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    This document presents an introduction to critical care of patients in intensive care units (ICU). It briefly describes the nursing role in the ICU, the admission criteria, general and specific objectives of care, and some of the commonly used procedures and monitoring such as electrocardiograms, central venous pressure, and arterial blood gases. It also covers ICU design considerations such as number of beds, space requirements, and location in relation to other services.

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    Upana Critical Care Trial

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    This document presents an introduction to critical care of patients in intensive care units (ICU). It briefly describes the nursing role in the ICU, the admission criteria, general and specific objectives of care, and some of the commonly used procedures and monitoring such as electrocardiograms, central venous pressure, and arterial blood gases. It also covers ICU design considerations such as number of beds, space requirements, and location in relation to other services.

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    This document presents an introduction to critical care of patients in intensive care units (ICU). It briefly describes the nursing role in the ICU, the admission criteria, general and specific objectives of care, and some of the commonly used procedures and monitoring such as electrocardiograms, central venous pressure, and arterial blood gases. It also covers ICU design considerations such as number of beds, space requirements, and location in relation to other services.

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    This document presents an introduction to critical care of patients in intensive care units (ICU). It briefly describes the nursing role in the ICU, the admission criteria, general and specific objectives of care, and some of the commonly used procedures and monitoring such as electrocardiograms, central venous pressure, and arterial blood gases. It also covers ICU design considerations such as number of beds, space requirements, and location in relation to other services.

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    Upana Critical Care Trial

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    This document presents an introduction to critical care of patients in intensive care units (ICU). It briefly describes the nursing role in the ICU, the admission criteria, general and specific objectives of care, and some of the commonly used procedures and monitoring such as electrocardiograms, central venous pressure, and arterial blood gases. It also covers ICU design considerations such as number of beds, space requirements, and location in relation to other services.

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    of 15

    PAN AMERICAN UNIVERSITY OF GUATEMALA

    MALACATAN SAN MARCOS HEADQUARTERS


    DEGREE IN NURSING
    COURSE: CRITICAL CARE NURSING
    LICDA. ASTRID PAOLA GONZALEZ OROZCO

    TRIAL ON CRITICAL CARE IN ICU PATIENTS

    STUDENT: URIAS UDIEL BARRIOS CALDERÓN


    MEAT: 201905048

    MALACATAN, SM MARCH 2019


    INTRODUCTION:

    Intensive care units are specialized settings for treating people who have serious
    imbalances in their health status, and who require care from the health personnel
    who work there. Among this staff is the nursing professional, who is responsible for
    the direct care of these people in relation to: Body hygiene, skin care, airway
    patency, nutrition, treatment administration, among other aspects. This professional
    practice requires an integrative profile from the nurse, not only from the field of
    theoretical and technological knowledge, skills, but also sensitivity. flexibility and
    empathy when providing care to critically ill patients.
    JUSTIFICATION

    The current changes and trends in social, cultural and economic patterns in our
    country in recent decades have generated transformations in lifestyles,
    environmental conditions, values and beliefs, and have negatively influenced the
    level of health of the population. . Industrial development, the high unemployment
    rate, stress, sedentary lifestyle, among other triggering factors, are leading to the
    increase and appearance of acute diseases and chronic-degenerative pathologies,
    favored by new habits. People with life-threatening injuries and illnesses need
    close, constant medical care, provided by a team of health professionals specially
    trained in critical care care.
    GOALS:

    General:

     Develop Nursing functions effectively and efficiently in an Intensive Care


    Unit.
     Promote lines of research that are relevant in Advanced Intensive Care
    Clinical Practice.

    Specifics:

     Provide global and direct care to the patient and family.


     Evaluate the specific protocols and procedures in the situations and/or
    problems that patients present in the Intensive Care Unit.
     Skillfully and safely use technology and means to support patient diagnosis.
     Coordinate activities with other components of the multidisciplinary team of
    the Intensive Care Unit
     Prepare a Research Project on a specific problem for a patient in the
    Intensive Care Unit.

    CONTENT:

    Intensive care unit:


    Patient in critical condition: A patient in critical condition is one who presents
    vital alterations of one or more organs that endanger their life and who is admitted
    to the ICU to be subject to monitoring, resuscitation, maintenance of vital signs and
    definitive therapy.

