Critical Care Nursing March2012

7/26/2019 Critical Care Nursing March2012

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march2012

Critical care nursing march2012 1. CRIIC!" C!R# $%R&I$' (rs.)etty.*.+unjum,n

!sst.*r,ess,r ',t.C,llege , $ursing !lappuha 2. einiti,n , a Critically ill *atient Critically ill

patients are dened as th,se patients wh, are haing

actual ,r p,tential lie-threatening health pr,blems. 3. eniti,n , a Critically Ill *atient he critically illpatient is highly4 ulnerable4 unstable and4 c,mple5thereby re6uiring igilantm,nit,ring and intense nursingcare.

7. Critical care It is a multidisciplinary health carespeciality that is meant ,r patients with acute liethreatening illness ,r injury.

8. Critical Care eam Intensiist !naesthetist %nit chies-eg: (edicine $ephr,l,gy Critical care nurse *hysi,therapist *sych,l,gist &,cial w,r9er ietician*harmacist $ursing !ssistant !ttenders &upp,rting sta-"ab ; ray pers,nnel


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B.ypes , Critical care units (edical intensiecare units *ediatric IC%s ne,natal IC%s Cardiac care units cardiac catheter labs ransplantati,n units #mergency departments *,st ,peratie care units and

rec,ery r,,ms $eur, /'astr, />rth, / %r,/Cardiac/h,racic (edical /&urgical IC%s.

10. einiti,n , Critical Care$ursing Critical carenursing is that specialty within nursing that dealsspecically with human resp,nses t, lie-threateningpr,blems. ! critical care nurse is a licensed pr,essi,nalnurse wh, isresp,nsible ,r ensuring that acutely andcritically ill patients and their amilies receie ,ptimalcare.

11. Critical Care $urse $urses are *rimary care

giers wh, are there with the patient 27 hrs. 12. $urses Resp,nsibility in Critical Care

C,mprehensie $ursing Care4 Initial !ssessment4(aintain !)C4 #arly Identicati,n , eteri,rati,n4*r,mpt Interenti,n in case , emergencies4 >ng,ing(,nit,ring4 Datch ,r E *reent c,mplicati,n4(anagement , c,mplicati,ns4 (anagement , thedisease and its Causes

13. $urses Resp,nsibility in Critical Care (eeting

the )asic needs , the *atient &ending E Receiingresults , diagn,stic test &upp,rtiecare:diete5ercisespiritual needs Rela5ati,n/iersi,n,r the patient ,cumentati,n Rep,rting &upp,rting the relaties C,rdinati,n , the teamw,r9

17. *rinciples , Critical Care$ursing #arlydiagn,sis/Identiicati,n , pr,blems *r,mpt reatment !nticipate c,mplicati,ns C,nsiderate use ,techn,l,gy =,listic appr,ach , n,t cause harm t, the patient Rec,gnise the limits , critical care )eneicience *atient !ut,n,my Fustice

18. ',lden Rules in Critical Care #ach nurse will beresp,nsible ,r the entire care , his/her patient and actst, c,,rdinate care with ,ther health team pr,essi,nals.Rati,nale: he caregier by assuming ull resp,nsibility,r m,nit,ring the patients c,nditi,n and care can detectchanges pr,mptly $, critical care patient will be letwith,ut a nurse . Rati,nale: Critically ill patients may haelie-threatening changes in their c,nditi,nG eg- pt may
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rem,e an inasie line ,r sel- e5tubate 6uic9ly. 15ygen saturati,n. Rati,nale: ! critically illpatientsH ital parameters changes rapidly which mayindicate deteri,rati,n , c,nditi,n.

1B. ',lden Rules in Critical Care !larms must belet ,n at all times. !ppr,priate limits will be selected at

the nurseHs discreti,n acc,rding t, instituti,nal p,licy.Rati,nale: , ensure rapid detecti,n , heart rate ,r )*changes.

20. ',lden Rules in Critical Care. !n #C' strip willbe ,btained and analyed acc,rding t, instituti,nal p,licy.

he #C' strips are analyed rhythm identied and tapedt, the bac9 , the case sheet. Changes are rep,rted t, thephysician. Rati,nale: =eart rate and rhythm are 9eys t,determining the hem,dynamic stability , an intensiecare patient.

