinating the stay
and help the patient to prepare to leave hospital.
Cardiac Catheterization Lab Nurse

a nursing professional and patient-care specialist who works in

the cardiac catheterization lab - the examination area of the
hospital that specializes in procedures which allow physicians to
visualize certain aspects of the heart.
Respiratory Therapist

- a specialized healthcare practitioner trained in critical

care and cardio-pulmonary medicine in order to work
therapeutically with people suffering from acute critical
conditions, cardiac and pulmonary disease
- graduate from a college or university with a degree in
respiratory therapy and have passed a national board
certifying examination.
Phlebotomist

- people trained to draw blood mostly from veins for clinical

or medical testing, transfusions, donations, or research
- duties of a phlebotomist may include:
a. interpreting the tests requested,
b. drawing blood into the correct tubes with the proper
additives, accurately explaining the procedure to the person
and preparing them accordingly,
c. practicing the required forms of asepsis,
d. practicing standard and universal precautions,
e. restoring haemostasis of the puncture site, giving
instructions on postpuncture care,
f. affixing tubes with electronically printed labels, and
delivering specimens to a laboratory
Emergency Physician
also known as an emergency room (ER) doctor or
emergency medicine physician, works in a
hospital's emergency care center to provide
immediate treatment to people with injuries,
illnesses, or ailments that require attention beyond
what an emergency medical technician can give.
Patients are often faced with life-threatening
situations and the ER doctor is responsible for
stabilizing patients
Flow of care of a client with life-threatening conditions.
Flow of care of a client with life-threatening
conditions.
TRIAGE SYSTEM

Triage is process of collecting health information from the client

and quick decision making. The Triage Nurse will use his/her
assessment skills and critical care thinking skill in sorting-out
injured clients.
Hospitals around the world use different Triage Acuity Systems.
Triage Nurses will have education and training in using these
acuity systems.
The following are Triage Acuity Systems:
1. ESI- Emergency Severity Index
2. CTAS- Canadian Triage and Acuity Scale
3. ATS- Australasian Triage Scale
4. MTS- Manchester Triage System
 Activity 2

Say something about each of the triage Acuity

system

Please answer by clicking the “raise hand” icon

Emergency Severity Index (ESI)

fundamental goal is to connect every patient to the right

resources at the right place and in the right amount of
time.
LEVELS OF ESI TRIAGE SYSTEM:
level 1 criteria
- include patients who are intubated, apneic, pulseless, or
unresponsive, as well as patients in imminent risk of
death if lifesaving interventions aren't started.
Level 2 criteria
- patient would be someone who arrives at the ED saying she's
hearing voices, is thinking of committing suicide, and describes a
detailed suicide plan. This patient is at high risk.
Level 3-5
-are focused on resource allocation
 Canadian Triage and Acuity Scale (CTAS)

- more accurately define patients’ needs for timely care.

- helps emergency departments to evaluate the patients’ acuity levels,
resource needs and departments’ performance against certain operating
objectives.
- Improves communication and public relations.
Australasian Triage Scale (ATS)

-a clinical tool used to establish the maximum waiting time for

medical assessment and treatment of a patient.
- aims to ensure that patients presenting to emergency departments
(EDs) are treated in the order of their clinical urgency and
allocated to the most appropriate assessment and treatment area.
 Categories:

1. ATS 1 (Immediate)
2. ATS 2 (10 minutes)
3. ATS 3 (30 minutes)
4. ATS 4 (60 minutes)
5. ATS 5 (120 minutes)
The ATS utilizes five categories from Category 1 – an immediately
life-threatening condition that requires immediate simultaneous
assessment and treatment – to Category 5 - a chronic or minor
condition which can be assessed and treated within two hours.
 Manchester Triage System

is a clinical risk management tool used by clinicians

worldwide to enable them to safely manage patient
flow when clinical need far exceeds capacity.
The Manchester Triage System (MTS) :
1. Red (Immediate)
2. Orange (Very Urgent 10 minutes)
3. Yellow (Urgent 60 minutes)
4. Green (Standard 120 minutes)
5. Blue (Non-Urgent 240 minutes)