    ICU admission criteria:

     Patients who present an acute critical condition or are on the verge of


    suffering from it.
     All patients must be theoretically recoverable from the problems that
    motivate admission to the unit.
     Patients who are unrecoverable in the long term but who have a problem
    that endangers their life immediately.
     ICU admission condition
     Insufficiency or instability of one or more major physiological systems.
     cardio respiratory arrest
     Severe respiratory insufficiency
     severe dehydration
     Renal insufficiency
     High physiological risk for older people with stability in danger.
     Potentially lethal arrhythmias.
     Acute myocardial infarction.
     Postoperative surgery with high risk
     Special and/or specialized care needs.
     Mechanical ventilatory support.
     Cardiac monitoring
     It is the measurement and recording of variables within a previously
    determined range.
     It allows us to control vital functions and complement our functions:
     HR *pulse oximetry
     FR

    Heart rate: It is the collection of cardiac electrical activity through the use of 3 or 5
    leads on the patient's chest.

    Aim

    Assessment of the ECG including analysis of heart rate, rhythm and morphology of
    the QRS complexes.

    Monitor types:
    Those that record only HR with electrocardiographic recording
    Those that record FC, FR, T/A, PVC and temperature on the screen

    Installation of cardiac electrodes:

    RA.- right arm


    LA.- left arm
    RL.- right leg
    LL.- left leg
    V.- precordial

    Non-invasive hemodynamic monitoring: Vital signs are those parameters that


    indicate the patient's hemodynamic status:

    F.C.
    FR
    T/A
    SaO2
    Medium pressure

    Pulsimetry: It is the non-invasive measurement of the oxygen transported by


    hemoglobin inside the blood vessels.

    Aim

    Obtain continuous information on oxygen saturation to assess its status.

    Electrocardiogram: It is the graphic representation of the electrical activity of the


    heart.

    Aim

    Obtain a record for the interpretation and documentation of cardiac electrical


    activity.
    Segments
    The P wave: consists of atrial activity and atrial contraction or systole.
    QRS Complex: corresponds to ventricular depolarization.
    T wave: corresponds to ventricular repolarization.
    Lead placement:

     V1 4th right intercostal space, next to the sternum.


     V2 4th left intercostal space, next to the sternum.
     V3 Between V2 and V4
     V4 5th left intercostal space, mid-clavicular line.
     V5 5th left intercostal space, anterior axillary line.
     V6 5th left intercostal space, mid-axillary line.
     RA and RL in right arm and ankle
     LA and LL in left arm and ankle

    Central venous pressure: CVP consists of measuring the pressure in the vena
    cava or right atrium in cm of water. It gives us an idea of heart sufficiency or failure.

    Aim

    Detect problems of hypovolemia, overhydration, heart failure and shock.


    Know if blood volume is deficient, adequate or excessive

    PVC values:

    0 to 5 cm H2O in right atrium


    6 to 12 cm H2O in vena cava.

    Values below normal could indicate a decrease in volume and the need for fluid
    administration, while values above normal would indicate an increase in volume.

    CVP measurement: It is measured at the distal end of the catheter with a scale.

    Arterial blood gas

    Concept: It is obtaining a blood sample through puncture

    The number of beds:


