118A Unit 1-3

Critical Care

Refers to a specialized branch of medicine focused on providing intensive, comprehensive care to patients who are experiencing, or are at high risk for, life-threatening conditions.

General ICU

Provides care for patients with a wide range of critical conditions, including sepsis, multi-organ failure, severe infections, and postoperative complications.

Cardiac ICU (CICU)

Focuses on patients with severe cardiac conditions, such as myocardial infarction, heart failure, or those undergoing cardiac surgery.

Neonatal ICU (NICU)

Provides care for critically ill newborns, including premature infants or those with congenital conditions.

Pediatric ICU (PICU)

Caters to critically ill children with various conditions, such as respiratory failure, trauma, or congenital anomalies.

Neurological ICU (Neuro ICU)

Specializes in patients with acute neurological conditions, such as stroke, traumatic brain injury, or spinal cord injury.

Surgical ICU (SICU)

Dedicated to patients recovering from major surgeries who require close monitoring and intensive care.

Critical Care in the Emergency Department (ED)

The ED provides initial stabilization and management of critically ill patients who present with emergencies such as severe trauma, acute myocardial infarction, or respiratory failure.

Trauma Centers

Specialized facilities within or associated with an ED that provide care for patients with severe, life-threatening injuries, such as those resulting from accidents, violence, or natural disasters.

High Dependency Unit (HDU) or Step-Down Unit

These units provide care for patients who are less critically ill than those in the ICU but still require close monitoring and support.

Post-Anesthesia Care Unit (PACU)

Also known as the recovery room, the PACU provides immediate postoperative care to patients emerging from anesthesia.

Cardiac Catheterization Laboratory (Cath Lab)

A specialized unit where procedures such as coronary angiography, angioplasty, and stent placement are performed to diagnose and treat cardiac conditions.

Mobile and Transport Units

Transporting critically ill patients between facilities or from the scene of an emergency to a hospital. Includes ground ambulances, air ambulances (helicopters or fixed-wing aircraft), and specialized transport teams.

Tele-ICU

A telemedicine platform that allows remote monitoring and management of ICU patients by critical care specialists who may not be physically present in the unit.

Assessment

The first and most crucial step in the nursing process is the comprehensive assessment of the patient. In critical care and emergency situations, this assessment must be rapid, systematic, and continuous to capture the dynamic changes in the patient's condition.

Chief Complaint and Present Illness

Determine the primary reason for the patient's admission and the events leading up to the current crisis.

Past Medical History

Identify any previous conditions that may impact current care, such as chronic illnesses, surgeries, or previous ICU admissions.

Medication History

Review all current medications, including prescription, over-the-counter, and herbal supplements, to identify potential drug interactions or adverse effects.

Social History

Assess lifestyle factors, including alcohol, tobacco, and drug use, as well as social support systems.

Family and Genetic History

Explore any familial patterns of disease that could affect the patient's condition.

Physical Assessment

Conduct a head-to-toe assessment focusing on critical systems (neurological, cardiovascular, respiratory, gastrointestinal, renal, and integumentary).

Vital Signs Monitoring

Continuous monitoring of heart rate, blood pressure, respiratory rate, temperature, and oxygen saturation is essential.

Laboratory and Diagnostic Tests

Interpret critical lab values and diagnostic studies that guide immediate care.

Invasive Monitoring

In critical care, invasive monitoring techniques like central venous pressure (CVP), pulmonary artery catheterization, or intracranial pressure (ICP) monitoring may be used.

Nursing Diagnosis

Nursing diagnosis involves identifying and prioritizing health problems based on the assessment data.

Impaired Gas Exchange

Acute respiratory distress syndrome (ARDS), pneumonia, or pulmonary embolism. Manifested by hypoxemia, tachypnea, and abnormal ABGs.

Decreased Cardiac Output

Myocardial infarction, cardiogenic shock, or heart failure. Manifested by hypotension, oliguria, and decreased peripheral perfusion.

Ineffective Tissue Perfusion

Sepsis, shock, or multi-organ dysfunction syndrome (MODS). Manifested by altered mental status, cool extremities, and lactic acidosis.

Risk for Infection

Invasive lines, surgical procedures, or immunosuppression. Preventive measures include strict aseptic techniques and early detection of signs of infection.

Risk for Fluid Volume Imbalance

Sepsis, burns, or trauma. Requires close monitoring of fluid intake/output, weight, and electrolyte levels.

Risk for Acute Confusion

Hypoxia, metabolic imbalances, or ICU delirium. Interventions include frequent reorientation, minimizing sensory overload, and ensuring adequate oxygenation.

