The document discusses monitoring and care of critically ill patients in the intensive care unit (ICU). It describes the types of equipment used in the ICU for patient monitoring, life support, emergency resuscitation and diagnosis. Some key aspects of nursing care for critically ill patients discussed include monitoring respiratory, cardiac, neurological and gastrointestinal function, managing pain, preventing skin breakdown and infection, and facilitating early mobilization. The goals of ICU care and nursing responsibilities are also reviewed.

1. MONITORING of Critically
ill Patients
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Prof.Dr. RS Mehta, BPKIHS

2. INTRODUCTION
Intensive care unit (ICU) equipment
includes patient monitoring, respiratory
and cardiac support, pain management,
emergency resuscitation devices, and
other life support equipment .
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Prof.Dr. RS Mehta, BPKIHS

3. Contd…
They are designed to care for patients
who are
 seriously injured,
 have a critical or life-threatening illness,
or
 have undergone a major surgical
procedure thereby requiring 24-hour care
and monitoring.
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Prof.Dr. RS Mehta, BPKIHS

4. PURPOSE
 An ICU may be designed and equipped to
provide care to patients with a range of
conditions, or it may be designed and
equipped to provide specialized care to
patients with specific conditions.
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Prof.Dr. RS Mehta, BPKIHS

5. Contd…
 Neuromedical ICU cares for patients with
acute conditions involving the nervous
system or patients who have just had
neurosurgical procedures and require
equipment for monitoring and assessing
the brain and spinal cord.
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Prof.Dr. RS Mehta, BPKIHS

6. Contd…
 A neonatal ICU is designed and
equipped to care for infants who are ill,
born prematurely, or have a condition
requiring constant monitoring.
 A trauma/burn ICU provides specialized
injury and wound care for patients
involved in auto accidents and patients
who have gunshot injuries or burns.
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Prof.Dr. RS Mehta, BPKIHS

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Prof.Dr. RS Mehta, BPKIHS

8. TYPES OF DEVICES
Intensive care unit equipment includes
 Patient monitoring devices
 Life support and emergency resuscitation
devices, and
 Diagnostic devices.
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Prof.Dr. RS Mehta, BPKIHS

9. PATIENT MONITORING EQUIPMENT
 Arterial line
 Bed side monitor
 Blood pressure device (sphygmomanometer)
 Blood pressure monitor
 Electrocardiograph(ECG or EKG machine)
 Electroencephalograph(EEG machine)
 Intracranial pressure monitor
 Pulse Oximeter
 Glucometer
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Prof.Dr. RS Mehta, BPKIHS

10. LIFE SUPPORT AND EMERGENCY
RESUSCITATION DEVICES
 MechanicalVentilator
 Laryngoscope
 Airway
 Infusion pump
 Crash cart(Resuscitation cart)
 Intra aortic ballon pump
 Continuous positive air pressure
machine (CPAP)
 Defibrillator
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Prof.Dr. RS Mehta, BPKIHS

11. DIAGNOSTIC EQUIPMENT
 Mobile x-ray units
 portable clinical laboratory devices,
 Bronchoscope
 Colonoscope
 Endoscope
 Gastroscope
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Prof.Dr. RS Mehta, BPKIHS

12. OTHER ICU EQUIPMENT
Disposable ICU equipment includes
 Urinary catheter
 Urinary drainage collector
 Suction catheter
 Nasogastric (NG) tube
 Intravenous(IV) line or catheter
 Feeding tube
 Breathing tube( Endotracheal tube)
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Prof.Dr. RS Mehta, BPKIHS

14. General Guidelines
 Monitoring ensures rapid detection of changes in the
clinical status
 Allows for accurate assessment of progress and
response to therapy
 When clinical signs and monitored parameters disagree,
assume that clinical assessment is correct
 Trends are generally more important than a single
reading
 Use non-invasive techniques when possible
 Alarms are crucial for patient safety

15. Clinical, Biochemical,Microbiological and
Imaging
 Clinical: GCS, vital sign, Skin temperature, color,
capillary refill, Urine output etc.
 Biochemical: Blood tests-electrolytes, CBC,
coagulation profile, etc.
 Microbiological: Blood cultures, urine culture etc.
 Imaging: X-rays, U/S, CT scan, MRI etc.

