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King Saud University
college of nursing
critical care nursing
lecture1
Introduction to critical care nursing
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Learning Outcome 1
• Define critical care nursing
• Define critical care nurse
• Define critical care patient
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Critical-care nursing
• is that specialty within nursing that deals
specifically with human responses to lifethreatening problems.
• A critical-care nurse is a licensed
professional nurse who is responsible for
ensuring that all critically ill patients and
their families receive optimal care
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Critical-care nursing
• The first intensive care units emerged in
the 1960s as a means to provide care to
very sick patients who needed one-to-one
care from a nurse.
• The first critical care unit were CCU and
recovery room
• It was from this environment that the
specialty of critical-care nursing emerged.
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Critical-care nursing
• Critical-care nurses rely upon a
specialized body of knowledge, skills, and
experience to provide care to patients and
families and create environments that are
healing, humane, and caring.
• Foremost, the critical-care nurse is a
patient advocate.
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Nurse as Patient Advocate
• Support autonomous decision making and
decisions made; respect values; represent
patient based on these choices
• Intervene in patient’s best interests; intercede for
those who cannot advocate for selves; help
patients get care
• Educate patient and family members
• Ensure safe, quality care
• Serve as liaison between patient, family, and
providers
• Help the patient obtain necessary care
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critically ill patients
• AACN Definition
• American Association of Critical Care Nurses
defines critically ill patients as
• “those who are at high risk for actual or potential
life threatening health problems. The more
critically ill the patient is, the more likely he or
she is to be highly vulnerable, unstable and
complex, thereby requiring intense and vigilant
nursing care.”
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Learning Outcome 3
• Discuss the concerns expressed by
critically ill patients
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1. Concerns of critically ill patients
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Noise, lights, and alarms
Being thirsty
Having tubes in their mouths and nose
Not being able to communicate
Being restricted by tubes/lines
Being unable to sleep
Not being able to control themselves
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Critical Care Environment
• Noise levels
• Light 24 hours/day
• Movement of
people and
equipment
• Lack of privacy
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Learning Outcome 4
• Compare and contrast the use of enteral
and parenteral nutrition in the critically ill
patient.
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COMMON
PROBLEMS OF
CRITICAL CARE
PATIENTS
• Nutrition:
– The primary goal of nutritional support is to
prevent or correct nutritional deficiencies.
– This is usually accomplished by the early
provision of enteral nutrition (i.e., delivery of
calories via the gastrointestinal [GI] tract) or
parenteral nutrition (i.e., delivery of calories
intravenously).
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1. Enteral Nutrition
• Delivery of nourishment by feeding tube in the
gastrointestinal tract
• Delivered through a large bore nasal or oral
gastric tube (short-term use)
• Small bore feeding tubes or gastrostomies (longterm use)
• Preferred route for nutritional supplementation
• Lower rates of infection
• Composed of proteins, calories, vitamins, and
minerals
• Standard formulas
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Enteral Feeding
• . Common Problems with Early Enteral
Feeding
• High gastric residual volumes
• Bacterial colonization of the stomach
• Increased risk of aspiration pneumonia
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Parenteral nutrition
• Infusion of nutrients using a venous catheter located in a large,
usually central vein
• Used when nutrition supplement is needed and enteral feedings
cannot be initiated within 24 hours of ICU admission
• Formulated by providing dextrose, lipids, protein, electrolytes, water,
and vitamin elements
• Specific components of the infusion is prescribed for each patient
• should be considered only when the enteral route is unsuccessful in
providing adequate nutrition or contraindicated
(e.g., paralytic ileus, diffuse peritonitis, intestinal obstruction, pancreatitis,
GI ischemia, intractable vomiting, and severe diarrhea).
•
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Common Problems Associated with Parenteral
Nutrition/Nurse Interventions
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Gut mucosal atrophy
Overfeeding
Hyperglycemia
Increased risk of infectious complications
Increased mortality
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Learning out come 5
Identify common problems in critical care
unit and there management
•
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Anxiety:
– The primary sources of anxiety for patients include the perceived
or anticipated threat to physical health, actual loss of control or
body functions, and an environment that is foreign.
– Assessing patients for anxiety is very important and clinical
indicators can include agitation, increased blood pressure,
increased heart rate, patient verbalization of anxiety, and
restlessness.
– To help reduce anxiety, the nurse should encourage patients
and families to express concerns, ask questions, and state their
needs; and include the patient and family in all conversations
and explain the purpose of equipment and procedures.
– Antianxiety drugs and complementary therapies may reduce the
stress response and should be considered.
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Pain:
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(1)
(2)
(3)
(4)
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The control of pain in the ICU patient is paramount as
inadequate pain control is often linked with agitation and
anxiety and can contribute to the stress response.
ICU patients at high risk for pain include patients
who have medical conditions that include ischemic, infectious,
or inflammatory processes;
who are immobilized;
who have invasive monitoring devices, including endotracheal
tubes;
and who are scheduled for any invasive or noninvasive
procedures.
