Critical care nursing focuses on the comprehensive management of patients facing life-threatening conditions through a structured practice framework and interdisciplinary collaboration. The goals include delivering individualized, safe, and effective care while addressing the physiological and psychological needs of critically ill patients and their families. The critical care unit is specifically equipped and staffed to provide intensive monitoring and support, and it upholds patient rights and ethical standards in healthcare delivery.

1. NURSING MANAGEMENT OF
PATIRNTS IN CRITICAL CARE
UNITS

2.  Critical care nursing is the specialty within nursing that deals
specifically with human responses to life-threatening problems. These
problems deal dynamically with human responses to actual or
potential life-threatening illnesses.
 The framework of critical care nursing is a complex, challenging area
of nursing practice.
 The critical care nursing practice is based on a scientific body of
knowledge and incorporates the professional competencies specific to
critical care nursing practice and is focused on restorative, curative,
rehabilitative, maintainable, or palliative care, based on identified
patient’s need.
 It upholds multi and interdisciplinary collaboration in initiating
interventions to restore stability, prevent complications, achieve and
maintain optimal patient responses.
Critical Care Nursing

3. Goals of Critical Care Nursing
 To promote optimal delivery of safe and quality care to the critically ill patients
and their families by providing highly individualized care so that the
physiological dysfunction as well as the psychological stress in the ICU are under
control;
 To care for the critically ill patients with a holistic approach, considering the
patient’s biological, psychological, cultural and spiritual dimensions regardless of
diagnosis or clinical setting;
 To use relevant and up-to-date knowledge, caring attitude and clinical skills,
supported by appropriate technology for the prevention, early detection and
treatment of complications to facilitate recovery.
 To provide palliative care to the critically ill patients in situations where their
health status is progressing to unavoidable death, and to help the patients and
families go through their painful sufferings.
 On the whole, critical care nursing should be patient-centered, safe, effective, and
efficient. The nursing interventions are expected to be delivered in a timely and
equitable manner.

4. 7 C’s of Critical care
Compassion Communication
Comfort:
protection of
patient from
suffering
Carefulness:
avoidance of
injury
Consistency (of
observation and
care)
Closure (Ethics
and Withdrawal of
treatment)

5.  Anticipatory Nursing Care
 Early Detection and Prompt Action
 Expertise
 Supportive Care
 Communication
 Collaborative Practice
 Preservation of Patient’s Physiological Defenses
 Prevention of Infection
 Crisis Intervention
 Stress Reduction
 Ethical Principles
 Efficiency
 Appropriate medical intervention
 Professionalism
 Safety and non-maleficence
 Respect and care
 Fair allocation
Principles of Critical Care Nursing

6. Critical Care Nurse
 A Critical Care Nurse is a licensed
professional nurse who is responsible for
ensuring that acutely and critically ill patients
and their families receive optimal care.
 A registered nurse who has the right
knowledge, skills, and competencies to meet
the needs of a critically ill patient without
direct supervision.

7. CRITICAL CARE UNIT

8. Critical Care Unit
 Critical Care Unit is a specially designed
and equipped facility staffed by skilled
personnel to provide effective and safe care
for patients with a life- threatening problem
that is potentially reversible.

10. Classification of Critical Care Unit
Critical Care Unit
Age Group
Neonatal
Pediatric
Adult
Specialty:
majority of the Critical Care Units provide service for
patients of various specialties. They are labeled as
General ICUs. In certain hospitals, the critical care
unit / service is dedicated to the following specific
groups:
Medical
Surgical
Cardio-thoracic
Cardiac
Respiratory
Neurosurgical
Trauma

11. Levels of ICU
• Resuscitation, short term mechanical ventilation and simple
invasive cardiovascular monitoring for <24 hours
•Provides monitoring, observation and short term ventilation. Nurse
patient ratio is 1:3 and the medical staff are not present in the unit
all the time
Level I
ICU
• Provides a high standard of general intensive care, including
complex multi-system life support
• Provides observation, monitoring and long term ventilation with
resident doctors. The nurse-patient ratio is 1:2 and junior
medical staff is available in the unit all the time and consultant
medical staff is available if needed
Level II
ICU
•Provides comprehensive critical care including complex multi-
system life support for an indefinite period
•Provides all aspects of intensive care including invasive
haemodynamic monitoring and dialysis. Nurse patient ratio is 1:1
Level III
ICU

12. Classification of Critical Care patients
Level O :
normal ward
care
Level 1: Patients 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

