coronary care unit

By Tekalign M.( Msc.)

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OBJECTIVE
At the end of this lesson the students will be able to

Understand critical care basics

Describe Prevention and causes of error in the ICU

Identify reduction methods of nosocomial infection

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CRITICAL CARE BASICS

Definition Critical care nursing is the delivery of

specialized care to critically ill patients.Illnesses and
injuries commonly seen in patients on critical care
units (CCUs) include:
 Gunshot wounds

 Heart failure and acute coronary syndromes

(unstable angina and myocardial infarction (MI).
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CRITICAL …

 Traumatic injuries (automotive collisions and

fails).
 Acute and chronic renal failure.
Lung, esophageal and gastric cancer

 Shock

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CRITICAL …

Surgeries such as abdominal and aortic

aneurysm repair
Acute respiratory failure and pulmonary
embolism.
 Acute pancreatitis, acute upper GI bleeding
and acute liver failure.
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The critical care nurse

Critical care nurses are responsible for making sure

that critically ill patient and members of their families
receive close attention and the best care possible.

Role:
staff nurses, nurse-educators, nurse-managers, case
managers, clinical nurse specialists, nurse
practitioners and nurse researchers.
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Staff Nurse:

Makes independent assessments

 Plans and implements patient care

Provides direct nursing care

Makes clinical observation and executes

interventions
Promotes activities of daily living
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Nurse Educators:

 Assesses patients‘ and families‘ learning needs;

plans and implements teaching strategies to meet
those needs.
Evaluate effectiveness of teaching
 Educates peers and colleagues
Possesses excellent interpersonal skills

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Nurse Manager:

Acts as an administrative representative of the unit.

Ensures that effective and quality nursing care is

provided in a timely and fiscally sound environment.

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Case Manager:

Manages comprehensive care of an individual

patient.
 Encompasses the patient‘s entire illness episode,
crosses all care settings and involves the collaboration
of all personnel who provide care.
 Is involved in discharge planning and making
referrals.
 Identifies community and personal resources.
 Arranges for equipments and supplies needed by
the patient on discharge.
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Clinical Nurse Specialist:

Participates in education and direct patient care.

Consults with patients and family members

Collaborates with other nurses and health care

team members to deliver high-quality care.

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Nurse Practitioner:

Provides primary health care (independently).

May obtain histories and conduct physical examinations.

Orders laboratory and diagnostic tests and interprets

results.
Treat patients

Counsels and educates patients and families.

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Nurse Researcher:

Reads current nursing literature

Applies information in practice
Collects data
 Conducts research studies
 Serves as a consultant during research study
implementation.

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Working Area:

Critical care nurses work wherever critically ill

patients are found, including:
 Adult, pediatric and neonatal ICUs.

 Coronary care and progressive coronary care units

 Emergency departments

 Post anesthesia care units.

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Wide range of responsibilities:

Being an advocate
Using sound clinical judgment
 Demonstrating caring practices
 Collaborating with a multidisciplinary team
 Demonstrating an understanding of cultural diversity
Providing patient and family teaching

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SCOPE OF CRITICAL CARE NURSING PRACTICE:

The scope of critical care nursing practice is described as a

dynamic process with three components:

1- The critically ill patients and their significant social

relationship.

2- The critical care nurse.

3- The environment where critical care nursing is practiced.16

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The goal of critical care nursing is :-

To ensure effective interaction of these three

elements to affect nursing practice and optimal
patient outcomes. The needs of the critically ill
patients are considerable. (two needs)

Physical needs: are equated with basic physiological

or biological needs for air, nutrition, and elimination.

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Non-physical needs: Include social, spiritual, and
psychological needs, social integrity (self-esteem),
information, and communications.
The nature of critical care is such that physical
needs are considered a priority and are almost always
met.
However, the critical care environment can actually
obstruct the fulfillment of non-physical needs
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 EXTENDED ROLES AS CRITICAL CARE NURSES

Critical care nurses have roles beyond their

professional boundary. With proper training and
established guidelines, algorithms, and protocols that
are continuously reviewed and updated, critical care
nurses also perform procedures and therapies that
are otherwise done by doctors..

