CONCEPT OF CRITICAL CARE NURSING

DGN 110/2

Prepared by : Puan Low

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)

CRITICAL CARE NURSING

The care of seriously ill clients from point of injury or illness until discharge from intensive 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 life-threatening 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 patient’s needs and severity of

the condition Manager: coordinates the care provided by

various health care Advocate: protects the patient’s 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 haemorrhage,

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

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 client’s 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

CRITICALLY ILL CLIENT

24 hour assessment Individualized plan

Monitoring evaluation

intervention

medication

Collaborative care

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