PREPARATION OF PATIENT
BEFORE
DR.ANJALATCHI MUTHUKUMARAN
VICE PRINCIPAL
ERA COLLEGE OF NURSING

INTRODUCTION
• AN INTENSIVE CARE UNIT, ALSO KNOWN AS AN INTENSIVE THERAPY UNIT OR
INTENSIVE TREATMENT UNIT OR CRITICAL CARE UNIT, IS A SPECIAL
DEPARTMENT OF A HOSPITAL OR HEALTH CARE FACILITY THAT PROVIDES
INTENSIVE CARE MEDICINE.

WHAT IS THE MEANING OF ICU?
• INTENSIVE CARE UNIT
• INTENSIVE CARE UNIT. A UNIT IN A HOSPITAL PROVIDING INTENSIVE CARE FOR
CRITICALLY ILL OR INJURED PATIENTS THAT IS STAFFED BY SPECIALLY TRAINED
MEDICAL PERSONNEL AND HAS EQUIPMENT THAT ALLOWS FOR CONTINUOUS
MONITORING AND LIFE SUPPORT. ABBREVIATION ICU

WHY DO PATIENTS GO TO ICU?
• INTENSIVE CARE IS NEEDED IF SOMEONE IS SERIOUSLY ILL AND REQUIRES
INTENSIVE TREATMENT AND CLOSE MONITORING, OR IF THEY'RE HAVING
SURGERY AND INTENSIVE CARE CAN HELP THEM RECOVER. MOST PEOPLE IN AN
ICU HAVE PROBLEMS WITH 1 OR MORE ORGANS. FOR EXAMPLE, THEY MAY BE
UNABLE TO BREATHE ON THEIR OWN.

TYPE OF ICU
• MEDICAL INTENSIVE CARE UNIT.
• SURGICAL INTENSIVE CARE UNIT.
• PEDIATRIC INTENSIVE CARE UNIT.
• NEONATAL INTENSIVE CARE UNIT.
• SICU
• CTVS
• RICU

ABCD OF CRITICAL CARE?
• THE ABCDEF BUNDLE INCLUDES: ASSESS, PREVENT, AND MANAGE PAIN (A),
• BOTH SPONTANEOUS AWAKENING TRIALS (SAT) AND SPONTANEOUS BREATHING
TRIALS (SBT) (B),
• CHOICE OF ANALGESIA AND SEDATION (C),
• DELIRIUM: ASSESS, PREVENT, AND MANAGE (D),
• EARLY MOBILITY AND EXERCISE (E), AND
• FAMILY ENGAGEMENT AND EMPOWERMENT (F).

LEVEL OF ICU
• LEVEL 1—WARD BASED CARE WHERE THE PATIENT DOES NOT REQUIRE ORGAN
SUPPORT (FOR EXAMPLE, THEY MAY NEED AN IV, OR OXYGEN BY FACE MASK)
• LEVEL 2—HIGH DEPENDENCY UNIT (HDU). ...
• LEVEL 3—INTENSIVE CARE.

PRINCIPLES OF ICU
• KIE: LUCE APPLIES FIVE PRINCIPLES OF MEDICAL ETHICS -- BENEFICENCE,
NONMALEFICENCE, AUTONOMY, DISCLOSURE, AND SOCIAL JUSTICE -- TO
ISSUES THAT OFTEN ARISE IN CRITICAL CARE MEDICINE.

WARM ROOM SUPPLY CHECKLIST
• PLACE ISOLATION SIGNAGE.
• PLACE PAPR CHECKLIST.
• PLACE DONNING/DOFFING SIGNAGE.
• ANTE ROOM ENTRANCE LOGS.
• SMALL BIOHAZARD BAGS FOR LABS.
• SMALL PAPER BAGS FOR STORAGE OF USED N95 MASKS.
• BOX OF REGULAR N95.
• BOX OF SMALL N95.

• THREE PACKS OF GOWNS
• BOX OF SMALL, MEDIUM, LARGE GLOVES
• FIVE FACE SHIELDS
• TWO TALL BIOHAZARD TRASH BINS
• RED BIOHAZARD TRASH BAGS
• BIOHAZARD BAG FOR GLIDESCOPE STYLET
• ONE CANISTER OF GREY TOP WIPES
• ONE CANISTER OF ORANGE TOP WIPES
• ONE CANISTER OF PURPLE TOP WIPES

ROOM DESIGNATION
• PATIENT ROOM – HOT ROOM
• NEGATIVE PRESSURE ANTEROOM (OR HALLWAY IF NO ANTEROOM) – WARM
ROOM
• HALLWAY – COLD ROOM

HOT ROOM SUPPLY CHECKLIST
• ONE CANISTER OF GRAY TOP WIPES
• ONE CANISTER OF ORANGE TOP WIPES
• ONE CANISTER OF PURPLE TOP WIPES
• ONE DISPOSABLE STETHOSCOPE IN ROOM
• ONE DISPOSABLE THERMOMETER IN ROOM
• REPLACE ALL BLACK TRASH BAGS WITH RED BIOHAZARD TRASH BAGS
• MOVE ICU BED INTO COLD ROOM IN PREPARATION TO GO PICK UP PATIENT

