Graduate Schoo|

Master Cf Sc|ence In Nurs|ng

IN1LNSIVL CAkL UNI1
Argu|||a Chr|st|ne Ioy L
Maca||nta| 8yron Lou|e C
Mora|es kyan 1
edro kando|f Iay A
1agu|nod 8ongbong A
8ackground
Abstract
Introduct|on
1ypes of |ntens|ve care un|t
About cr|t|ca| care nurs|ng
ICU equ|pments
Scenar|o
Conc|us|on
As advances have been made ln medlclne and
Lechnology paLlenL care has become much more
complex 1o provlde approprlaLe care nurses
needed speclallzed knowledge and skllls whlle
care dellvery mechanlsms also needed Lo evolve
Lo supporL paLlenLs' needs for conLlnuous
monlLorlng and LreaLmenL 1he flrsL lnLenslve
care unlLs emerged ln Lhe 1930s as a means Lo
provlde care Lo very slck paLlenLs who needed
oneLoone care from a nurse lL was from Lhls
envlronmenL LhaL Lhe speclalLy of crlLlcalcare
nurslng emerged
rlLlcal Lhlnklng helps Lhe nurse Lo navlgaLe Lhe complex
and sLressful envlronmenL of Lhe lD rlLlcal Lhlnklng
lncludes more Lhan [usL nurslng knowledge lL lncludes
Lhe ablllLy Lo Lhlnk Lhrough complex mulLlfaceLed
problems Lo anLlclpaLe needs recognlze poLenLlal and
acLual compllcaLlons and Lo experLly communlcaLe wlLh
Lhe Leam A nurse who ls able Lo Lhlnk crlLlcally wlll glve
beLLer paLlenL care varlous sLraLegles can be used Lo
develop crlLlcal Lhlnklng ln lD nurses nurse leaders are
encouraged Lo supporL Lhe developmenL of crlLlcal
Lhlnklng skllls ln less experlenced sLaff wlLh Lhe goal of
lmprovlng Lhe nurses ablllLy Lo work ln Lhe lD and
lmprovlng paLlenL ouLcomes
rlLlcal care nurslng provldes care for paLlenLs
LhaL are serlously lll and rellanL on llfe supporL
equlpmenL for Lhelr recovery rlLlcal care
nurslng can cover a varleLy of seLLlngs
lncludlng coronary care emergency and hlgh
dependency nurslng areas 1he crlLlcal care
nurse worklng ln Lhe lnLenslve care unlL
essenLlally cares for one paLlenL and Lhelr
famlly
1hese characLerlsLlcs requlre nurslng
sLaff Lo dlsplay unlque quallLles and
hlgh levels of crlLlcal
Lhlnklng boLh as lndlvlduals and as
parL of a Leam
1he lD ls a place of hlgh
paLlenL aculLy complex
paLhologles and mulLlple
unknowns"
% WhaL klnd of admlsslons wlll arrlve Loday?
% When wlll Lhey arrlve?
% Pow acuLely lll wlll Lhey be?
% WhaL slgns/sympLoms of paLhologles wlll paLlenLs
presenL wlLh?
% Pow many wlll requlre lmmedlaLe llfesavlng
measures?
% WhaL Lype and how many monlLorlng devlces wlll Lhe
paLlenL requlre?
% WhaL level of undersLandlng wlll paLlenLs and/or Lhelr
famlly possess?