21. ',lden Rules in Critical Care ?,r a stable n,n-acute patient with,ut inasie m,nit,ring e6uipment italsigns will be d,ne at the sta nurses discreti,n at leasteery h,ur. Rati,nale: , ensure stable ital signs.

emperatures will be measured ,n all patients at least 67hRati,nale: emperature changes may indicate inecti,n ,r,ther disease states.

22. ',lden Rules in Critical Care !ll patientsadmitted ,r neur,l,gical pr,blems will hae h,urlyneur,l,gical assessments per,rmed using the 'lasg,w
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C,ma &cale. Rati,nale: , 6uic9ly reerence prei,usuncti,n i deteri,rati,n ,ccurs t, pr,ide a clearunderstanding , the patients neur,l,gical status.

23. ',lden Rules in Critical Care he turning , all

critically ill patients eery tw, h,urs is d,ne unlessc,ntraindicated with s9in assessment rec,rded.Rati,nale: his is t, reliee pressure p,ints and all,w ,rs9in perusi,n. !ll intensie care patients will hae chest* 67h and as needed unless c,ntraindicated. Rati,nale:Imm,bility increases the ris9 ,r the retenti,n ,secreti,ns and reduced entilati,n.

27. ',lden Rules in Critical Care !ll critical carepatients will hae range , m,ti,n e5ercises 67h unless

c,ntraindicated .his will be rec,rded. Rati,nale: ,reduce p,ssible c,ntracture ,rmati,n E pressure s,re andt, pr,m,te en,us return. *erineal care will be d,neeery shit and as needed ,r all patients. Rati,nale: ,pr,m,te hygiene and c,m,rt.

28. ',lden Rules in Critical Care . !ll Critical Carepatients will hae m,uth care d,ne eery ,ur h,urs withinspecti,n ,r ,ral s,res. eeth will be brushed eery shitand as needed. Rati,nale: Intubati,n increases ris9 ,r

deel,ping m,uth ulcers and/,r inecti,ns. he Critical

Care nurse may restrain patients at his/her discreti,n.*r,ided d,cumentati,n d,ne acc,rding t, h,spitalp,licies and pr,cedures. Rati,nale: , ensure lie-supp,rting tubes ,r lines are n,t disc,nnected.

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daily.. Rati,nale: , rem,e bacterial c,ntaminates andreplace with an aseptic dressing

2A. ',lden Rules in Critical Care $ursing care willbe spaced ,ut t, all,w peri,ds , rest. Rati,nale: &ens,ry

,erl,ad predisp,ses the patient t, dis,rientati,n. !llpatients wh, hae n,t had a b,wel m,ement will bechec9ed ,r impacti,n eery 3 days. Rati,nale: , m,nit,rb,wel uncti,n

2B. ',lden Rules in Critical Care *r,cedures will bee5plained t, patientsG pers,n place and time beingrepeatedly stated t, the patient. &ens,ry stimulati,nie. radi,s tape rec,rders will be pr,ided ,r patients asindicated during the day. Rati,nale: It is n,t 9n,wn h,w

much an unc,nsci,us patient can hear ,r c,mprehend.&ens,ry depriati,n leads t, dis,rientati,n. !n5ietydecreases with an awareness , ,nes surr,undings.

30. ',lden Rules in Critical Care In,rmati,n andem,ti,nal supp,rt needs ,r the amily and patient will bepr,ided by the nurse/physician/s,cial w,r9er as re6uired.Rati,nale: he critical nature , the patients illness placestremend,us strain ,n the patient and amily unit. heenir,nment will be maintained in a mechanically sae

c,nditi,n thr,ugh: dry J,,rs g,,d repair , urniturepr,per placement , machines and e6uipment cleanlinessand g,,d repair , e6uipment. Rati,nale: , reduce ris9st, patients isit,rs ,r sta.

