Critical Care Nursing

CONCEPT OF CRITICAL CONCEPT OF CRITICAL CARE NURSINGCARE NURSING

DGN 110/2DGN 110/2

Prepared by : Puan Low Prepared by : Puan Low

CRITICAL CARECRITICAL CARE

Define critical nursing Define critical nursing Understand the principles of critical care nursing Understand the principles of critical care nursing Identify the goals of critical care nursingIdentify the goals of critical care nursing State the roles and functions of critical nurse State the roles and functions of critical nurse Understand the legal and ethical issues that can Understand the legal and ethical issues that can

affect critical care nursing affect critical care nursing Apply concept of clinical mapping in critical Apply concept of clinical mapping in critical

nursing nursing

CRITICALCRITICAL

CrucialCrucial CrisisCrisis EmergencyEmergency Serious Serious Requiring immediate actionRequiring immediate action Thorough and constant observationThorough and constant observation Total dependent Total dependent

(Oxford Dictionary)(Oxford Dictionary)

CRITICAL CARE NURSINGCRITICAL CARE NURSING

The care of seriously ill clients from point of The care of seriously ill clients from point of injury or illness until discharge from injury or illness until discharge from intensive careintensive care


Deals with human responses to life Deals with human responses to life threatening problems -trauma /major threatening problems -trauma /major surgerysurgery

(Mary,L.S., Deborah, G.K. & Marthe, J.M. (Mary,L.S., Deborah, G.K. & Marthe, J.M. 2005) 2005)


Comprehensive, specialized and Comprehensive, specialized and individualized nursing care services which individualized nursing care services which are rendered to patients, with life are rendered to patients, with life threatening conditions and their families.threatening conditions and their families.

(Shuva, D. G.2005)(Shuva, D. G.2005)

CRITICAL CARE NURSECRITICAL CARE NURSE

care for clients who are very illcare for clients who are very ill provide direct one to one careprovide direct one to one care Responsible for making life-and death decisionResponsible for making life-and death decision At high risk of injury or illness from possible At high risk of injury or illness from possible

exposure to infectionsexposure to infections Communication skill is of optimal importanceCommunication skill is of optimal importance

CRITICALLY ILL CLIENTCRITICALLY ILL CLIENT

At high risk for actual or potential life-At high risk for actual or potential life-threatening health problems threatening health problems

More illMore ill Required more intensive and careful nursing Required more intensive and careful nursing

care care

CLASSIFICATION OF CRITICAL CLASSIFICATION OF CRITICAL CARE PATIENTSCARE PATIENTS

Level O : normal ward careLevel O : normal ward care Level 1: at risk of deteriorating , support Level 1: at risk of deteriorating , support

from critical care teamfrom critical care team Level 2 : more observation or intervention, Level 2 : more observation or intervention,

single failing organ or post operative care single failing organ or post operative care Level 3; advanced respiratory support or Level 3; advanced respiratory support or

basic respiratory support ,multiorgan failure basic respiratory support ,multiorgan failure

HIGH DEPENDENCY CARE HIGH DEPENDENCY CARE

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

(A&E) (A&E) Intensive care units (ICU)Intensive care units (ICU)

CONTINUUM OF CARE CONTINUUM OF CARE

General wardGeneral ward High dependency areas : CCU,Renal HDU, High dependency areas : CCU,Renal HDU,

recovery recovery Intensive care unitIntensive care unit

INTENSIVE CARE UNITINTENSIVE CARE UNIT Area where the critically clients are cared forArea where the critically clients are cared for Filled with stressFilled with stress Loss of privacyLoss of privacy Artificial lighting 24 hoursArtificial lighting 24 hours Constant noiseConstant noise Physical painPhysical pain DiscomfortDiscomfort

PRINCIPLES OF CRITICAL PRINCIPLES OF CRITICAL CARECARE

Continuous monitoring and treatmentContinuous monitoring and treatment High intensity therapies and interventionsHigh intensity therapies and interventions Expert surveillance and efficiencyExpert surveillance and efficiency Alert to early manifestation of other organ Alert to early manifestation of other organ

failurefailure Recognition of parameters denoting Recognition of parameters denoting

progress or deterioratingprogress or deteriorating

GOALS OF CRITICAL CAREGOALS OF CRITICAL CARE

Towards the survival of the critical ill Towards the survival of the critical ill patients and restoring quality of lifepatients and restoring quality of life

Restoring optimal physiological, Restoring optimal physiological, psychological, social and spiritual potentialpsychological, social and spiritual potential

