Critical_Care_Nursing_Presentation (1).pptx

critical care nursing ppt

1. Nursing Management of Patients in Critical Care Units IV Semester AHN - Unit XI Acharya College of Nursing

2. Definition of Critical Care Nursing Critical care nursing is a specialized area of nursing that involves caring for patients with life-threatening conditions requiring comprehensive and continuous monitoring. Nurses in critical care units (CCUs), including ICUs, play a vital role in stabilizing patients, preventing complications, and supporting recovery.

3. Importance & Scope Critical care nurses stabilize patients, prevent complications, and support recovery in ICU/CCU settings.

4. 7 C’s of Critical Care Compassion Communication •Consideration Comfort Carefulness Consistency Closure

5. Principles Overview Holistic care continuous monitoring advanced competence rapid decision-making communication, ethics family support infection control technology use compassion.

6. Holistic Patient-Centered Care Critical care nursing must address physical , psychological , emotional , spiritual , and social needs of patients and families. Involves individualized care planning based on the patient’s condition, prognosis, preferences, and cultural background .

7. Continuous & Comprehensive Monitoring Constant observation using advanced monitoring tools (e.g., cardiac monitors, ventilators, arterial lines). Early recognition of changes in vital signs, lab values, and neurological status is key for prompt intervention .

8. Advanced Clinical Competence Critical care nurses must possess in-depth knowledge and skills in handling: Mechanical ventilation Hemodynamic monitoring Emergency resuscitation Drug titration (e.g., inotropes, sedatives)

9. Rapid & Accurate Decision-Making: High acuity patients require quick judgment and critical thinking in emergencies. Nurses should collaborate closely with physicians, respiratory therapists, and other healthcare professionals to ensure timely interventions.

10. Effective Communication & Teamwork: Critical care involves interdisciplinary collaboration among healthcare team members. Nurses should maintain clear, concise, and accurate communication regarding the patient’s condition, treatment plan, and progress.

11. Ethical & Legal Considerations Nurses must respect patient autonomy , informed consent , and confidentiality . Must be aware of ethical dilemmas (e.g., end-of-life decisions, organ donation).

12. Family Support & Involvement: Families are often in distress; nurses provide emotional support regular updates involve them in decision-making.

13. Infection Control & Safety Critical care patients are vulnerable to nosocomial infections . Strict adherence to aseptic techniques , hand hygiene , use of PPE , and ventilator-associated pneumonia (VAP) bundles is essential. Prevent pressure injuries , falls , and medication errors .

14. Use of Technology & Documentation : Nurses must be skilled in using electronic health records , monitoring equipment , and alarm systems . Accurate documentation of assessment findings, interventions, medications, and patient responses is essential for legal and clinical continuity .

15. Compassionate & Resilient Care: Nurses should provide care with compassion and empathy , even in high-stress environments. Self-care, stress management , and emotional resilience are important for avoiding burnout.

16. Organization of Critical Care Unit A well-planned physical set-up ensures the delivery of safe and effective care in a CCU. The design should promote infection control easy accessibility privacy efficient monitoring.

17. Physical Set-up of CCU a . Location near ED/OT Ideally located close to emergency department, operation theatres, diagnostic areas (radiology, labs), and surgical/medical wards. Easy access to ambulance services and elevators.

18. b. Unit Size and Bed Capacity: Recommended: 6–12 beds per unit to ensure effective management. Should include adequate space for equipment, staff movement, and family access.

19. C. Layout and Zones: Patient care area: With proper spacing (minimum 150 sq. ft per bed), head-end wall-mounted panels for oxygen, suction, and electrical outlets. Nursing station: Central location with visibility to all beds. Support areas: Clean and dirty utility rooms, medication preparation area, storage, staff restrooms, hand-washing stations. Waiting area: Comfortable, with communication support for patient families .

20. D. Equipment in Physical Set-up Monitors, ventilators, infusion pumps, defibrillators, suction apparatus, ABG machine, crash cart, emergency trolley. CCTV and alarm systems for continuous surveillance

21. Policies in C RITICAL C ARE U NIT Clear policies guide the functioning of the CCU and ensure patient safety and quality care. a. Admission and Discharge Policy: Clear criteria for admission (e.g., hemodynamic instability, respiratory failure, post-operative complications). Transfer policy once the patient stabilizes. b. Infection Control Policy: Hand hygiene protocols, use of PPE, sterile procedures, isolation when needed. Environmental cleaning and waste management guidelines.