13. Roles and Responsibilities of Critical Care
Nurse
 Assessing a patient’s condition and planning and
implementing patient care plans
 Provides direct comprehensive bedside care to patients
 Treating wounds and providing advanced life support
 Assisting physicians in performing procedures
 Able to attach equipments on patients as ordered and
interprets the data, graphs on monitors etc.
 Observing and recording patient vital signs
 Ensuring that ventilators, monitors and other types of
medical equipment function properly
 Administering intravenous fluids and medications

14.  Collaborating with fellow members of the critical care team
 Responding to life-saving situations, using nursing standards
and protocols for treatment
 Acting as patient advocate
 Documents appropriately
 Ensures patient safety
 Follows the policies and procedures of the unit and the
institution
 Is an expert in nursing knowledge and practice
 Promotes quality assurance in nursing
 Providing education and support to patient families
contd

15. Medical staff including:
 ICU Director/Intensivist, with sufficient experience to provide
for patient care, administration, teaching, research, audits etc.
 Doctors
 Trained Nursing staff: 1:1 for ventilated patients and 1:2 for
other patients;
 Nurse in charge with ICU qualification
 Allied health and ancillary staff: Respiratory services,
physiotherapist, dietician, biomedical engineer, technicians,
computer programmer, social worker, counsellor,
housekeeping staff etc.
Staffing

16. ICU Organization
 It requires intelligent planning
 One must keep the need of the hospital and its
location
 An institute may plan beds into multiple units under
separate management by single discipline specialist
such as Medical ICU, Surgical ICU, CCU, Burns
ICU, Trauma ICU etc.
 The number of ICU beds in a hospital ranges from 2
to 20% of the total number of hospital beds.
 10% of total ICU beds are allotted towards Isolation
Room.

17. Contd
 Each intensive care unit should be a geographically distinct area
within the hospital with controlled access
 No through traffic to other departments should occur
 Location: should be chosen so that the unit is adjacent to, or
within direct elevator travel to and from, the Emergency
Department, Operating Room, Intermediate care units, and
Radiology Department.
 Corridors, lifts and ramps should be spacious enough to provide
easy movement of bed/ trolley of a critically sick patient
 Bed space: 150- 200 sq. ft. area per open bed with 8 ft. between
beds. 225- 250 sq. ft. area per bed if in a single room. Beds should
be adjustable with side rails and wheels; no head board should be
there.
 Isolation Room: 250 sq. ft

18. Contd
Patient Areas :
 Oxygen outlets,
 Suction outlets (gastric, tracheal and underwater seal),
 Compressed air outlets
 Power outlets per bed
 Bedside storage, hand rinse solution, equipment shelf on head
end
 Storage must be provided for each patient's personal
belongings, patient care supplies, linen and toiletries.
 Locking drawers and cabinets must be used if syringes and
pharmaceuticals are stored at the bedside.
 Hooks and devices to hang infusions/ blood bags extended
from the ceiling with a sliding rail to position

19.  Multi- channel invasive monitors, ventilators, infusion pumps, portable
X- Ray unit, fluid and bed warmers, portable light, defibrillators,
anesthesia machines and difficult airway management equipments are
necessary
 A cardiac arrest/emergency alarm button must be present at every
bedside within the ICU.
 Central nursing station,
 ICU conference room
 Staff lounge, and any on-call rooms.
 Visitors' Lounge or Waiting Area
 Adjustable curtains and blinds
 X- Ray Viewing Area
 Work Areas and Storage
 Equipment Storage
Contd

20. Contd
 Special Procedures Room
 Reception Area
 Clean Utility Room
 Dirty Utility Room
 Pantry
 Conference Room
 Patient Transportation
 Supply and Service Corridors
 Patient Modules
Each Intensive Care Unit must have :-
 Oxygen,
 Compressed Air
 Vacuum
 Electric Supply
 Water Supply
 Lighting
 Environmental Control Systems
 Computerized Charting
 Other Facilities

21. Oxygen, suction, compressed air

27. THE RIGHT OF THE CRITICALLY
ILL PATIENT
The International Council of nurses (ICN) views
health care as the rights of every individual
regardless of financial political, geographical,
racial and religious consideration. This right
includes the right to choose or decline care,
including the right to accept or refuse treatment
or nourishment; informed consent;
confidentiality and dignity, including the right to
die with dignity. It involves both the right of
those seeking care and the providers