31. ',lden Rules in Critical Care Is,lati,n techni6uewill be ,ll,wed . Rati,nale: , minimie cr,ss inecti,n t,patients isit,rs and sta. &harps and glass will bedisp,sed , int, sharps c,ntainers. Rati,nale: , pr,tecthealth care w,r9ers r,m injury/c,ntaminati,n

32. ',lden Rules in Critical Care !ny c,ntainers ,b,dy Juids Ki.e. sucti,n b,ttles ,r chest drainage setsLmust be disp,sed in the appr,priate bi,haard bag ,r b,5.Rati,nale: , reduce ris9 , c,ntaminati,n t, health carew,r9ers during handling. !ll electrical e6uipment will: begr,unded hae 3-pr,ng plugs be used away r,m water,r wet J,,rs be pr,tected r,m spillage , li6uids beinspected by )i,medical epartment. !ny e6uipmentthat maluncti,ns ,r appears damaged will be rep,rted t,)i,medical ept.

33. ',lden Rules in Critical Care "abels will be
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aM5ed t,: all bedside medicati,ns intraen,us bags andb,ttles all w,und ,r bladder irrigati,ns multid,se ialsmultiple drainage bags/b,ttles hem,dynamic transducersand m,nit,rs . Rati,nale: , reduce ris9 ,r err,rs. !ll

medicati,ns will be reiewed by the Critical Carephysicians Kup,n admissi,n t, %nit.L and either re,rdered,r st,pped. $ursing sta will ensure this has been d,nepri,r t, carrying ,ut any medicati,n treatment ,rinestigatie ,rders. Rati,nale: , ensure ,ptimalmanagement.

37. ',lden Rules in Critical Care entilat,rychanges will ,nly be d,ne up,n written ,rder. Rati,nale:

, maintain ,ptimal and c,nsistent respirat,ry

management !ll ,rders written ,ther than by the Critical

Care physicians will be br,ught t, the attenti,n , theCritical Care physician by the nurse pri,r t, being carried,ut. Rati,nale: , ensure all therapy is c,nsistent withg,als ,r the patients management

38. ',lden Rules in Critical Care $arc,tics (!N$> be 9ept at the bedside. Rati,nale: , maintainnarc,tic c,ntr,l. isiting is neg,tiated between thenurse and amily with c,nsiderati,n gien t, unit actiity

and instituti,nal p,licy. Rati,nale: It is imp,rtant t,c,mmunicate in,rmati,n t, ,nc,ming nurse t, a,iddiscrepancies.

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critical care unit will hae a minimum I access , tw,Rati,nale: , ensure rapid resuscitati,n with I drugs ,rJuid i needed. Critical care patients are at suMcient ris9t, warrant multiple access.

3B. ',lden Rules in Critical Care !ll change , shitrep,rts will include a reiew , all physician ,rders labresults medicati,n administrati,n rec,rd and j,int reiew, systemwise status. Rati,nale: , ensure c,mmunicati,nbetween shits and reduce p,tential ,r medicati,n ,rtreatment err,rs. =ealth status is j,intly reiewed t,ensure that b,th inc,ming and ,ut g,ing shits are clear,n interpretati,n , ndings t, be able t, pr,mptly detecta change in patient c,nditi,n

70. ',lden Rules in Critical Care !ll sta w,r9ing at

a bedside where an acute trauma ,r actiely bleeding ,rris9 , splash r,m b,dy Juids e5ists e.g. sucti,ning. :wear pr,tectie g,ggles mas9s and gl,es. Rati,nale: It isduring peri,ds , acute crisis when health care w,r9ersare at the highest ris9 ,r disease transmissi,n.

71. &9ill in *r,cedures - (,nit,ring-)*C**ulse>5ygenati,n'C& #nd,tracheal&ucti,ning C*R- !"& !dministrati,n , rugs I

luids D,und Care Care , rain *repare ,r

iagn,stic *r,cedures ?eeding-$as,gastric eeding (eeting #liminati,n need- Catheterise #5ercise:Chest*hysi,*assie #5ercise =ygienic Care

72. (,nit,ring in Critical Care #C' =eart rate )l,,d *ressure:!)*C**!*$I)* &p>2 emprature

73. &upplies and #6uipments inCritical care unit !djustable(,able )ed (,nit,r Inusi,n pump&yringe pump entillat,r #mergency drugs Intubati,n tray eibrillat,r

77. &upplies and #6uipments inCritical care unit#nd,tracheal ubes E " sc,pe!mbu $as,gastrictubes #C' cable and electr,des)* cables ?,leys catheters rainsI tubings I inusi,ns&yringes/$eedles/Cannula #mergency drugs

78. (rs.)etty.*.+unjum,n!sst.*r,ess,r',t.C,llege, $ursing!lappuha

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adances hae been made in medicine and techn,l,gypatient care has bec,me m,re c,mple5.