22. c. Patient Care Policy: Evidence-based care protocols (ventilator care bundles, sedation, weaning protocols). Daily multidisciplinary rounds, documentation standards. d. Communication Policy: Regular updates to family members. Use of consent forms and advanced directives. e. Ethical and Legal Guidelines: End-of-life care policies, do-not-resuscitate (DNR) orders, and decision-making frameworks. Confidentiality and patient rights.

23. Staffing Norms Adequate and competent staffing is essential for delivering high-quality care in critical settings a. Nurse-Patient Ratio: 1:1 ratio for ventilated or critically ill patients. 1:2 for stable ICU patients. Senior nurses should supervise and guide juniors, especially during emergencies. b. Medical Staff: Intensivist-led team available 24/7. Inclusion of residents, specialists (e.g., cardiologists, pulmonologists), and emergency medicine physicians.

24. c. Allied Health Professionals: Respiratory therapists, physiotherapists, dietitians, pharmacists, clinical psychologists. Biomedical engineers for equipment maintenance. d. Support Staff: Housekeeping, transport aides, data entry operators, and ward clerks. e. Training and Competency: Ongoing in-service education, ACLS/BLS certification, simulation training. Orientation programs for new staff.

25. Summary The organization of a critical care unit plays a vital role in saving lives and enhancing patient outcomes. A well-structured physical environment, robust policies, and appropriate staffing norms are foundational elements for safe, ethical, and high-quality critical care delivery.

26. Protocols in the Critical Care Unit Protocols are standard operating procedures (SOPs) that guide clinical practices in the CCU. They ensure patient safety reduce errors improve outcomes.

27. Common Protocols in CCU: Admission and Discharge Protocols: Criteria for admission to CCU (e.g., hemodynamic instability, respiratory failure). Discharge planning once the patient is stable. Infection Control Protocols: Strict hand hygiene. Use of PPE (Personal Protective Equipment). Aseptic technique for all invasive procedures. Monitoring Protocols: Continuous ECG, SpO ₂, BP, respiratory rate monitoring. Neurological, renal, and hemodynamic assessments.

28. Emergency Protocols: Code blue procedures. Advanced Cardiac Life Support (ACLS) protocols. Rapid response team activation. Medication Administration Protocols: Use of infusion pumps for titrated drug delivery. Double-checking high-alert medications (e.g., inotropes, sedatives). Ventilator Management Protocols: Initiation, maintenance, weaning off ventilation. Monitoring ABG values and patient response. Nutrition Protocols: Enteral or parenteral nutrition based on patient condition. Daily nutritional assessment. Communication Protocols: Daily rounds with multidisciplinary team. SBAR (Situation, Background, Assessment, Recommendation) for shift handovers.

29. 2. Equipment in the Critical Care Unit Advanced life-supporting equipment is essential for continuous monitoring and managing critically ill patients. Cardiac Monitors: For continuous ECG, heart rate, BP, SpO ₂, respiratory rate. Ventilators: For mechanical ventilation in patients with respiratory failure. Infusion Pumps and Syringe Pumps: Accurate delivery of IV medications. Defibrillator: For managing cardiac arrest or arrhythmias. Suction Apparatus: For airway clearance.

30. Pulse Oximeter: Non-invasive monitoring of oxygen saturation. ABG Analyzer: For real-time arterial blood gas results. Bedside Ultrasound/ECG Machines: For diagnostics and monitoring. Patient Beds with Side Rails and Alarms: Adjustable for patient positioning and safety. Crash Cart: Fully equipped with emergency drugs and equipment.

31. Supplies in CCU Airway: ET tubes, laryngoscope; IV: cannulas, fluids; dressings; catheters; feeding tubes; PPE; emergency drugs; documentation tools.

32. Critical Care Equipment Ventilator: Supports/ resplaces breathing; modes include SIMV, CPAP; nurse monitors settings and alarms.

33. Modes of Mechanical Ventilation 1. Control Modes Patient has little or no effort – ventilator does all work. CMV (Controlled Mandatory Ventilation): Ventilator delivers a set tidal volume/rate. Patient cannot trigger breath. Used in paralyzed, sedated, or anesthetized patients 2. Assist/Control Mode (A/C or ACV) Every breath (patient-initiated or machine-triggered) is delivered with a preset tidal volume. Ensures full support. Risk: hyperventilation if patient breathes rapidly. 3. Intermittent Mandatory Ventilation (IMV) Ventilator gives preset breaths, but patient can breathe spontaneously in between (without assistance). SIMV (Synchronized IMV): Preset breaths are synchronized with patient’s efforts. Reduces breath-stacking, commonly used in weaning.

