This document outlines the care of critically ill patients. It discusses common conditions seen in critically ill patients like pain, breathing issues, decreased tissue perfusion, immobility, and altered mental status. It then assesses the airway, breathing, circulation, and neurological status of patients. The document provides details on managing the airway, breathing, circulation, pain, fluids and electrolytes, nutrition, mobility, temperature, activity, coping, and infection risk for critically ill patients. It describes various nursing interventions needed for their care.

1. SUB: Medical Surgical
Nursing
TOPIC : CARE OF CRITICAL ILL
PATIENT
Asha Kiran V
AK
1

2. CARE OF CRITICALLY ILL PATIENT
AK 2

3. Condition of patient
AK 3
Pain
Altered
breathing
function
Decreased
tissue
perfusion
Immobility
Obstructed
Airway
Nutritional
deficit
Altered
conscious
status
Multi organ
failure
Immunocompromised
status
Altered coping
status
Undergone
trauma/surgery

4. Contributing factors
AK 4
1. Chronic comorbid illnesses
2. Severe acute physiologic derangements
3. High frequency of indwelling catheters
–The use and maintenance of these catheters
necessitate frequent contact with health care
workers, which predispose patients to colonization
and infection with nosocomial pathogens
4.

5. ASSESSMENT
AK 5
1,AIRWAY
Secretions/blood in airway
Vomiting
Noisy breathing/stridor
Mouth breathing
Use of accessory muscles of respiration
Respiratory rate
Tongue falling back

6. ASSESSMENT
AK 6
2, BREATHING
• Chest movement
•Chest examination(inspection, palpitation,
auscultation)
• oxygen saturation
•ABG
• Use of accessory muscles,
• Stridor

7. ASSESSMENT
AK 7
3. CIRCULATION
Vital parameters
HR, BP, Arterial pressure
CVP
IV Line
Urine output
Drains
4. DISABILITY

8. 1. AIRWAY MANAGEMENT
AK 8
Maintaining Patent Airway:
• Regular Suctioning =
Oral/EndoTracheal
• Position
- recovery position, Fowlers up
• Airway Device
– Nasopharyngeal airway,
oropharyngeal airway
• Elevating the head end into 30%
• Intubation if indicated

9. 2. BREATHING
AK 9
Maintaining Adequate gas exchange
 Assessing for RR, stridor, use of accessory
muscles, ABG and Spo2
 Maintaining adequate oxygenation through
administration of oxygen or by mechanical
ventilation if indicated
 Routine suctioning to keep the patent airway
 Elevating head end of the patient
 Regular nebulization

10. 3. CIRCULATION
AK 10
Maintaining adequate Tissue
Perfusion:
 Assessing vitals, ECG, Peripheral
pulses, blood loss, drains and oedema
Administration of IV fluids.
- Crystalloids/ Colloids as indicated,
 Transfusion of Blood and blood
product
- whole blood, PRBC, FFP

11. 3. CIRCULATION
AK 11
Maintaining adequate Tissue
Perfusion:
Maintaining peripheral or central
line
Maintaining Intake output chart
 Monitoring urine out put. Urine
output greater than 0.5
ml/kg/hour
 Keeping emergency drugs and
equipment ready

12. 4. Pain management
AK 12
Pain Management:
Assessing intensity, location and
severity of pain
 Reassuring the patient
Restricting the activities of patient.
Administering analgesics
Application of diversion therapy
 Providing a calm and quite
environment to induce rest and sleep

13. Altered Fluid & electrolyte Balance
AK 13
Maintaining Volume Balance:
HYPOVOLEMIA
 Assess for hypotension, Increased pulse rate,
decreased urinary output
 Flattened arterial pressure curve
 Weak thread peripheral pulses
 Decreased skin turgor

14. Altered Fluid & electrolyte Balance
AK 14
Maintaining Volume Balance:
HYPERVOLEMIA
 Assess for full and bounding pulse
 Distended neck veins
 Increased CVP
 Loud heart sounds

15. Nutritional imbalance
AK 15
MAINTAINING IMPROVED NUTRITIONAL STATUS:
Monitoring body weight, weight loss BMI
Assessing for signs of nausea, vomiting or loss
of appetite
 To
 Administration of anti emetics, PPI and
antacids
 Offering frequent, small feedings if orally
allowed
 Providing oral hygiene before meals

16. IMPAIRED PHYSICAL MOBILITY
AK 16
PREVENTION OF COMPLICATIONS OF IMMOBILITY:
 Assessing for skin changes,redness over pressure
points
 Changing of positions 2 hrly
 Using of air mattresses
 Applying heal and elbow protectors
Preventive measures for foot drops, contractures and
muscle wasting
 Providing Physiotherapy – Passive range of motion
exercises
 Maintaining proper body alignment

17. MAINTAINING BODY TEMPERATURE
AK 17
Maintaining Normal Body Temperature:
HYPERTHERMIA
• Checking body temperature 2hrly/4hrly
• Providing cold compressions in case of hyperthermia
• Administration of anti pyretics
PREVENTION OF HYPOTHERMIA
• By providing warm environment
• Warming Blankets
• Air warming Systems such as BAIR HUGGER
BLANKETS

18. ACTIVITY INTOLERANCE
AK 18
ACTIVITY & EARLY AMBULATION
 Physiotherapy
 Encouraging patient to perform
activities of daily living
 Encouraging deep breathing and
coughing exercises, extremity
excercises
 Ambulation at the earliest
 Preventive measures for foot drops,
contractures and muscle wasting

19. INDIVIDUAL & FAMILY COPING
AK 19
Establishing rapport with patient and
family
 Explaining CCU regime
 Evaluating patient’s response to
illness
 Helping the patient to develop trust
in health care staff
 Giving frequent explanations to the
patient about progress

20. RISK FOR INFECTION/SEPSIS
AK 20
HOSPITAL ACQUIRED INFECTION:
 VAP
 CRBSI
 CAUTI
 VAP
 SSI

21. RISK FOR INFECTION/SEPSIS
AK 21
INFECTION CONTROL MEASURES
 Monitoring and assessing for signs of infection
 Handwashing
 Following aseptic technique during procedures
 Restriction on visitors
 Providing meticulous care to catheter sites
Administering Anti biotics
 Monitoring vitals - Temperature
