MONITORING of Critically ill

Patients

1
Prof. Dr. RS Mehta, BPKIHS
INTRODUCTION
Intensive care unit (ICU) equipment
includes patient monitoring, respiratory
and cardiac support, pain management,
emergency resuscitation devices, and
other life support equipment .

Prof. Dr. RS Mehta, BPKIHS 2

Contd…
They are designed to care for patients
who are
seriously injured,
have a critical or life-threatening illness,
or
have undergone a major surgical
procedure thereby requiring 24-hour care
and monitoring.

Prof. Dr. RS Mehta, BPKIHS 3

PURPOSE

An ICU may be designed and equipped to

provide care to patients with a range of
conditions, or it may be designed and
equipped to provide specialized care to
patients with specific conditions.

Prof. Dr. RS Mehta, BPKIHS 4

Contd…
Neuromedical ICU cares for patients with
acute conditions involving the nervous
system or patients who have just had
neurosurgical procedures and require
equipment for monitoring and assessing
the brain and spinal cord.

Prof. Dr. RS Mehta, BPKIHS 5

Contd…
 A neonatal ICU is designed and
equipped to care for infants who are ill,
born prematurely, or have a condition
requiring constant monitoring.

A trauma/burn ICU provides specialized

injury and wound care for patients
involved in auto accidents and patients
who have gunshot injuries or burns.

Prof. Dr. RS Mehta, BPKIHS 6

Prof. Dr. RS Mehta, BPKIHS 7
TYPES OF DEVICES
Intensive care unit equipment includes
Patient monitoring devices
 Life support and emergency resuscitation
devices, and
Diagnostic devices.
 

Prof. Dr. RS Mehta, BPKIHS 8

PATIENT MONITORING
EQUIPMENT
Arterialline
Bed side monitor
Blood pressure device (sphygmomanometer)
Blood pressure monitor
Electrocardiograph(ECG or EKG machine)
Electroencephalograph(EEG machine)
Intracranial pressure monitor
Pulse Oximeter
Glucometer

Prof. Dr. RS Mehta, BPKIHS 9

LIFE SUPPORT AND
EMERGENCY RESUSCITATION
DEVICES
Mechanical Ventilator
Laryngoscope
Airway
Infusion pump
Crash cart(Resuscitation cart)
Intra aortic ballon pump
Continuous positive air pressure
machine (CPAP)
Defibrillator
Prof. Dr. RS Mehta, BPKIHS 10
DIAGNOSTIC EQUIPMENT

Mobile x-ray units

portable clinical laboratory devices,
Bronchoscope

Colonoscope

Endoscope

Gastroscope

Prof. Dr. RS Mehta, BPKIHS 11

OTHER ICU EQUIPMENT

Disposable ICU equipment includes

Urinary catheter
Urinary drainage collector
Suction catheter
Nasogastric (NG) tube
Intravenous(IV) line or catheter
Feeding tube
Breathing tube( Endotracheal tube)

Prof. Dr. RS Mehta, BPKIHS 12

 General Guidelines
 Monitoring ensures rapid detection of changes in the
clinical status
 Allows for accurate assessment of progress and response
to therapy
 When clinical signs and monitored parameters disagree,
assume that clinical assessment is correct
 Trends are generally more important than a single
reading
 Use non-invasive techniques when possible
 Alarms are crucial for patient safety
Clinical, Biochemical, Microbiological and
Imaging

 Clinical: GCS, vital sign, Skin temperature, color,

capillary refill, Urine output etc.
 Biochemical: Blood tests-electrolytes, CBC,
coagulation profile, etc.
 Microbiological: Blood cultures, urine culture etc.
 Imaging: X-rays, U/S, CT scan, MRI etc.
16
CARDIAC MONITOR
DEFIBRILLATION

04/30/21 04:34 18
04/30/21 04:34 19
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PULSE OXIMETRY
Glucometer
CARE OF CRITICALLY ILL
PATIENT
 Patients in the critical care unit

Respiratory difficulties impairing the clients

abilities to ventilate or oxygenate. Often include
severe pneumonia, pulmonary embolism, drug
overdose, and respiratory distress.

