CRITICAL CARE

NURSING

Mrs.Priyanka koshti,Indore Nursing College 1

CRITICAL

▪ Crucial
▪ Crisis
▪ Emergency
▪ Serious
▪ Requiring immediate action
▪ Thorough and constant observation
▪ Total depende
(Oxfo
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 DEFINITIONS

▪ CRITICALCARE :
CRITICAL CARE IS A TERM USED
TO DESCRIBE AS THE CARE OF
PATIENTS WHO ARE EXTREMELY
ILL AND WHOSE CLINICAL
CONDITION IS UNSTABLE OR
POTENTIALLY UNSTABLE.
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▪ CRITICALCARE UNIT :
IT IS DEFINED AS THE UNIT IN
WHICH COMPREHENSIVE CARE
OF A CRITICALLY ILL PATIENT
WHICH IS DEEMED TO
RECOVERABLE STAGE IS
CARRIED OUT.

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▪ CRITICALCARE NURSING :
IT REFERS TO THOSE
COMPREHENSIVE, SPECIALIZED
AND INDIVIDUALIZED NURSING
CARE SERVICES WHICH ARE
RENDERED TO PATIENTS WITH
LIFE THREATENING CONDITIONS
AND THEIR FAMILIES.

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Critical Care Technology

▪ ECG monitoring ▪ Temperature

▪ Arterial Lines ▪ Pulmonary Artery
▪ Oxygen Saturation Catheter
▪ Ventilation ▪ IABP
▪ Intracranial Pressure ▪ Extensive use of
Monitoring pharmaceuticals

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An Ideal ICU

P 7
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
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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
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

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DESIGN OF ICU

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 ORGANIZATION OF ICU

▪ DESIGN OF ICU :
1. Should be at a geographically distinct area
within the hospital, with controlled access.
2. There should be a single entry and exit.
However, it is required to have emergency exit
points in case of emergency and disaster.
3. There should not be any through traffic of
goods or hospital staff. Supply and professional
traffic should be separated from public/visitor
traffic.
4. 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.
5. Corridors, lifts and ramps should be spacious
enough to provide easy movement of bed/trolley
of a critically sick patient.
6. Close, easy proximity is also desirable to
diagnostic facilities, blood bank, pharmacy etc.
▪ BED STRENGTH:
1. 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.
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2. 3-5 beds per 100 hospital beds for a Level III ICU
or 2 to 20% of the total no of hospital beds.
3. 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.

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▪ 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 :
1. 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.
2. Nursing staff – The major teaching tertiary care
ICU requires trained nurses in critical care. 22
 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.

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Design Summary:

▪ For critically ill: unstable patients

▪ Level: I II III
▪ Bed strength: ideal 8-14
▪ Each pt. > 100 sq. ft. ( 125-150 desirable)
▪ Additional space = 100%
▪ 10% isolation bed
▪ At least 2 barriers to enter ICU
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▪ Only one entry and exit, emergency exit
▪ Proper fire extinguisher
▪ At least 2 ft. away from head wall
▪ Central nursing station: all pt. visible
Environment requirements:
▪ Heating, ventilation, air-conditioning
system in ICU (HVAC system)
▪ Fully air-conditioned : 6 cycle/hr, 2 cycle
outside air
▪ Temperature = 16-25 oC
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▪ Light: high illumination, 150 foot candle
(fc), overhead light = 20fc, floor light at
night = 10fc
▪ Noise control: Under 45 dBA in day, <40
in evening, <20 in night. (watch tick= 20
& normal conversation at 55)
▪ Furniture: solid, non-porous, stain
resistant.
▪ Floor: easy to clean and non-slippery
▪ Wall= 4-5 ft. finished with tiles
▪ Ceiling: paint with soft color, no wire lines
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Summary…
▪ Stressors in ICU:
▪ - Patients and family stressors
▪ Staff stressors:
Nurses role is to decrease stress:
examining feeling about death, listen
attentively to needs, use touch therapy
as applicable, family care, maintain
privacy, allow cultural practices as
possible.
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Core Competencies

▪ Patient Care
▪ Medical Knowledge
▪ Professionalism & Ethics
▪ Interpersonal Communication Skills
▪ Practice-based Learning and
Improvement
▪ Systems-based Practice
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Objective Parameters Model for ICU
admission
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

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▪ 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

▪ Electrocardiogram
▪ Myocardial infarction with complex arrhythmias,
hemodynamic instability or congestive heart failure
▪ Sustained ventricular tachycardia or ventricular
fibrillation
▪ Complete heart block with hemodynamic instability

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▪ Physical Findings (acute onset)
▪ Unequal pupils in an unconscious patient
▪ Burns covering > 10% BSA
▪ Anuria
▪ Airway obstruction
▪ Coma
▪ Continuous seizures
▪ Cyanosis
▪ Cardiac tamponade

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Functions of critical care nurse

▪ Help to restore life process: BLS/ALS

▪ Help to maintain life sustaining functions
▪ Manage crisis/ critical care situations
▪ Maintain standard: follow guidelines
▪ Maintain team spirit and IPR
▪ Ensure availability of all equipments
▪ Provide continue nursing services
▪ Maintain good rapport with family
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Thank you

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“It may seem a
strange principle to
enunciate (articulate)
as the very first
requirement in a
Hospital that it should
do the sick no harm.”
[1859]

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Role of
Nurses in
ICU

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▪ ICU nurses play a vital role in the patient’s
care, including the following:

▪ Taking regular blood tests

▪ Changing the patient’s treatment in line with test
results
▪ Giving the patient the drugs and fluids that the
doctors have prescribed
▪ Recording a patient’s blood pressure, heart rate
and oxygen levels
▪ Clearing fluid and mucus from the patient’s chest
using a suction tube
▪ Turning the patient in his or her bed every few
hours to prevent sores on the skin
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Contd…
▪ Cleaning the patient’s teeth and
moistening the mouth with a wet sponge
▪ Washing the patient in bed
▪ Changing the sheets
▪ Changing a patient’s surgical stockings,
which help circulation when he or she is
inactive (lying still) for a long time
▪ Putting drops in the patient’s eyes to make
it easier to blink
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Nurses role to patient with CVP
▪ Position the patient in Semi Fowler position.
▪ Removes clothing that could constrict the
neck or upper chest
▪ Provide adequate lightening to visualize
effectively the external jugular veins.
▪ Prevent the infection from the ports by
change dressing.

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Contd…

▪ Label the date of insertion and change.

▪ Observe for complication such as
pneumothorax, hemothorax, hematoma,
cardiac tamponade, air embolism and
colonization of micro-organism.

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Thank you…!!!

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