CONTINUED
• ASSIGN DEDICATED NURSE AND WARM ROOM ASSISTANT
• LABEL PATIENT ROOM WITH LIME GREEN STICKER
• DECREASE ROOM TEMPERATURE
• REMOVE PATIENT/GUEST RECLINER
• PLACE ISOLATION SIGNAGE
• EVALUATE NEED FOR TELEHEALTH AND PLACE COMMUNICATION DEVICE IF
AVAILABLE
• ENSURE RESPIRATORY HAS PREPARED ROOM WITH OXYGEN SOURCE, VENTILATOR,
ETC., AS NEEDED

COLD ROOM SUPPLY CHECKLIST
• PPE STATION
• STAFF ENTRANCE LOG
• SMALL PAPER BAGS FOR STORAGE OF USED N95 MASK

ESSENTIAL ICU EQUIPMENT
• EQUIPMENT USED IN AN INTENSIVE CARE UNIT RANGES FROM
GENERAL EQUIPMENT, SUCH AS BLOOD PRESSURE MONITORS, TO
HIGHLY SPECIALISED DEVICES SUCH AS DIALYSIS MACHINES.
• BEDS
• BLOOD PRESSURE CUFF
• CENTRAL VENOUS CATHETERS
• ENDOTRACHEAL TUBE (ETT OR BREATHING TUBE)
• ICU BEDSIDE MONITORS
• INDWELLING URINARY CATHETER (IDC)
• NASOGASTRIC TUBE (NG TUBE)
• RESUSCITATOR BAG
• SATURATION MONITOR
• SEQUENTIAL COMPRESSION DEVICES
• SYRINGE DRIVER OR SYRINGE PUMP
• VENTILATOR

PRIORITIZATION 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
• PRIORITY 1: THESE ARE CRITICALLY ILL, UNSTABLE PATIENTS IN NEED OF
INTENSIVE TREATMENT AND MONITORING THAT CANNOT BE PROVIDED
OUTSIDE OF THE ICU
• PRIORITY 2: THESE PATIENTS REQUIRE INTENSIVE MONITORING AND MAY
POTENTIALLY NEED IMMEDIATE INTERVENTION. NO THERAPEUTIC LIMITS ARE
GENERALLY STIPULATED FOR THESE PATIENTS. EXAMPLES INCLUDE PATIENTS
WITH CHRONIC COMORBID CONDITIONS WHO DEVELOP ACUTE SEVERE MEDICAL
OR SURGICAL ILLNESS.
• PRIORITY 3: THESE UNSTABLE PATIENTS ARE CRITICALLY ILL BUT HAVE A
REDUCED LIKELIHOOD OF RECOVERY BECAUSE OF UNDERLYING DISEASE OR
NATURE OF THEIR ACUTE ILLNESS

CONTINUED
• PRIORITY 4: THESE ARE PATIENTS WHO ARE GENERALLY NOT APPROPRIATE FOR
ICU ADMISSION

PURPOSE:
• TO DEFINE POLICIES GUIDING CARE OF PATIENT IN THE INTENSIVE CARE UNIT

RESPONSIBILTY:
• ALL MEDICAL AND PARAMEDICAL STAFF AT CRITICAL CARE UNITS,
• INFECTION CONTROL TEAM,
• BIOMEDICAL ENGINEER,
• HOUSEKEEPING STAFF

POLICY
• 1) INTENSIVE CARE ADMISSION AND / OR DISCHARGE SHALL BE DECIDED BY
TREATING DOCTOR. EACH PATIENT SHALL BE UNDER THE CARE OF A NURSE,
ALWAYS MAINTAINING THE PATIENT TO NURSE RATIO OF 2:1. INTENSIVE CARE
AREAS SHALL FOLLOW INFECTION CONTROL PRACTICES AS PER PROCEDURE.
(REF: INFECTION CONTROL MANUAL). INTENSIVE CARE UNITS SHALL FOLLOW
THE QUALITY ASSURANCE PROGRAMME.
• 2) VISITORS SHALL NOT BE ALLOWED IN HIGH DEPENDENCY AREAS, EXCEPT IN
SPECIAL SITUATIONS WHEREIN RESTRICTED ENTRY OF ONE OR TWO CLOSE
RELATIVES SHALL BE PERMITTED DURING VISITING HOURS ONLY. 3) AS AND
WHEN THERE IS A SHORTAGE OF BEDS, PATIENTS THOSE WHO ARE NORMAL WILL
BE SHIFTED TO THE WARDS AND PRIORITY WILL BE GIVEN TO THE EMERGENCY
PATIENTS. 4) ONE EMPTY BED SHALL BE KEPT RESERVED FOR ALL THE TIME FOR
RECEIVING EMERGENCY PATIENTS WHO NEED ICU ADMISSION. 5) QUALITY