Circulatoryproblems such as hypotension or

dysrhythmias, MI, etc.

Neurological changes such as loss of

consciousness or changes in the mental status.
Patients in the critical care unit…
 Clients with head injuries, brain surgery, stroke or
spinal cord injuries are admitted to the ICU for
frequent reassessment.

 Metabolic problems such as abnormal electrolytes

from diabetes, renal failure, or acid base imbalances
require intensive monitoring and medication
titration to control and treat complications.

 Clients who have had open heart surgery, thoracic

surgery, brain surgery, extensive abdominal or
orthopedic surgery are admitted post operatively to
the ICU for monitoring.
Patients in the critical care unit…
 Clientswho have less invasive procedures but have
a personal history of cardiac or pulmonary disease
may also be admitted for observation and frequent
assessment.

 Life threatening infection or the risk of infection,

such as burn wounds or sepsis, requires intensive
care to control the blood pressure and maintain
perfusion of the heart, brain, lungs and kidneys.

 Clients with sepsis or large open wounds require

very intensive care for medication administration
and fluid management.
 Nursing Care of critically ill patients

Preadmission
Based on their preadmission assessment findings,
nurses should consider the following:

Obtaining appropriate consults (i.e., nutrition,

physical/occupational/speech therapist)
Implementing safety precautions
Using pressure-relieving devices
Organizing family meetings
During ICU

Multiple Organ Systems

Encouraging early, frequent mobilization/ambulation
Providing proper oral hygiene
Ensuring adequate pain control
Reviewing/assessing medication appropriateness
Avoiding poly pharmacy/high-risk medications
Securing and ensuring the proper functioning of tubes
/catheters
Actively taking measures to maintain normothermia
Closely monitoring fluid volume status
Respiratory care
 Altered ventilation, poor secretion clearance, impaired muscle
function and lung collapse (atelectasis) occur in the supine position.

 Encourage and assist with coughing, deep breathing, incentive

spirometer use.

 Assess for signs of swallowing dysfunction and aspiration.

 Closely monitor pulse oximetry and arterial blood gas results.

 Consider the use of specialty beds.

 Advocate for early weaning trials and extubation as soon as

possible.
Respiratory…

 In those patients who are mechanically ventilated:

o Keep the head of the bed elevated to more than 30
degrees.
o Provide frequent oral care.
o Maintain adequate cuff pressures.
o Use continuous sub glottic suctioning devices.
o Do not routinely change ventilator circuit tubing.
o Assess the need for stress ulcer and deep venous
thrombosis (DVT) prophylaxis.
o Turn the patient as tolerated.
o Maintain general hygiene practices.
Cardiovascular care
 Prolonged immobility impairs autonomic vasomotor
responses to sitting and standing causing profound postural
hypotension.

 Carefully monitor the clients’ hemodynamic and electrolyte

status.

 Closely monitor the clients’ electrocardiogram (ECG) with an

awareness of many conduction abnormalities seen. Consult
with physician regarding prophylaxis when appropriate.

 Advocate for the removal of invasive devices as soon as the

patient's condition warrants. The least restrictive device may
include long-term access.
Neurologic care
 Closely monitor the clients’ neurologic and mental status.

 Screen for delirium and sedation level at least once per shift.

 Implement the following interventions to reduce delirium:

◦ Promote sleep, mobilize as early as possible, review
medications that can lead to delirium, treat dehydration,
reduce noise, close doors/drapes to allow privacy, provide
comfortable room temperature, encourage family and
friends to visit, allow the older adult to assume their
preferred sleeping positions, discontinue any unnecessary
lines or tubes, and avoid the use of physical restraints,
using least restraint for minimum time only when
absolutely necessary.
Neurologic care…
◦ Maximize the clients’ ability to communicate his or her needs
effectively and interpret their environment.
 Face the patients when speaking to them, get their attention
before talking, speak clearly and loud enough for them to
understand, allow them enough time (pause time) to respond
to questions, provide them with a consistent provider, use
visual clues to remind them of the date and time, and provide
written or visual input for a message.