7@. =ist,ry , Critical Care $ursing , pr,ideappr,priate care and ,r c,ntinu,us m,nit,ring and

treatment , critically ill nurses needed specialied9n,wledge and s9ills. $ightingale has deel,pedc,ncept , clustering m,st acutely ill pts in 1A00.

7A. =ist,ry , Critical Care $ursing he irstintensie care units emerged in the 1B80s t, pr,ide caret, ery ill patients wh, needed ,ne-t,-,ne care r,m anurse. ?r,m this enir,nment the specialty , critical carenursing emerged.

7B. ?uture , Critical Care $ursing Rapid adances

in healthcare and techn,l,gy hae c,ntributed t, 9eepingm,re pe,ple ,ut , the h,spital. =,weer patients incritical care units are m,re ill than eer be,re. (anypatients in t,dayHs critical care units w,uld n,t haesuried in the past.

80. ?uture , Critical Care $ursing (any patientswh, w,uld hae been cared ,r in a critical care unit eyears ag, are n,w being cared ,r ,n medical wards ,r ath,me.

81. ?uture , Critical Care $ursing It has been

pr,p,sed that the h,spitals , the uture will be largecritical care units and ,ther types , care will be pr,idedin alternatie l,cati,ns ,r at h,me. Critical care nurseswill need t, 9eep pace with the latest in,rmati,n anddeel,p s9ills t, manage new treatment meth,ds andtechn,l,gies.

82. ?uture , Critical Care $ursing !s issuesrelating t, patient care bec,me increasingly c,mple5 andnew techn,l,gies and treatments are intr,duced criticalcare nurses will need t, bec,me eer m,re9n,wledgeable.

83. Critical Care $urse Critical care nurses musthae specialied b,dy , 9n,wledge s9ills and e5periencet, pr,ide care t, patients and amilies and createenir,nments that are healing humane and caring ,ry,ur patient.

87. Dhat Critical Care $urses , Critical carenurses practice in settings where patients re6uire c,mple5assessment high-intensity therapies and interenti,ns
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and c,ntinu,us nursing igilance. he critical care nurseis a patient ad,cate respecting and supp,rting the basicalues rights and belies , the critically ill patient.

88. $urse , Critical care %nit Respect and supp,rt

the right , the patient ,r the patientHs designatedsurr,gate t, aut,n,m,us in,rmed decisi,n ma9ing.Interene when the best interest , the patient is in6uesti,n. =elp the patient ,btain necessary care. Respect the alues belies and rights , the patient.*r,ide educati,n and supp,rt t, help the patient ,r thepatientHs relaties t, ma9e decisi,ns.

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carb,n di,5ide in the bl,,d. #ach patient bed in an IC%has a physi,l,gic m,nit,r that measure these b,dyactiities. !ll m,nit,rs are netw,r9ed t, a central nursesstati,n.


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dierent wae ,rm. !rterial lines can als, be used ,rdrawing bl,,d thus eliminating the need ,r repeatedenipuntures Ka surgical puncture , a ein ,rwithdrawing bl,,dL.


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e5pand. %rinary catheter: %rinary catheters ,tenreerred t, as ?,ley catheters are inserted thr,ugh theurethra int, the bladder. >nce in the bladder the catheteris 9ept in place by a ball,,n which is inJated at the end

, the catheter. %rinary catheters c,ntinu,usly drain thebladder and all,w ,r accurate measurement , urinary,utput which is e5tremely imp,rtant in Juid managementand in assessing 9idney uncti,n.


