CONCEPT OF CRITICAL CARE NURSING

CRITICAL
Crucial Crisis Emergency Serious Requiring immediate action Thorough and constant observation Total dependent (Oxford Dictionary)

SEVEN Cs OF CRITICAL CARE

Compassion Communication (with patient and family). Consideration (to patients, relatives and colleagues) and avoidance of Conflict. Comfort: prevention of suffering Carefulness (avoidance of injury) Consistency Closure (ethics and withdrawal of care).

CRITICAL CARE NURSING

Deals with human responses to life threatening problems -trauma /major surgery (Mary,L.S., Deborah, G.K. & Marthe, J.M. 2005)

CRITICAL CARE NURSING

Comprehensive, specialized and individualized nursing care services which are rendered to patients, with life threatening conditions and their families. (Shuva, D. G.2005)

CRITICAL CARE NURSE

care for clients who are very ill provide direct one to one care Responsible for making life-and death decision At high risk of injury or illness from possible exposure to infections Communication skill is of optimal importance

CRITICALLY ILL CLIENT

At high risk for actual or potential lifethreatening health problems More ill Required more intensive and careful nursing care

CLASSIFICATION OF CRITICAL CARE PATIENTS

Level O : normal ward care Level 1: at risk of deteriorating , support from critical care team Level 2 : more observation or intervention, single failing organ or post operative care Level 3; advanced respiratory support or basic respiratory support ,multiorgan failure

HIGH DEPENDENCY CARE

Coronary care units (CCU) Renal high dependency unit (HDU) Post-operative recovery room Accident and emergency departments (A&E) Intensive care units (ICU)

CONTINUUM OF CARE
General ward High dependency areas : CCU,Renal HDU, recovery Intensive care unit

INTENSIVE CARE UNIT

Area where the critically clients are cared for Filled with stress Loss of privacy Artificial lighting 24 hours Constant noise Physical pain Discomfort

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

GOALS OF CRITICAL CARE

Towards the survival of the critical ill patients and restoring quality of life Restoring optimal physiological, psychological, social and spiritual potential Helping the families of the critically ill patients in coping with crises

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

A, B, C, D, E MODELS
Airway: patent Breathing: respiratory rate Circulation: pallor, hemorrhage Disability:altered conscious level Expose to examine: unseen haemorrhage, wound leakage

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
Haematology 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

medication

CRITICALLY ILL CLIENT

Collaborative care
Monitoring evaluation

intervention

CONCLUSION
the experience of critical illness has a profound effect on the client, family and nurses Nurses and family interventions played an important role in the recovery of client

PREPARATION RECEIVING OF PATIENT

NURSING CARE OF CRITICALLY ILL PATIENT

THINGS TO REMEMBER
Dont leave patient alone Dont mute the alarm Resuscitator bag available & function

NURSING CARE OF CRITICALLY ILL PATIENT

TAKE OVER REPORT Vital Sign B/P, HR, SPO2 - Hourly Ventilation Mode General Condition conscious level Responsibility

NURSING CARE OF CRITICALLY ILL PATIENT

POTENCY AIRWAY Size ETT Marking Cuff to be inflate manometer 25 30cmH2O Auscultate air entry Secure with tape / plaster

NURSING CARE OF CRITICALLY ILL PATIENT

HYGIENE Eye Toilet Mouth Toilet Swabbing (private part) Sponging Dressing Change Linen

NURSING CARE OF CRITICALLY ILL PATIENT

OBSERVATION Cannulation site - inflamation - leaking - bleeding - change dressing

NURSING CARE OF CRITICALLY ILL PATIENT

OBSERVATION
CVP Line Arterial line Peripheral line Change line day 7 or any sign of infection

NURSING CARE OF CRITICALLY ILL PATIENT

OBSERVATION
IV & Drugs Infusion - volumetric pump function, - solution, rate & dilution are correct - labeled - prepared before finished

NURSING CARE OF CRITICALLY ILL PATIENT

OBSERVATION Tubes Operation Wound Drainage Ventilator mode setting, circuit, humidifier, water trap

NURSING CARE OF CRITICALLY ILL PATIENT

INFECTION CONTROL Clean procedure apron & glove Sterile procedure apron, glove & mask Hand hygiene before and after procedure Isolation room / cohort

NURSING CARE OF CRITICALLY ILL PATIENT

PSYCHOLOGICAL SUPPORT Orientation Reassurance Health Education

NURSING CARE OF CRITICALLY ILL PATIENT

DOCUMENTATION Date & Time Report on GCS patient Drs order Observation Nursing care