34. 4. Pressure Support Ventilation (PSV) Patient initiates all breaths. Ventilator provides preset pressure to overcome airway resistance. Used in weaning. 5. Continuous Positive Airway Pressure (CPAP) Patient breathes spontaneously with constant positive pressure. No mandatory breaths given. Improves oxygenation, prevents alveolar collapse. Used in weaning & in sleep apnea. 6. Pressure-Controlled Ventilation (PCV) Each breath delivered at preset pressure for a preset time. Tidal volume varies. Used in ARDS, stiff lungs.

35. 7. Volume-Controlled Ventilation (VCV) Each breath delivers a fixed tidal volume. Pressure varies. Used when precise control of ventilation is required. 8. BiPAP (Bilevel Positive Airway Pressure) Non-invasive mode with two pressures: IPAP (inspiratory positive airway pressure). EPAP (expiratory positive airway pressure). Used in COPD, sleep apnea . 9. High-Frequency Ventilation (HFV) Delivers very small tidal volumes at high rates (60–300 breaths/min). Used in neonates, ARDS, and during surgery.

36. Mode Tidal Volume (VT) Rsp,rate FiO ₂ PEEP/ Pressure Use CMV 6–8 mL/kg 12–16 40–100% 5 cm H₂O Paralyzed/sedated A/C 6–8 mL/kg ≥12 (patient can add) 40–60% 5–10 cm H₂O Full support SIMV 6–8 mL/kg 6–12 35–60% 5 cm H₂O Weaning PSV Variable Spontaneous 30–50% PS 5–20 + PEEP 5 Weaning CPAP Spontaneous Spontaneous 21–50% 5–10 cm H₂O Sleep apnea, weaning PCV Variable 12–16 40–100% Pressure 15–30 ARDS, stiff lungs VCV 6–8 mL/kg (4–6 ARDS) 12–16 40–60% 5–10 cm H₂O Precise VT delivery BiPAP VT variable Spontaneous/10–12 30–60% IPAP 10–20, EPAP 4–8 COPD, non-invasive HFV 1–3 mL/kg 60–300 30–100% MAP 10–30 Neonates, ARDS

37. Nursing Care of a Patient on Mechanical Ventilator Purpose of Mechanical Ventilation To maintain adequate oxygenation and ventilation. To reduce the work of breathing. To support respiratory function until the patient recovers. Nurse’s Responsibilities A. Airway Management Ensure endotracheal/tracheostomy tube is secured and patent. Suction secretions using sterile technique when required. Monitor cuff pressure (20–25 cm H₂O) to prevent aspiration and tracheal injury. Provide humidification to prevent mucosal drying.

38. B. Monitoring Monitor vital signs, SpO₂, arterial blood gases (ABG). Observe for signs of hypoxia: restlessness, cyanosis, tachycardia. Assess ventilator settings (mode, FiO ₂, tidal volume, rate, PEEP). Continuously check alarms – never switch them off without assessing cause. C. Patient Care Maintain semi-Fowler’s position (30–45°) to prevent aspiration and improve lung expansion. Provide regular oral care with chlorhexidine to reduce ventilator-associated pneumonia (VAP). Perform chest physiotherapy if prescribed. Provide eye care to prevent dryness/ulceration. Assess skin around securing tapes for pressure injury.

39. D. Preventing Complications Ventilator Associated Pneumonia (VAP) Prevention Bundle : Hand hygiene before/after patient contact. Elevate head of bed 30–45°. Daily assessment for readiness to wean. Oral care with antiseptic solution. Subglottic secretion drainage (if available). Monitor for barotrauma, volutrauma , oxygen toxicity. Prevent accidental extubation by careful handling. E. Nutrition and Hydration Provide enteral feeding as per order (check gastric residual volume). Maintain adequate hydration (IV/enteral).

40. F. Psychological Support Explain procedures to the patient and family. Use communication aids for intubated patients. Provide reassurance to reduce anxiety. G. Documentation Record ventilator settings, patient’s tolerance, ABG values, suctioning, and nursing interventions.

41. 3. Weaning from Ventilator Gradual reduction of support once the patient improves. Observe for signs of weaning intolerance: tachypnea, tachycardia, diaphoresis, restlessness. Provide emotional support during the process.

42. Critical Care Equipment Cardiac Monitor: Continuous ECG, HR, BP, SpO₂; nurse interprets data and responds to alarms.

43. Critical Care Equipment Defibrillator: Delivers shocks in VF/VT; nurse ensures readiness and follows ACLS. Definition A defibrillator is a life-saving device that delivers an electrical shock to the heart to restore normal cardiac rhythm during life-threatening arrhythmias like ventricular fibrillation and pulseless ventricular tachycardia.

