The document discusses the assessment of critically ill patients. It outlines four stages of assessment: pre-arrival, admission quick check, comprehensive admission assessment, and ongoing assessment. The pre-arrival assessment begins when information is received about an upcoming admission. The admission quick check focuses on ABCDE parameters immediately upon patient arrival. The comprehensive admission assessment involves an in-depth review of medical and social history as well as a full physical exam. Ongoing assessment is performed periodically to monitor for changes in patient status. The goal of assessment is to effectively care for the patient's needs and detect any deterioration.

1. ASSESSMENT OFASSESSMENT OF
CRITICALLY ILL PATIENTCRITICALLY ILL PATIENT
ByBy
Yasmeen RahimYasmeen Rahim

2. OBJECTIVESOBJECTIVES
By the end of this presentationBy the end of this presentation
students will be able to:students will be able to:
Define assessment for criticallyDefine assessment for critically
patient.patient.
Discuss the assessment framework.Discuss the assessment framework.
– Prearrival assessmentPrearrival assessment
– Admission quick checkAdmission quick check
– Comprehensive admission assessmentComprehensive admission assessment
– Ongoing assessmentOngoing assessment

3. ASSESSMENTASSESSMENT
The assessment of critically ill patientThe assessment of critically ill patient
and their families is an essentialand their families is an essential
competency for critical carecompetency for critical care
practitioners.practitioners.
Assessment skills must be systematicAssessment skills must be systematic
to be able to effectively progress toto be able to effectively progress to
the patient care.the patient care.

4. CONT.CONT.
The assessment approach shouldThe assessment approach should
emphasizes the collection ofemphasizes the collection of
assessment data in organizedassessment data in organized
manner consistent with patient caremanner consistent with patient care
priorities.priorities.
Assessment should focus first on theAssessment should focus first on the
patient and then on the technology.patient and then on the technology.
Two standard approaches: head toTwo standard approaches: head to
toe approach and body systemtoe approach and body system
approach.approach.

5. CONT.CONT.
The assessment process can beThe assessment process can be
viewed as four distinct stages:viewed as four distinct stages:
– Prearrival stagePrearrival stage
– Admission quick checkAdmission quick check
– Comprehensive admissionComprehensive admission
– Ongoing assessment.Ongoing assessment.

7. PREARRIVAL ASSESSMENTPREARRIVAL ASSESSMENT
A pre arrival assessment begins theA pre arrival assessment begins the
moment information is receivedmoment information is received
about the upcoming admission ofabout the upcoming admission of
patient.patient.
It helps in painting the initial pictureIt helps in painting the initial picture
of the patient.of the patient.
It allows CCN to begin anticipatingIt allows CCN to begin anticipating
the patient’s physiologic andthe patient’s physiologic and
psychologic needs.psychologic needs.

8. CONT.CONT.
It allow CCN to determineIt allow CCN to determine
appropriate resources that areappropriate resources that are
needed to care for the patient.needed to care for the patient.
It allow CCN to adequately prepareIt allow CCN to adequately prepare
the environment to meet thethe environment to meet the
specialized needs of the patient andspecialized needs of the patient and
family.family.

9. EQUIPMENT FOR STANDARDEQUIPMENT FOR STANDARD
ROOM SETUPROOM SETUP
Bedside ECG & invasive pressure monitor.Bedside ECG & invasive pressure monitor.
ECG electrodes.ECG electrodes.
Blood pressure cuff.Blood pressure cuff.
Pulse oximetry.Pulse oximetry.
Suction gauges and canister setup.Suction gauges and canister setup.
Suction catheter.Suction catheter.
Bag valve mask / rebreathing bag.Bag valve mask / rebreathing bag.
Oxygen flow meter, appropriate tubingOxygen flow meter, appropriate tubing
and delivery device.and delivery device.