1he quallLles LhaL make Lhe lD such an
lnLeresLlng place lnclude
1he consLanLly changlng someLlmes chaoLlc
envlronmenL ls whaL drlves nurses Lo Lhls
speclalLy ln order Lo funcLlon coheslvely Lhe
enLlre healLhcare Leam musL be aLLuned Lo
one anoLher's sLrengLhs and weaknesses uue
Lo Lhe hlghsLress slLuaLlons LhaL ofLen occur
ln Lhe lD a sense of LrusL usually develops
among Lhe enLlre healLhcare Leam ln Lhls
envlronmenL of hlgh paLlenL aculLy and rapldly
changlng paLlenL condlLlons Lhe lD nurse
needs Lo be a crlLlcal Lhlnker and needs Lo
know how Lo use sLraLegles LhaL ald crlLlcal
Lhlnklng
serves as Lhe sLrucLural framework behlnd all
crlLlcal care nurses' pracLlce 1he model sLaLes
LhaL Lhe needs or characLerlsLlcs of paLlenLs and
famllles lnfluence and drlve Lhe acLlons of nurses
1he Synergy Model ldenLlfles elghL paLlenL needs
or characLerlsLlcs and elghL nurslng
compeLencles DndersLandlng and uLlllzaLlon of
Lhe Synergy Model enhances Lhe crlLlcal Lhlnklng
ablllLles of Lhe crlLlcal care nurse SubsequenLly
when Lhese paLlenL needs and nurslng
compeLencles are allgned paLlenL ouLcomes are
opLlmlzed
1he elghL paLlenL
characLerlsLlcs LhaL are
evaluaLed by nurses
% Stab|||ty 1he ablllLy Lo malnLaln a sLeady sLaLe lncludlng
physlologlc psychologlcal emoLlonal and famlly or soclal
sLablllLy
% Comp|ex|ty 1he lnLrlcaLe lnLerconnecLedness of Lwo or more
sysLems (eg body famlly and soclal sysLems)
% red|ctab|||ty 1he characLerlsLlc LhaL allows one Lo expecL an
lllness Lo progress ln a speclflc manner
% Vu|nerab|||ty SuscepLlblllLy Lo a sLressor
% kes|||ency 1he ablllLy Lo reLurn Lo a normal level of
funcLlonlng
W art|c|pat|on |n dec|s|onmak|ng 1he exLenL Lo whlch Lhe
paLlenL and Lhe paLlenL's famlly engage ln declslonmaklng
% art|c|pat|on |n care 1he exLenL Lo whlch Lhe paLlenL or famlly
engages ln aspecLs of care
% kesource ava||ab|||ty 1he resources LhaL Lhe paLlenL/cllnlcal
unlL can brlng Lo a slLuaLlon
9aLlenLs and famllles move along Lhese elghL
conLlnuums and lnfluence how a nurse
approaches and cares for paLlenLs 1he
Synergy Model ouLllnes elghL nurslng
compeLencles Lo respond Lo paLlenL needs ln
order Lo enhance ouLcomes 1hese
dlmenslons of nurslng pracLlce span Lhe
conLlnuum from compeLenL Lo experL and
lnclude
W C||n|ca| [udgment llnlcal reasonlng whlch
lncludes cllnlcal declslon maklng coupled wlLh
nurslng skllls acqulred by formal and experlenLlal
knowledge
% C||n|ca| |nqu|ry 1he ongolng process of
quesLlonlng and evaluaLlng pracLlce
% Car|ng pract|ces All nurslng acLlvlLles Lo whlch
Lhe paLlenL and famlly respond
% kesponse to d|vers|ty 1he senslLlvlLy Lo
recognlze appreclaLe and lncorporaLe dlfferences
ln Lhe provlslon of care
% Advocacy Worklng on anoLher's behalf
and represenLlng Lhe concerns of Lhe
paLlenL and famlly
% Iac|||tat|on of |earn|ng 1he ablllLy Lo
faclllLaLe paLlenL famlly colleague and unlL
learnlng
% Co||aborat|on Worklng wlLh oLhers Lo
promoLe each person's conLrlbuLlons
% Systems th|nk|ng AppreclaLlng Lhe care
envlronmenL LhaL recognlzes hollsLlc
lnLerrelaLlonshlps
neonaLal lnLenslvecare unlL (NICU) ls an lnLenslve care
unlL speclallzlng ln Lhe care of lll or premaLure