Continuous intravenous sedation and an analgesic agent are a
practical and effective strategy for sedation and pain control.
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Impaired communication:
– Inability to communicate can be distressing for the
patient who may be unable to speak because of
sedative and paralyzing drugs or an endotracheal
tube.
– The nurse should explore alternative methods of
communication, including the use of devices such as
notepads or computer keyboards.
– Nonverbal communication is important. Comforting
touch with ongoing evaluation of the patient’s
response should be provided.
– Families should be encouraged to touch and talk with
the patient even if the patient is unresponsive or
comatose.
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Delirium
• Sudden onset of disturbances in cognition,
attention, and perception
• Manifest as hyperactive, hypoactive, or
mixed
• Mixed type is most prevalent in ICU
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Delirium
– Delirium in ICU patients ranges from 15% to 40%.
• Demographic factors predisposing the patient to delirium include
1.advanced age,
2. preexisting cerebral illnesses,
3.Environmental factors that can contribute to delirium include sleep
deprivation, anxiety, sensory overload, and immobilization.
4.Physical conditions such as hemodynamic instability, hypoxemia,
hypercarbia, electrolyte disturbances, and severe infections can
precipitate delirium.
5. Certain drugs (e.g sedatives, furosemide, antimicrobials)
have been associated with the development of delirium
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Management of Delirium
• The ICU nurse must identify predisposing factors
that may precipitate delirium and improve the
patient’s mental clarity and cooperation with
appropriate therapy (e.g., correction of
oxygenation, use of clocks and calendars).
• If the patient demonstrates unsafe behavior,
hyperactivity, insomnia, or delusions, symptoms
may be managed with neuroleptic drugs (e.g.,
haloperidol).
• The presence of family members may help reorient
the patient and reduce agitation.
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Management of Delirium
• Treatment includes medication and environment
and supportive strategies
• Treatment with sedatives alone can worsen
delirium
• Decrease drugs that contribute to delirium or
discontinue them
• Limit unnecessary noise
• Provide patients with eyeglasses or hearing
aides
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Sleep problems:
– Patients may have difficulty falling asleep or have disrupted
sleep because of noise, anxiety, pain, frequent monitoring, or
treatment procedures.
– Sleep disturbance is a significant stressor in the ICU,
contributing to delirium and possibly affecting recovery and can
decreases patient immunity
– The environment should be structured to promote the patient’s
sleep-wake cycle by clustering activities, scheduling rest periods,
dimming lights at nighttime, opening curtains during the daytime
(natural light), obtaining physiologic measurements without
disrupting the patient, limiting noise, and providing comfort
measures.
– Benzodiazepines like Diazepam (Valium)lorazepam
(Ativan) and benzodiazepine-like drugs (Zolpidem) can be
used to induce and maintain sleep.
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Learning Outcome 6
• Discuss ways to identify and meet the
needs of families of critically ill patients.
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ISSUES RELATED TO FAMILIES
• Family members play a valuable role in the
patient’s recovery and should be considered
members of the health care team.
• They contribute to the patient’s well-being by:
– Providing a link to the patient’s personal life
– Advising the patient in health care decisions or
functioning as the decision maker when the patient
cannot
– Helping with activities of daily living
– Providing positive, loving, and caring support
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ISSUES RELATED TO FAMILIES
• To provide family-centered care effectively,
• the nurse must be skilled in crisis intervention.
– Interventions can include active listening, reduction of
anxiety, and support of those who become upset or
angry.
– Other health team members (e.g., , psychologists, )
may be helpful in assisting the family to adjust and
should be consulted as necessary.
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ISSUES RELATED TO FAMILIES
• The major needs of families of critically ill patients have been
categorized as
• informational needs,
• reassurance needs,
• and convenience needs.
– Lack of information is a major source of anxiety for the family.
– The family needs reassurance regarding the way in which the patient’s
care is managed and decisions are made and the family should be
invited to meet the health care team members, including physicians,
nurses ,dietitian, respiratory therapist, social worker, and physical
therapist, .
– Rigid visitation policies in ICUs should be reviewed, and a move toward
less restrictive,
– Research has demonstrated that family members of patients
undergoing invasive procedures, including cardiopulmonary
resuscitation, should be given the option of being present at the bedside
during these events.
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Needs of Families of Critically Ill Patients
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Personnel care about the patients
Believe there is hope
Waiting room near the patient
Called when changes in the patient occur
Know the prognosis
Have questions answered honestly
Know specific facts about patient’s progress
Be allowed to see the patient frequently
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Needs of Families of Critically Ill Patients
• Provide information
• Discuss patient goals
• Written instructional guidelines to provide
information about critical care
• A way to contact the nurse
• Consistency in the nurse
• Open visiting hours
• Assess to telephones, bathrooms, and food
• Good communication
• Relaxed waiting area near the patient
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Visual Map
Critically Ill Patient Summary
5/25/2017
IMAD THULTHEEN CRITICAL
CARE NURSING
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