Critical Nurse

coronary care unit
By Tekalign M.( Msc.)
02/23/2024 1
OBJECTIVE
At the end of this lesson the students will be able to
Understand critical care basics
Describe Prevention and causes of error in the ICU
Identify reduction methods of nosocomial infection
02/23/2024 2
CRITICAL CARE BASICS
Definition Critical care nursing is the delivery of

specialized care to critically ill patients.Illnesses and
injuries commonly seen in patients on critical care
units (CCUs) include:
 Gunshot wounds
 Heart failure and acute coronary syndromes

(unstable angina and myocardial infarction (MI).
02/23/2024 3
CRITICAL …
 Traumatic injuries (automotive collisions and
fails).
 Acute and chronic renal failure.
Lung, esophageal and gastric cancer
 Shock
02/23/2024 4
CRITICAL …
Surgeries such as abdominal and aortic

aneurysm repair
Acute respiratory failure and pulmonary
embolism.
 Acute pancreatitis, acute upper GI bleeding
and acute liver failure.
02/23/2024 5
The critical care nurse
Critical care nurses are responsible for making sure

that critically ill patient and members of their families
receive close attention and the best care possible.
Role:
staff nurses, nurse-educators, nurse-managers, case
managers, clinical nurse specialists, nurse
practitioners and nurse researchers.
02/23/2024 6
Staff Nurse:
Makes independent assessments
 Plans and implements patient care
Provides direct nursing care
Makes clinical observation and executes

interventions
Promotes activities of daily living
02/23/2024 7
Nurse Educators:
 Assesses patients‘ and families‘ learning needs;

plans and implements teaching strategies to meet
those needs.
Evaluate effectiveness of teaching
 Educates peers and colleagues
Possesses excellent interpersonal skills
02/23/2024 8
Nurse Manager:
Acts as an administrative representative of the unit.
Ensures that effective and quality nursing care is
provided in a timely and fiscally sound environment.
02/23/2024 9
Case Manager:
Manages comprehensive care of an individual

patient.
 Encompasses the patient‘s entire illness episode,
crosses all care settings and involves the collaboration
of all personnel who provide care.
 Is involved in discharge planning and making
referrals.
 Identifies community and personal resources.
 Arranges for equipments and supplies needed by
the patient on discharge.
02/23/2024 10
Clinical Nurse Specialist:
Participates in education and direct patient care.
Consults with patients and family members
Collaborates with other nurses and health care
team members to deliver high-quality care.
02/23/2024 11
Nurse Practitioner:
Provides primary health care (independently).
May obtain histories and conduct physical examinations.
Orders laboratory and diagnostic tests and interprets

results.
Treat patients
Counsels and educates patients and families.
02/23/2024 12
Nurse Researcher:
Reads current nursing literature

Applies information in practice
Collects data
 Conducts research studies
 Serves as a consultant during research study
implementation.
02/23/2024 13
Working Area:
Critical care nurses work wherever critically ill

patients are found, including:
 Adult, pediatric and neonatal ICUs.
 Coronary care and progressive coronary care units
 Emergency departments
 Post anesthesia care units.
02/23/2024 14
Wide range of responsibilities:
Being an advocate
Using sound clinical judgment
 Demonstrating caring practices
 Collaborating with a multidisciplinary team
 Demonstrating an understanding of cultural diversity
Providing patient and family teaching
02/23/2024 15
SCOPE OF CRITICAL CARE NURSING PRACTICE:
The scope of critical care nursing practice is described as a
dynamic process with three components:
1- The critically ill patients and their significant social
relationship.
2- The critical care nurse.
3- The environment where critical care nursing is practiced.16

