Nursing management of critically ill patient in intensive care units

Nursing management of
critically ill patient.

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.

ADMISSION & ORIENTATION OF THE
PATIENT TO ICU

ADMISSION & ORIENTATION OF THE
PATIENT TO ICU
•1. 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.
• 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.

Admission Quick Check Assessment in
CCU
• 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 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)

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)

• The patient general medical history
& severity of illness can be assessed
by the patient history.
• Physical examination and laboratory
tests.

• To provide physiological support to the
patient and reduce the anxiety & fear
about ICU/ CCU environment.
• To maintain adequate tissue circulation
& tissue perfusion through out the body.
• Maintain fluid & electrolyte balance.

• Close monitoring patients vital signs continuously
with attaching monitors patients who critically ill.
• All medications are administered according to
CCU/ICU policy and careful monitoring patient
response to treatment.
• To support the Activities of daily living (ADL) &
assist to patient to perform basic activities.
• For disoriented & anxious patient need for frequent
orientation.

• Provide continuous monitoring of respiratory
function such rate, rhythm, spo2, and ABGs.
• Perform and encourage to patient to do respiratory
exercise such as deep breathing exercise, coughing,
spirometry exercise and postural drainage to prevent
pulmonary complications.
• The nurse always follow strict aseptic precautions
when handling central I.V lines, artial lines, catheters.

MAINTAIN THE FLOWSHEET
• A well organized flow sheet provides around-the-clock
information regarding the different organ systems
Major categories appropriate for an ICU flow sheet include:
1. Vital signs
2. Neurological status
3. Hemodynamic parameters
4. Ventilator settings
5. Respiratory parameters
6. Inputs and outputs
7. Laboratory data
8. Medications.

• Patient who receiving sedatives and narcotics
drugs nurse should carefully monitor side
effects associated with this drugs.
• All activities carried out in ICU/CCU towards
patient treatment must be record and report
appropriately.
• Control nosocomial infection (HAI)
appropriately according to CCU/ICU policy.

• To provide for continuous monitoring of the patient.
Such as:
1. Continuous monitoring ECG.
2. Vital signs, heart sounds, breath sounds,
fluids intake and output, neurological
status, bowel & bladder movements, skin
integrity, nutrition status.
3. Pain assessment

• Patients who are under mechanical ventilator & endotrachial
intubation the nurse should give special focus. For example:
1. Monitoring patient status
2. Monitoring ventilator settings
3. Prevent complications
4. Prevent infections
5. Oral hygiene
6. Suctioning
7. Position changes
8. Eye care
9. Prevent displacement of tubes

• Frequent position changes to prevent pressure
ulcer.
• Each nurse will be responsible for the entire
care of his/her patient, and acts to coordinate
care with other health team professionals.
• Appropriate communication to patient family
members about treatment, procedures, patient
recovery, and patient response towards
treatment.

• The staff nurse will report any changes in
his/her patient's condition directly to the
physician.
• All patients admitted for neurological
problems will have hourly neurological
assessments performed. All patients will have
a neurological assessment evaluated and
recorded on the flow sheet at least once per
shift, using the Glasgow Coma Scale.

• All Critical Care patients will have
mouth care done every four hours with
inspection for oral skin sores. Teeth will
be brushed every shift and as needed.

• The environment will be maintained in a
mechanically safe condition through: dry
floors, good repair of furniture, proper
placement of machines and equipment,
cleanliness, freedom from clutter, and
good repair of equipment.

MANGEMENT OF EMERGENCIES
• In ICU/CCU at any time medical
emergencies or life threatening medical
complications can occur and that require
immediate response to save patient life.
• The nurse should be keep the unit ready
to face emergency situation in advance

Maintains of reports and records
• Complete and concise reports and
records are vital for quality of patient
care in ICU/CCU.
• Each report and record consist complete
detail of client medical condition,
history, diagnosis, treatment, prognosis
etc.

Management Of Environment in CCU
The physical aspects of environment are contributing
factors to patient recovery in ICU.
1. Regulation of atmospheric
temperature, humidity and air
movement in the unit.
2. Adequate lighting
3. Preventing excess noise in the unit
4. Elimination of unpleasant odors.

Management Of Environment in CCU
1. Safe handling & dispose of
biomedical wastes
2. Freedom from vermin's, insects &
animals.
3. Fire prevention measures
4. Provision of adequacy privacy
5. Control of visitors

Nursing management of critically ill patient in intensive care units

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