16. 16

17. CARDIAC MONITOR

18. DEFIBRILLATION
4/20/2021 10:04 AM 18

19. 4/20/2021 10:04 AM 19

20. 20

21. PULSE OXIMETRY

22. Glucometer

23. CARE OF CRITICALLY ILL
PATIENT

24. Patients in the critical care unit
 Respiratory difficulties impairing the clients
abilities to ventilate or oxygenate. Often include
severe pneumonia, pulmonary embolism, drug
overdose, and respiratory distress.
 Circulatory problems such as hypotension or
dysrhythmias, MI, etc.
 Neurological changes such as loss of
consciousness or changes in the mental status.

25. Patients in the critical care unit…
 Clients with head injuries, brain surgery, stroke or
spinal cord injuries are admitted to the ICU for
frequent reassessment.
 Metabolic problems such as abnormal electrolytes
from diabetes, renal failure, or acid base imbalances
require intensive monitoring and medication
titration to control and treat complications.
 Clients who have had open heart surgery, thoracic
surgery, brain surgery, extensive abdominal or
orthopedic surgery are admitted post operatively
to the ICU for monitoring.

26. Patients in the critical care unit…
 Clients who have less invasive procedures but have
a personal history of cardiac or pulmonary disease
may also be admitted for observation and frequent
assessment.
 Life threatening infection or the risk of infection,
such as burn wounds or sepsis, requires intensive
care to control the blood pressure and maintain
perfusion of the heart, brain, lungs and kidneys.
 Clients with sepsis or large open wounds require
very intensive care for medication administration
and fluid management.

27. Nursing Care of critically ill patients
Preadmission
Based on their preadmission assessment findings,
nurses should consider the following:
 Obtaining appropriate consults (i.e., nutrition,
physical/occupational/speech therapist)
 Implementing safety precautions
 Using pressure-relieving devices
 Organizing family meetings

28. During ICU
Multiple Organ Systems
 Encouraging early, frequent mobilization/ambulation
 Providing proper oral hygiene
 Ensuring adequate pain control
 Reviewing/assessing medication appropriateness
 Avoiding poly pharmacy/high-risk medications
 Securing and ensuring the proper functioning of
tubes /catheters
 Actively taking measures to maintain normothermia
 Closely monitoring fluid volume status

29. Respiratory care
 Altered ventilation, poor secretion clearance, impaired muscle
function and lung collapse (atelectasis) occur in the supine position.
 Encourage and assist with coughing, deep breathing, incentive
spirometer use.
 Assess for signs of swallowing dysfunction and aspiration.
 Closely monitor pulse oximetry and arterial blood gas results.
 Consider the use of specialty beds.
 Advocate for early weaning trials and extubation as soon as
possible.

30. Respiratory…
 In those patients who are mechanically ventilated:
oKeep the head of the bed elevated to more than
30 degrees.
oProvide frequent oral care.
oMaintain adequate cuff pressures.
oUse continuous sub glottic suctioning devices.
oDo not routinely change ventilator circuit tubing.
oAssess the need for stress ulcer and deep venous
thrombosis (DVT) prophylaxis.
oTurn the patient as tolerated.
oMaintain general hygiene practices.

32. Cardiovascular care
 Prolonged immobility impairs autonomic vasomotor
responses to sitting and standing causing profound postural
hypotension.
 Carefully monitor the clients’ hemodynamic and electrolyte
status.
 Closely monitor the clients’ electrocardiogram (ECG) with
an awareness of many conduction abnormalities seen.
Consult with physician regarding prophylaxis when
appropriate.
 Advocate for the removal of invasive devices as soon as the
patient's condition warrants. The least restrictive device may
include long-term access.

33. Neurologic care
 Closely monitor the clients’ neurologic and mental status.
 Screen for delirium and sedation level at least once per shift.
 Implement the following interventions to reduce delirium:
◦ Promote sleep, mobilize as early as possible, review
medications that can lead to delirium, treat dehydration,
reduce noise, close doors/drapes to allow privacy, provide
comfortable room temperature, encourage family and
friends to visit, allow the older adult to assume their
preferred sleeping positions, discontinue any unnecessary
lines or tubes, and avoid the use of physical restraints,
using least restraint for minimum time only when
absolutely necessary.

