INTRODUCTION TO CRITICAL CARE

Critical care nursing is the field of nursing with a focus on the utmost care of the critically ill or unstable patients following extensive injury, surgery or life threatening diseases. The aims of Intensive and Critical Care Nursing are to promote excellence of care of critically ill patients by specialist nurses and their professional colleagues.

Critical Care

  • Critical care (medicine) is the multidisciplinary healthcare specialty that cares for patients with acute, life-threatening illness or injury.
  • Critical care (Intensive Care) is a healthcare specialty that cares for patients with acute, life-threatening illness or injury and involves multiple skills and specialties.

Critical Illness

  • Critical illness is a condition where life cannot be sustained without invasive therapeutic interventions.

Critically Ill Patient

  • Critically ill patient is defined as those patients who are at high risk for actual or potential life-threatening health problems and they are highly vulnerable, unstable and complex, thereby requiring intense and vigilant nursing care.

The Aim of the Critical Care

  • The aim of the critical care is to see that one provides a care such that patient improves and survives the acute illness or tides over the acute exacerbation of the chronic illness.

CRITICAL CARE NURSING

  • Critical care nursing is the field of nursing with a focus on the utmost care of the critically ill or unstable patients.
  • Critical care nursing is that specialty within nursing that deals specifically with human responses to life-threatening problems.
  • Critical care nursing is a branch of nursing practice that deals patients with the life-threatening problems and being supported with life saving measures.

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 the necessary equipment's and supplies are mandatory for smooth running of the unit.
  • 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 holistic patient care. Collaborate practice is more and more warranted for critical care more than in any other field.
  • 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.
  • Continuous monitoring and treatment.
  • High intensity therapies and interventions.
  • Alert to early manifestation of other organ failure.
  • Recognition of parameters denoting progress or deteriorating.
  • Communication - Intra professional, inter departmental and inter personal communication has a significant importance in the smooth running of unit. Collaborative practice of communication model unlike the traditional practice model enhances better outcome as far as patient, nurse, physician and hospital are concerned. This model centers around the patient, fosters individual clinical decision-making, uses integrated medical records and join review of care.
  • 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.
  • Crisis Intervention & 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 pattern and provide avenues for positive coping.
  • Expert surveillance and efficiency.-

CRITICAL CARE NURSE

Critical care nurse is a licensed professional nurse who is responsible for providing total nursing care of seriously acute and chronically ill patients experiencing life-threatening problems requiring complex assessment, high intensity therapies and interventions, and continuous nursing vigilance.

Ratio

  • ICU nurse-patient ratio 1:1 for ventilated cases and 1:2 for other cases.
  • 1:2 to 1:3 nurse patient ratios is acceptable for less seriously sick patients.

Qualifications

  • Should be a registered nurse (RN)
  • Should preferably have critical-care training course or orientation that includes essential information on the care of the critically ill patient.

Roles

  • Care provider : help the client to obtain necessary care and supporting the basic needs and comprehensive direct care to the patient and family
  • Educator: based on patient's needs and severity of the condition
  • Manager: coordinates the care provided by various health care
  • Advocate: protects the patient's rights

Responsibility / Functions

  • Critical-care nurse will perform actions listed below:
  • Assesses and implements treatment for patient responses to life-threatening health problems
  • Provides direct measures to resuscitate, if necessary
  • Uses independent, dependent, and interdependent interventions to restore stability, prevent complications, and achieve and maintain optimal patient responses
  • Critical Care Nurse
  • Provides health education to the patient and family
  • Supervises patient care and ancillary personnel
  • Supports patient adaptation, restores health, and preserves the patient's rights, including the right to refuse treatment

Skill

  • Admission, Transfer and Discharge of patient
  • Bedside Safety
  • Bedside and Patient Care Planning
  • Patient Care Issues –
    • Essential patient care
    • Skin Care
    • Safe Moving and handling
    • Monitoring of vital signs
  • Documentation
    • Observation chart,
    • Fluid balance chart,
    • Care plan
  • Respiratory Care (Airway and Breathing)
    • Airway management,
    • Manual Ventilation,
    • Care of Endotracheal/ Tracheostomy Tube
    • Respiratory Support,
    • Ventilation
    • Extubation
  • Cardiovascular Care (Circulation)
    • Arterial lines
    • Central lines
    • Fluid management
    • Emergency clinical situations (shock, cardiac arrest)
  • Neurological Care (Disability)
    • Level of consciousness (AVPU / GCS)
    • Sedation and analgesia
  • Nutritional Care
    • Enteral nutrition
    • Glycaemia control
  • Psychosocial / Spiritual Care
  • Infection Control
  • Laboratory Investigations

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