28. Protocols of critical care
 No critical care patient will be left without a nurse in attendance.
 Each nurse will be responsible for the entire care of his/her patient, and acts to
coordinate care with other health team professionals.
 The staff nurse will report any changes in his/her patient's condition directly to
the physician.
 All critical care patients will have continual ECG monitoring.
 Alarms must be left on the ECG and arterial lines at all times.
 For a stable, non-acute patient without invasive monitoring equipment, vital
signs are measured at least every hour.
 The turning of all critically ill patients every two hours around the clock is
done unless contraindicated, with skin assessment recorded as part of the
every four-hour assessment.
 All Critical Care patients will have mouth care done every four hours with
inspection for oral skin sores.
 The Critical Care nurse may restrain patients at his/her discretion. Provided
documentation done according to hospital policies and procedures.

29.  All dressings unless otherwise indicated will be changed daily.
 Nursing care will be spaced out to allow periods of rest.
 The nurse must give a full report to another staff nurse prior to
leaving for a break.
 Procedures will be explained to patients
 Information and emotional support needs for the family and patient will be
provided by the nurse/physician/social work/palliative care, as required.
 The environment will be maintained in a mechanically safe condition
through: dry floors, good repair of furniture, proper placement of machines
and equipment, cleanliness, freedom from clutter, and good repair of
equipment.
 Isolation technique will be followed as per infection control manual.
 Any containers of body fluids (i.e. suction canisters or chest drainage sets)
must be disposed in the appropriate biohazard bag or box.
 All medications will be reviewed by the Critical Care physicians (upon
admission to Unit.) and either reordered or stopped. Nursing staff will
ensure this has been done prior to carrying out any medication, treatment
or investigative orders. Each treatment/medication must be listed.

30.  Respiratory orders may only be carried out when written by the patient's
physician.
 All orders written other than by the Critical Care physicians will be
brought to the attention of the Critical Care physician by the nurse prior
to being carried out.
 Narcotics MAY NOT be kept at the bedside. If use is not immediate
after withdrawal from the narcotic cabinet, wastage as per narcotic
protocol will be carried out.
 Visiting is negotiated between the nurse and family, with consideration
given to unit activity and institutional policy.
 The nurse/physician will notify families of significant deteriorations in
the patient's condition.
 All staff working at a bedside where an acute trauma or actively
bleeding patient is being managed will wear protective goggles, masks
and gloves. Protective gear is also required anytime risk of splash from
body fluids exists e.g. suctioning.

31. Equipments and supplies
PATIENT MONITORING EQUIPMENT :
 Glucometer
 Pulse Oximeter
 Intracranial pressure monitor
 Electroencephalograph(EEG machine)
 Electrocardiograph(ECG or EKG machine)
 Blood pressure monitor
 Sphygmomanometer
 Bed side monitor
 Arterial line

32. Cardiac monitor

33. Intracranial pressure monitor

34. ECG machine

35. EEG

37. LIFE SUPPORT AND EMERGENCY
RESUSCITATION :
 Defibrillator
 Continuous positive air pressure machine
(CPAP)
 Intra aortic balloon pump
 Crash cart(Resuscitation cart)
 Infusion pump
 Airway
 AMBU
 Laryngoscope
 Mechanical Ventilator

38. Infusion Pump
Ventilator
Defibrillator

39. Laryngoscope
Airways

40. CPAP machine

41. AMBU

42. Diagnostic equipment
 Gastroscope
 Endoscope
 Colonoscope
 Bronchoscope
 Portable clinical laboratory devices
 X-ray units

43. Gastrocope

45. Colonoscope

46. Bronchoscope

47. Portable x-ray and USG machine

48. Other ICU equipment (disposable)
 Endotracheal tube
 Tracheostomy tube
 Feeding tubes like, Nasogastric (NG) tube,
gastrostomy feeding tube etc
 Oxygen masks, nasal canulas, etc
 Intravenous (IV) line or catheter
 Suction catheter
 Urinary drainage collector
 Urinary catheter

49. Endotracheal tube

50. Tracheostomy tube

51. Feeding tubes

52. Suction catheter

53. Urinary catheter and drainage collector

54. IV Catheters

55. Oxygen delivery

56. Other supplies
 Syringes
 Needles
 Surgical blades
 Sutures
 Restraints
 Emergency Medications
 Solutions
 Dressing equipments
 Personal protective equipment
 Linen
 Sterile trays and supplies
 Dustbins
 Supportive devices, etc