CONCEPT OF CRITICAL CARE NURSING

CRITICAL CARE Define critical nursing Understand the principles of critical care nursing Identify the goals of critical care nursing State the roles and functions of critical nurse Understand the legal and ethical issues that can affect critical care nursing Apply concept of clinical mapping in critical nursing CRITICAL Crucial Crisis Emergency Serious Requiring immediate action Thorough and constant observation Total dependent (Oxford Dictionary) The care of seriously ill clients from point of injury or illness until discharge from intensive care Deals with human responses to life threatening problems -trauma /major surgery (Mary,L.S., Deborah, G.K. & Marthe, J.M. 2005) Comprehensive, specialized and individualized nursing care services which are rendered to patients, with life threatening conditions and their families

PRINCIPLES OF CRITICAL CARE Continuous monitoring and treatment High intensity therapies and interventions Expert surveillance and efficiency Alert to early manifestation of other organ failure Recognition of parameters denoting progress or deteriorating ROLES OF CRITICAL NURSE Care provider : help the client to obtain necessary care and supporting the basic needs comprehensive direct care to the patient and family Educator: based on patients needs and severity of the condition Manager: coordinates the care provided by various health care Advocate: protects the patients rights CRITICAL CARE NURSING Constant and rapid assessment: close monitoring and respond to treatment Providing appropriate nursing interventions Documenting and reporting Observing mental state of family state Maintaining a spiritual attitude PATIENT ASSESSMENT Know : medical history, social history, medical interventions See : airway patency, pallor, sweating, mental state, posture, facial expression, general condition Find : respiratory care, adequacy of oxygenation, pulse, blood pressure, urine output, conscious level, monitor for changes in any of the above ( Norman & Cook, 2000) A, B, C, D, E MODELS Airway: patent Breathing: respiratory rate Circulation: pallor, hemorrhage Disability: altered conscious level Expose to examine: unseen hemorrhage, wound leakage (Smith, 2000)

PATIENT MONITORING Information from monitoring equipment Accuracy of equipment Compare with manual recordings Assess ,record and analyze findings frequently / continuously PATIENT SAFETY errors due to hectic and complex environment compromised physiologic interventions multiple technologic and pharmacologic interventions, care provider Work at a fast pace IMMEDIATE CARE Administer oxygen via face mask Maintain client safety Maintain fluid replacement Monitor cardiac instability Monitor urine output hourly Arterial blood gas analysis Referral to critical care INVESTIGATIONS Hematology Biochemistry X-ray SUBSEQUENT CARE Monitor continuously Position : upright Conscious level Intravenous therapy Medication :Analgesia and antibiotics Nil by mouth blood sugar levels Oral and tube feeding Document clients response

ETHICAL ISSUES ethnic and religious doctrines that limit treatment options allocation of resources that may limit admission or promote premature discharge Use of critical care beds for terminally ill clients Discontinuation of resuscitation or life support measures

CLINICAL MAPPING 24 hour Assessment Individualized plan

CRITICALLY ILL CLIENT

Medication Intervention

Collaborative care evaluation