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)
TYPES OF CRITICAL CARE UNIT
NEONATAL INTENSIVE UNIT
(NICU)
SPECIAL CARE NURSERY (SCN)
PAEDIATRIC INTENSIVE CARE
UNIT (PICU)
PSYCHIATRIC INTENSIVE UNIT
(PICU)
CORONARY CARE UNIT (CCU)
CARDIAC SURGERY INTENSIVE
CARE UNIT (CSICU)
CARDIOVASCULAR INTENSIVE
CARE UNIT (CVICU)
MEDICAL INTENSIVE CARE UNIT
(MICU)
MEDICAL SURGICAL INTENSIVE
CARE UNIT (MSICU)
OVERNIGHT INTENSIVE
RECOVERY (OIR)
NEUROSCIENCE /
NEUROTRAUMA INTENSIVE
CARE UNIT (NICU)
NEURO INTENSIVE CARE UNIT
(NICU)
BURN INTENSIVE CARE UNIT
(BNICU)
SURGICAL INTENSIVE CARE UNIT
(SICU)
TRAUMA INTENSIVE CARE UNIT
(TICU)
SHOCK TRAUMA INTENSIVE
CARE UNIT (STICU)
TRAUMA – NEURO CRITICAL
CARE INTENSIVE CARE UNIT
(TNCC)
RESPIRATORY INTENSIVE CARE
UNIT (RICU)
GERIATRIC INTENSIVE CARE
UNIT (GICU)
Types of ICU
- General
Medical Intensive Care Unit(MICU)
Surgical Intensive Care Unit
Medical Surgical Intensive Care Unit(MSICU) - Specialized
Neonatal Intensive Care Unit(NICU)
Special Care Nursery(SCN)
Paediatric Intensive Care Unit(PICU)
Coronary Care Unit(CCU)
Cardiac Surgery Intensive Care Unit(CSICU)
Neuro Surgery Intensive Care Unit(NSICU)
Burn Intensive Care Unit(BICU)
Trauma Intensive Care Unit
PRINCIPLES OF CRITICAL CARE NURSING
- ANTICIPATION
- EARLY DETECTION AND PROMPT ACTION
- COLLABORATIVE PRACTICE
- COMMUNICATION
- Prevention of Infection
- Crisis Intervention and Stress
Reduction
The first principle in critical care is ____
One has to recognize the high risk patients and anticipate the requirements, complications and be prepared to meet any emergency. Unit is properly organized in which all necessary equipments and supplies are mandatory for smooth running of the unit.
ANTICIPATION
The prognosis of the patient depends on
the early detection of variation, prompt
and appropriate action to prevent or
combat complication. Monitoring of
cardiac respiratory function is of prime
importance in assessment.
EARLY DETECTION AND PROMPT ACTION
Critical Care, which has originated as technical sub-specialized body of knowledge has evolved into a comprehensive discipline requiring a very specialized body of knowledge for the physicians and nurses working in the critical care unit fosters a partnerships for decision making and ensures quality and compassionate patient care.
Collaborate practice is more and more warranted for critical care more than in any other field.
COLLABORATIVE PRACTICE
Intra professional, inter departmental and inter personal communication has a significant importance in the smooth running of unit. Collaborative practice of communication model
COMMUNICATION
Nosocomial infection cost a lot in the health care services. Critically ill patients requiring intensive care are at a greater risk than other patients due to the
immunocompromised state with the antibiotic usage and stress, invasive lines, mechanical ventilators, prolonged stay and severity of illness and environment of the critical unit itself.
Prevention of Infection
partnerships are formulated
during crisis. Bonds between nurses,
patients and families are stronger during
hospitalization. As patient advocates,
nurses assist the patient to express fear
and identify their grieving patttern and
provide avenues for positive coping.
Crisis Intervention and Stress
Reduction
ORGANIZATION OF ICU
DESIGN OF ICU
BED STRENGTH
STAFFING
DESIGN OF ICU
- Should be at a geographically distinct area within the hospital, with controlled access.
- There should be a single entry and exit. However, it is required to have emergency exit points in case of emergency and disaster.
- There should not be any through traffic of goods or hospital staff. Supply and professional traffic should be separated from public/visitor traffic.
- Safe, easy, fast transport of a critically sick pt should be a priority in planning its location. Therefore, the ICU should be located in close proximity or ER, OT, trauma ward etc.
- Corridors, lifts and ramps should be spacious enough to provide easy movement of bed/trolley of a critically sick patient.
