Prelim Flashcards
Critical
-Crucial
-Crisis
-Emergency
-Serious
-Requiring immediate action
-Thorough and constant observation
-Total dependent
-the care of seriously ill clients from point of injury until discharge from intensive care
-Deals with human responses to life threatening problems - trauma/major surgery
Critical Care Nursing
Care for clients who are very ill
-Provide Direct one to one care
-Responsible for making life and death decision
-At hig risk of injury or illness from possible exposure to infections
-Communication skill is of optimal importance
CRITICAL CARE NURSE
-At high risk for actual or potential lifethreatening health problems
-More ill
-Required more intensive and careful
nursing care
CRITICALLY ILL CLIENT
Is a term used to describe as the care of patients who are extremely ill and whose clinical condition is unstable.
Critical Care
IT IS DEFINED AS THE UNIT IN
WHICH COMPREHENSIVE CARE
OF A CRITICALLY ILL PATIENT
WHICH IS DEEMED TO
RECOVERABLE STAGE IS
CARRIED OUT.
CRITICAL CARE UNIT
IT REFERS TO THOSE
COMPREHENSIVE, SPECIALIZED
AND INDIVIDUALIZED NURSING
CARE SERVICES WHICH ARE
RENDERED TO PATIENTS WITH
LIFE THREATENING CONDITIONS
AND THEIR FAMILIES.
CRITICAL CARE NURSING
Critical Care Technology
-ECG Monitoring
-Arterial Lines
-Oxygen Saturation
-Ventilation
-Intracranial Pressure Monitoring
-Temperature
-Pulmonary Artery Catheter
-IABP (Intra Aortic Balloon Pump)
-Extensive use of Pharmaceuticals
-Specialty in dealing with human responses to life-threatening problems
-Requires extensive knowledge and a continual desire to learn
Critical Care Nurse
Economic Impact of ICU (1994)
- <10% of hospital beds
- 30% of acute care hospital cost
- > 20% of hospital budget
- 1% of GNP expended for ICU care
With aging of the population
Demand for critical care service will
increase
Shock wards
established for
resuscitation
Transfusion practices
in early stages
After World war-II,
nursing shortage
forced grouping of
postoperative patients
in recovery areas
World War II
1950’s: use of
mechanical ventilation
(“iron lung”) for treatment
of polio
Development of
respiratory intensive care
units
At the same time, general
ICU’s developed for sick
and postoperative
patients
Polio epidemic
Collaboration between nurses and
physicians
1950’s & 1960’s – CV Disease most
common diagnosis
1960’s – 30-40% mortality rate for MI
1965 – 1
st specialized ICU – The
Coronary Care Unit
Emergence of Specialized ICU’s
History Continued
Heart Lung Resuscitation (1957)
I. FIRST AID: OXYGENATE THE BRAIN IMMEDIATELY
-Airway
-Breathe
-Circulate
II. START SPONTANEOUS CIRCULATION
-Drugs
-EKG
-Fluids
III. SUPPORT RECOVERY
-Gauge
-Hypothermia
-Intensive care
ICU’s also treat the dying
“Life is pleasant.
Death is peaceful.
It is the transition
that is difficult”
Isaac Asimov
American Association of
Critical-Care Nurses - AACN
1969
Educational support
Certification
Largest professional specialty nursing organization
Scholarships
Research
Publishes 2 journals
Local chapters
Political awareness
Provides standards of practice
Multidisciplinary & Collaborative
approach to ICU care
- Medical & nursing directors :
co-responsibility for ICU management - a team approach :
doctors, nurses, R/T, pharmacist - use of standard, protocol, guideline
consistent approach to all issues - dedication to coordination and communication for all aspects of ICU management
- emphasis on research, education, ethical issues, patient advocacy
Team Dynamics
A multidisciplinary team to effectively
attain specified objective
Physician team leader & critical care
nurse manager
Critical Care Practice
Pattern
Open
Closed
transitional
Definition :
any attending physician with hospital
admitting privileges can be the physician of
record and direct ICU care. (All other
physicians are consultants)
Disadvantage :
lack of a cohesive plan
Inconsistent night coverage
Duplication of services
Open Units
Definition:
An intensivist is the physician of record for ICU patients. (other physicians are
consultants), All orders & procedures carried out by ICU staff
- advantage:
- improved efficiency
- standardized protocol for care
- disadvantage:
- potential to lock out private physician
- increase physician conflict
Closed Units
Definition:
intensives are locally present shared comanaged care between ICU staff and private physician
ICU staff is a final common pathway for orders and procedures
Advantage:
reduce physician conflict, standard policies and
procedures usually present
Disadvantage:
confusion and conflict regarding final authority &
responsibilities for patient care decision
Transitional Units
ICU Model Care
- Full-time intensivist model :
patient care is provided by an intensivist - Consultant intensivist model :
an intensivist consults for another physician to
coordinate or assist in critical care, but dose not
have primary responsibility for care - Multiple consultant model:
multiple specialists are involved in the patient care,
(esp. R/T doctors for ventilators), but none is
designated especially as the consultant intensivist - Single physician model :
primary physician provides all ICU care
A Good ICU
- Well organized
trust
coordinated care
* Full-time intensivist: daily round
* protocol & policies (eg: how to DC elective
operation when bed not available)
* bedside nurses (master degree)
* no intern - A team:
doctors, nurses, R/T, pharmacists
* led by full time intensivists
critical care trained
available in a timely fashion (24hr/day)
no competiting clinical responsibilities
during duty
* closed units, if resources allow
What are the conditions
considered as Critical?
