Lets Explore the ICULets 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.

• Pharmacists

• Unit clerks

• Nurses

• Physicians (IM, Pulmonary, etc.)

• PA’s

The ICU Health Care Team•Respiratory therapists

•Other medical consultants from a broad range of specialties including surgery, pediatrics, anesthesiology, and social services

Where do the patients come from?

• 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

Intensive Care Unit

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

The monitors are your second major bedside assessment tool – the first is your eyes.

EQUIPMENT

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

NEW VENT OLD VENT

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 CARTA 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 LinesA 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 occurs

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!!!

• Be empathetic

• EDUCATE, EDUCATE, EDUCATE

• Anticipate needs

• Keep them updated

Intensive Care Unit

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?

There is more than one type of ICU? WHAT?

NICU PICU

SICU

MICU

CICU

Intensive Care Unit

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?

• Pediatricians• Neonatologists• NNPs, PNPs• Nurses• OT (feeding)• PT (positioning,

massage)• Child life specialist• Respiratory Therapy

• 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?– 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

• 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…