1. critical care concepts

CRITICAL CARE NURSING:
CONCEPTS
1

CRITICAL
 Crucial
 Crisis
 Emergency
 Serious
 Requiring immediate action
 Thorough and constant observation
 Total dependent
(Oxford Dictionary)
2Prof. Dr. R S Mehta, BPKIHS

CRITICAL CARE NURSING
 The care of seriously ill clients from point
of injury or illness until discharge from
intensive care
 Deals with human responses to life
threatening problems -trauma /major
surgery
(Mary,L.S., Deborah, G.K. & Marthe, J.M. 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

DEFINITIONS
 CRITICAL CARE :
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.

 CRITICAL CARE 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.

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

An Ideal ICU

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

Team Dynamics
 A multidisciplinary team to effectively
attain specified objective
 Physician team leader & critical care
nurse manager

Critical Care Practice
Pattern
 Open
 Closed
 transitional

Open Units
Definition :
any attending physician with hospital
admitting privileges can be the physician of
record and direct ICU care. (All other
physicians are consultants)
Disadvantage :
 lack of a cohesive plan
 Inconsistent night coverage
 Duplication of services

Closed Units
 Definition:
An intensivist is the physician of record for
ICU patients. (other physicians are
consultants), All orders & procedures carried
out by ICU staff
• advantage:
• improved efficiency
• standardized protocol for care
• disadvantage:
• potential to lock out private physician
• increase physician conflict

Transitional Units
Definition:
intensives are locally present shared co-
managed care between ICU staff and private
physician
ICU staff is a final common pathway for orders
and procedures
Advantage:
reduce physician conflict, standard policies and
procedures usually present
Disadvantage:
confusion and conflict regarding final authority &
responsibilities for patient care decision

ICU Model Care
 Full-time intensivist model :
 patient care is provided by an intensivist
 Consultant intensivist model :
 an intensivist consults for another physician to
coordinate or assist in critical care, but dose not
have primary responsibility for care
 Multiple consultant model:
 multiple specialists are involved in the patient care,
(esp. R/T doctors for ventilators), but none is
designated especially as the consultant intensivist
 Single physician model :
 primary physician provides all ICU care

A Good ICU
 Well organized
trust
coordinated care
• Full-time intensivist: daily round
• protocol & policies (eg: how to DC elective
operation when bed not available)
• bedside nurses (master degree)
• no intern

A Good ICU
 A team:
doctors, nurses, R/T, pharmacists
• led by full time intensivists
critical care trained
available in a timely fashion (24hr/day)
no competiting clinical responsibilities
during duty
• closed units, if resources allow

What are the conditions
considered as Critical?
1. ANY PERSON WITH LIFE
THREATENING CONDITION
2. PATIENTS WITH :
 ARF
 AMI
 CARDIAC TAMPONATE
 SEVERE SHOCK

 HEART BLOCK
 ACUTE RENAL FAILURE
 POLY TRAUMA, MULTIPLE
ORGAN FAILURE AND ORGAN
DYSFUNCTION
 SEVERE BURNS

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 22Prof. Dr. R S Mehta, BPKIHS

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

PRINCIPLES OF CRITICAL
CARE NURSING
ANTICIPATION : The first
principle in critical care is Anticipation.
One has to recognize the high risk
patients and anticipate the requirements,
complications and be prepared to meet
any emergency. Unit is properly
organized in which all necessary
equipments and supplies are mandatory
for smooth running of the unit.

EARLY DETECTION AND
PROMPT ACTION :
 The prognosis of the patient depends on
the early detection of variation, prompt
and appropriate action to prevent or
combat complication. Monitoring of
cardiac respiratory function is of prime
importance in assessment.
Prof. Dr. R S Mehta, BPKIHS 25

 COLLABORATIVE PRACTICE :
Critical Care, which has originated as technical
sub-specialized body of knowledge has evolved
into a comprehensive discipline requiring a very
specialized body of knowledge for the physicians
and nurses working in the critical care unit fosters
a partnerships for decision making and ensures
quality and compassionate patient care.
Collaborate practice is more and more warranted
for critical care more than in any other field.

COMMUNICATION :
 Intra professional, inter departmental and
inter personal communication has a
significant importance in the smooth
running of unit. Collaborative practice of
communication model
Prof. Dr. R S Mehta, BPKIHS 27

 Prevention of Infection : Nosocomial
infection cost a lot in the health care services.
Critically ill patients requiring intensive care are at
a greater risk than other patients due to the
immunocompromised state with the antibiotic
usage and stress, invasive lines, mechanical
ventilators, prolonged stay and severity of illness
and environment of the critical unit itself.

 Crisis Intervention and Stress
Reduction : partnerships are formulated
during crisis. Bonds between nurses,
patients and families are stronger during
hospitalization. As patient advocates,
nurses assist the patient to express fear
and identify their grieving patttern and
provide avenues for positive coping.

“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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1. critical care concepts

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