This document provides an overview of key concepts in critical care nursing. It defines critical care nursing as focused on caring for critically ill or unstable patients with the goal of restoring physiologic and psychological stability. The roles of a critical care nurse include providing direct patient care, education, advocacy, and coordinating a multidisciplinary team. Safe transportation of critically ill patients requires maintaining their level of care during transfer through thorough planning, communication, and emergency preparedness.

1. CORE CONCEPTS INCORE CONCEPTS IN
CRITICAL CARE NURSINGCRITICAL CARE NURSING
ByBy
Yasmeen RahimYasmeen Rahim

2. OBJECTIVESOBJECTIVES
By the end of this presentation, students will be able
to:
• Define what is critical care nursing.
• Describe the roles of CCN.
• Explain what is Evidence Based Practice.
• Discuss the patient’s experience with critical illness.
• Review family’s experience with critical illness.
• List down end of life issues in critical care.
• Discuss about transportation of critically ill patients.

3. CRITICAL CARE NURSINGCRITICAL CARE NURSING
• Critical care nursing is the field of
nursing with a focus on the care of the
critically ill or unstable patients.
• The aims of Critical Care Nursing are to
promote excellence through caring,
competency and commitment in critically
ill patients.
• CCN deals with human responses to life
threatening problems.

4. CONT.CONT.
• Goal is to restore physiologic, psychologic
stability of severely ill patient.
• A critical care nurse must have knowledge
and skill beyond those of nurse generalist.
• CCN should use the nursing process as a
framework for practice.
• CCN encompass independent, dependent
and interdependent nursing interventions.

5. ROLES OF CCNROLES OF CCN
• CARE PROVIDER: provides comprehensive,
highly technical direct care to patient and family,
also in response to life threatening health
conditions.
• EDUCATOR: provides education to patient and
family based on identified learning needs.
• ADVOCATE: protects and fights for patient’s
rights.
• MANAGER: coordinates the care provided by
multidisciplinary team.

6. FUNCTIONS OF CCNFUNCTIONS OF CCN
• Assesses and implements treatment for
patient responses to life threatening health
problems.
• Uses independent, dependent and
interdependent interventions to restore
stability, prevent complications and to
achieve and maintain optimal patient
response.

7. CONT.CONT.
• Provides health education to patient and family.
• Supervise patient care and ancillary personnel.
• Support patient’s adaptation, restore health and
preserves patient’s rights.
• Provide direct measures to resuscitate if
necessary.

8. CRITICAL CARE ENVIRONMENTCRITICAL CARE ENVIRONMENT
• Noise levels
• Light 24 hours/day
• Movement of people
and equipment
• Lack of privacy
LIGHTS
ACTION
CAMERA
ICU can seem like
a movie set
LIGHTS
ACTION
CAMERA
ICU can seem like
a movie set

10. ESSENTIAL PHYSIOLOGICESSENTIAL PHYSIOLOGIC
CONCEPTSCONCEPTS
• Ventilation
• Gas exchange
• Tissue perfusion
• Fluid and electrolyte balance
• Acid base balance

11. PATIENT EXPERIENCINGPATIENT EXPERIENCING
CRITICAL ILLNESSCRITICAL ILLNESS
• Admitting in ICU may signal a threat to the
life and well-being of the patient.
• ICU patients are subject to multiple
physical, psychological, and environmental
stressors.
• Prolong stress lead to immunosuppression,
hypoperfusion, tissue hypoxia, and eventual
death.

12. CONT.CONT.
• Environmental stressors also contribute to
patient’s stress.
• Blinking monitors, ventilators, intravenous
(IV) pumps, noise from equipment and the
health practitioners talking at the bedside,
bright lights and code management.
• Anxiety may be defined as an emotional
state of apprehension in response to a real
or perceived threat.

13. NURSING INTERVENTIONSNURSING INTERVENTIONS
• Create a healing environment which allow
critically ill patients to have their
psychological needs as well as physical
needs met.
• Promote rest and sleep as deprivation can
lead to altered cognition, confusion,
impaired wound healing, and the inability
to wean from the ventilator due to muscle
fatigue and carbon dioxide retention.

14. CONT.CONT.
• Have the patient use earplugs.
• Assess sleep time and quality of sleep by
asking the patient when possible.
• Provide a 5-minute backrub before sleep.
• Eliminate pain.
• Position patient for comfort with pillows.
• Evaluate the need for nursing care
interruptions.

15. CONT.CONT.
• Titrate environmental stimuli: turn down
lights, turn down alarms, and decrease
noise from television and talking.
• Stop the practice of bathing patients in the
middle of the night for the convenience of
the nursing staff.
• Allow family to be with the patient.
• Practice culturally sensitive care.

16. CONT.CONT.
• Build trust relationship with patient by
displaying confident, caring attitude,
demonstrate technical competence, and
develop effective communication
techniques.
• Patient’s need to know all aspects of the
their care.
• Involving the patient in decision making.

17. CONT.CONT.
• Presence and reassurance is a
meaningful strategy for alleviating distress
or anxiety in the patient.
• Recognize and promote patients' spiritual
sources of strength.

18. TRANSPORTING CRITICALLYTRANSPORTING CRITICALLY
ILL PATIENTSILL PATIENTS
• Transporting critically ill patients within
hospital or outside hospital is a great
challenge.
• Within hospital transfer could be because
of diagnostic and therapeutic purposes.
• Safe patient transport requires thoughtful
planning, organization and interdisciplinary
communication and cooperation.

19. CONT.CONT.
• The goal during transport is to maintain the
same level of care regardless of location.
• Transfer of critically ill patient always involves
some degree of risk to the patient (risk vs
benefit ratio).
• Proper assessment for risk of complications
should be performed before transport.

20. COMPLICATIONSCOMPLICATIONS
• Pulmonary: hyperventilation, hypoventilation,
airway obstruction, aspiration, changes in
ABG’s.
• Cardiovascular: hypotension, hypertension,
arrhythmias, decrease tissue perfusion, cardiac
ischemia.
• Gastrointestinal: nausea, vomiting.
• Neurological: increased ICP, cerebral hypoxia,
cerebral hypercarbia, paralysis.
• Pain.

21. PREPERATIONPREPERATION
• What is current level of care?
• What will be needed during the transfer to
maintain level of care?
• What additional resources may be
required during transport?
• Do you have all necessary equipment
needed in the emergency during
transport?

22. CONT.CONT.
• Minimum 3 people should accompany the patient.
• One should be assigned critical care nurse, other
should be a doctor and third one should be a
nursing assistant.
• Transport equipments should include a cardiac
monitor, airway management equipment, source
of oxygen, standard resuscitation drugs, ample
supply of IV fluids, resuscitation cart within range.
• Documentation.

23. MODE OF TRANSPORTMODE OF TRANSPORT
• Physician must order type of transport – The
level of transport should be the same as the
level of care the patient is already receiving.
• Ambulances
– BLS
– ACLS
• Air transport – All ACLS
– Helicopter
– Fixed wing