- Close, easy proximity is also desirable to diagnostic facilities, blood bank, pharmacy etc.
BED STRENGTH
- It is recommended that total bed strength in ICU should be between 8-12 and not less than 6 or not more than 24 in any case.
- 3-5 beds per 100 hospital beds for a Level III ICU or 2 to 20% of the total no of hospital beds.
- 1 isolation bed for every ICU beds.
BED AND ITS SPACE:
1. 150-200 sq.ft per open bed with 8 ft in between beds.
2. 225-250 sq.ft per bed if in a single room.
3. Beds should be adjustable, no head board, with side rails and wheels.
4. Keep bed 2 ft away from head wall.
ACCESSORIES:
1. 3 O2 outlets, 3 suction outlets (gastric, tracheal and underwater seal), 2 compressed air outlets and 16 power outlets per bed.
2. Storage by each bedside.
3. Hand rinse solution by each bedside.
4. Equipment shelf at the head end.
5. Hooks and devices to hang infusions/ blood bags, extended from the ceiling with a sliding rail to position.
6. Infusion pumps to be mounted on stand or poles.
7. Level II ICUs may require multi channel invasive monitors.
8. ventilators, infusion pumps, portable X ray unit, fluid and bed warmers, portable light, defibrillators, anaesthesia machines and difficult airway management equipments are necessary.
STAFFING
- Medical Staff – the best senior medical staff to be appointed as an Intensive Care Director or Intensivist. Less preferred are other specialists from anaesthesia / medicine who has clinical
commitment elsewhere. Junior staff are intensive care trainers and trainees on deputation from other disciplines. - Nursing staff – The major teaching tertiary care ICU requires trained nurses in critical care. The no of nurses ideally required for such unit is 1:1 ratio, however it might not be possible to have
such members in our set up. So 1 nurse for 2 patients is acceptable. The no of trained nurses should also be worked out by the type of ICU, the workload and work statistics and type of patient
load.
3.Allied Services – Respiratory services,
Nutritionist, Physiotherapist, Biomedical engineer, technicians, computer programmer, clinical pharmacist, social worker / counsellor and other support staff, guards and grade IV workers.
Factors to be considered in recruiting
Critical Care Nurses are:
- Intra and interpersonal factors
- Technical Qualifications.
- Educational background
- Clinical Experience.
PRIME RESPONSIBILITIES OF A CRITICAL CARE NURSE
Continuous monitoring
Keep ready emergency trolley / crash
Cart
Efficient Individualized Care.
Counseling and information to family.
Application of policies and procedures
Proper records of all activities
Maintain infection control principles.
Keep update with advance
information.
QUICK REFERENCE PROTOCOL FOR
MANAGING EMERGENCY IN ICU
Quickly review the patient - Identity,
History , Physical Exam.
Be with the patient, ask for help.
Place the patient in a suitable position.
Attach the cardiac monitor and call for
crash cart.
Maintain ABC Along with expert team
Introduce IV, CV line
Administer medication as needed.
Carry on Investigations - ABG, ECG,
Urea, Creatinine, Blood Sugar,
Cardiac enzymes.
Maintain Fluid and Electrolytes .
Record right things at right time
rightly.
