lec # 1 basic concepts ccn

CORE CONCEPTS IN CORE CONCEPTS IN CRITICAL CARE NURSINGCRITICAL CARE NURSING

ByBy

Yasmeen RahimYasmeen Rahim

OBJECTIVESOBJECTIVES By the end of this presentation, students will be able

to:• Define what is critical care nursing.• Describe the roles of CCN.• Explain what is Evidence Based Practice.• Discuss the patient’s experience with critical illness.• Review family’s experience with critical illness.• List down end of life issues in critical care.• Discuss about transportation of critically ill patients.

CRITICAL CARE NURSINGCRITICAL CARE NURSING

• Critical care nursing is the field of nursing with a focus on the care of the critically ill or unstable patients.

• The aims of Critical Care Nursing are to promote excellence through caring, competency and commitment in critically ill patients.

• CCN deals with human responses to life threatening problems.

CONT.CONT.

• Goal is to restore physiologic, psychologic stability of severely ill patient.

• A critical care nurse must have knowledge and skill beyond those of nurse generalist.

• CCN should use the nursing process as a framework for practice.

• CCN encompass independent, dependent and interdependent nursing interventions.

ROLES OF CCNROLES OF CCN• CARE PROVIDER: provides comprehensive,

highly technical direct care to patient and family, also in response to life threatening health conditions.

• EDUCATOR: provides education to patient and family based on identified learning needs.

• ADVOCATE: protects and fights for patient’s rights.

• MANAGER: coordinates the care provided by multidisciplinary team.

FUNCTIONS OF CCNFUNCTIONS OF CCN

• Assesses and implements treatment for patient responses to life threatening health problems.

• Uses independent, dependent and interdependent interventions to restore stability, prevent complications and to achieve and maintain optimal patient response.

CONT.CONT.

• Provides health education to patient and family.

• Supervise patient care and ancillary personnel.

• Support patient’s adaptation, restore health and preserves patient’s rights.

• Provide direct measures to resuscitate if necessary.

CRITICAL CARE ENVIRONMENTCRITICAL CARE ENVIRONMENT• Noise levels• Light 24 hours/day• Movement of people

and equipment• Lack of privacy

LIGHTS ACTION CAMERA

ICU can seem like a movie set

LIGHTS ACTION CAMERA

ICU can seem like a movie set

ESSENTIAL PHYSIOLOGIC ESSENTIAL PHYSIOLOGIC CONCEPTSCONCEPTS

• Ventilation

• Gas exchange

• Tissue perfusion

• Fluid and electrolyte balance

• Acid base balance

PATIENT EXPERIENCING PATIENT EXPERIENCING CRITICAL ILLNESSCRITICAL ILLNESS

• Admitting in ICU may signal a threat to the life and well-being of the patient.

• ICU patients are subject to multiple physical, psychological, and environmental stressors.

• Prolong stress lead to immunosuppression, hypoperfusion, tissue hypoxia, and eventual death.

CONT.CONT.

• Environmental stressors also contribute to patient’s stress.

• Blinking monitors, ventilators, intravenous (IV) pumps, noise from equipment and the health practitioners talking at the bedside, bright lights and code management.

• Anxiety may be defined as an emotional state of apprehension in response to a real or perceived threat.

NURSING INTERVENTIONSNURSING INTERVENTIONS

• Create a healing environment which allow critically ill patients to have their psychological needs as well as physical needs met.

• Promote rest and sleep as deprivation can lead to altered cognition, confusion, impaired wound healing, and the inability to wean from the ventilator due to muscle fatigue and carbon dioxide retention.

CONT.CONT.

• Have the patient use earplugs.

• Assess sleep time and quality of sleep by asking the patient when possible.

• Provide a 5-minute backrub before sleep.

• Eliminate pain.

• Position patient for comfort with pillows.

• Evaluate the need for nursing care interruptions.

CONT.CONT.

• Titrate environmental stimuli: turn down lights, turn down alarms, and decrease noise from television and talking.

• Stop the practice of bathing patients in the middle of the night for the convenience of the nursing staff.

• Allow family to be with the patient.

• Practice culturally sensitive care.

CONT.CONT.

• Build trust relationship with patient by displaying confident, caring attitude, demonstrate technical competence, and develop effective communication techniques.

• Patient’s need to know all aspects of the their care.

• Involving the patient in decision making.

CONT.CONT.

• Presence and reassurance is a meaningful strategy for alleviating distress or anxiety in the patient.

• Recognize and promote patients' spiritual sources of strength.

TRANSPORTING CRITICALLY TRANSPORTING CRITICALLY ILL PATIENTSILL PATIENTS

• Transporting critically ill patients within hospital or outside hospital is a great challenge.

• Within hospital transfer could be because of diagnostic and therapeutic purposes.

• Safe patient transport requires thoughtful planning, organization and interdisciplinary communication and cooperation.

CONT.CONT.

• The goal during transport is to maintain the same level of care regardless of location.

• Transfer of critically ill patient always involves some degree of risk to the patient (risk vs benefit ratio).

• Proper assessment for risk of complications should be performed before transport.

COMPLICATIONSCOMPLICATIONS• Pulmonary: hyperventilation, hypoventilation,

airway obstruction, aspiration, changes in ABG’s.

• Cardiovascular: hypotension, hypertension, arrhythmias, decrease tissue perfusion, cardiac ischemia.

• Gastrointestinal: nausea, vomiting.• Neurological: increased ICP, cerebral hypoxia,

cerebral hypercarbia, paralysis.• Pain.

PREPERATION PREPERATION

• What is current level of care?

• What will be needed during the transfer to maintain level of care?

• What additional resources may be required during transport?

• Do you have all necessary equipment needed in the emergency during transport?

CONT.CONT.• Minimum 3 people should accompany the patient.• One should be assigned critical care nurse, other

should be a doctor and third one should be a nursing assistant.

• Transport equipments should include a cardiac monitor, airway management equipment, source of oxygen, standard resuscitation drugs, ample supply of IV fluids, resuscitation cart within range.

• Documentation.

MODE OF TRANSPORTMODE OF TRANSPORT• Physician must order type of transport – The

level of transport should be the same as the level of care the patient is already receiving.

• Ambulances – BLS – ACLS

• Air transport – All ACLS – Helicopter – Fixed wing