newborn lnfanLs
9edlaLrlc lnLenslvecare unlL (ICU) ls an area wlLhln a
hosplLal speclallzlng ln Lhe care of crlLlcally lll lnfanLs
chlldren and Leenagers
9sychlaLrlc lnLenslvecare unlL (ICU) ls a Lype of
psychlaLrlc lnpaLlenL ward 1hese wards are always
locked (le enLry and exlL ls conLrolled by Lhe nurslng
sLaff) and sLafflng levels are hlgher Lhan on a normal
acuLe admlsslon ward
oronary care unlL (CCU) ls a hosplLal ward speclallzed
ln Lhe care of paLlenLs wlLh hearL aLLacks unsLable
anglna ardlac dysrhyLhmla and (ln pracLlce) varlous
oLher cardlac condlLlons LhaL requlre conLlnuous
monlLorlng and LreaLmenL
Medlcal lnLenslvecare unlL (MICU) ls an adulL crlLlcal
care unlL provldlng comprehenslve care for crlLlcally lll
medlcal paLlenLs wlLh a vasL varleLy of dlagnoses
Surglcal lnLenslvecare unlL (SICU) ls an adulL crlLlcal
care unlL deslgned Lo provlde comprehenslve care for
crlLlcally lll surglcal and Lrauma paLlenLs
Surglcal 1rauma lnLenslvecare unlL (S1ICU) ls
deslgned speclflcally for surglcal or Lrauma
paLlenLs who requlre conLlnuous care
observaLlon and/or Lherapy noL avallable ouLslde
an lnLenslve care seLLlng
neuroLrauma lnLenslvecare unlL (NICU) provldes
mulLldlsclpllnary care Lo crlLlcally lll paLlenLs who
have susLalned prlmarlly cenLral nervous sysLem
ln[ury and may have oLher assoclaLed ln[urles
erlaLrlc lnLenslvecare unlL (GICU) ls a speclal
Lype of lnLenslve care unlL dedlcaLed Lo
managemenL of crlLlcally lll elderly
9osL AnaesLhesla are DnlL (ACU) ls a vlLal parL
of hosplLals ambulaLory care cenLers and oLher
medlcal faclllLles lL ls an area normally aLLached
Lo operaLlng LheaLer sulLes deslgned Lo provlde
care for paLlenLs recoverlng from anesLhesla
wheLher lL be general anesLhesla reglonal
anesLhesla or local anesLhesla
rlLlcal care nurslng ls LhaL speclalLy wlLhln
nurslng LhaL deals speclflcally wlLh human
responses Lo llfeLhreaLenlng problems A
crlLlcal care nurse ls a llcensed professlonal
nurse who ls responslble for ensurlng LhaL
acuLely and crlLlcally lll paLlenLs and Lhelr
famllles recelve opLlmal care
rlLlcally lll paLlenLs are deflned as Lhose
paLlenLs who are aL hlgh rlsk for acLual or
poLenLlal llfeLhreaLenlng healLh problems
1he more crlLlcally lll Lhe paLlenL ls Lhe more
llkely he or she ls Lo be hlghly vulnerable
unsLable and complex Lhereby requlrlng
lnLense and vlgllanL nurslng care
rlLlcal care nurses pracLlce ln seLLlngs where
paLlenLs requlre complex assessmenL hlgh
lnLenslLy Lheraples and lnLervenLlons and
conLlnuous nurslng vlgllance rlLlcal care
nurses rely upon a speclallzed body of
knowledge skllls and experlence Lo provlde
care Lo paLlenLs and famllles and creaLe
envlronmenLs LhaL are heallng humane and
carlng loremosL Lhe crlLlcal care nurse ls a
paLlenL advocaLe
especL and supporL Lhe rlghL of Lhe paLlenL
or Lhe paLlenLs deslgnaLed surrogaLe Lo
auLonomous lnformed declslon maklng
lnLervene when Lhe besL lnLeresL of Lhe
paLlenL ls ln quesLlon
Pelp Lhe paLlenL obLaln necessary care
crlLlcal care nurses
especL Lhe values bellefs and rlghLs of Lhe
paLlenL
9rovlde educaLlon and supporL Lo help Lhe
paLlenL or Lhe paLlenLs deslgnaLed surrogaLe
make declslons
