Download ICU

Lets Explore the ICU
What is the Purpose of the ICU?
To provide around-the-clock
intensive monitoring and
treatment of patients seven days
a week.
The ICU Health Care Team
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Pharmacists
Unit clerks
Nurses
Physicians (IM,
Pulmonary, etc.)
• PA’s
•Respiratory therapists
•Other medical consultants
from a broad range of
specialties including
surgery, pediatrics,
anesthesiology, and social
services
Intensive Care Unit
Where do the patients come from?
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The general hospital floors
The ER
Transfers from other hospitals & nursing homes
OR
“Direct Admits”, bypassing the ER
Intensive Care Unit
What types of patients would you see?
Post heart surgery
MI’s
Renal and Liver failure
CVA’s
Pulmonary embolism
Sepsis
Shock
Drug overdose
Arrhythmias
Suicidal
Hypoglycemic coma
ARDS
A Common ICU Room? Or NOT!
A REAL ICU Room
A day in the life of
an ICU nurse…
• YouTube - Critical Care Nurse: Day in The Life
http://www.youtube.com/watch?v=P3x-ASSwLv0
EQUIPMENT
The monitors are your second major bedside
assessment tool – the first is your eyes.
What is on the monitor
screen?
•EKG
•Heart rate
•Blood pressure
•Arterial pressure
•O2 Saturation
•Respirations
EQUIPMENT cont….
Ventilators:
a machine designed
to mechanically move
breathable air into
and out of the lungs
CHEST TUBES:
a flexible plastic tube that is
inserted through the side of
the chest into the pleural
space to drain blood, body
fluid or air.
LARYNGOSCOPE
& ETT
•Laryngoscope: An
instrument that helps in
intubation for mechanical
ventilation.
•Endotracheal Tube:
inserted into a patient's
trachea in order to ensure
that the airway is not
closed off and that air is
able to reach the lungs.
Regarded as the most
reliable available method
for protecting a patient's
airway.
Intubated Patient
CRASH CART
A set of trays/drawers/shelves on
wheels used in hospitals for
transportation and dispensing of
emergency meds/equipment at the
site of the emergency for life
support.
Includes:
•Defibrillator with pads
•AMBU bag
•Medications
•IV equipment
•Normal Saline
•Procedure kits
•Oxygen tank
•And much more
Central IV Lines
A catheter placed into
a large vein in the neck
(internal jugular
vein),chest (subclavian
vein) or groin (femoral
vein).
It is used to administer
medication or fluids,
obtain blood tests and
directly obtain
cardiovascular
measurements (central
venous pressure).
What EQUIPMENT do you SEE?
LABS
•Nurses mostly draw the labs
•Similar labs to those drawn in the ER
Common Labs Include:
•ABG’s (drawn by the RT usually)
•Evaluates the respiratory effort
•Glucose levels
•Chemistry
•Coagulation--Fibrinogen,
Prothrombin
•Cardiac enzymes—proteins
released into the bloodstream
when heart muscle damage
Intensive Care Unit
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What are the routines of the ICU?
Report, assessment, time management
Record info: flow sheets, med sheets, intake
and output totals, lab results, nurses notes
Monitoring
KARDEX
Carrying out orders
Documentation q2h
Administering medication
Intensive Care Unit
How does the ICU affect the family members?
• Feelings of uncertainty
• Scared and afraid
• Angry
• Inquisitive
• Guilt
Intensive Care Unit
The IN’s and OUT’s of and
ICU Patient
SEE HANDOUT
Intensive Care Unit
How to care for the family members?
Practice HOLISTIC Care!!!
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Be empathetic
EDUCATE, EDUCATE, EDUCATE
Anticipate needs
Keep them updated
What’s next?
•Transfer to floor
•Take to surgery
•Discharge (rare)
What are some important facts to consider
before going into an ICU as a student?
Intensive Care Unit
There is more than one type of ICU? WHAT?
NICU
PICU
SICU
MICU
CICU
Lets look inside a
NICU…
NICU at Cook Children’s Fort Worth
http://www.youtube.com/watch?v=NZT-mnCzTvc
What’s a NICU?
• Neonatal Intensive Care Unit/Special Care Nursery
• For premature and critically ill term infants
• Different levels of care for newborns…Levels I-III
– Level I: Lowest level of care (Newborn Nursery)
– Level II: Intermediate care—IV fluids, oxygen, “feeder growers”,
CPAP, 32 wks gestation or greater
– Level III: Highest level of care
• 23 weeks gestation or greater (generally)
• Ventilators
• Surgeries (sometimes in the unit!)—post operative
care
• Nitrous oxide therapy, Extra Corporeal Membrane
Oxygenation (ECMO)– heart/lung bypass
A Real NICU
Who works there?
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Pediatricians
Neonatologists
NNPs, PNPs
Nurses
OT (feeding)
PT (positioning,
massage)
• Child life specialist
• Respiratory Therapy
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Pharmacist
Pharmacy Technicians
Lactation Consultants
Chaplains
And more!
Why do we need a special ICU for
infants?
• In premature infants, every body system is
underdeveloped
• What problems do you think that a baby
would have with each body system?
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Nervous?
Cardiovascular?
GI?
Immune?
Endocrine?
Respiratory?
Musculoskeletal?
Reproductive?
Urinary?
What problems would you see?
• Chronic lung disease of
prematurity (BPD)
• Necrotizing enterocolitis
• Jaundice
• Meconium aspiration
• Congenital heart defects
• Apnea
• Anemia
• Intraventricular
Hemorrhage
• Bradycardia
• Retinopathy of
prematurity
• Sepsis
• Hypothermia
Bronchopulmonary Dysplasia
(BPD)
Developmental care
• Simulate a womb-like environment
– Warm, humid, dark, quiet
• Developmental positioning to aid with
neurologic and musculoskeletal
development
– Make the environment
less stressful
• Poor weight gain
and growth
• Abnormal VS
Stress signals
• May be different than
in term babies,
children and adults
• Crying
– Less common in the very ill
or very premature babies
• Frowning
• Wrinkled forehead
• Averted gaze
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Extended arms and legs
“Stop” hands
“Shut down”
Changes in vital signs
What stress cues are this baby
displaying?
What is RIGHT with this
picture?
The Goal…