10. CONT.CONT.
IV poles and infusion pumps.IV poles and infusion pumps.
Bedside supply cart that containsBedside supply cart that contains
such things like alcohol swabs, nonsuch things like alcohol swabs, non
sterile gloves, syringes etc.sterile gloves, syringes etc.
Admission kit which contain bathAdmission kit which contain bath
basin and general hygiene supplies.basin and general hygiene supplies.
Admission and critical careAdmission and critical care
documentation forms.documentation forms.

11. ADMISSION QUICK CHECKADMISSION QUICK CHECK
It is obtained immediately upon patientIt is obtained immediately upon patient
arrival.arrival.
It is based on assessing theIt is based on assessing the
parameters represented by the ABCDE.parameters represented by the ABCDE.
– AAirwayirway
– BBreathingreathing
– CCirculation,irculation, CCerebral perfusion,erebral perfusion, CChiefhief
complaintcomplaint
– DDrugs and diagnostic testsrugs and diagnostic tests
– EEquipmentquipment

12. CONT.CONT.
General appearance (LOC)General appearance (LOC)
AirwayAirway
– Patency of airwayPatency of airway
– Position of artificial airwayPosition of artificial airway
BreathingBreathing
– Quantity and quality of respirationQuantity and quality of respiration
– Breath soundsBreath sounds
– Presence of spontaneous breathingPresence of spontaneous breathing

13. CONT.CONT.
Circulation and cerebral perfusionCirculation and cerebral perfusion
– ECG (rate and rhythm)ECG (rate and rhythm)
– Blood pressureBlood pressure
– Peripheral pulses and capillary refillPeripheral pulses and capillary refill
– Skin color, temperature and moistureSkin color, temperature and moisture
– Presence of bleedingPresence of bleeding
– LOC, responsivenessLOC, responsiveness

14. CONTCONT
Chief complaintChief complaint
– Primary body systemPrimary body system
– Associated symptomsAssociated symptoms
Drugs and diagnostic testsDrugs and diagnostic tests
– Drugs prior to admissionDrugs prior to admission
– Current medicationsCurrent medications
– Review diagnostic test resultsReview diagnostic test results
EquipmentsEquipments
– Patency of vascular and drainage systemsPatency of vascular and drainage systems
– Appropriate functioning and labelingAppropriate functioning and labeling
AllergiesAllergies

15. CONT.CONT.
Quick overview of ABCDE ensureQuick overview of ABCDE ensure
early interventions for any lifeearly interventions for any life
threatening situation.threatening situation.
It validates that cardiac andIt validates that cardiac and
respiratory functions are sufficient.respiratory functions are sufficient.

16. COMPREHENSIVE ADMISSIONCOMPREHENSIVE ADMISSION
ASSESSMENTASSESSMENT
A comprehensive admissionA comprehensive admission
assessment is performed ASAP.assessment is performed ASAP.
It is an in depth assessment of theIt is an in depth assessment of the
past medical and social history and apast medical and social history and a
complete physical examination ofcomplete physical examination of
each body system.each body system.
It provides the nurse invaluableIt provides the nurse invaluable
insight into proactive interventionsinsight into proactive interventions
that may be needed.that may be needed.

17. CONT.CONT.
Past medical historyPast medical history
– Medical conditions, surgical procedures.Medical conditions, surgical procedures.
– Psychiatric / emotional problemsPsychiatric / emotional problems
– HospitalizationsHospitalizations
– Previous medicationsPrevious medications
– AllergiesAllergies
– Review of body systemsReview of body systems

18. CONT.CONT.
Social historySocial history
– Age, genderAge, gender
– Ethnic originEthnic origin
– Height, weightHeight, weight
– OccupationOccupation
– Marital statusMarital status
– Primary family member / significant othersPrimary family member / significant others
– Religious affiliationsReligious affiliations
– Advance directives, Power of AttorneyAdvance directives, Power of Attorney
– Substance abuseSubstance abuse

