Introduction to Intensive

care nursing

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 Critical care nursing (NUR414)
Prepared by
Dr /Dawlat Ahmed
Lecture of medical surgical
nursing
KING KHALED UNIVESITY
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Outlines

Definitions of acute and critical care nursing

Legal , ethical and cultural issues in critical care
nursing
Psychosocial & familial aspects of intensive care
nursing
Strategies and basic principals of critical care
Setting up an intensive care unit

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Critical care nursing

Is the field of nursing with a focus on

the utmost care of the critically ill or
unstable patients following extensive
injury, surgery or life threatening
diseases.

WORKING AREAS

General intensive care Units,

Medical Intensive Care Units,
Surgical Intensive Care Units,
Trauma Intensive Care Units,
Coronary Care Units,
Cardiothoracic Intensive Care Units,
Burns Unit
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Acute care versus critical care
Acute care hospitals are distinguished from long-term care
facilities such as nursing homes, rehabilitation centers, and
psychiatric hospitals by the fact that the average client stay
is less than 30 days.
Critical care is a type of acute care .
Critical care refers to a place (critical care unit)

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Critical care nursing

Is that specialty within nursing that deals specifically with

human responses to life-threatening 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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History of critical care

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

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 Critical care unit

Critical care unit is a specially designed and equipped

facility staffed by skilled personnel to provide
effective and safe care for dependent patients with a
life threatening problem.

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 Icus can be classified as:

Level I: This can be referred as high dependency is where

close monitoring, resuscitation, and short term ventilation
<24hrs has to be performed.
Level II: Can be located in general hospital, undertake
more prolonged ventilation. Must have resident doctors,
nurses, access to pathology, radiology, etc.
Level III: Located in a major tertiary hospital, which is a
referral hospital. It should provide all aspects of intensive
care required.
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 Roles of critical care nurse

Care provider
Educator
Manager
Advocate
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 Nurses role in icus as care
provider
Continuous monitoring and treatment
Required emergency interventions
Care of patients who are medically unstable
Care of patient with sever traumatic injury

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 Advocate

The American Association of

Critical-Care Nurses (AACN)
defines this advocacy as "respecting
and supporting the basic values,
rights and beliefs of the critically ill
client."
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 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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LEGAL AND ETHICAL ISSUES
IN CRITICAL CARE NURSING

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 Critical care has come to be associated with high-
tech, aggressive & often risk-filled medical care.
The critical care nurse are often confronted with
ethical & legal dilemmas related to various ethical
principles & it has increased dramatically since the
early 1990s.
Many dilemmas are byproducts of advanced medical
technologies & therapies developed over the past
several decades.

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 Autonomy

Agreement to respect another's right

to determine a course of action
support of independent decision
making.

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 Beneficence :Compassion; taking positive action
to help others
Nonmaleficence- avoidance of harm or hurt

Justice : implies that all citizens have an equal

right to receive quality nursing care regardless of
who they are

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 Fidelity- . It involves an
agreement to keep our
promises
Veracity : telling truth
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CULTURAL ISSUES
Nurses who practice in the 21st century will be
interacting with an increasingly multicultural American
society.

Areas of the United States & K.S.A that had many

nationalities and cultures from all over the world.

This diverse population requires that nurses be able to

recognize differences

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 REASONS FOR ADMISSION TO THE
INTENSIVE CARE UNIT
The most common reasons for admission to ICU
are for intensive monitoring and life-supportive
care or for intensive nursing care that cannot be
provided on a general medical surgical floor.

Clients may be admitted following surgery, from

the emergency room .

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 Common conditions necessitating
admission to ICU include the following:

Respiratory difficulties impairing the client's

ability to ventilate or oxygenate:
pneumonia, pulmonary embolism, drug
overdose, and respiratory distress.

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Circulatory problems such as hypotension (low
blood pressure) or cardiac rhythm disorders:

Neurologic changes, such as loss of

consciousness or changes in mental status:
.
Clients with head injuries, brain surgery, stroke, or
spinal cord injury are admitted to the ICU for
frequent reassessment

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Clients with sepsis .
Metabolic problems, such as abnormal
electrolytes from diabetes, renal failure, or
acid-base imbalances .
Clients with open heart surgery, thoracic
surgery, brain surgery, extensive abdominal
surgery, or orthopedic surgery are admitted
postoperatively to the ICU for monitoring

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 Psychosocial needs of the patient in ICUs
1.Clients in the ICU are at a most critical stage.

2.Not only do these clients have great physical needs,

but their emotional, psychological, social, and
environmental needs must be identified.

3.Critically ill clients often experience pain,

immobility, disorientation, and sleep deprivation.

4.They can feel isolated, anxious, and depressed.

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 5.

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Fears about their treatments, the unknown, and
even death are not unusual.

Everything in their environment is stress

producing unusual machines, loud noises,
equipment alarms, constant light, and constant
attention, staff conversations, physical restraints,
lack of privacy, inadequate control of pain and
anxiety, and separation from significant others.

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Alteration of sleep quality and quantity in the critically ill client
can have important adverse consequences

Including impaired immunity and healing,

An increase in oxygen consumption and carbon dioxide
production,
Negative nitrogen balance, and stimulation of the "fight or
flight" response of the sympathetic nervous system.
An overwhelming sense of powerlessness is the overall
recurrent theme verbalized by critically ill clients.

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 What I can do ?
Create a healing
environment
A.
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Controlling the environment to avoid or
diminish the stressors that are specific to the
critically ill client.

Allowing open visitation as able, providing

appropriate day and night cycles of activity and
sleep,

Controlling noise and conversation can allow the

client a more restful and therapeutic recovery.

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Providing privacy and explaining all equipment, noise, and
activities can be comforting measures for the critically ill client
as well as his or her family.

Designing some type of simple communication system to

allow the client at least to answer "yes" or "no" questions is
important.

The nurse must adequately assess the client's analgesia and

sedation needs.

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Often few overt clues are evident that the client requires
such medications.

Looking at subtle changes in vital signs or behavior and

routinely providing sedation and analgesia are frequently
required.
lastly, the nurse may need to control open visitation to
balance clients' needs for rest with families' needs to be
close to their loved one.
Often complementary and alternative therapies, such as
massage, prayer, music therapy,
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The top priorities of critical care families are
1. Assurance
2. Hope
3. To know the prognosis
4. To understand how the client was being
treated medically.
5. To feel accepted by hospital staff

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6. To feel the hospital personnel care about
the client
7. To have explanations given in terms that
can be understood

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 Examples of nursing diagnoses
for patient with critical illness
Anxiety
Body image disturbance
Impaired verbal communication
Self esteem disturbance
Powerlessness
Spiritual distress
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 Basic principals of critical
care nursing and setting up
An ICU

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 Factors of consideration

Sources of patients
Admission and discharge criteria
Expected rate of occupancy
Personnel required
Technological resources
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