    The ideal room should not have less than 8 beds nor more than 12, it allows for an
    adequate division of human resources and adequate economic performance.
    Space requirements:
    Once the number of beds in the unit has been established, its total size must be
    established.
    • In addition to the number of beds, there are other determinants of space. Indeed,
    in an ICU different types of spaces are required:
    1) The space assigned for the beds, including the necessary place for the control
    equipment and the activity to be carried out.
    2. The support space for all activities within the unit, including central monitoring,
    drug preparation section, clean and dirty support areas, etc.
    3. Technical support spaces, including meeting areas, x-ray viewing room,
    archives, equipment storage areas, director's office, on-call doctor's rooms, etc.
    Location of the unit:
    Two different possibilities are presented:
    • The design of a new unit
    • The reconditioning of a pre-existing one.
    • In either situation, it must be taken into account that there are services that must
    be close to the Unit, others that must be at a distance and others that are
    indifferent.
    • It must be an area protected from the usual flow of circulation of patients, visitors
    and staff of other services.
    It is very important that the ICU has 24-hour access to:
    - Surgical wards - Emergency units - ICU - Sterilization - Hemodialysis - Laboratory
    - Blood bank - Pharmacy
    The space of a bed:
    An important consideration when designing the unit is to establish the space per
    bed, taking into account the needs for regular assistance and monitoring
    equipment, and the space necessary for non-continuous use equipment, such as
    hemodialysis machines, extracorporeal circulation equipment, plasmapheresis, etc.
    It must allow free access to the patient on all sides of the bed. This access is
    generally affected by the location of the bed and the type of monitors or sources of
    electricity, oxygen, aspiration, etc.
    It is convenient to have a specific storage space for each bed. Medications,
    disposable materials, the patient's own utensils and other items necessary for
    quick and efficient care must be located there.
    Other considerations to take into account:
    1) the possibility of maintaining orientation in time in critical patients, fundamentally
    in the day-night sequence, for which it is very useful to have windows with views to
    the outside
    2) helping to maintain adequate sleep patterns in the patient
    3) maintaining a correct level of sensory stimulation.
    Utilities:
    Each ICU must have sources of electrical power, water, oxygen, compressed air,
    vacuum and environmental control (temperature, humidity, lighting) capable of
    sustaining the needs of patients and the care team under normal and emergency
    situations, and must comply with with the requirements and standards of the
    respective control entities.
    Equipment of an intensive care unit patient cubicle:
    • intensive clinical bed with anti-decubitus mattress
    • cardiac monitor with the possibility of connection to a central unit with: ECG
    channel
    • invasive pressure channels
    • non-invasive pressure channel
    • Pulse oximeter
    • Temperature control
    • Corresponding alarms
    • fan volume
    • Oxygen intakes from the central network
    • central aspiration intakes
    • medical compressed air intake
    • Infusion pumps
    • enteral nutrition pump
    • insufflation bag with PEEP valve
    • Nebulizer
    • procedure lamp
    • wall sphygmomanometer or vital signs monitor
    • stethoscope

    Equipment in the intensive care unit:


    • Arrest cart with: defibrillator, cardiac monitor, PEEP insufflation bag
    • Portable heart monitor
    • Portable defibrillator with external pacemaker
    • Transfer fan
    • Procedure cart
    • Bronchoscope
    • Transfer stretchers
    • Oxigen bottles
    • Portable lightning equipment
    • Central monitor for 6 beds or more
    • Quadruple negatoscopes
    • Laryngoscopes for every 3 beds
    • Radiolucent bed
    • Non-invasive mechanical ventilator
    • Conventional hemodialysis machine, whose management will depend on the
    nursing staff of the Hemodialysis Unit.
    • Fiber intracranial pressure measurement system

    Organization of the intensive care unit :

    The ICU should excel in providing quality care to critically ill patients.
    For proper functioning, it requires a qualified team of doctors, nurses and
    paramedical technicians in sufficient numbers, whose function is to provide
    multidisciplinary and comprehensive care.

    Nursing:
    Nursing staff must have knowledge and experience in the management of critical
    patients, and must remain constantly trained to use diagnostic and therapeutic
    equipment. The training of intensive care nurses must be subject to some type of
    accreditation.
    The ICU nursing team is made up of a Nurse Coordinator and the clinical or
    treating nurses.
    Nurse (or) Head of Service:
    You will be responsible for organizing, scheduling, directing and evaluating ICU
    nursing activities, ensuring timely and effective care. Must have formal training in
    the area of administration and training in the area of intensive care or critical
    patient care.

    CONCLUSION

    The care of patients in critical condition tests the skills, knowledge and clinical
    experience of nurses, not only due to the health status of patients with multiple
    interfering needs, but also due to the barriers and distortions that arise to that the
    interaction and communication with patients offers the expected results in terms of
    contributing to the recovery of health or a peaceful death.
    As could be seen, some of the approaches of a nursing theorist were put into
    practice by nurses when carrying out care with critically ill patients, even when they
    had neither the intention nor the awareness to do so. This situation can be found in
    many care settings; However, it is expected that better results will be achieved in
    the practice of care if it is carried out under clearly defined theoretical guidelines
    that direct the actions of nursing practitioners.