Sepsis

A collaborative problem requiring coordinated care among the healthcare team, including physicians, pharmacists, and respiratory therapists.

Acute Kidney Injury (AKI)

Collaborative management involving nephrologists, the use of renal replacement therapies, and careful fluid/electrolyte management.

Cardiac Dysrhythmias

Collaboration with cardiologists, the use of antiarrhythmic drugs, and continuous ECG monitoring.

Planning

In critical care, planning involves setting priorities, establishing expected outcomes, and determining nursing interventions tailored to the patient’s condition.

Life-Threatening Priorities

Address conditions that pose an immediate threat to life, such as airway obstruction, hemorrhage, or cardiac arrest.

Preventing Complications

Prioritize interventions that prevent the worsening of the patient’s condition, such as prophylaxis for deep vein thrombosis (DVT) or stress ulcers.

Promotion of Recovery

Plan for interventions that promote recovery, such as early mobilization, pain management, and nutritional support.

Measurable and Time-Bound

Outcomes should be specific, measurable, attainable, relevant, and time-bound (SMART).

Client-Centered

Outcomes should reflect the patient's goals and preferences.

Individualized Care Plans

Develop a care plan that reflects the unique needs of the patient, considering their medical history, current condition, and psychosocial factors.

Interdisciplinary Collaboration

Plan care in collaboration with the healthcare team, including input from physicians, therapists, dietitians, and social workers.

Contingency Planning

Prepare for potential complications or changes in the patient's condition, such as having protocols for rapid response or code blue situations.

Implementation

Implementation involves putting the care plan into action through both independent and collaborative nursing interventions.

Psychologic Care

Providing emotional support, reassurance, and facilitating communication with the patient and family.

Spiritual Care

Addressing the spiritual needs of patients and families, offering pastoral care or facilitating the involvement of religious practices.

Pharmacological Therapeutics

Administering medications as prescribed, including vasopressors, sedatives, antibiotics, and managing drug interactions.

Complementary and Alternative Therapies

Incorporating therapies such as acupuncture, massage, or aromatherapy as appropriate and in collaboration with patient preferences.

Nutritional and Diet Therapy

Ensuring the patient receives adequate nutrition, whether through enteral or parenteral routes.

Surgical Intervention

Preparing patients for emergency surgeries, providing post-operative care, and managing potential complications.

Immunologic Therapy

Administering immunosuppressants, biologics, or other therapies as indicated in conditions like organ transplants or autoimmune diseases.

Education on Disease Process and Treatment

Explain the nature of the illness, expected outcomes, and the rationale for treatments to the patient and family.

Discharge Planning and Home Care

Provide instructions on medication management, wound care, signs of complications, and when to seek medical attention after discharge.

Health Promotion and Prevention

Teach patients about lifestyle modifications, such as smoking cessation, diet changes, and exercise, to prevent recurrence of critical conditions.

Evaluation

Evaluation involves determining the effectiveness of the interventions and the progress toward achieving the patient’s goals and outcomes.

Physiologic Outcomes

Assess improvements in vital signs, lab results, and overall physical status.

Psychosocial Outcomes

Evaluate the patient's and family's emotional and psychological well-being.

Based on Outcomes

If the outcomes are not met, reassess the patient's condition, modify the nursing diagnoses, and adjust the care plan accordingly.

Continuous Evaluation

Regularly reassess the patient's progress, especially in the dynamic environment of critical care, where conditions can change rapidly.

Accurate and Timely Documentation

Document all assessments, interventions, outcomes, and any changes in the care plan in the patient's medical record. Ensure that documentation is thorough, precise, and in accordance with legal and institutional guidelines.

Interdisciplinary Communication

Communicate patient status and care updates with the entire healthcare team to ensure continuity and coordination of care.

Handover and Discharge Summaries

Provide comprehensive handover reports during shift changes and detailed discharge summaries that outline the patient's course of care, outcomes, and follow-up instructions.

Emergency

Any sudden illness or injury that is perceived to be a crisis threatening the physical or psychological wellbeing of the person or group.

Emergency Nursing

Providing nursing care to prevent imminent severe damage or death or to avert serious injury.

Emergency Nursing Care

The assessment, diagnosis and treatment of perceived, actual or potential, sudden or urgent, physical or psychosocial problems that are primarily acute.

First Aid

The giving of immediate treatment to an injured person.

Triage

A systematic method which ensures that clients requiring immediate attention receives it.

Disaster

Sudden catastrophic events that disrupt patterns of life and in which there is possible loss of life and property in addition to multiple injuries.

Emergency Medical Services (EMS)

A community wide, coordinated means of responding to an accident or a medical emergency.