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Such procedures and therapies are:
a. Sampling and analyzing arterial blood gases;
b. Weaning patients off ventilations;

c. Adjusting intravenous analgesia / sedations;

d. Performing and interpreting ECGs;

e. Titrating intravenous and central line medication

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f. Initiating defibrillation to patient with ventricular

fibrillation or lethal ventricular tachycardia

g. Removal of pacer wire, femoral sheaths and chest

tubes

h. Other procedures deemed necessary by their

respective institution under a clinical protocol

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PREVENTION OF ERRORS IN THE ICU
Intensive care unit patients are critically ill and they
are:
1. Attached to many equipments
2. Indwelling catheter/lines
3. Various invasive/non invasive procedure
4. Various medication
5. Various type of documentation
6. Limited time and pace of activity quicker
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TYPES OF ERRORS

Equipment related

Medication related

Documentation related

Communication related

 Skill related

Infection related

 Management related
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EQUIPMENT RELATED

Cardiac Monitor
Set alarm limits

 Inform at slightest change

 Never suspend /put off alarms.

 One monitor nurse/doctor at the central station at

all times.
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Ventilator

Constant attention.

Setting alarm limits.

Monitoring saturation.

 Securing of the tube

 Ambu bag with reservoir at bedside.

 Prevention of tube blockage.

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Ventilator…

 Maintaining of respiratory flow sheet.

 Use of steri-case of high peep.

Prevention of pressure ulcers,& oral ulcers

All ventilators to be connected to the ups system.

Prevention of infection.

Good communication & psychological support

 Sedation, pain relief,

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Errors…
Infusion pump
 Adequate Knowledge of equipment
 Accurate flow rate

Syringe pump
 Knowledge about medicine dilution

ECG machine
 Attach leads properly
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Errors…
MEDICATION RELATED
Follow 6 RIGHTS
1) Right patient
2) Right medicine
3) Right dose
4) Right route
5) Right time
6) Right documentation
No abbreviation
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Errors…
DOCUMENTATION RELATED
 Recording all events

All sheets to have patients label

 Filing of printed reports

COMMUNICATION RELATED
 Language

 Be a good listener
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Errors…

SKILL RELATED
Pressure ulcer

Aspiration

 Injury

 Oral ulcer

 Bowel and bladder

 Blood collection
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 Errors…

INFECTION RELATED
Infection control protocol
Hand washing/ Hand rub
Aseptic technique
 Needle stick injury

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Errors…

MANAGEMENT RELATED

 Nurse patient ratio

 Delegation of duty

 Check list

 Stock
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PREVENTION OF NOSOCOMIAL INFECTION

NOSOCOMIAL INFECTION

 Clinical infections occurring in a patient after 48 hours

of admission to the hospital are known as Nosocomial

or Hospital acquired infection.

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RISK FACTORS FOR NOSOCOMIAL INFECTION

A. Inadequate primary defenses

 Broken skin or mucosa

 Traumatized tissue

 Decreased cilliary action

 Obstructed urine outflow

 Altered peristalsis

 Change in pH of secretions

 Decreased mobility
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RISK FACTORS…

B. Inadequate Secondary Defenses

 Reduced hemoglobin level

 Suppression of WBC‘s ( drug or disease related )

 Low WBC Count

Suppressed inflammatory response

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RISK FACTORS…

RISK OF NOSOCOMIAL
INFECTION IN ICU‘S IS HIGH.
Why???

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 RISK OF NOSOCOMIAL INFECTION IN ICU‘S IS HIGH??

They are critically ill

More invasive procedures are performed

Surgical procedures are performed

Overuse of broad spectrum antibiotics

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RISK OF NOSOCOMIAL…

 Use of multiple devices

 Long duration of stay
 Handled by many
 Immuno-compromised
 Multiorgan failure
 More use of equipment

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SITES AND CAUSES FOR NOSOCOMIAL INFECTIONS

1. URINARY TRACT

Improper hand hygiene

Frequency of catheterization

 Open drainage system

 Disconnection of catheter and tubing

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Sites and causes…

Repeated bladder irrigations

 Improper perineal hygiene

Contamination of drainage bag port

Obstructed urinary drainage

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Sites and causes…

2. SURGICAL OR TRAUMATIC WOUNDS

 Improper hand hygiene and washing techniques
 Improper skin preparation
Improper dressing techniques
Use of contaminated solutions/ointments/dressing
material /instruments
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Sites and causes…

3. RESPIRATORY TRACT

Improper hand hygiene

Contaminated equipment

Improper / inadequate suction techniques

Improper mucous/secretions disposal

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Sites and causes…

4. BLOOD STREAM

oImproper hand hygiene

o Improper techniques used for vascular access

o Contaminated IV fluids / Additives/drugs and devices

o Improper care and failure to change of cannulation sites

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 Thank you very
much

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