34. Neurologic care…
◦ Maximize the clients’ ability to communicate his or her needs
effectively and interpret their environment.
 Face the patients when speaking to them, get their attention
before talking, speak clearly and loud enough for them to
understand, allow them enough time (pause time) to respond
to questions, provide them with a consistent provider, use
visual clues to remind them of the date and time, and provide
written or visual input for a message.
 Provide the clients’ with alternate means of communication
(e.g., providing him or her with a pen and paper, using
nonverbal gestures, and/or using specially designed boards
with alphabet letters, words, or pictures).
 Provide translators/interpreters as needed.

35. Pain management
 Provide adequate pain control while avoiding
over sedation or under sedation.

36. Gastrointestinal care
 The supine position predisposes to gastro-oesophageal reflux
and aspiration pneumonia.
 Nursing patients 30° head-up prevents this.
 Early enteral feeding reduces infection, stress ulceration and
GI bleeding.
 Immobility is associated with gastric stasis and constipation;
gastric stimulants and laxatives are essential
 Monitor for signs of GI bleeding and delayed gastric emptying
and motility.
◦ Encourage adequate hydration, assess for signs of fecal
impaction, and implement a bowel regimen.

37. Gastrointestinal…
 Advocate for stress ulcer prophylaxis.
 Implement aspiration precautions.
◦ Keep the head of the bed elevated to a high
Fowler's position, frequently suction copious
oral secretions, bedside evaluate swallowing
ability by a speech therapist, assess phonation
and gag reflex, monitor for tachypnea.
 Ensure tight glucose control.

38. Neuromuscular
 Immobility, prolonged neuromuscular blockade
and sedation promote muscle atrophy, joint
contractures and foot drop.
 Physiotherapy and splints may be required.

39. Genitourinary care
 Assess any GU tubes to ensure patency and
adequate urinary output.
 Advocate for early removal of Foley catheters.
 Use other less invasive devices/methods to facilitate
urine collection (i.e., external or condom catheters,
offering the bedpan on a scheduled basis, and
keeping the nurse's call bell/signal within the clients’
reach).
 Monitor blood levels of nephrotoxic medications as
ordered.

40. Immune/Hematopoietic care
 Ensure the older adult is ordered appropriate DVT
prophylaxis (i.e., heparin, sequential compression
devices).
 Monitor laboratory results, assess for signs of
anemia relative to patient's baseline.
 Recognize early signs of infection–restlessness,
agitation, delirium, hypotension etc.
 Accurately maintain infection control/prevention
protocols.

41. Skin care
 Conduct thorough skin assessment.
 Alertly monitor room temperature, make every
effort to prevent heat loss, and carefully use and
monitor rewarming devices.
 Use methods known to reduce the friction and
shear that often occur with repositioning in bed.
 In severely compromised patients, the use of
specialty beds may be appropriate.

42. Skin…
 Techniques such as frequent turning, pressure-
relieving devices, early nutritional support, as
well as frequent ambulation may not only
protect clients’ skin but also promote the
health of their cardiovascular, respiratory, and
GI systems.
 Closely monitor IV sites, frequently check for
infiltrations and use of nonrestrictive dressings
and paper tape.

44. Eye Care
The eye is protected from dryness
from frequent lubrication by blinking
Complications from poor eye care
in patient’s who are unable to blink
include corneal ulceration, viral or
bacterial conjunctivitis
Corneal abrasions develop in 40-60%
of ICU patients2
Goals of eye care are to provide
comfort and protect from injury &
infection

45. Dressing and wound care
 Replace wound dressings as necessary.
 Change arterial and central venous catheter
dressings every 48-72 h

46. Core Competencies
 Patient Care
 Medical Knowledge
 Professionalism & Ethics
 Interpersonal Communication Skills
 Practice-based Learning and Improvement
 Systems-based Practice
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Prof.Dr. R S Mehta, BPKIHS

47. 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
Prof.Dr. R S Mehta, BPKIHS 47

48. THANK YOU!
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Prof.Dr. RS Mehta, BPKIHS