    BIBLIOGRAPHY:
    Alles, M (2006) Management by Competencies the Dictionary. Argentina: Granica
    Editorial
    http://enfermeriaintegral.blogspot.mx/2008/02/implementacin-ytrabajo-en.html
    Pythagoras
    It is believed that he was born in 569 BC on the island of Samos , next to
    Miletus , being the son of Menesarchus, perhaps a rich merchant from
    Samos.
    He probably traveled to Egypt, Phenicia and Babylon. He returned to
    Samos during the dictatorship of Polycrates (538-522). Around 529 he
    traveled to southern Italy and founded the Pythagorean brotherhood in
    Croton .
    Educated in the teachings of early Ionian philosophers such as Thales of
    Miletus , Anaximander , and Anaximenes . Around 530 BC He settled
    in Crotona, a Greek colony in southern Italy, where he founded a
    movement with political and philosophical purposes, known as
    Pythagoreanism .
    Pythagoras' philosophy is known only through the work of
    his disciples. The Pythagoreans advised obedience and silence, abstinence,
    simplicity in dress and self-analysis. The first prominent modern vegetarian was
    Pythagoras. The Pythagorean diet came to mean avoiding the meat of slaughtered
    animals. Pythagorean ethics first became a philosophical morality between 490-
    430 BC with the desire to create a universal and absolute law including an order
    not to kill ''living creatures'', to abstain from ''disgusting strident slaughter'',
    particularly animal sacrifices, and to ''never eat meat'' - of ''The Feast of Heretics''.
    They believed in immortality and the transmigration of the soul. Pythagoras
    proclaimed that he had been Euphorbus, and fought during the Trojan War.
    Among the mathematical investigations of the Pythagoreans are their studies of
    even and odd numbers , prime numbers and squares , essential in the theory of
    numbers. They cultivated the concept of number, which became for them the
    crucial principle of all proportion, order and harmony in the universe. Through
    these studies, they established a scientific foundation for mathematics.

    In geometry they discovered the hypotenuse theorem , known as Pythagorean


    theorem , which states that the square of the hypotenuse of a right triangle is
    equal to the sum of the squares of the other two sides. In astronomy, the
    Pythagoreans represented an advance in classical scientific thought, since they
    were the first to consider the Earth as a globe that rotates with other planets
    around a central fire. They explained the harmonious order of all things as bodies
    moving according to a numerical scheme, in a simple and all-encompassing
    sphere of reality. They thought that the celestial bodies were separated from each
    other by intervals corresponding to lengths of harmonic chords and maintained that
    the movement of the spheres gives rise to a musical sound, the so-called harmony
    of the spheres .

    The Pythagoreans gained great political influence in Magna Graecia (southern


    Italy), which provoked reactions against them. The first forced Pythagoras to
    abandon Croton and retire to Metaponte , where it is said that he starved himself
    to death in 495 BC, although there are other versions of his death.
    He was a Greek philosopher and mathematician considered the first pure
    mathematician who contributed significantly to the advancement of Hellenic
    mathematics, geometry and arithmetic derived particularly from numerical
    relationships and applied, for example, to "the theory of weights and measures."
    Pythagoreanism formulated principles that influenced both Plato and Aristotle and
    more generally in the later "development of mathematics" and in rational
    philosophy in the West.
    No original writings of Pythagoras have been preserved.
    MATHEMATICAL THEORY: the mathematical science practiced by Pythagoras
    and mathematicians differs from the treatment of this science that is carried out in
    modern universities or institutions. "The Pythagoreans were not interested in
    formulating or solving mathematical problems" nor did "open problems" exist for
    them in The traditional meaning of the term Pythagoras' interest was "the
    principles" of mathematics "the concept of number" "concept of the triangle"
    Pythagoras recognized properties in numbers such as "personality" "masculine and
    feminine" "perfect and imperfect" "beautiful and ugly" the number ten was
    especially valued.
    THEOREMS:

    1. Pythagoras theorem
    2. perfect solids
    3. interior angles of a triangle

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