NURSING MANAGEMENT
OF CRITICALLYILL
PATIENT
Prepared by :
Ms Mononita Bhattacharjee
([Link] Medical Surgical
Nursing)
WHAT IS…
• CRITICAL CARE NURSING
• CRITICALLY ILL PATIENTS
• CRITICAL CARE UNITS
INTRODUCTION
CRITICAL CARE NURSING: It is the field
of nursing with a focus on the utmost care of
the critically ill (or) unstable patients.
CRITICALLY ILL PATIENTS : critically ill
patients are those who are at risk for actual (or)
potential life threatening health problems.
Cont…
CRITICAL CARE UNITS: CCUs or
Intensive care units (ICUs) are designed to
meet the special needs of acutely and critically
ill patients.
WHAT ARE THE CONDITIONS
CONSIDERED AS CRITICAL?
• Any person with life Threatening
condition
• Patients with :
– Acute respiratory failure
– Acute mycardial infarction
– Cardiac tamponate
– Severe shock
– Heart block
Cont…
– Acute renal failure
– Poly trauma,
– Multiple Organ failure
and
– Organ Dysfunction
– Severe burns
CLASSIFICATION OF
CRITICAL CARE PATIENTS
• Level O : normal ward care.
• Level 1: at risk of deteriorating , support
from critical care team.
• Level 2 : more observation or
intervention, single failing organ or post
operative care
• Level 3; advanced respiratory support or
basic respiratory support ,multi-organ failure.
GUIDING PRINCIPLES
• Delivery of optimal and appropriate care
• Relief of distress
• Compassion and support
• Dignity
• Information
• Care and support of relatives and
caregivers
PROCESS OF
NURSING
MANAGEMENT
ADDMISSION & ORIENTATION
OF THE PATIENT TO ICU
CCU or ICU Orientation to patient &
family members.
ADMISSION QUICK CHECK
ASSESSMENT IN CCU
• General appearance (consciousness) .
• Airway: Patency Position of artificial airway
(if present)
• Breathing: Quantity and quality of
respirations (rate, depth, pattern, symmetry,
effort, use of accessory muscles) Breath
sounds Presence of spontaneous breathing.
Cont…
• Circulation and Cerebral Perfusion: ECG
(rate, rhythm, and presence of ectopy) Blood
pressure Peripheral pulses and capillary refill
skin, color, temperature, moisture. Presence
of bleeding Level of consciousness,
responsiveness.
Cont…
• Past Medical History
• Medical conditions, surgical procedures
• Psychiatric/emotional problems
• Hospitalizations
• Medications (prescription, over-the-counter,
illicit drugs) and time of last medication
dose.
• Allergies
• Review of body systems
PHYSICAL ASSESSMENT IN
CCU/ICU
• Nervous system
• Cardiovascular system
• Respiratory system
• Renal system
• Gastrointestinal system
• Endocrine, hematologic,
and
• Immune systems
• Integumentary system
ASSESSMENT OF THE PATIENTS
& PLANNING FOR PATIENT
CARE
• KNOW : medical history, social history,
medical interventions
• SEE : airway patency, pallor, sweating, mental
state, posture, facial expression, general
condition
• FIND : respiratory care, adequacy of
oxygenation, pulse, blood pressure, urine
output, conscious level, monitor for changes
in any of the above • ( Norman & Cook,
2000)
ASSESSMENT OF THE PATIENTS
& PLANNING FOR PATIENT
CARE IN CCU/ICU
A, B, C, D, E MODELS
• Airway: patent
• Breathing: respiratory rate
• Circulation: pallor, hemorrhage
• Disability: altered conscious level
• Expose to examine: unseen
hemorrhage, wound leakage. ( Smith,
2000)
NURSING MANAGEMENT OF
CRITICALLY ILL PATIENT
• Continuous monitoring
• Respiratory care
• Cardio vascular care
• Gastrointestinal
• Nutritional care
• Neuromuscular
• Comfort and reassurance
Cont…
• Communication with the patient
• Infection control, skin care ,general
hygiene and mouth care
• Fluid, electrolyte and glucose balance
• Bowel and Bladder care
• Dressing and wound care
• Communication with patient and relatives
Continuous monitoring
Respiratory care
• Improving Oxygenation
• Appropriate use of medication
• Monitoring of treatment efficacy
• Recognition of early warning signs of an
exacerbation with rapid access to appropriate
services (Ventilator, Crash trolley, Emergency
drugs)
• Positioning (Fowlers position)
• Suctioning if necessary
• Tracheostomy care.
Cardio vascular care
• Continuous Cardiac Monitoring
(dysrhythmia)
• Appropriate use of medication
• Monitoring of treatment efficacy
• Recognition of early warning signs of an
exacerbation with rapid access to appropriate
services (Defibrillator , ECG, Emergency
drugs)
• Positioning
Gastro-intestinal/ Nutritional care
• The supine position predisposes to gastro-
esophageal reflux and aspiration pneumonia
Patients with 30 degree head up prevents this.
• Early enternal feeding reduces infection, stress
ulceration and GI bleeding.
• Immobility is associated with gastric stasis and
constipation, So, provide gastric stimulants
and laxatives.
Neuromuscular care
• Immobility, prolonged neuromuscular
blockage and sedation promotes atropy, joint
contractures and foot drops may occur.
• Physiotherapy and splints may be required.
Comfort and reassurance
• Anxiety, discomfort and pain must be
recognized and relieved with reassurance,
physical measures, analgesics and sedatives.
• In particular, endotracheal or nasogastric tubes,
bladder or bowel distension, inflamed.
• Line sites ,painful joints and urinary cathetors
often causes discomfort, and are often
overlooked.
Communication with the patient
• Assist interaction with appropriate
communication .
• Tell the patient about the care
prognosis.
• And if the patient is unconscious ,
communicate about their health status and
care prognosis to their family members.
Communication with the patient
Infection control
• Hand washing is vital to prevent transmission
of organisms between patients.
• Disposable aprons are recommended, sterile
technique (e.g. gloves, masks, gowns, sterile
field) is essential for all invasive
procedures(e.g. line insertion).
Cont…
• Isolation transmissible infections (e.g.
for
tuberculosis)
• Thorough cleaning of bed spaces(e.g. routinely
and after patient discharge)
Skin care, general hygiene and mouth
care
• Cutaneous pressure sores are due to local
pressure(e.g. bony prominences). Friction
malnutrition edema ischemia damaged related
to moist or soiled skin.
• Provide sponge bath, mouth care and general
hygiene to the patient.
Pressure Points
• Turn every 2 and protect
patientsusceptible areas.
hours beds relieves
Special and assist turning.
pressure
• Provide back care.
Fluid electrolytes and glucose balance
• Regularly assess fluid and electrolytes balance
by maintaining I/O chart hourly.
• Insulin resistance and hyperglycemia
are common but maintaining
normo-glycemia
improves outcomes.
Bladder care
• Urinary catheters causes painful urethral ulcers
and must be stabilized by providing urinary
catheter care.
• Early removal reduces urinary tract infections.
Dressing and wound
care
• Replace wound dressings as necessary.
• Change arterial and central venous
catheter dressings every 48- 72 hours.
Communication with relatives
• Family members receive information from
many care givers with different perspectives
and knowledge.
• Critical care teams must aim to be consistent
in their assessments and honest about
uncertainties.
• All conversation should be documented.
For Listening!