02/23/2024
The goal of critical care nursing is :-
To ensure effective interaction of these three

elements to affect nursing practice and optimal
patient outcomes. The needs of the critically ill
patients are considerable. (two needs)
Physical needs: are equated with basic physiological

or biological needs for air, nutrition, and elimination.
02/23/2024 17
Non-physical needs: Include social, spiritual, and
psychological needs, social integrity (self-esteem),
information, and communications.
The nature of critical care is such that physical
needs are considered a priority and are almost always
met.
However, the critical care environment can actually
obstruct the fulfillment of non-physical needs
02/23/2024 18
EXTENDED ROLES AS CRITICAL CARE NURSES
Critical care nurses have roles beyond their

professional boundary. With proper training and
established guidelines, algorithms, and protocols that
are continuously reviewed and updated, critical care
nurses also perform procedures and therapies that
are otherwise done by doctors..
02/23/2024 19
Such procedures and therapies are:
a. Sampling and analyzing arterial blood gases;
b. Weaning patients off ventilations;
c. Adjusting intravenous analgesia / sedations;
d. Performing and interpreting ECGs;
e. Titrating intravenous and central line medication

02/23/2024 20
f. Initiating defibrillation to patient with ventricular
fibrillation or lethal ventricular tachycardia
g. Removal of pacer wire, femoral sheaths and chest
tubes
h. Other procedures deemed necessary by their
respective institution under a clinical protocol

02/23/2024 21
PREVENTION OF ERRORS IN THE ICU
Intensive care unit patients are critically ill and they
are:
1. Attached to many equipments
2. Indwelling catheter/lines
3. Various invasive/non invasive procedure
4. Various medication
5. Various type of documentation
6. Limited time and pace of activity quicker
02/23/2024 22
TYPES OF ERRORS
Equipment related
Medication related
Documentation related
Communication related
 Skill related
Infection related
 Management related
02/23/2024 23
EQUIPMENT RELATED
Cardiac Monitor
Set alarm limits
 Inform at slightest change
 Never suspend /put off alarms.
 One monitor nurse/doctor at the central station at

all times.
02/23/2024 24
Ventilator
Constant attention.
Setting alarm limits.
Monitoring saturation.
 Securing of the tube
 Ambu bag with reservoir at bedside.
 Prevention of tube blockage.
02/23/2024 25
Ventilator…
 Maintaining of respiratory flow sheet.
 Use of steri-case of high peep.
Prevention of pressure ulcers,& oral ulcers
All ventilators to be connected to the ups system.
Prevention of infection.
Good communication & psychological support
 Sedation, pain relief,

02/23/2024 26
Errors…
Infusion pump
 Adequate Knowledge of equipment
 Accurate flow rate
Syringe pump
 Knowledge about medicine dilution
ECG machine
 Attach leads properly
02/23/2024 27
Errors…
MEDICATION RELATED
Follow 6 RIGHTS
1) Right patient
2) Right medicine
3) Right dose
4) Right route
5) Right time
6) Right documentation
No abbreviation
02/23/2024 28
Errors…
DOCUMENTATION RELATED
 Recording all events
All sheets to have patients label
 Filing of printed reports
COMMUNICATION RELATED
 Language
 Be a good listener
02/23/2024 29
Errors…
SKILL RELATED
Pressure ulcer
Aspiration
 Injury
 Oral ulcer
 Bowel and bladder
 Blood collection
02/23/2024 30
Errors…
INFECTION RELATED
Infection control protocol
Hand washing/ Hand rub
Aseptic technique
 Needle stick injury
02/23/2024 31
Errors…
MANAGEMENT RELATED
 Nurse patient ratio
 Delegation of duty
 Check list
 Stock
02/23/2024 32
PREVENTION OF NOSOCOMIAL INFECTION
NOSOCOMIAL INFECTION
 Clinical infections occurring in a patient after 48 hours
of admission to the hospital are known as Nosocomial
or Hospital acquired infection.
02/23/2024 33
RISK FACTORS FOR NOSOCOMIAL INFECTION
A. Inadequate primary defenses
 Broken skin or mucosa
 Traumatized tissue
 Decreased cilliary action
 Obstructed urine outflow
 Altered peristalsis
 Change in pH of secretions
 Decreased mobility
02/23/2024 34
RISK FACTORS…
B. Inadequate Secondary Defenses
 Reduced hemoglobin level
 Suppression of WBC‘s ( drug or disease related )
 Low WBC Count
Suppressed inflammatory response

