CRITICAL CARE NURSING

NCM 106 MS Intensive

Critical Care Nurses Association of the
Philippines, Inc. , 8/F Medical Arts Building
Philippine Heart Center, East Avenue, Quezon
City
The first step inside an ICU can be
overwhelming.
The machinery is complex,
medications are potent, stress and
worry are visible on the faces of the
families, and alarms seem to sound
endlessly.
ICU can be intimidating and confusing.
The ICU is a place where skilled
nurses, doctors, technologists,
pharmacists, respiratory therapists,
and others competently care for the
sickest clients in the hospital.
 What is CRITICAL CARE?

A term used to describe “the care of

patients who are extremely ill and
whose clinical condition is unstable or
potentially unstable.”
 History of CRITICAL CARE

During WW2, “shock wards” were

developed to meet the needs of
injured soldiers.
After the war, a nursing shortage
spurred the development of PACU to
ensure prompt attentive care for
clients emerging from anesthesia.
 History continued
By 1960 almost every hospital in the US could
boast of such recovery room.
In 1940’s, the polio epidemic required the use
of iron lungs as well as tracheotomy procedures
and manual ventilation to support client with
respiratory paralysis. The physical needs were
so great that intensive nursing care was
required by these clients.
 History continued…

In the 1950’s, mechanical ventilation

was developed. It was found that care
of clients requiring ventilatory support
was more efficient when clients were
grouped together in a single unit.
 History continued….

Today all tertiary hospitals, both here

and abroad have at least one ICU,
many of them specializing in caring for
highly specific groups of clients.
Examples include Cardiovascular,
Trauma, neurologic, surgical, pediatric,
respiratory, transplantation, burn,
neonatal, spinal cord injury, and
medical ICUs’ to name a few.
 Reasons for admission in the ICU

The most common reasons for

admission to ICU are for intensive
monitoring and life-supportive care or
for intensive nursing care that cannot
be provided on a general medical
surgical floor.
Clients may be admitted following
surgery, from the ER, or from other
floors within the hospital.
 Common conditions requiring
admission to ICU
Respiratory difficulties impairing the
client’s ability to ventilate or
oxygenate. These problems include
disorders such as PNEUMONIA,
PULMONARY EMBOLISM, DRUG
OVERDOSE, and RESPIRATORY
DISTRESS.
Circulatory problems such as
hypotension or cardiac rhythm
disorders, such as MI, bleeding from
internal or external wounds, or may
have irregular heart rhythms that have
become life-threatening.
The term “hemodynamically unstable”
is used to describe these clients.
Neurologic changes, such as loss of
consciousness or changes in mental
status.
Clients with head injuries, brain
surgery, stroke, or SCI are admitted to
the ICU for frequent assessment.
Life-threatening infection or the risk of
infection, such as burn wounds or
sepsis, requires intensive care to
control the BP and maintain perfusion
of the heart, brain, lungs, and kidneys.
Metabolic problems, such as abnormal
electrolytes from diabetes, renal
failure, or acid-base imbalances
require intensive monitoring and
medication titration to control and
treat complications.
Clients who have had open heart
surgery, thoracic surgery, brain surgery,
extensive abdominal surgery are
admitted postoperatively to the ICU for
monitoring.
Clients who have less invasive
procedures, but have a personal history
of cardiac or pulmonary disease, may
also be admitted for observation and
frequent assessment.
 Needs of the critically ill client and
family
Clients in the ICU are at a most
vulnerable stage.
Not only do these clients have great
physical needs, but their emotional,
psychological, social, and
environmental needs must be
identified
 Needs continued…

Critically ill clients often experience

pain, immobility, disorientation, and
sleep deprivation.
They can feel isolated, anxious and
depressed.
Fears about their treatments, the
unknown, and even death are unusual.
 Needs continued…

Everything in their environment is

stress producing (unusual machines,
loud noises, equipment alarms,
constant light, and constant attention,
staff conversations, physical restraints,
lack of privacy, inadequate control of
pain and anxiety, and separation from
significant others)
 Needs continued….

Alteration of sleep quality and quantity

in the critically ill client can have
important adverse consequences,
including impaired immunity and
healing, an increase in oxygen
consumption and CO2 production,
negative nitrogen balance, and
stimulation of the “fight or flight”
response of the SNS.
 Needs continued…

An overwhelming sense of
powerlessness is the overall recurrent
theme verbalized by the critically ill
clients.
Characteristics of HOPELESSNESS can
actually impede recovery and lead to
to specific behavioral and physiologic
changes.
 Characteristics of HOPELESSNESS

Crying
Decreased or flat affect
Decreased response to stimuli
Decreased verbalization
Diminished interest in external objects
Interference with learning
Irritability
 Hopelessness continued….

Lack of involvement in care

Lack of motivation or initiative
Motionlessness
Muteness
Passivity
Reduced activity
Sad expression
 Cont….