Core Competencies
Patient Care
Medical Knowledge
Professionalism & Ethics
Interpersonal Communication Skills
Practice-based Learning and
Improvement
Systems-based Practice
Family Need of the Critical Care Patient
Information – major source of anxiety and litigation (legal issues)
Reassurance – can reassure care is
being given
Convenience – access to the patient
Job description
- Patient care
Multidisciplinary rounds
Bed allocation/triage
Infection control
Protocol development
Quality control/assurance - Education
Residents, fellows, med students, nurses, respiratory therapists,
nurse practitioners - Research
Quality assurance projects
Clinical trials
Database-driven projects
Critical illness are grouped by the system of the body;
A. Cardiac System
B. Pulmonary System
C. Neurologic disorder
D. Drug Ingestion and Drug Overdose
E. Gastrointestinal Disorders
F. Endocrine
G. Surgical
H. Miscellaneous
- Acute myocardial infarction with complications
- Cardiogenic shock
- Complex arrhythmias requiring close monitoring and intervention
- Acute congestive heart failure with respiratory failure and/or
requiring hemodynamic support - Hypertensive emergencies
- Unstable angina, particularly with dysrhythmias, hemodynamic
instability, or persistent chest pain - Cardiac tamponade or constriction with hemodynamic instability
- Dissecting aortic aneurysms
- Complete heart block
A. Cardiac System
- Acute respiratory failure requiring ventilatory support
- Pulmonary emboli with hemodynamic instability
- Massive hemoptysis
B. Pulmonary System
- Intracranial hemorrhage
- Meningitis with altered mental status or respiratory
compromise - Central nervous system or neuromuscular disorders
with deteriorating neurologic or pulmonary function - Status epilepticus
- Severe head injured patients
C. Neurologic disorder
- Hemodynamically unstable drug ingestion
- Drug ingestion with significantly altered mental
status with inadequate airway protection - Seizures following drug ingestion
D. Drug Ingestion and Drug Overdose
- Life threatening gastrointestinal bleeding including
hypotension, angina, continued bleeding, or with
comorbid conditions - Hepatic failure
- Severe pancreatitis
E. Gastrointestinal Disorders
- Diabetic ketoacidosis complicated by hemodynamic
instability, altered mental status, respiratory
insufficiency, or severe acidosis - Severe hypercalcemia with altered mental status,
requiring hemodynamic monitoring - Hypo or hypernatremia with seizures, altered mental
status - Hypo or hypermagnesemia with hemodynamic
compromise or dysrhythmias - Hypo or hyperkalemia with dysrhythmias or muscular
weakness - Hypophosphatemia with muscular weakness
F. Endocrine
- Post-operative patients requiring
hemodynamic monitoring/ventilatory
support or extensive nursing care
G. Surgical
- Septic shock with hemodynamic instability
- Hemodynamic monitoring
- Environmental injuries (lightning, near
drowning, hypo/hyperthermia)
H. Miscellaneous
Admission Criteria in ICU
The ICU admission decision may be based on
several models utilizing prioritization, diagnosis,
and objective parameters models.
A. Prioritization Model
B. Diagnosis Model
C. Objective Parameters Model
This system defines those that will benefit most
from the ICU (Priority 1) to those that will not
benefit at all (Priority 4) from ICU admission.
Prioritization Model
These are critically ill, unstable patients in need of
intensive treatment and monitoring that cannot be
provided outside of the ICU. Usually, these
treatments include ventilator support, continuous
vasoactive drug infusions. Examples of these patients
may include post-operative or acute respiratory
failure patients requiring mechanical ventilatory
support and shock or hemodynamically unstable
patients receiving invasive monitoring and/or
vasoactive drugs.
Priority 1
These patients require intensive monitoring
and may potentially need immediate
intervention. Examples include patients with
chronic comorbid conditions who develop
acute severe medical or surgical illness.
Priority 2
These unstable patients are critically
ill but have a reduced likelihood of recovery because of underlying disease or nature of their acute illness. Examples include patients with metastatic malignancy complicated by infection,
cardiac tamponade, or airway obstruction.
Priority 3
These are patients who are generally
not appropriate for ICU admission. Admission of
these patients should be on an individual basis,
under unusual circumstances and at the
discretion of the ICU Director. These patients
can be placed in the following categories:
Priority 4
This model uses specific conditions or diseases to determine appropriateness of
ICU admission.