19. CONT.CONT.
Psychosocial assessmentPsychosocial assessment
– General communicationGeneral communication
– Coping stylesCoping styles
– Anxiety and stressAnxiety and stress
– Current stressorsCurrent stressors
– Family needsFamily needs
SpiritualitySpirituality
– Faith / spiritual preferenceFaith / spiritual preference
– Healing practicesHealing practices

20. PHYSICAL ASSESSMENTPHYSICAL ASSESSMENT
Nervous systemNervous system
– LOC (by assessing GCS)LOC (by assessing GCS)
– PupilsPupils
– Motor strength of extremitiesMotor strength of extremities
Cardiovascular systemCardiovascular system
– BP, heart rate and rhythm, heart soundsBP, heart rate and rhythm, heart sounds
– Capillary refill, peripheral pulsesCapillary refill, peripheral pulses
– Patency of IVs and verification of IV medsPatency of IVs and verification of IV meds
– Hemodynamic pressure and waveformsHemodynamic pressure and waveforms

21. CONT.CONT.
Respiratory systemRespiratory system
– Respiration rate and rhythmRespiration rate and rhythm
– Breath soundsBreath sounds
– Color and amount of secretionsColor and amount of secretions
– Noninvasive (pulse oximetry, end tidal CONoninvasive (pulse oximetry, end tidal CO22
– Mechanical ventilation parametersMechanical ventilation parameters
– Arterial and venous blood gasesArterial and venous blood gases
Renal systemRenal system
– Intake and outputIntake and output
– Color and amount of urinary outputColor and amount of urinary output
– Lab values (BUN, creatinine)Lab values (BUN, creatinine)

22. CONT.CONT.
Gastrointestinal systemGastrointestinal system
– Bowel soundsBowel sounds
– Contour of abdomenContour of abdomen
– Position of drainage tubesPosition of drainage tubes
– Color and amount of secretionsColor and amount of secretions
– Bilirubin and albumin valuesBilirubin and albumin values
Endocrine, hematologic and immunologicEndocrine, hematologic and immunologic
systemsystem
– Fluid and electrolyte balanceFluid and electrolyte balance
– CBC and coagulation valuesCBC and coagulation values
– Temperature and WBC with differential countTemperature and WBC with differential count

23. CONT.CONT.
Integumentary systemIntegumentary system
– Color and skin temperatureColor and skin temperature
– Intactness of skinIntactness of skin
– Areas of rednessAreas of redness
Pain / discomfortPain / discomfort
– Assessed in each systemAssessed in each system
– Response to interventionsResponse to interventions

24. CONT.CONT.
PsychosocialPsychosocial
– Mental status and behavioral responsesMental status and behavioral responses
– Reaction to critical illness experienceReaction to critical illness experience
(stress, anxiety, coping mechanism)(stress, anxiety, coping mechanism)
– Presence of cognitive impairmentsPresence of cognitive impairments
(dementia, delirium, depression)(dementia, delirium, depression)
– Family functioning and needsFamily functioning and needs
– Ability to communicate needsAbility to communicate needs
– Ability to participate in careAbility to participate in care
– Sleep patternsSleep patterns

25. ONGOING ASSESSMENTONGOING ASSESSMENT
After the baseline comprehensiveAfter the baseline comprehensive
assessment is completed, ongoingassessment is completed, ongoing
assessments are performed atassessments are performed at
varying intervals.varying intervals.
It should be done after every fewIt should be done after every few
minutes for unstable patients andminutes for unstable patients and
after 4 to 6 hours for stable patients.after 4 to 6 hours for stable patients.

26. CONT.CONT.
Additional assessment should beAdditional assessment should be
done when:done when:
– When caregiver change.When caregiver change.
– Before and after any major proceduralBefore and after any major procedural
interventions (intubation etc).interventions (intubation etc).
– Before and after transport out of theBefore and after transport out of the
critical care unit for diagnosticcritical care unit for diagnostic
procedures or other events.procedures or other events.
– Deterioration in physiologic or mentalDeterioration in physiologic or mental
status.status.
– Initiation of any new therapy.Initiation of any new therapy.