The document discusses critical care nursing and monitoring patients in the intensive care unit. It describes different levels of critical care from level 0 to level 3, with higher levels involving more advanced support and multi-organ failure. Various types of intensive care units are also outlined, including medical, surgical, neonatal and more specialized units. The document provides guidance on monitoring patients in the ICU, including assessing physiological parameters, vital signs, physical exams and laboratory reports. Close monitoring and documentation of the patient's condition is emphasized as important for patient care, legal protection and reimbursement.

1. CRITICAL CARE NURSING:
Monitoring, Assessment &
Care of Patients
1Prof. Dr. Ram Sharan Mehta, MSND, CON, BPKIHS

2. 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 2Prof. Dr. R S Mehta, BPKIHS

3. 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
3Prof. Dr. R S Mehta, BPKIHS

4. MONITORING IN CRITICAL CARE
AREAS…
 Airway monitoring
 Keep talking to your patient
 Breathing check
 Don’t forget to auscultate your patient
 Circulation monitoring
 When in doubt check bilateral limb BP and radio-femoral delay
 Disability(neurological monitoring)
 Keep an eye when your patients walking
 Expose and look for problems
 Keep an eye on all tubes and wires
 Pain management is must

5. A
• ACIDOSIS
• AORTIC
DISSECTION
• ALCOHOL
• AIRWAY
B • BREATHING
• BABY
C
• CIRCULATION
• COMPRESSION
• COOLING
D
• DISABILITY
• DEFIBRILLATION
• TRENDELENBURG
POSITION
E
• EXPOSURE
• EFFUSION
• EMBOLISM
• ECG

6. Guidelines for monitoring the
patients in ICU:
 Decrease anxiety & fear: reassure, sedation
 Assess: all physiological parameters
 Inspect & examine pt.: LOC, secretions etc.
 Vitals : TPR BP RR HR Pao2, paco2, urine output
 Weight gain
 Capillary refill: 3-5 sec
 Phy. Exam: head to toe & systematic
 ETT, Airway, subcutaneous emphysema, chest tube,
 Skin temp, gastric distention
 All relevant Laboratory reports: ABG, BUN, LFT etc.
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29. Documentation
29Prof. Dr. RS Mehta, BPKIHS

30. What is Clinical
Documentation?
Clinical documentation in a patient's
record includes any and all
documentation that relates to the care of
the patient during the patient's stay or
encounter.
30Prof. Dr. RS Mehta, BPKIHS

31. In the inpatient setting, some of the important
pieces of the patent’s clinical documentation
include:
• Patient History & Physical examination
• Progress Notes
• Orders
• Procedure Reports
• Anesthesia Reports
• Pathology Reports
• Radiology/Nuclear Medicine Reports
• Cardiology Reports
• Consultation Reports
• Notes Provided by Nursing Staff
• Discharge Summary
31Prof. Dr. RS Mehta, BPKIHS

32. Why is Clinical
Documentation Important
• Patient Care & Quality
• Legal Protection
• Operations and Management
• Strategic and Financial Planning
• Research
• Reimbursement & Revenue
32Prof. Dr. RS Mehta, BPKIHS

33. The move toward Electronic Medical Records
(EMRs)
and Critical Care Information Systems (CCIS)
33Prof. Dr. RS Mehta, BPKIHS

34. SEVEN Cs OF CRITICAL CARE
 Compassion (empathy, concern)
 Communication (with patient and family).
 Consideration (to patients, relatives and
colleagues) and avoidance of Conflict.
 Comfort: prevention of suffering
 Carefulness (avoidance of injury)
 Consistency
 Closure (ethics and withdrawal of care).
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35. Thank you
35Prof. Dr. RS Mehta, BPKIHS

36. Monitoring the Patients in
Intensive Care Unit
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83. Thank you
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