(described above in critically ill patient)
Diagnosis Model
- Vital Signs
* Pulse < 40 or > 150 beats/minute
* Systolic arterial pressure < 80 mm Hg or 20 mm Hg below the
patient’s usual pressure
* Mean arterial pressure < 60 mm Hg
* Diastolic arterial pressure > 120 mm Hg
* Respiratory rate > 35 breaths/minute - Laboratory Values (newly discovered)
* Serum sodium < 110 mEq/L or > 170 mEq/L
* Serum potassium < 2.0 mEq/L or > 7.0 mEq/L
* PaO2 < 50 mm Hg pH < 7.1 or > 7.7
* Serum glucose > 800 mg/dl
* Serum calcium > 15 mg/dl
* Toxic level of drug or other chemical substance in a
hemodynamically or neurologically compromised patient - Radiography/Ultrasonography/Tomography
(newly discovered)
Cerebral vascular hemorrhage, contusion or
subarachnoid hemorrhage with altered mental status
or focal neurological signs
Ruptured viscera, bladder, liver, esophageal varices
or uterus with hemodynamic instability
Dissecting aortic aneurysm
4.Electrocardiogram
Myocardial infarction with complex arrhythmias,
hemodynamic instability or congestive heart failure
Sustained ventricular tachycardia or ventricular
fibrillation
Complete heart block with hemodynamic instability
- Physical Findings (acute onset)
Unequal pupils in an unconscious patient
Burns covering > 10% BSA
Anuria
Airway obstruction
Coma
Continuous seizures
Cyanosis
Cardiac tamponade
Objective Parameters Model
Team of Critical Care Unit
- Physicians
- Nurses
- Respiratory Therapists
- Pharmacists
- Physical Therapist
- Dieticians
- Medical Radiation Technologist
- Medical Laboratory Technologist
- Trauma Coordinator
- Social Worker
- Clinical Educator
- Ward Clerk
- Pastoral Care
- Manager
Critical Care
Considerations
F=Feeding/fluid
A=Analgesics
S=Sedation
T=Thrombolytic agents
H=Head elevation
U=Ulcer – bed sore
G=Glucose monitoring
Feeding and Fluids
Enteral Feeding
Oral Feeding
Transparental Diet
o Oro - gastric and Naso - gastric feeding
o Churn diet
o Dairy and poultry products (Milk, egg,
youghort)
o High protein liquid diet
o Medications
Enteral feeding
o Hospital diet
o Bland diet
o Normal diet
o Liquid intake
Oral feeding
o OLICLINOMEL
Includes:-
* Amino acid solution with electrolyte (5.5%) volume
800 ml
* Amino acid 44 gram
* Na acetate
* Na glycerophosphate
* KCl
MgCl2
Sodium
Magnesium
PO4
Acetate
Chloride
Glucose 20% solution with CaCl2
Transparenteral diet
Overall volume of TPN = 2000 ml
Osmolarity = 75 mOsm/L
pH = 6
Amino acid = 44 gram
Total calorie = 1,215 Kcal
Overall volume of TPN = 2000 ml
Osmolarity = 75 mOsm/L
pH = 6
Amino acid = 44 gram
Total calorie = 1,215 Kcal
IV fluids like NS, RL, 5% D, 10% D, DNS
Fluids
Analgesics
- Fentanyl
- Morphine
- Acetaminophen and NSAIDs
Fentanyl
o It works 600 times more effectively than
Morphine and reduces the pain and
increases the pain threshold
o Used in moderate and severe pain
o In ICU 50 – 100 µg per Kg
o Antidote Naloxone 0.05 mg/ Kg
Morphine
o Reduces pain
o Chiefly used in MI
o 2-4 mg dissolved in 10 ml NS
o Antidote: Naloxone
o Supplied by hospital
o Often more effective than opioids in reducing pain from pleural or pericardial rubs, a pain that responds poorly to opioids.
o particularly effective in reducing muscular and skeletal pain
o Tab form: 500mg OD
Acetaminophen and NSAIDs
Sedatives
Benzodiazepines
1. Midazolam
2. Diazepam
oShort acting sedatives and hypnotics
oIn intubated patients
oDose 0.01- 0.05 mg/Kg for several hours
Midazolam
Diazepam
- Adult dose = 0.2 – 0.5 mg/ Kg
- Not given in MI patients
Dissociative Anaesthesia
- Ketamine
- Propofol
Ketamine adult dose
Adult dose= 1 – 3 mg/kg IV
Propofol
o Arousal is rapid 10- 15 min
o Used in neuro cases and those with
increased ICP, during tracheostomy
procedure
Inotropes
Dopamine
Dobutamine
Nor- adrenaline
Thrombolytic agents
TEDS compressive stocking
SCD (Systematic Compressive Device)
LMWX
Heparin flush
Head elevation
Head is elevated to 30 degree.
Ulcer
Two hourly position change
Back care in each shift
Oxygen therapy
Each shift dressing of pressure sore
Air mattresses
Glucose monitoring
RBS as prescribed
Insulin therapy
Careful monitoring of signs of
Hypoglycemia
(trembling, clammy skin, palpitations,
anxiety, sweating, hunger, and irritability)
Infection control
Hand washing before, during and after the procedure
Sterility maintenance during procedures
Use of disinfectants
Weekly high wash
Monthly culture test of health personnel, equipments
and infrastructures
Regular inspection by infection control team
Each shift CVP dressing
Specific equipments used in
ICU and CCU
Ventilators
Infusion pumps
Cardiac monitors
Defibrillator
ABG machine
ECG machine
Drugs used in CCU
Aspirin
Clopidogrel
Nitroglycerine
Atorvastatins
LMWX
Morphine