epresenL Lhe paLlenL ln accordance wlLh Lhe
paLlenLs cholces
SupporL Lhe declslons of Lhe paLlenL or
deslgnaLed surrogaLe or Lransfer care Lo an
equally quallfled crlLlcal care nurse
lnLercede for paLlenLs who cannoL speak for
Lhemselves ln slLuaLlons LhaL requlre
lmmedlaLe acLlon
MonlLor and safeguard Lhe quallLy of care Lhe
paLlenL recelves
AcL as a llalson beLween Lhe paLlenL Lhe
paLlenLs famlly and oLher healLhcare
professlonals
rlLlcal care nurses work ln a wlde varleLy of
seLLlngs fllllng many roles lncludlng bedslde
cllnlclans nurse educaLors nurse researchers
nurse managers cllnlcal nurse speclallsLs and
nurse pracLlLloners WlLh Lhe onseL of
managed care and Lhe resulLlng mlgraLlon of
paLlenLs Lo alLernaLlve seLLlngs crlLlcal care
nurses are carlng for paLlenLs who are more lll
Lhan ever before
at|ent Advocacy
9aLlenL advocacy refers Lo Lhe nurse acLlng on
behalf of and ln Lhe besL lnLeresL of Lhe
paLlenL rlLlcal care nurses respecL paLlenL
values bellefs and rlghLs LducaLlng Lhe
paLlenL and famlly so Lhey can make lnformed
cholces abouL care ls an example of paLlenL
advocacy
Advanced Assessment
rlLlcal care nurses musL perform complex
physlcal assessmenLs as parL of monlLorlng
paLlenL condlLlon and sLaLus 1hls would
lnclude cardlac ausculLaLlon (llsLenlng Lo hearL
sounds and murmurs) and abdomlnal
palpaLlon
Intens|ve Intervent|on
ecause condlLlons of Lhe crlLlcally lll may
qulckly change crlLlcal care nurses musL be
prepared Lo respond Lo Lhem 1hls lncludes
havlng a very Lhorough knowledge of Lhe
paLhophyslology of complex lllnesses and Lhe
nurslng acLlons LhaL Lyplcally accompany
Lhem
|gh1ech Mon|tor|ng
rlLlcal and lnLenslve care lnvolves Lhe use of
hlgh Lech monlLorlng sysLems nurses worklng
wlLh crlLlcal paLlenLs are Lralned ln LelemeLry
1elemeLry ls a compuLerlzed monlLorlng
sysLem LhaL LransmlLs essenLlal lnformaLlon
abouL Lhe condlLlon of a paLlenL (hearL and
lung acLlvlLy) ased upon Lhe lnformaLlon
nurses can make healLhcare [udgmenLs
Spec|a||zed Care
1here are speclallzed areas wlLhln crlLlcal care
nurslng rlLlcal care nurslng subspeclalLles
are Lyplcally based upon a speclflc populaLlon
such as neonaLal or pedlaLrlc crlLlcal care
Whlle boLh focus on care of chlldren neonaLal
crlLlcal care nurses care for crlLlcally lll lnfanLs
from blrLh Lo 1 monLh old
lnLenslve care unlL (lD) equlpmenL lncludes
paLlenL monlLorlng resplraLory and cardlac
supporL pa|n management emergency
resusclLaLlon devlces and oLher llfe supporL
equlpmenL deslgned Lo care for paLlenLs who
are serlously ln[ured have a crlLlcal or llfe
LhreaLenlng lllness or have undergone a
ma[or surglcal procedure Lhereby requlrlng
24hour care and monlLorlng
An lD may be deslgned and equlpped Lo provlde
care Lo paLlenLs wlLh a range of condlLlons or lL
may be deslgned and equlpped Lo provlde
speclallzed care Lo paLlenLs wlLh speclflc
condlLlons lor example a neuromedlcal lD
would care for paLlenLs wlLh acuLe condlLlons
lnvolvlng Lhe nervous sysLem or for paLlenLs who
have [usL had neurosurglcal procedures and
would requlre equlpmenL for monlLorlng and
assesslng Lhe bra|n and sp|na| cord
An arLerlal llne or arLerlal caLheLer ls a small Lhln
