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    Nursing Management of Criticallyill Patient: Prepared By: Ms Mononita Bhattacharjee (M.SC Medical Surgical Nursing)

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    priyagerard
    Critical care nursing involves providing utmost care to critically ill or unstable patients in critical care units like ICUs. Nurses manage critically ill patients through continuous monitoring, respiratory support, cardiovascular care, infection control and dressing changes. Other aspects of care include nutritional support, skin care, communication and addressing patients' comfort. The goal is to relieve distress, support dignity and provide information to patients and their families.

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    Nursing Management of Criticallyill Patient: Prepared By: Ms Mononita Bhattacharjee (M.SC Medical Surgical Nursing)

    Uploaded by

    priyagerard
    71 views35 pages
    Critical care nursing involves providing utmost care to critically ill or unstable patients in critical care units like ICUs. Nurses manage critically ill patients through continuous monitoring, respiratory support, cardiovascular care, infection control and dressing changes. Other aspects of care include nutritional support, skin care, communication and addressing patients' comfort. The goal is to relieve distress, support dignity and provide information to patients and their families.

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    nursing management of critically ill patient

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    Critical care nursing involves providing utmost care to critically ill or unstable patients in critical care units like ICUs. Nurses manage critically ill patients through continuous monitoring, respiratory support, cardiovascular care, infection control and dressing changes. Other aspects of care include nutritional support, skin care, communication and addressing patients' comfort. The goal is to relieve distress, support dignity and provide information to patients and their families.

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    71 views35 pages

    Nursing Management of Criticallyill Patient: Prepared By: Ms Mononita Bhattacharjee (M.SC Medical Surgical Nursing)

    Uploaded by

    priyagerard
    Critical care nursing involves providing utmost care to critically ill or unstable patients in critical care units like ICUs. Nurses manage critically ill patients through continuous monitoring, respiratory support, cardiovascular care, infection control and dressing changes. Other aspects of care include nutritional support, skin care, communication and addressing patients' comfort. The goal is to relieve distress, support dignity and provide information to patients and their families.

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    © All Rights Reserved
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    of 35

    NURSING MANAGEMENT

    OF CRITICALLYILL
    PATIENT

    Prepared by :
    Ms Mononita Bhattacharjee
    (M.Sc 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!

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