- ANY PERSON WITH LIFE
THREATENING CONDITION - PATIENTS WITH :
ARF
AMI
CARDIAC TAMPONATE
SEVERE SHOCK
HEART BLOCK
ACUTE RENAL FAILURE
POLY TRAUMA, MULTIPLE
ORGAN FAILURE AND ORGAN
DYSFUNCTION
SEVERE BURNS
IT IS THE FIRST STAGE OF NURSING
PROCESS IN WHICH THE NURSE
SHOULD CARRY OUT A COMPLETE
AND HOLISTIC NURSING ASSESSMENT OF EVERY PATIENT’S NEEDS,
REGARDLESS OF THE REASON FOR
THE ENCOUNTER.
NURSING ASSESSMENT
COMPONENTS OF
NURSING ASSESSMENT
- NURSING HISTORY
- Psychological and Social Examination
- Physical Examination
- Documentation of Assessment
Taking a nursing history prior to
the physical examination allows a nurse to establish a
rapport with the patient and family.
Elements of the history include –
Health Status
Cause of present illness including symptoms
Current management of illness
Past medical history including family’s medical history
Social history
Perception of illness
NURSING HISTORY
Client’s perception
Emotional health
Physical health
Spiritual health
Intellectual health
Psychological and Social Examination
A nursing assessment
includes physical examination, where the observation or measurement of signs, which can be observed or measured, or symptoms such as
nausea or vertigo, which can be felt by the patient. The techniques used may include Inspection, Palpation, auscultation and Percussion in addition to the vital signs like temperature, pulse,
respiration , BP and further examination of the body systems such as the cardiovascular or musculoskeletal systems.
Physical Examination
The Assessment is documented in the patient’s medical or nursing records, which may be on paper or as part of the electronic medical record which can be assessed by all members of the health care team.
Documentation of Assessment
CLASSIFICATION OF
CRITICAL CARE UNITS
Level I, II, III
PROVIDES MONITORING,
OBSERVATION AND SHORT
TERM VENTILATION. NURSE
PATIENT RATIO IS 1:3 AND THE
MEDICAL STAFF ARE NOT
PRESENT IN THE UNIT ALL THE
TIME.
LEVEL - I
PROVIDES OBSERVATION,
MONITORING AND LONG TERM
VENTILATION WITH RESIDENT
DOCTORS. THE NURSE-PATIENT
RATIO IS 1:2 AND JUNIOR
MEDICAL STAFF IS AVAILABLE IN
THE UNIT ALL THE TIME AND
CONSULTANT MEDICAL STAFF IS
AVAILABLE IF NEEDED.
LEVEL - II
PROVIDES ALL ASPECTS OF
INTENSIVE CARE INCLUDING
INVASIVE HAEMODYNAMIC
MONITORING AND DIALYSIS.
NURSE PATIENT RATIO IS 1:1
LEVEL - III
CLASSIFICATION OF
CRITICAL CARE PATIENTS
LEVEL 0-3
normal ward care
Level 0
at risk of deteriorating , support
from critical care team
Level 1
more observation or
intervention, single failing organ or post
operative care
Level 2
advanced respiratory support or basic respiratory support ,multiorgan
failure
Level 3
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)