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e6uipment ,r patients wh, are Pc,ding.P hat is theirital signs are in a danger,us range. he emergencye6uipment includes a debrillat,r airway intubati,ndeices a resuscitati,n bag/mas9 and medicati,n b,5.

Crash carts are strategically l,cated in the IC% ,rimmediate aailability ,r when a patient e5periencescardi,respirat,ry ailure.

@2. 4 Intraa,rtic ball,,n pumpOa deice that helpsreduce the hearts w,r9l,ad and helps bl,,d J,w t, thec,r,nary arteries ,r patients with unstable anginamy,cardial inarcti,n Kheart attac9L ,r patients awaiting,rgan transplants. Intraa,rtic ball,,n pumps use a ball,,nplaced in the patients a,rta. he ball,,n is ,n the end , a

catheter that is c,nnected t, the pumps c,ns,le whichdisplays heart rate pressure and electr,cardi,gram K#C'Lreadings. he patients #C' is used t, time the inJati,nand deJati,n , the ball,,n.

@3. iagn,stic e6uipment he use , diagn,stic e6uipment is als, re6uired in the IC%. (,bile 5-ray unitsare used ,r bedside radi,graphy particularly , the chest.(,bile 5-ray units use a battery-,perated generat,r thatp,wers an 5-ray tube. =andheld p,rtable clinical

lab,rat,ry deices ,r p,int-,- care analyers are used

,r bl,,d analysis at the bedside. ! small am,unt , wh,lebl,,d is re6uired and bl,,d chemistry parameters can bepr,ided much aster than i samples were sent t, thecentral lab,rat,ry.

@7. >ther IC% e6uipment isp,sable IC% e6uipment includes urinary K?,leyL catheters cathetersused ,r arterial and central en,us lines &wan-'ancatheters chest and end,tracheal tubes gastr,intestinaland nas,gastric eeding tubes and m,nit,ring electr,des.&,me patients may be wearing a p,sey est als, called a=,udini jac9et ,r saetyG the purp,se is t, 9eep thepatient stati,nary. &penc, b,,ts are padded supp,rtdeices made , lambs w,,l t, p,siti,n the eet andan9les , the patient. &upp,rt h,se may als, be placed ,nthe patients legs t, supp,rt the leg muscles and aidcirculati,n.

@8. #6uipment !# %nit-!ccess,ries-+its !ir(attresses !spirat,rs )ar C,de-rac9ing &ystems )ariatricChairs )edside (edicati,n !dministrati,n )l,,d *r,duct
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!dministrati,n )l,,d Darmers )usiness C,nsultingCardiac >utput (,nit,r Central &upply #6uipment Clinical#ducati,n C,mmunicati,ns #6uipment C,mputer DallD,r9stati,ns C,mputers C,nsci,us &edati,n (,nit,r C*!*

(achines Cry,genic #6uipment ebrillat,rs iabetes#6uipment iagn,stic #+'-#C' iagn,stic #6uipmentisinect,rs-Dashers #lectr,encephal,graphy #6uipment#mergency Carts #nd,sc,py #6uipment K?le5ible E Rigid&c,pesL #nd,sc,py-Cameras #,9ed *,tential &ystems#5am R,,m ables ?l,wmeters ?luid Daste (anagement?lu,r,sc,py #6uipment ?,am (attresses ?,,t &witches?reeers-?ridges =eadwall &ystems =ealthcare ?urniture=eaters =,spital )eds =,spital #6uipment &ystems

&upp,rt =,spital #6uipment-*r,ject *lanners =umidiers=ydr,c,llat,r =eating %nits Ice (a9ers Installati,n E e-Installati,n K(edical #6uipmentL Internet #6uip. E &upplyDareh,use Is,lati,n Carts I pumps

@perati,n he IC% is a demanding enir,nment due t, the critical c,nditi,n , patients andthe ariety , e6uipment necessary t, supp,rt andm,nit,r patients. here,re when ,perating IC%e6uipment sta sh,uld pay attenti,n t, the types ,

deices and the ariati,ns between dierent m,dels , thesame type , deice s, they d, n,t ma9e an err,r in,perati,n ,r adjustment. !lth,ugh many h,spitals ma9ean e,rt t, standardie e6uipment O,r e5ample usingthe same manuacturers inusi,n pumps ,r patientm,nit,ring systems ,lder deices and n,nstandardiede6uipment may still be used particularly when the IC% isbusy. Clinical sta sh,uld be sure t, chec9 all deices andsettings t, ensure patient saety.

