critical care seminar ppt with detailed exp

critical care

1. SEMINAR CRITICAL CARE NURSING CONCEPT,PRINCIPLES AND SCOPE

2. Critical Care Unit/ICU ICU is highly specialized and sophisticated area of a hospital which is specifically designed, staffed, located, furnished and equipped, dedicated to the management of critically sick patients, injuries or complications. It is department with dedicated medical, nursing and allied staffs. 2

3. HDU (High Dependency Unit) A specifically staffed and equipped section of an intensive care complex that provides level of care intermediate between intensive care and general ward care. It must be near ICU Geographically and functionally, with intenvist service. 3

4. CRITICAL Crucial Crisis Emergency Serious Requiring immediate action Thorough and constant observation Total dependent (Oxford Dictionary) 4

5. CRITICAL CARE NURSING The care of seriously ill clients from point of injury or illness until discharge from intensive care Deals with human responses to life threatening problems -trauma /major surgery ( Mary,L.S ., Deborah, G.K. & Marthe , J.M. 2005) 5

6. CRITICAL CARE NURSE care for clients who are very ill provide direct one to one care Responsible for making life-and death decision At high risk of injury or illness from possible exposure to infections Communication skill is of optimal importance Specialty dealing with human responses to life-threatening problems Requires Extensive Knowledge and a Continual Desire to Learn 6

7. CRITICALLY ILL CLIENT At high risk for actual or potential life-threatening health problems More ill Required more intensive and careful nursing care 7 Prof. Dr. R S Mehta, BPKIHS

8. 8

9. CRITICAL CARE NURSING : IT REFERS TO THOSE COMPREHENSIVE, SPECIALIZED AND INDIVIDUALIZED NURSING CARE SERVICES WHICH ARE RENDERED TO PATIENTS WITH LIFE THREATENING CONDITIONS AND THEIR FAMILIES. 9

10. 10 Historical Background

11. World War II Shock wards established for resuscitation Transfusion practices in early stages After World war-II, (1939-1945) nursing shortage forced grouping of postoperative patients in recovery areas 11

12. Polio epidemic 1950’s: use of mechanical ventilation (“iron lung”) for treatment of polio Development of respiratory intensive care units At the same time, general ICU’s developed for sick and postoperative patients 12

13. 13 History … Collaboration between nurses and physicians 1950’s & 1960’s – CV Disease most common diagnosis 1960’s – 30-40% mortality rate for MI 1965 – 1 st specialized ICU – The Coronary Care Unit Emergence of Specialized ICU’s

14. Multidisciplinary & Collaborative approach to ICU care Medical & nursing directors : Co-responsibility for ICU management • A team approach : Doctors, Nurses, R/T, Pharmacist • Use of standard, protocol, guideline Consistent approach to all issues • Dedication to coordination and communication for all aspects of ICU management • Emphasis on research, education, ethical issues, patient advocacy 14

15. ICU Model Care Full-time intensivist model : patient care is provided by an intensivist Consultant intensivist model : an intensivist consults for another physician to coordinate or assist in critical care, but dose not have primary responsibility for care Multiple consultant model: multiple specialists are involved in the patient care, (esp. R/T doctors for ventilators), but none is designated especially as the consultant intensivist Single physician model : primary physician provides all ICU care 15

16. A Good ICU Well organized: trust & coordinated care • Full-time intensivist : daily round, critical care trained, available in a timely fashion (24hr/day) • protocol & policies • bedside nurses: adequate (master degree)  no intern Team of: doctors, nurses, R/T, pharmacists • closed units, if resources allow 16

17. HIGH DEPENDENCY CARE Coronary care units (CCU) Renal high dependency unit (HDU) Post-operative recovery room Accident and emergency departments (A&E) Intensive care units (ICU) 17

18. CLASSIFICATION OF CRITICAL CARE 18

19. Level-I Usually found in District hospital, Small nursing homes, and small hospitals. Provides immediate and short term cardio-respiratory support Provides Short term invasive ventilator service Nurse Patient ration= 1:2 ABG-desirable 19

20. Level -II Large general hospitals, zonal hospitals, Nursing homes with specialty services. Bed strength 6-12 Long term ventilation ability Blood bank service available Multisystem life support available CT MRI desirable 20

21. Level - III Recommended for tertiary level hospital or specialty and super-specialty hospitals Centre of excellence Provide comprehensive critical care Preferably closed ICU, Headed by intensivist Protocol and policies are observed All required equipments and supplies available 21

22. Types of ICU General Medical Intensive Care Unit(MICU) Surgical Intensive Care Unit Medical Surgical Intensive Care Unit(MSICU) Specialized Neonatal Intensive Care Unit(NICU) Special Care Nursery(SCN) Paediatric Intensive Care Unit(PICU) Coronary Care Unit(CCU) Cardiac Surgery Intensive Care Unit(CSICU) Neuro Surgery Intensive Care Unit(NSICU) Burn Intensive Care Unit(BICU) Trauma Intensive Care Unit 22

23. PRINCIPLES OF CRITICAL CARE NURSING ANTICIPATION : The first principle in critical care is Anticipation. One has to recognize the high risk patients and anticipate the requirements, complications and be prepared to meet any emergency. Unit is properly organized in which all necessary equipments and supplies are mandatory for smooth running of the unit. 23