02/23/2024 35
RISK FACTORS…
RISK OF NOSOCOMIAL
INFECTION IN ICU‘S IS HIGH.
Why???
02/23/2024 36
RISK OF NOSOCOMIAL INFECTION IN ICU‘S IS HIGH??
They are critically ill
More invasive procedures are performed
Surgical procedures are performed
Overuse of broad spectrum antibiotics
02/23/2024 37
RISK OF NOSOCOMIAL…
 Use of multiple devices

 Long duration of stay
 Handled by many
 Immuno-compromised
 Multiorgan failure
 More use of equipment
02/23/2024 38
SITES AND CAUSES FOR NOSOCOMIAL INFECTIONS
1. URINARY TRACT
Improper hand hygiene
Frequency of catheterization
 Open drainage system
 Disconnection of catheter and tubing

02/23/2024 39
Sites and causes…
Repeated bladder irrigations
 Improper perineal hygiene
Contamination of drainage bag port
Obstructed urinary drainage
02/23/2024 40
Sites and causes…
2. SURGICAL OR TRAUMATIC WOUNDS

 Improper hand hygiene and washing techniques
 Improper skin preparation
Improper dressing techniques
Use of contaminated solutions/ointments/dressing
material /instruments
02/23/2024 41
Sites and causes…
3. RESPIRATORY TRACT
Improper hand hygiene
Contaminated equipment
Improper / inadequate suction techniques
Improper mucous/secretions disposal

02/23/2024 42
Sites and causes…
4. BLOOD STREAM
oImproper hand hygiene
o Improper techniques used for vascular access
o Contaminated IV fluids / Additives/drugs and devices
o Improper care and failure to change of cannulation sites
02/23/2024 43
Thank you very
much
02/23/2024 44

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coronary care unit

By Tekalign M.( Msc.)

Understand critical care basics

Describe Prevention and causes of error in the ICU

Identify reduction methods of nosocomial infection

Definition Critical care nursing is the delivery of

 Heart failure and acute coronary syndromes

 Traumatic injuries (automotive collisions and

Surgeries such as abdominal and aortic

Critical care nurses are responsible for making sure

Makes independent assessments

 Plans and implements patient care

Provides direct nursing care

Makes clinical observation and executes

 Assesses patients‘ and families‘ learning needs;

Acts as an administrative representative of the unit.

Ensures that effective and quality nursing care is

provided in a timely and fiscally sound environment.

Manages comprehensive care of an individual

Participates in education and direct patient care.

Consults with patients and family members

Collaborates with other nurses and health care

team members to deliver high-quality care.

Provides primary health care (independently).

May obtain histories and conduct physical examinations.

Orders laboratory and diagnostic tests and interprets

Counsels and educates patients and families.

Reads current nursing literature

Critical care nurses work wherever critically ill

 Coronary care and progressive coronary care units

 Post anesthesia care units.

The scope of critical care nursing practice is described as a

dynamic process with three components:

1- The critically ill patients and their significant social

2- The critical care nurse.

3- The environment where critical care nursing is practiced.16

To ensure effective interaction of these three

Physical needs: are equated with basic physiological

Critical care nurses have roles beyond their

c. Adjusting intravenous analgesia / sedations;

d. Performing and interpreting ECGs;

e. Titrating intravenous and central line medication

fibrillation or lethal ventricular tachycardia

g. Removal of pacer wire, femoral sheaths and chest

h. Other procedures deemed necessary by their

respective institution under a clinical protocol

 Inform at slightest change

 Never suspend /put off alarms.

 One monitor nurse/doctor at the central station at

Setting alarm limits.

 Securing of the tube

 Ambu bag with reservoir at bedside.

 Prevention of tube blockage.

 Maintaining of respiratory flow sheet.

 Use of steri-case of high peep.

Prevention of pressure ulcers,& oral ulcers

All ventilators to be connected to the ups system.

Good communication & psychological support

 Sedation, pain relief,