ADMISSION CRITERIA IN ICU
• ADMISSION CRITERIA ARE USED TO SELECT PATIENTS WHO ARE LIKELY TO
BENEFIT FROM CARE IN ICUS. PATIENTS WHO MEET ANY OF THE FOLLOWING
CRITERIA SHALL BE ADMITTED TO THE ICUS AT THE REQUEST OF THE
CONSULTANT. WHILE WE MAKE EVERY EFFORT TO STRICTLY ADHERE TO
ADMISSION CRITERIA, WE ACCOMMODATE REQUESTS FROM CONSULTANTS WHO
CLINICALLY FEEL THAT A PATIENT WOULD BENEFIT FROM CLOSE MONITORING
IN THE CRITICAL CARE UNIT EVEN THROUGH NOT STRICTLY MEETING THE
CRITERIA STATED BELOW

RESPIRATORY:
• ACUTE RESPIRATORY FAILURE (PAO2 < 60 MM HG).
• RESPIRATORY RATE > 30 BREATHS/MINUTE AND
• ACUTE RESPIRATORY FAILURE (PAO2 < 60 MM HG).
• RESPIRATORY RATE > 30 BREATHS/MINUTE AND
• PULMONARY EMBOLI WITH HAEMODYNAMIC INSTABILITY.
• MASSIVE HAEMOPTYSIS

SURGICAL:
• POST-OPERATIVE PATIENTS REQUIRING HAEMODYNAMIC MONITORING,
VENTILATOR SUPPORT OR EXTENSIVE NURSING CARE.
• PATIENTS WITH SURGICAL ABDOMEN REQUIRING PREOPERATIVE FLUID AND/OR
ELECTROLYTE RESUSCITATION
• POLYTRAUMA WITH SIGNIFICANT INJURY TO THORACIC / ABDOMINAL ORGANS
REQUIRING SURGICAL INTERVENTION.

RENAL
• PATIENT WHO HAS ACUTE RENAL FAILURE WITH ACCOMPANYING RESPIRATORY
OR HEMODYNAMIC COMPONENTS REQUIRE CLOSE MONITORING &
RESPIRATORY/ HEMODYNAMIC SUPPORT.
• SIGNIFICANT ACIDOSIS OR ALKALOSIS.
• HYPO OR HYPERKALEMIA WITH DYSARHYTHMIAS OR MUSCULAR WEAKNESS.
• HYPO OR HYPERNATREMIA WITH SEIZURES, ALTERED MENTAL STATUS.
• SEVERE HYPERCALCEMIA WITH ALTERED MENTAL STATUS, REQUIRING CLOSE
NEUROLOGICAL MONITORING.
• HYPO OR HYPERMAGNESEMIA WITH HAEMODYNAMIC COMPROMISE OR
DYSARRHYTHMIAS OR MUSCULAR WEAKNESS

DRUG INGESTION AND OVERDOSE:
• DRUG INGESTION WITH SIGNIFICANTLY ALTERED MENTAL STATUS &
INADEQUATE AIRWAY PROTECTION / HEMODYNAMIC INSTABILITY.
• SEIZURES FOLLOWING DRUG INGESTION

ENDOCRINE SYSTEM
• DIABETIC KETOACIDOSIS COMPLICATED BY HEMODYNAMIC INSTABILITY,
ALTERED MENTAL STATUS, RESPIRATORY INSUFFICIENCY, OR SEVERE ACIDOSIS.
• THYROID STORM OR MYXEDEMA COMA WITH HEMODYNAMIC INSTABILITY.
7.2.5.3 OTHER ENDOCRINE PROBLEMS SUCH AS ADRENAL CRISIS WITH
HEMODYNAMIC INSTABILITY

MISCELLANEOUS
• ENVIRONMENTAL INJURIES (LIGHTING, NEAR DROWNING, HYPERTHERMIA OR
HYPOTHERMIA).
• ANY OTHER CLINICAL CONDITIONS REQUIRING ICU LEVEL NURSING CARE
• SUICIDAL GESTURES INCLUDING PARTIAL HANGING, DRUG OVERDOSES AND
OTHER SELF-INFLICTED INJURIES.

ROLE OF NURSING OFFICER
• ICU NURSE RESPONSIBILITIES INCLUDE EVALUATING A PATIENT'S CONDITION
AND ADMINISTERING TREATMENT, AS WELL PROVIDING CONSTANT SUPPORT
THROUGHOUT RECOVERY TIME. ULTIMATELY, YOU WILL WORK DIRECTLY WITH
PATIENTS TO ENSURE THEY RECEIVE THE ATTENTION AND MEDICAL CARE
NEEDED BASED ON THEIR CONDITION.

CONCLUSION
• PREPARATION OF THE PATIENT INCLUDES THE PREOPERATIVE ASSESSMENT,
REVIEW OF PREOPERATIVE TESTS, OPTIMISATION OF MEDICAL CONDITIONS,
ADEQUATE PREOPERATIVE FASTING, APPROPRIATE PREMEDICATION, AND THE
EXPLANATION OF ANAESTHETIC RISK TO PATIENTS.

THANK YOU