24. EARLY DETECTION AND PROMPT ACTION : The prognosis of the patient depends on the early detection of variation, prompt and appropriate action to prevent or combat complication. Monitoring of cardiac respiratory function is of prime importance in assessment. 24

25. COLLABORATIVE PRACTICE : Critical Care, which has originated as technical sub-specialized body of knowledge has evolved into a comprehensive discipline requiring a very specialized body of knowledge for the physicians and nurses working in the critical care unit fosters a partnerships for decision making and ensures quality and compassionate patient care. Collaborate practice is more and more warranted for critical care more than in any other field. 25

26. COMMUNICATION : Intra professional, inter departmental and inter personal communication has a significant importance in the smooth running of unit. Collaborative practice of communication model 26

27. Prevention of Infection : Nosocomial infection cost a lot in the health care services. Critically ill patients requiring intensive care are at a greater risk than other patients due to the immunocompromised state with the antibiotic usage and stress, invasive lines, mechanical ventilators, prolonged stay and severity of illness and environment of the critical unit itself. 27

28. Crisis Intervention and Stress Reduction : Partnerships are formulated during crisis. Bonds between nurses, patients and families are stronger during hospitalization. As patient advocates, nurses assist the patient to express fear and identify their grieving patttern and provide avenues for positive coping. 28

29. Critical Care Considerations F= Feeding/fluid A= Analgesics S= Sedation T= Thrombolytic agents H= Head elevation U= Ulcer – bed sore G= Glucose monitoring 29

30. Feeding and Fluids It includes E nteral feeding Oro - gastric and Naso - gastric feeding Dairy and poultry products (Milk, egg, youghort ) High protein liquid diet Medications 30

31. O ral feeding Hospital diet Bland diet Normal diet Liquid intake 31

32. Transparenteral diet Parenteral feeding, also known as intravenous feeding or total parenteral nutrition (TPN), is a method of feeding that delivers nutrients directly into a vein, bypassing the digestive system 32

33. Pain Management Must

34. MEDICATIONS USING IN ICU Analgesics Fentanyl It works 600 times more effectively than Morphine and reduces the pain and increases the pain threshold Used in moderate and severe pain Antidote Naloxone 0.05 mg/ Kg 34

35. Morphine Reduces pain Chiefly used in MI 2-4 mg dissolved in 10 ml NS Antidote: Naloxone 35

36. Acetaminophen and NSAIDs Often more effective than opioids in reducing pain from pleural or pericardial rubs, a pain that responds poorly to opioids . particularly effective in reducing muscular and skeletal pain Tab form: 500mg OD 36

37. Sedatives Benzodiazepines Midazolam Short acting sedatives and hypnotics In intubated patients Dose 0.01- 0.05 mg/Kg for several hours 37

38. Benzodiazepines… Diazepam Adult dose = 0.2 – 0.5 mg/ Kg Not given in MI patients 38

39. Ketamine Adult dose= 1 – 3 mg/kg IV 39

40. Propofol A rousal is rapid 10- 15 min Used in n euro cases and those with increased ICP, during tracheostomy procedure 40

41. INOTROPES Dopamine Dobutamine Nor- adrenaline 41

42. Thrombolytic agents Compressive stocking SCD (Systematic Compressive Device) LMWX Heparin flush 42

43. Other Drugs used in ICU Aspirin Clopidogrel Nitroglycerine Atorvastatins 43

44. Sedation score in ICU is done by RASS 44 (Richmond Agitation Sedation Scale = RASS)

45. RASS ( Richmond Agitation Sedation Scale) Number Characteristics Definition Intervention +4 Combative Violent, immediate danger to staff Restrain and sedate +3 Very agitated Aggressive, pull or remove tubes Restrain and sedate +2 Agitated Frequent non purposeful movement, fights ventilator Restrain and sedate +1 Restless Anxious movement but not aggressive or vigorous Sedate Alert and calm 45

46. Number Characteristics Definition Intervention -1 Drowsy Not fully alert but has sustained awakening, eye contact to voice (>10 sec) Verbal stimulation -2 Light sedation Briefly awakens, eye contact to voice (<10sec) Verbal stimulation -3 Moderate sedation Moderate or eye opening to voice but no eye contact Verbal stimulation -4 Deep sedation No response to voice but movement or eye opening to physical stimuli Physical stimulation -5 No response No response to voice or physical stimuli Physical stimulation 46

47. ROLE OF CRITICAL CARE NURSE Care provider Educator Patient advocate Leadership role Role in research

48. SCOPE OF CRITICAL CARE NURSING Cardiovascular Critical Care Neurocritical Care Trauma and Surgical Critical Care Burn Critical Care Pediatric Critical Care Neonatal Critical Care Oncology Critical Care Pulmonary and Respiratory Critical Care Infectious Disease Critical Care Transplant Critical Care Renal and Dialysis Critical Care Geriatric Critical Care Sepsis and Shock Management Palliative and End-of-Life Care in ICUEmergency and Disaster Nursing

49. PROTOCOLS OF INTENSIVE CARE UNITS Staffing Levels Bed strength Equipments

50. Medication calculation