44. Types of Defibrillators Manual Defibrillator – used by trained professionals; requires ECG rhythm recognition. Automated External Defibrillator (AED) – gives voice prompts; can be used by laypersons. Implantable Cardioverter Defibrillator (ICD) – implanted in patients at high risk of sudden cardiac arrest. Wearable Cardioverter Defibrillator (WCD) – worn externally for temporary protection. Nurse’s Responsibilities A . Preparation & Safety Ensure the defibrillator is checked daily for proper functioning. Keep charged and pads available. Ensure proper connection to power source or battery backup. Apply conductive gel/pads to prevent skin burns. Maintain universal precautions and ensure no one touches the patient during shock.

45. B. During Defibrillation Quickly assess patient’s rhythm (VF, pulseless VT). Switch on defibrillator and select appropriate mode. Apply paddles/pads firmly on the chest (sternum-apex position). Select energy level: Biphasic: 120–200 Joules. Monophasic: 360 Joules. Announce loudly “ Clear! ” before shock delivery. Deliver shock and immediately resume CPR for 2 minutes. C. Monitoring Continuously monitor cardiac rhythm, pulse, SpO₂, and ECG after defibrillation. Check patient’s response and vital signs. Be alert for recurrent arrhythmias.

46. D. Documentation Record: Indication for defibrillation. Rhythm observed. Number of shocks, energy levels, and time delivered. Patient’s response and post-shock condition. Report to physician immediately. Complications to Watch For Skin burns at pad site. Arrhythmias post-shock (asystole, bradycardia). Myocardial injury.

47. Critical Care Equipment Infusion Pump: Delivers fluids/drugs at controlled rates.

48. Critical Care Equipment Syringe Pump: Administers small volumes of potent drugs over time.

49. Critical Care Equipment Suction Machine: Removes airway secretions; prevents aspiration.

50. Critical Care Equipment Pulse Oximeter: Monitors oxygen saturation and pulse.

51. Critical Care Equipment ABG Analyzer: Measures pH, PaO₂, PaCO₂, HCO₃; guides respiratory management.

52. Critical Care Equipment Crash Cart: Mobile emergency equipment and drug trolley.

53. ACLS Introduction & Objectives Set of protocols for urgent treatment of cardiac arrest, stroke, and life-threatening emergencies.

54. ACLS Algorithm Recognition, CPR, defibrillation, airway, medications, post-arrest care.

55. CPR & Defibrillation CPR: 30:2 compressions:breaths, depth 5 cm, rate 100–120/min. Defibrillation: Immediate for VF/VT, resume CPR after shock.

56. Airway Management & Medications Advanced airway techniques; epinephrine, amiodarone, atropine as per protocol.

57. Nursing Management Objectives Maintain ABC, prevent complications, monitor, intervene, comfort, support family.

58. Airway, Breathing, Circulation Ensure airway patency, oxygen/ventilation, monitor cardiac status, manage fluids/vasopressors.

59. Nutrition, Infection Prevention Enteral/parenteral feeding, glucose/electrolyte monitoring, asepsis, PPE, early infection signs.

60. Skin Integrity & Psychosocial Support Repositioning, skin care, pressure-relieving devices, emotional reassurance.

61. Documentation & Communication Accurate recording, timely reporting, SBAR handovers.

62. Transitional Care Definition & Objectives Smooth, safe, informed transfer between care levels; prevent readmission; educate and support.

63. Nurse’s Role, Challenges, Strategies Advocate, educate, coordinate; address poor communication, incomplete documentation, limited resources.

64. Ethical Principles in Critical Care Autonomy, beneficence, non-maleficence, justice, veracity, fidelity.

65. Legal Aspects in Critical Care Consent, negligence, patient rights, documentation, advance directives, organ donation.

66. Communication Principles Preparation, rapport, assess understanding, share news, respond to emotions, provide support, document.

67. SPIKES Protocol Setting, Perception, Invitation, Knowledge, Empathy, Strategy/Summary.

68. End-of-Life Care Symptom management, communication, emotional support, spiritual care, comfort measures, family involvement.

69. Challenges in EOL Care Emotional stress, difficulty shifting to palliative goals, cultural conflicts, ethical dilemmas.

70. Conclusion & Summary Critical care nursing demands knowledge, vigilance, skill, compassion; protocols, equipment, ethics all ensure quality outcomes.