Helping the families of the critically ill Helping the families of the critically ill patients in coping with crisespatients in coping with crises

ROLES OF CRITICAL NURSEROLES OF CRITICAL NURSE

Care provider : help the client to obtain necessary Care provider : help the client to obtain necessary care and supporting the basic needscare and supporting the basic needs

comprehensive direct care to the patient and comprehensive direct care to the patient and family family

Educator: based on patient’s needs and severity of Educator: based on patient’s needs and severity of the conditionthe condition

Manager: coordinates the care provided by Manager: coordinates the care provided by various health carevarious health care

Advocate: protects the patient’s rightsAdvocate: protects the patient’s rights


Constant and rapid assessment: close monitoring Constant and rapid assessment: close monitoring and respond to treatmentand respond to treatment

Providing appropriate nursing interventionsProviding appropriate nursing interventions Documenting and reporting Documenting and reporting Observing mental state of family stateObserving mental state of family state Maintaining a spiritual attitudeMaintaining a spiritual attitude

PATIENT ASSESSMENTPATIENT ASSESSMENT

Know : medical history, social history, medical Know : medical history, social history, medical interventionsinterventions

See : airway patency, pallor, sweating, mental See : airway patency, pallor, sweating, mental state, posture, facial expression, general conditionstate, posture, facial expression, general condition

Find : respiratory care, adequacy of oxygenation, Find : respiratory care, adequacy of oxygenation, pulse, blood pressure, urine output, conscious pulse, blood pressure, urine output, conscious level, monitor for changes in any of the abovelevel, monitor for changes in any of the above

( Norman & Cook, 2000)( Norman & Cook, 2000)

A, B, C, D, E MODELS A, B, C, D, E MODELS

Airway: patent Airway: patent Breathing: respiratory rateBreathing: respiratory rate Circulation: pallor, hemorrhageCirculation: pallor, hemorrhage Disability:altered conscious levelDisability:altered conscious level Expose to examine: unseen haemorrhage, Expose to examine: unseen haemorrhage,

wound leakage wound leakage

( Smith, 2000)( Smith, 2000)

PATIENT MONITORINGPATIENT MONITORING

Information from monitoring equipment Information from monitoring equipment Accuracy of equipment Accuracy of equipment Compare with manual recordingsCompare with manual recordings Assess ,record and analyze findings Assess ,record and analyze findings

frequently / continuously frequently / continuously

PATIENT SAFETYPATIENT SAFETY

errors due to hectic and complex errors due to hectic and complex environment environment

compromised physiologic interventionscompromised physiologic interventions multiple technologic and pharmacologic multiple technologic and pharmacologic

interventions, care provider interventions, care provider Work at a fast paceWork at a fast pace

IMMEDIATE CAREIMMEDIATE CARE

Administer oxygen via face mask Administer oxygen via face mask Maintain client safetyMaintain client safety Maintain fluid replacement Maintain fluid replacement Monitor cardiac instability Monitor cardiac instability Monitor urine output hourly Monitor urine output hourly Arterial blood gas analysisArterial blood gas analysis Referral to critical care Referral to critical care

INVESTIGATIONSINVESTIGATIONS

HaematologyHaematology BiochemistryBiochemistry X-rayX-ray

SUBSEQUENT CARE SUBSEQUENT CARE

Monitor continuouslyMonitor continuously Position : uprightPosition : upright Conscious levelConscious level Intravenous therapy Intravenous therapy Medication :Analgesia and antibiotics Medication :Analgesia and antibiotics Nil by mouth blood sugar levels Nil by mouth blood sugar levels Oral and tube feeding Oral and tube feeding Document client’s responseDocument client’s response

ETHICAL ISSUESETHICAL ISSUES

ethnic and religious doctrines that limit ethnic and religious doctrines that limit treatment optionstreatment options

allocation of resources that may limit allocation of resources that may limit admission or promote premature dischargeadmission or promote premature discharge

Use of critical care beds for terminally ill Use of critical care beds for terminally ill clientsclients

Discontinuation of resuscitation or life Discontinuation of resuscitation or life support measuressupport measures

CLINICAL MAPPING

CRITICALLY ILL CLIENT

24 hour assessment Individualized plan

Monitoring evaluation

intervention

medication

Collaborative care

CONCLUSIONCONCLUSION

the experience of critical illness has a the experience of critical illness has a profound effect on the client, family and profound effect on the client, family and nursesnurses

Nurses and family interventions played an Nurses and family interventions played an important role in the recovery of clientimportant role in the recovery of client

Documents

Critical Care Nursing