@@. Intensie care unit patient m,nit,ring systemsare e6uipped with alarms that s,und when the patientsital signs deteri,rateO,r instance when breathingst,ps bl,,d pressure is t,, high ,r t,, l,w ,r when heartrate is t,, ast ,r t,, sl,w. %sually all patient m,nit,rsc,nnect t, a central nurses stati,n ,r easy superisi,n.&ta at the IC% sh,uld ensure that all alarms areuncti,ning pr,perly and that the central stati,n is staedat all times. ?,r reusable patient care e6uipmentclinical sta ma9e certain t, pr,perly disinect andsterilie deices that hae c,ntact with patients.
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isp,sable items such as catheters and needles sh,uldbe disp,sed , in a pr,perly labeled c,ntainer.

@A. !&&(#$ >? CRIIC!""NI"" *!I#$ R,le ,$urse

@B. !ssessment , Critically Ill *atient !ssessment,n !dmissi,n etailed assessment Kwhen patientbec,me stableL >ng,ing m,nit,ring

A0. >bjecties > !ssessment Identiyabn,rmalities *lan treatment E care *reent c,mplicati,n !ssess pr,gress/deteri,rati,n #arly detecti,n E Immediate Interenti,n in emergencies&t,re data as legal d,cument >er data t, =ealth Careteam

A1. Respirat,ry !ssessment Rate #,rt

epthuse , accessary muscles C,ugh &ecreti,n )reath &,und &p>2 !ny eatures , =yp,5ia

A2. Respirat,ry !ssessment !irway !)' Chest ;-Ray $ebulisati,n Chest *hysi,therapy entilat,r &ucti,ning # ube Chest rainage

A3. Cardiac !ssessment $I)* *%"E =earts,unds!)* C* #C' F*

A7. !rterial )l,,d *ressure

A8. Central en,us *ressurea wae Q atrialc,ntracti,nc wae Q bulging , tricuspid ale int, atriumat start , entricular c,ntracti,n5 descent Q atriumrela5es and tricuspid ale is pulled d,wnwards wae Qpassie lling , right atrium and ena caae whentricuspid ale cl,sesy descent Q tricuspid ale ,pensand bl,,d J,ws int, right entricle

A$ &p,ntane,us , tal9 ,
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pain $, resp,nse B7. 'C&- (,t,r resp,nse >bey c,mmand ",calise

pain Dithdraw t, pain !bn,rmal le5i,n !bn,rmal e5tensi,n $, resp,nse

B8. 'C&: erbalResp,nse>rientedC,nusedInappr,priatew,rdsInc,mprehensible s,unds$, resp,nseA Qc,ma

B


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10B. =ydrati,nal &tatus I$!+# >%*% %rine >ral rainage $as,gastric Intraen,us $' aspirate ,mitus

110. Integumentary system C,l,r e5ture

emp urg,r >dema 111. !*!C=# !ge Chr,nic health pr,blem !cid

base balance $eur,l,gical assessment =aem,dynamics and Resp status )l,,d inestigati,nndings

112. =ead , ,e !ssessment 113. iagn,stic ?indings"!) Radi,l,gical E

,ther=bD)C ; Ray#&R C*latelet %&'&,dium(RI*,tassium #nd,sc,pyR)&

117. &ympt,ms/C,mplicati,ns >nset",cati,n/Intensity urati,n Cause !ggraating act,rRelieing act,r reatment

118. !ssessment E Interenti,ns =ygiene $utriti,n )ladder ),wel #5ercise !" *sych,l,gical &piritual

11


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Inc,rp,rate eidence based nursing practice and identiythe areas , research in the ield , critical carenursing. 18. Identiy the s,urces , stress and manageburn,ut syndr,me am,ng health care pr,iders. 1

Documents

Critical Care Nursing March2012