plasLlc Lube slmllar Lo an lv caLheLer LhaL ls
lnserLed lnLo a paLlenL's arLery An arLerlal
caLheLer allows Lhe lnLenslve care sLaff
Lo consLanLly monlLor a paLlenL's blood pressure
whlch may be essenLlal for Lhe sLablllsaLlon of Lhe
paLlenL's condlLlon An arLerlal caLheLer also
provldes access for Lhe frequenL blood sampllng
a crlLlcally lll paLlenL needs lood may be
wlLhdrawn from Lhe paLlenL Lhrough Lhe Lublng
wlLhouL havlng Lo use a needle for each blood
LesL
A balloon Lamponade Lube ls a speclallsed
Lube whlch ls lnserLed lnLo Lhe oesophagus or
food plpe Lo compress swollen blood vessels
called 'varlces' CLher names for Lhls Lube
lnclude SengsLakenlakemore Lube a S
1ube or a MlnnesoLa 1ube
1he beds used ln an lnLenslve are DnlL are
speclally deslgned Lo be able Lo meeL Lhe unlque
needs of crlLlcally lll paLlenLs 1he lD bed ls
deslgned Lo be able
Lo LransporL crlLlcally lll venLllaLed paLlenLs
Lo supporL Lhe paLlenL comforLably
Lo provlde room Lo carry porLable oxygen
cyllnders sucLlon equlpmenL emergency
resusclLaLlon equlpmenL lnLravenous lnfuslons
and Lhelr pumps as well as a LransporL monlLor
and venLllaLor
A bedslde monlLor ls a dlsplay of ma[or body funcLlons
on a devlce LhaL looks llke a Lelevlslon screen or
compuLer monlLor 1he number of body funcLlons Lhe
monlLor measures ls up Lo Lhe docLor and nurse
1he monlLor ls aLLached Lo wlres called leads AL Lhe
oLher end Lhe leads are aLLached Lo senslng devlces
aLLached Lo Lhe paLlenLs body 1he senslng devlce
sends elecLronlc slgnals Lo Lhe monlLor whlch dlsplays
Lhe readlngs for Lhe speclflc body funcLlon belng
monlLored
A l9A9 machlne ls a relaLlvely small devlce LhaL asslsLs
wlLh a paLlenLs breaLhlng lL ls connecLed by flexlble
Lublng Lo a face mask worn by Lhe paLlenL (as
lllusLraLed) 1he l9A9 machlne helps push alr and
oxygen lnLo Lhe lungs and Lhen helps Lo hold Lhe lungs
lnflaLed Lhereby allowlng more oxygen Lo enLer Lhe
lungs l9A9 may be used Lo supporL breaLhlng for a
number of paLlenL condlLlons lncludlng
ardlac lallure
AdulL esplraLory ulsLress Syndrome
hronlc CbsLrucLlve 9ulmonary ulsease
9neumonla
A enLral venous aLheLer (v) or enLral
Llne ls an lnLravenous llne LhaL ls used for
glvlng Lhe paLlenL flulds and / or medlcaLlons
lL may be used when Lhe paLlenL's velns ln Lhe
arms are dlfflculL Lo access or when cerLaln
medlcaLlons or nuLrlenLs need Lo be glven LhaL
cannoL be admlnlsLered lnLo Lhe smaller velns
found ln Lhe arm
enal ulalysls machlnes are commonly known
as kldney machlnes because Lhey asslsL Lhe
kldneys Lo work 1here are many reasons why
someone may need Lo be dlalysed
lf Lhe kldneys are noL worklng saLlsfacLorlly
because of dlsease or ln[ury
1o remove harmful wasLes
1o remove exLra fluld
An LlecLroencephalograph or LL ls a
recordlng of braln waves whlch show Lhe
elecLrlcal acLlvlLy of braln cells An LL
machlne ls used Lo record Lhese elecLrlcal
lmpulses
An LndoLracheal or breaLhlng 1ube ls a plasLlc
Lube used durlng mechanlcal venLllaLlon a
procedure Lo asslsL a paLlenL ln breaLhlng Cne
end of Lhe breaLhlng (endoLracheal) Lube ls
placed lnLo Lhe wlndplpe (Lrachea) Lhrough
Lhe mouLh or nose 1hls ls called lnLubaLlon