 Provide the clients’ with alternate means of communication

(e.g., providing him or her with a pen and paper, using
nonverbal gestures, and/or using specially designed boards
with alphabet letters, words, or pictures).

 Provide translators/interpreters as needed.

Pain management

Provide adequate pain control while avoiding

over sedation or under sedation.
Gastrointestinal care
 The supine position predisposes to gastro-oesophageal reflux
and aspiration pneumonia.

 Nursing patients 30° head-up prevents this.

 Early enteral feeding reduces infection, stress ulceration and

GI bleeding.

 Immobility is associated with gastric stasis and constipation;

gastric stimulants and laxatives are essential

 Monitor for signs of GI bleeding and delayed gastric

emptying and motility.
◦ Encourage adequate hydration, assess for signs of fecal
impaction, and implement a bowel regimen.
Gastrointestinal…
Advocate for stress ulcer prophylaxis.
Implement aspiration precautions.
◦ Keep the head of the bed elevated to a high
Fowler's position, frequently suction copious
oral secretions, bedside evaluate swallowing
ability by a speech therapist, assess phonation
and gag reflex, monitor for tachypnea.

Ensure tight glucose control.

Neuromuscular

Immobility, prolonged neuromuscular blockade

and sedation promote muscle atrophy, joint
contractures and foot drop.

Physiotherapy and splints may be required.

Genitourinary care
 Assess any GU tubes to ensure patency and
adequate urinary output.

 Advocate for early removal of Foley catheters.

 Use other less invasive devices/methods to facilitate

urine collection (i.e., external or condom catheters,
offering the bedpan on a scheduled basis, and
keeping the nurse's call bell/signal within the
clients’ reach).

 Monitor blood levels of nephrotoxic medications as

ordered.
Immune/Hematopoietic care
 Ensure the older adult is ordered appropriate DVT
prophylaxis (i.e., heparin, sequential compression
devices).

 Monitor laboratory results, assess for signs of

anemia relative to patient's baseline.

 Recognize early signs of infection–restlessness,

agitation, delirium, hypotension etc.

 Accurately maintain infection control/prevention

protocols.
Skin care

 Conduct thorough skin assessment.

 Alertly monitor room temperature, make every

effort to prevent heat loss, and carefully use and
monitor rewarming devices.

 Use methods known to reduce the friction and shear

that often occur with repositioning in bed.

 In severely compromised patients, the use of

specialty beds may be appropriate.
Skin…

Techniques such as frequent turning, pressure-

relieving devices, early nutritional support, as
well as frequent ambulation may not only
protect clients’ skin but also promote the health
of their cardiovascular, respiratory, and GI
systems.

Closely monitor IV sites, frequently check for

infiltrations and use of nonrestrictive dressings
and paper tape.
 Eye Care
The eye is protected from dryness
from frequent lubrication by blinking

Complications from poor eye care

in patient’s who are unable to blink
include corneal ulceration, viral or
bacterial conjunctivitis

Corneal abrasions develop in 40-60% of

ICU patients2

Goals of eye care are to provide

comfort and protect from injury &
infection
Dressing and wound care

Replace wound dressings as necessary.

Change arterial and central venous catheter
dressings every 48-72 h
Core Competencies
Patient Care
Medical Knowledge
Professionalism & Ethics
Interpersonal Communication Skills
Practice-based Learning and
Improvement
Systems-based Practice

Prof. Dr. R S Mehta, BPKIHS 46

Functions of critical care nurse
Help to restore life process: BLS/ALS
Help to maintain life sustaining functions
Manage crisis/ critical care situations
Maintain standard: follow guidelines
Maintain team spirit and IPR
Ensure availability of all equipments
Provide continue nursing services
Maintain good rapport with family

Prof. Dr. R S Mehta, BPKIHS 47

THANK YOU!

Prof. Dr. RS Mehta, BPKIHS 48