for cardiovascular nurse students

1. St. Paul’s Hospital Millennium Medical College
CARE OF CRITICALLY ILL PATIENT
Prepared by : Tigist Tsegaye (MSc)
Department of Medical Surgical Nursing
Postgraduates Cardiovascular Nursing Programme
October 2023
Sr Tigist Tsegaye (CVNP,MSc) 1

2. Learning objectives
 At the end of this session students will
be able to:
 Define care of critically ill patient
 Describe the guiding principles care of
critically ill patient
 Discuss the nursing management of
critically ill patient
Sr Tigist Tsegaye (CVNP,MSc) 2

3. Out line
 Introduction
 Guiding principles of care of critically ill
patient
 Complete monitoring
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4. INTRODUCTION
 Care of critically ill patient is care of
patients who are at risk of actual or
potential life threatening health
problems.
 Critically ill patient are patients with:
-Acute Respiratory Failure
- Cardiac Tamponade
-Severe Shock
Sr Tigist Tsegaye (CVNP,MSc) 4

5. Con...
-Heart block
- Sever burn
-Multiple organ failure
-Polytrauma
- Acute Renal Failure
Sr Tigist Tsegaye (CVNP,MSc) 5

6. Guiding principles of care of
critically ill patient
 Delivery of optimal and appropriate care
 Relief of distress
 Compassion and support
 Respecting Dignity
 Information
 Rehabilitation
 Care and support of relatives and care
givers
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7. The Nursing management of
critically ill patient
 Complete monitoring
 Respiratory care
 Cardiovascular care
 Venous thrombosis prophylaxis
 Gastrointestinal careNutritional care
 Neuron muscular care
 Comfort and reassurance
 Communication with patient
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8. Con...
 Infection control
 General hygiene and mouth care
 Fluid, electrolyte and glucose balance
 Bladder care
 Dressing and wound care
 Communication with relatives
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9. Complete monitoring
 Using ABCDE we can perform full nursing
assessment and clinical examination
 A-air= way patent
 B-breathing=respiratory rate
 C-circulation=pallor ,hemorrhage
 D-disability=altered level of conscious
level
 E-exposure=unseen hemorrhage, wound leakage
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10. Con...
Respiratory care
 Patient may have:
-air way obstruction
-altered ventilation
-poor secretion clearance
-atelectasis
-impaired muscle function
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11. Con...
Nursing Managements
 Assist in coughing
 Chest percussion
 Fowlers positioning
 Bronchodilators
 Suctioning(q4h)
 Tracheostomy care
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12. Con...
 Cardiovascular care
 Continuous cardiac monitoring (dysrhythmia)
 Observing early warning signs and preparing
rapid access like defibrillator
 Positioning
 Venous thrombosis prophylaxis
 To prevent pulmonary embolism.
Sr Tigist Tsegaye (CVNP,MSc) 12

13. Con...
Gastrointestinal careNutritional care
 Supine position predispose the patient to
esophageal reflux and aspirational
pneumonia. Head of the bed to be tilted 30
degree prevent it.
 Early eternal feeding reduces infection ,
stress ulceration, and GI bleeding
 Gastric stimulants and laxatives are essential
to prevent GI stasis.
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14. Con..
Neuron muscular care
 Prolonged immobility cause
neuromuscular blockage and sedation
causes atrophy, joint contracture and foot
drop
 Physiotherapy and splint are needed
 GLASGOW COMA scale to be performed
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15. GLASGOW COMA scale
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16. Con...
Comfort and reassurance
 Anxiety, pain and discomfort should be
assessed and relieved by physical
measures, sedatives and analgesics.
 Bowel or bladder distention endo-
tracheal tubes, nasogastic tubes ,urinary
catheters to be source of discomfort
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17. Con..,
Communication with patient
 Assist communication with proper
language
 Tell patient about the prognosis of his
care
 For unconscious patient communicate
with the family.
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18. Con...
Infection Control
 Hand washing
 Disposable gowns
 Sterile techniques for invasive procedures
 Isolation for transmissible infections
 Thorough cleaning between bed spaces
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19. Con...
General hygiene and mouth care
 Provide sponge bath and mouth care
 Turn patient every 2hr to prevent
susceptible area
 Provide back care
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20. Con..
Fluid, electrolyte and glucose balance
 Monitor intake and out put every one
hour.
 Maintain normo-glycemia
Bladder care
 Urinary catheter care should be given
 Early removal of urinary catheter may
reduce urinary tract infection
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21. Con...
Dressing and wound care
 Change dressing when necessary
 Change arterial and central line dressing
every 48-72hrs
Communication with relatives
 Communication should be consistence
with relatives
 All conversion should be documented.
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22. Reference
 Mower WR, Myers G, Nicklin EL, Kearin KT,
Baraff LJ, Sachs C. Pulse oximetry as a fifth
vital sign in emergency geriatric assessment.
Acad Emerg Med 1998;5:858-865.
 Ernst A, Zibrak JD. Carbon monoxide
poisoning. N Engl J Med 1998;339:1603-1608.
 3 Cummins RO, Hazinski MF. The most
important changes in the international ECC
and CPR guidelines 2000. Circulation
2000;102(suppl):S371-S376.
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23. Thank you
Sr Tigist Tsegaye (CVNP,MSc) 23