1he oLher end of Lhe Lube ls connecLed Lo
a breaLhlng machlne (mechanlcal venLllaLor)
An lnLraaorLlc balloon pump also known as
an lA9 ls used Lo asslsL Lhe hearL Lo pump
more blood around Lhe body
lL also lmproves Lhe dellvery of oxygen Lo Lhe
hearL
9aLlenLs who have had a bleed lnLo Lhe braln
a severe blow Lo Lhe head or who have had
braln surgery may geL swelllng of Lhe braln
1hls swelllng may cause an lncrease of Lhe
pressure wlLhln Lhe skull whlch may lmpalr
Lhe funcLlon of Lhe braln A speclal probe
called an lnLracranlal 9ressure MonlLor (l9)
may be lnserLed lnLo a venLrlcle of Lhe braln
or lnLo braln Llssue Lo measure Lhls pressure
lnLravenous lnfuslon pumps are used ln
hosplLals Lo conLrol boLh Lhe raLe and amounL
of fluld or medlcaLlon LhaL ls glven Lo a
paLlenL ?ou may also hear lL belng called an
'lv' 'lMLu' 'drlp' 'lvA' or 'pump'
A nasogasLrlc (n) Lube ls a flexlble plasLlc
Lube LhaL goes Lhrough Lhe paLlenLs mouLh or
nose lnLo Lhe sLomach SomeLlmes Lhls Lube
wlll go Lhrough Lhe paLlenL's mouLh lnLo Lhe
sLomach Lhen lL ls called an 'orogasLrlc'
Lube ln boLh lnsLances Lhe Lube funcLlons Lhe
same way and are usually only referred Lo as
an n"
An oxygen mask ls a devlce used Lo glve
lnLenslve are paLlenLs exLra oxygen whlle
Lhey are slck
A Lemporary pacemaker ls a devlce whlch
dellvers a small elecLrlcal dlscharge Lo Lhe
hearL when a paLlenL has lnserLed under
elecLrlcal problems of a slow or lrregular
hearLbeaL
A paLlenL conLrolled analgesla (9A) pump
dellvers paln rellef medlcaLlon Lo a paLlenL
Lhrough an lnLravenous cannula when Lhey
push a buLLon A 9A pump ls usually used for
paLlenLs afLer Lhey have had an operaLlon
9A are noL common ln lnLenslve care as
paLlenLs musL be fully consclous Lo use Lhem
properly
9ulse onLour ardlac CuLpuL MonlLorlng
(9lC) provldes conLlnuous lnformaLlon
abouL how well Lhe hearL ls funcLlonlng 1he
monlLorlng may be Lhrough a sLand alone
machlne (such as Lhe one plcLured Lo Lhe
rlghL) or lnLegraLed lnLo Lhe paLlenL monlLor
A perlpheral lnLravenous caLheLer ls used ln
lnLenslve are Lo dellver flulds or drugs such
as anLlbloLlcs Lo a paLlenL 1hey are also called
lv cannulae lv caLheLers perlpheral llnes or
slmply 'lv'
A SaLuraLlon MonlLor (9ulse CxlmeLer) ls a
devlce LhaL measures Lhe oxygen saLuraLlon
level ln a paLlenL's blood 1he oxygen
saLuraLlon level represenLs Lhe amounL of
oxygen carrled ln Lhe blood
SucLlon caLheLers are long flexlble Lubes LhaL
are used ln lnLenslve care Lo remove flulds
from Lhe mouLh and alrways of crlLlcally lll
paLlenLs rlLlcally lll paLlenLs ofLen have
dlfflculLy wlLh swallowlng or coughlng
emoval of Lhese flulds ls lmporLanL Lo ensure
Lhe lungs remaln clear and Lhe paLlenL ls able
Lo breaLhe properly
SequenLlal compresslon devlces (Su) are
used ln lnLenslve care Lo reduce Lhe rlsk of
deep veln Lhrombosls (uv1) ln Lhe lower llmbs
of crlLlcally lll paLlenLs Su are someLlmes
referred Lo as 'calf compressors' uv1s are a
serlous compllcaLlon assoclaLed wlLh belng
lmmoblle for a perlod of Llme
A syrlnge drlver or syrlnge pump ls a
sophlsLlcaLed pump used Lo dellver small
quanLlLles of lnLravenous medlcaLlons and
flulds