Sense of incompetence
Sleep disorders
Social withdrawal
Tenseness
Weakness
Weight loss
 Cont…
Because of airway devices, medications, or
physical pathology, many critically ill clients
cannot communicate their needs well, making
their situation even more stressful.
Even with the best of circumstances and
nursing care, critically ill clients can experience
delirium, often called ICU psychosis.
 Responsibilities of the CCN

Controlling the environment to avoid or

diminish the stressors that are specific
to the critically ill client.
Allowing open visitation as able.
Providing appropriate day and night
cycles of activity and sleep.
Controlling noise and conversation to
allow the client a more restful and
therapeutic recovery.
 Responsibilities cont…

Providing privacy and explaining all

equipment, noise and activities can be
comforting measures for the critically
ill client as well as his/her family.
Designing some type of simple
communication system to allow the
client at least to answer “yes” or “no”
question is important.
 Responsibilities cont…

The nurse must must adequately

assess the client’s analgesia and
sedation needs. Often few overt clues
are evident that the client requires
such medications.
The nurse may need to control open
visitation to balance clients’ needs for
rest with families’ needs to be close to
their loved one.
 Family needs in the ICU

Family members must have their

physical and emotional needs met.
Assurance that the best care was
being given to their family member by
caring personnel.
To feel that there is HOPE.
To know the PROGNOSIS
 Family needs cont…

To understand how the client was

being treated medically.
To be reassured that it is all right to
leave for a while.
To feel accepted by hospital staff.
To feel someone is concerned for the
family’s health.
 Family needs cont…

To feel the hospital personnel care

about the client
To have explanations given in terms
that can be understood.
 Critical Care Nursing
CCNs concentrate specifically on the care of
clients with life-threatening problems.
Interventions for these clients must be adjusted
continually based on constant monitoring of
their response to treatment.
Because of the multidisciplinary nature of
critical care, coordination of care is essential,
and the CCN is primarily responsible for it.
 CCN continued….

Continuous nursing vigilance is the key

to this nursing specialty and can make
a significant difference in client
outcomes.
The CCN does not just use the latest
machines and technologies to provide
highly technical nursing, although,
maintaining technological devices is
crucial.
 CCN continued….

Creating an environment that promotes healing

or an optimal health level in a nurturing, caring
manner is especially essential for a critically ill
client to ensure positive optimal outcomes.
Often complementary and alternative therapies
such as massage, prayer, music therapy, &
therapeutic energy provision, assist the CCN in
providing such a healing environment.
 CCN continued….

Providing such care must include not

only the client but also his/her family
members and significant others.
Critically ill client does not remember
his/her ICU stay; however, the time in
the CCU is often a significant
emotional even & is traumatic for
his/her loved ones.
 CCN continued….

Only coping mechanism families have

is HOPE.
It is extremely essential that the CCN
foster this coping mechanism because
hope can fortify a family’s inner
strength and helps the family
members look beyond the present
situation of pain and suffering.
 CCNs will do the following:

Respect and support the right of the

patient or the patient’s designated
surrogate to autonomous informed
decision-making.
Intervene when the best interest of the
patient is in question..
Help the patient obtain necessary
care.
 CCNs continued…..

Respect the values, beliefs, and rights

of the patient.
Provide education and support to help
the patient or the patient’s designated
surrogate to make decisions.
Represent the patient in accordance
with the patient’s choices.
 Cont….

Support the decisions of the patient or

the patient’s designated surrogate, or
transfer care to an equally qualified
CCN.
Intercede for patients who cannot
speak for themselves in situations that
require immediate action.
Monitor and safeguard the quality of
care the patient receives.
 Cont….

Act as liaison between the patient, the

patient’s family, and health care
professionals.
 Critical Care Practice settings and
roles
CC nursing is not limited to designated CCU.
They may work with critically ill clients in ICU,
PACU, ER and in step-down units.
It is not the location of care that is important,
however.
CCN is not nursing in a specific place; rather, it
is nursing with a specific mind-set that utilizes a
specialized body of knowledge and skills.
 Cont…

CCN must constantly keep up with the

latest information and become
proficient with more complex new
technologies and treatments.
CCNs are found in a variety of formal
roles: bedside nurse, critical care
educator, case management, unit or
department manager, clinical nurse
specialist, and nurse practitioner.
 Cont….

Bedside nurses are the backbone of

critical care nursing.
It is the bedside CCN who coordinates
the entire team’s efforts to implement
the plan of care and modify it as
needed by the client’s response.
 Advance Practice Nurses in Critical
Care
RN with a master’s degree who have a
specialty in critical care.
The Critical Care Clinical Nurse
Specialist uses an advanced level of
knowledge of critical care,
pharmacology, and pathophysiology in
completing the role of educator,
consultant, manager, researcher, and
practitioner.
 Cont……….
The Acute Care Nurse Practitioner (ACNP) provides
advanced nursing care to acutely and critically ill
clients in a wide variety of settings, including the
emergency departments, ICUs, and step-down
units.
Making rounds, developing a plan of care, &
performing specific advanced procedures are all
task of the ACNP.
Some ACNPs serve as intensivists and may insert
central lines or chest tubes, assist with surgery or
intubation or complete various functions once
reserved for physicians.
 Standards for Acute
The Standards for Acute and Critical
and Critical Care
Care Nursing Practice describe the
Nursing
practice Practice
of the nurse who cares for an
acutely or critically ill patient no
matter where that patient is cared for
within the healthcare environment.
 The Standards for Acute
and
are Critical
defined Care Nursing
as authoritative
statements that describe a level of
Practice
care or performance common to the
profession of nursing by which the
quality of nursing practice can be
judged.
are written to establish an example of
the roles and responsibilities expected
of the practitioner by the profession at
large.