Good Samaritan Law

When an off-duty nurse happens to passed by an accident, there is an ethical and moral, if not a legal duty to stop and render assistance. A nurse who stops and aids accident victims without compensation will not be liable for untoward results to his acts.

Expressed Consent

When a conscious person who understands questions and the plan of care gives the responder permission to give care.

Implied Consent

The law assumes that if the person could respond, he or she would agree to care.

Daily Triage

Done on a routine basis every day in the emergency department. Goal: Identify the sickest patients in order to assess and provide treatment to them first before providing treatment to others who are less ill.

Incident Triage

Occurs when the emergency department is stressed by a large number of patients but is still able to provide care to all victims utilizing existing agency resources.

Disaster Triage

Employed when local emergency services are overwhelmed to the point that immediate care cannot be provided to everyone who needs it. Goal: Shift to identifying injured or ill patients who have a good chance of survival with immediate care that does not require extraordinary resources.

Critical (Disaster Triage Category)

Life-threatening but likely to be amenable to rapid interventions that do not require an inordinate amount of resources.

Urgent (Disaster Triage Category)

Conditions that are serious and if not treated in a timely manner, are likely to deteriorate to become critical.

Minor (Disaster Triage Category)

The care required can be provided by a low-tech setting and a delay in treatment would unlikely contribute to a significant deterioration in the victim's condition.

Catastrophic (Disaster Triage Category)

Conditions that have a very grave prognosis or would require an amount of resources that are so large they would divert care from others with a much better prognosis.

Tactical-Military Triage

Similar to disaster triage; only military mission objectives rather than traditional civilian guidelines drive the triage and transport decisions.

Special Condition Triage

Used when patients present from incidents involving WMD, such as radiation, biological or chemical contaminants.

Canadian Triage and Acuity Scale (CTAS)

A robustly developed tool as a triage system and acuity scale that conceptually supports nurse-led triage, provides the ability to assign acuity based on symptomatic presentations, and does not take into consideration the patient's likely diagnosis or expected diagnostic/treatment resources.

Level I – Resuscitation (CTAS)

Should receive medical care immediately 98% of the time, and 70%–90% of these patients are likely to be admitted.

Level II – Emergent (CTAS)

Should receive medical care within 15 minutes 95% of the time, and 40%–70% are likely to be admitted.

Level III – Urgent (CTAS)

Should receive medical care within 30 minutes 90% of the time, and 20%–40% are likely to be admitted.

Level IV – Less Urgent (CTAS)

Should receive medical care within 60 minutes 85% of the time, and 10%–20% are likely to be admitted.

Level V – Non-urgent (CTAS)

Should receive medical care within 120 minutes 80% of the time, and 0%–10% are likely to be admitted.

Emergency Severity Index (ESI)

A five-level emergency department (ED) triage algorithm that provides clinically relevant stratification of patients into five groups from 1 (most urgent) to 5 (least urgent) on the basis of acuity and resource needs.

Emergency Severity Index (ESI)

A research-based, descending, algorithmic, five-level acuity scale, based on evaluating both patient acuity (for the top two levels) and then expected resource needs (for the bottom three levels).

Australasian Triage Scale (ATS)

A fully developed, valid, and reliable five-level, symptom-driven, nurse-led triage system and acuity scale that uses a conceptual line of questioning.

Manchester Triage System (MTS)

A fully developed, valid, and reliable five-level, symptom-driven, nurse-led triage system and acuity scale that uses a symptom-specific algorithmic approach with over 50 flow charts.

Red (Prehospital Disaster Triage)

Critical; unstable, with acute problems for immediate intervention is likely to save life or limb.

Yellow (Prehospital Disaster Triage)

Urgent; acute problem and stable, but may deteriorate.

Green (Prehospital Disaster Triage)

Delayed; injured or ill, but stable and not likely to deteriorate if treatment is delayed (referred to as walking wounded).

Black (Prehospital Disaster Triage)

Expectant; dead or non-salvageable given the available resources.

Primary Survey (Initial Assessment)

Designed to help the Emergency Medical Responder to detect all immediate threats to life.

Secondary Survey (Focused History and Physical Exam)

Performed after the initial assessment. It is assumed that the life-threatening problems have been found and corrected. The main purpose is to discover and care for a patient's specific injuries or medical problems.

Alert (AVPU)

The patient is awake, responsive, oriented, and talking with the responder.

Verbal (AVPU)

The patient appears to be unresponsive at first, but will respond to a loud verbal stimulus from the responder.

Painful (AVPU)

The patient does not respond to verbal stimuli, but responds to painful stimuli such as sternal rub or a gentle pinch to the shoulder.